Identification of diabetic neuropathic patients at risk of foot ulceration through finite element models and cluster analysis

Guiotto, Annamaria; Sawacha, Z.; Scarton, Alessandra; Guarneri, G.; Avogaro, Angelo; Cobelli, Claudio

doi:10.1186/1757-1146-7-s1-a27

Cited by 2 publications

(4 citation statements)

References 5 publications

(4 reference statements)

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“…In addition, the effect of custom insole material property on induced stresses on the diabetic foot (with ulcers) was evaluated. In the mesh convergence study, three pressure values (0.1, 0.2, and 0.3 MPa) were selected from the literature-based range 6,11,15 to evaluate the accuracy of the results (induced von Mises stresses generated at the bottom of the foot) with the four different meshes described in Figure 7 and choose the optimal mesh for our analyses.…”

Section: Methodsmentioning

confidence: 99%

“…In literature, the foot pressures with respect to the range of normal forces applied by persons of different weights have been quantified to be in the range of 0.1 to 0.3 MPa during standing and walking. 6,11,15 In this study, the highest foot pressure of 0.3 MPa was applied throughout on the area indicated in Figure 6(a) for all analyses, and the induced stresses were examined at the bottom of the foot and at the ulcers, with and without custom insoles. The advantages of the novel custom insole design with ulcer isolations, with respect to the amount of stress relieved at the foot and ulcers, were also studied.…”

Section: Loads and Boundary Conditionsmentioning

confidence: 99%

“…5 Since the last decade, a significant amount of research has been conducted to understand the mechanics of formation and progression of diabetic ulcers. [6][7][8] Advanced imaging techniques such as magnetic resonance imaging (MRI) have been used to model the human foot 9,10 and finite element (FE) modeling techniques have been employed to study the induced stresses in different foot conditions. Guiotto et al 11 and Ledoux et al 3 found a strong correlation between morphological alterations of the foot and the incidence of ulcers.…”

Section: Introductionmentioning

confidence: 99%

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Novel insole design for diabetic foot ulcer management

Chanda

Unnikrishnan

2018

Proc Inst Mech Eng H

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Around the world, over 400 million people suffer from diabetes. In a chronic diabetic condition, the skin underneath the foot often becomes extremely soft and brittle, resulting in the development of foot ulcers. In literature, a plethora of footwear designs have been developed to reduce the induced stresses on a diabetic foot and to consequently prevent the incidences of foot ulcers. However, to date, no insole design exists which can handle post-ulcer diabetic foot conditions without hindering the mobility of the patients. In the current work, a novel custom insole design with arch support and ulcer isolations was tested for effective stress reduction in a diabetic foot with ulcers using finite element modeling. A full-scale model of the foot was developed with ulcers of different geometries and sizes at the heel and metatarsal regions of the foot. The stresses at the ulcer locations were quantified for standing and walking with and without the novel custom insole model. The effect of material properties of the insole on the ulcer stress reduction was quantified extensively. Also, the effectivity of a novel synthetic skin material as the insole material was tested for stress offloading at the ulcers and the rest of the foot. From the analyses, peak stress reductions were observed at the ulcers up to 91.5% due to the ulcer isolation in the novel custom insole design and the skin-like material. Specifically, the ulcer isolation feature in the insole was found to be approximately 25% more effective in peak stress reduction for commonly occurring ulcers with irregular geometry, over the tested regular circular ulcer geometry. Also, a threshold material stiffness was found for the custom insole, below which the peak stresses at the ulcers did not decrease any further. Based on this information, a working prototype of the custom insole was developed with custom ulcer isolations, which will be subjected to further testing. The results of this study would inform better custom insole designing and material selection for post-ulcer diabetic conditions, with effective stress reduction at the ulcers, and the possibilities of preventing further ulceration.

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Section: Methodsmentioning

confidence: 99%

Section: Loads and Boundary Conditionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Novel insole design for diabetic foot ulcer management

Chanda

Unnikrishnan

2018

Proc Inst Mech Eng H

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“…However, for the diabetic community, mobility is hindered due to neuropathy and incidences of foot skin cracking and ulcer formations [207,212]. Hence, in the current work, only foot pressures in cases of standing or walking were simulated [208][209][210]. The main load applied was on the area indicated in Figure 5.41A.…”

Section: Finite Element Modelingmentioning

confidence: 99%

Biofidelic soft composites–experimental and computational modeling

Chanda¹

2018

Preprint

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Biofidelic soft composites or tissues form the building blocks of the human body. Understanding the complex mechanics of these soft composites is the key to understanding the genesis and progression of disease. Biomechanically, soft composites exhibit anisotropic mechanical behavior and comprise of multiple fiber layers within a soft matrix. To date, there is a lack of understanding of the anisotropic mechanical behavior of soft composites, primarily due to unavailability of a robust characterization framework. In this dissertation, novel multiscale computational and experimental investigation models are developed to simulate and characterize anisotropic soft composite mechanical behavior. Soft composite surrogates were first developed to simulate various tissues in the human body namely the skin, brain, artery and vaginal tissues. Novel anisotropic soft composite models were also fabricated taking into consideration the tissue anisotropy and multifunctional properties. Hyperelastic anisotropic constitutive relationships were formulated to precisely characterize the mechanical behavior of soft composite considering varying fiber and matrix contributions, fiber-matrix interactions, fiber orientations and multiple fiber layers. Coupled with high fidelity experimental and computational models, microscopy, and Digital Image Correlation (DIC) studies, the damage and repair of soft composite surrogates are also discussed in this dissertation, with relevance to soft tissue wounds and suture. Computational modeling to understand the interaction between multiple soft composite systems and its effect on soft composite damage are also highlighted in this work. Some specific soft composite interaction systems modeled were the female pelvic system under abdominal loads, whole body impact due to blast, and ulceration in diabetic foot. This dissertation lays the foundation for micro and macro scale anisotropic soft composite modeling and characterization using high fidelity experimental and numerical techniques which will be indispensable for studying tissue mechanics and other soft composite applications in engineering and medicine.

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Identification of diabetic neuropathic patients at risk of foot ulceration through finite element models and cluster analysis

Abstract: Figure 1 Example of the results of a FEM simulation with ulcerated subject's boundary conditions: Plantar pressures (left) and Von Mises internal stresses (right).

Cited by 2 publications

References 5 publications

Novel insole design for diabetic foot ulcer management

Novel insole design for diabetic foot ulcer management

Biofidelic soft composites–experimental and computational modeling

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