Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot

Abstract

Background-Ground reaction forces from walking result in stress (pressure) and soft tissue strain at the plantar aspect of the foot. Excessive plantar pressure and tissue strain on the insensate foot may lead to ulceration. Our study investigated the effect of therapeutic footwear and custom-made orthotic inserts on pressure and tissue strain along the second ray of the plantar foot, and how these two variables are associated.Methods-Twenty subjects (mean age 57.3 [SD 9.3], 12 male, 8 female, body mass index 32.5 [SD 7.4]) with diabetes mellitus, peripheral neuropathy, and a history of a plantar ulcer participated. Plantar pressure data were recorded during computed tomography scans for four conditions (barefoot, shoe, shoe+total contact insert, and shoe+total contact insert+metatarsal pad). For each condition tested, tissue strain and plantar pressure were determined at the second metatarsal head and at 15 other points along the second ray. Intepretation-Footwear and orthotic devices tested in this study decreased pressure and soft tissue strain at the second ray of the foot, and these two variables were strongly related. A better understanding of the role tissue strain plays in distributing plantar forces may lead to improvements in the design of orthotic devices. Findings-Differences

Effects of internal stress concentrations in plantar soft-tissue—A preliminary three-dimensional finite element analysis

“…However, these techniques can only be utilized to evaluate gross plantar tissue deformation during standing [15] and walking [16,17], plantar fat-pad displacement [18], or internal tissue strain at specific areas of the foot plantar [19]. To date, the internal tissue stress/strain distribution within the foot complex is rarely known [20].…”

Avaliação de um programa para prevenção de úlceras neuropáticas em portadores de diabetes

“…Therapeutic education and foot protection with footwear are two of the five crucial points defined by the Consensus 12 for the care of diabetic patients at risk of neuropathic injuries due to insensitivity. These interventions, which are complementary, have been identified as strategies that can reduce the incidence and recurrence of neuropathic injuries in diabetic patients [14][15][16][17][18] . The Consensus 12 recommends that these interventions be targeted specifically at patients at high risk of injury, however as essentially preventive actions, they should be also targeted at patients with less severe neuropathy because it is a complication that worsens with the development of diabetes 5,9,10,16 .…”

Inter- and intra-observer reliability of masking in plantar pressure measurement analysis

“…This equipment is now considered to be an invaluable tool in the assessment of 'feet at risk' [6] and in integrated biomechanical approaches combining EMG, 3D motion analysis and force plate [7,8].…”