Plantar tissue stiffness in patients with diabetes mellitus and peripheral neuropathy

Klaesner, Joseph W.; Hastings, Mary K.; Zou, Dequan; Lewis, Cara L.; Mueller, Michael J.

doi:10.1053/apmr.2002.35661

Cited by 131 publications

(120 citation statements)

References 29 publications

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“…There is an increasing awareness that pathological conditions such as plantar heel pain or diabetic foot are associated with changes in the mechanical behaviour of plantar soft tissue (Hsu et al, 2007(Hsu et al, , 2000(Hsu et al, , 2002Klaesner et al, 2002;Spears and Miller-Young, 2006;Zheng YP, Choi YK et al, 2000). Therefore, quantifying the mechanical properties of plantar soft tissue has been an exciting and evolving topic for the past few years.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies involving age-matched groups of people with diabetes (type-2) and people without diabetes have indicated that plantar soft tissue tends to be stiffer (Chao et al, 2011;Klaesner et al, 2002) and harder (Piaggesi et al, 1999) in diabetic patients. However, no real consensus has yet been reached in terms of the actual effect of diabetes on plantar soft tissue biomechanics as well as on the aetiology and possible implications of such changes.…”

Section: Introductionmentioning

confidence: 99%

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A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad, implications for assessing the risk of mechanical trauma

Behforootan

Chatzistergos

Chockalingam

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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Cite this article as: Sara Behforootan, Panagiotis E. Chatzistergos, Nachiappan Chockalingam and Roozbeh Naemi, A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad with implications for assessing the risk of mechanical trauma, Journal of the Mechanical Behavior of Biomedical Materials, http://dx.doi.org/10.1016Materials, http://dx.doi.org/10. /j.jmbbm.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Purpose: To develop a clinically viable non-invasive method of assessing the mechanical properties of the heel pad. Furthermore the effect of non-linear mechanical behaviour of the heel pad on its ability to uniformly distribute foot-ground contact loads in light of the effect of overloading is also investigated. Methods:An automated custom device for ultrasound indentation was developed along with custom algorithms for the automated subject specific modeling of heel pad. Non-time-dependent and time-dependent material properties were inverse engineered from results from quasistatic indentation and stress relaxation test respectively. The validity of the calculated coefficients was assessed for five healthy participants. The implications of altered mechanical properties on the heel pad's ability to uniformly distribute plantar loading were also investigated in a parametric analysis. Results:The subject specific heel pad models with coefficients calculated based on quasi-static indentation and stress relaxation were able to accurately simulate dynamic indentation.Average error in the predicted forces for maximum deformation was only 6.6 ± 4.0%. When the inverse engineered coefficients were used to simulate the first instance of heel strike the error in terms of peak plantar pressure was 27%. The parametric analysis indicated that the heel pad's ability to uniformly distribute plantar loads is influenced both by its overall deformability and by its stress/ strain behaviour. When overall deformability stays constant, changes in stress/strain behaviour leading to a more "linear" mechanical behaviour appear to improve the heel pad's ability to uniformly distribute plantar loading. Conclusions:The developed technique can accurately assess the visco-hyperelastic behaviour of heel pad. It was observed that specific change in stress-strain behaviour can enhance/weaken the heel pad's ability to uniformly distribute plantar loading that will increase/decrease the risk for overloading and trauma.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad, implications for assessing the risk of mechanical trauma

Behforootan

Chatzistergos

Chockalingam

et al. 2017

Journal of the Mechanical Behavior of Biomedical Materials

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“…These include: the capacity to work, drive a car, perform housework, sleep comfortably, as well as issues relating to self-consciousness and finances. A recent high quality systematic review supports this issue acknowledging the need for increased inclusion of health-related quality of life measures in offloading research [14].…”

Section: Introductionmentioning

confidence: 93%

A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers

Raspovic

Landorf

2014

Journal of Foot and Ankle Research

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Background: Offloading is key to preventing or healing plantar neuropathic foot ulcers in diabetes. Total contact casts or walkers rendered irremovable are recommended in guidelines as first-line options for offloading, however the use of such devices has been found to be low. This study aimed to investigate offloading practices for diabetes-related plantar neuropathic ulcers. Methods: An online survey of closed and open-ended questions was administered via SurveyMonkey®. Forty-one podiatrists experienced in high-risk foot practice, from 21 high-risk foot services around Australia, were approached to participate. Results: The response rate was 88%. Participants reported using 21 modalities or combinations of modalities, for offloading this ulcer type. The most frequently used modalities under the forefoot and hallux were felt padding, followed by removable casts or walkers, then non-removable casts or walkers. Participants indicated that many factors were considered when selecting offloading modality, including: compliance, risk of adverse effects, psycho-social factors, restrictions on activities of daily living, work needs and features of the wound. The majority of participants (83%) considered non-removable casts or walkers to be the gold-standard for offloading this ulcer type, however they reported numerous, particularly patient-related, barriers to their use.

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“…The sense of compliance plays a more important role in medical procedures. For example, physicians and surgeons perceive the compliance of biological tissues to diagnose symptoms of diseases [4] or to distinguish between healthy tissue and malignant tumors [5]. However, in robotic or minimally invasive surgery, this tactile information is not communicated through the rigid handles of surgical instruments [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Compliance display using a tilting-plate tactile feedback device

Yazdian¹,

Doxon²,

Johnson³

et al. 2014

2014 IEEE Haptics Symposium (HAPTICS)

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This paper presents a tactile display device for replicating compliance sensation when interacting with deformable and nondeformable compliant objects in a virtual environment. Two small tilting plates approximately reproduce surface deformations of a compliant object. In addition to tactile information, kinesthetic information is rendered through a modified haptic paddle force feedback device. The tilting plates are moved in conjunction with the measured position of the user's finger as they pressed into the virtual surface. In a psychophysical experiment, we evaluated the effect of adding tilting motion of the device's actuated plates on the perceived compliance of a virtual surface with a kinesthetic stiffness of 60 N/mm. The experiment results indicate that tilting rates of 5, 10, and 20 deg/cm reduced the perceived stiffness of the surface by 3, 9, and 17 N/m, respectively. The advantages of the new device include its light-weight, low-cost, and simple design. These device features make it practical to integrate this compliance display with user interfaces for applications such as video games or even robotic surgery.

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Plantar tissue stiffness in patients with diabetes mellitus and peripheral neuropathy

Cited by 131 publications

References 29 publications

A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad, implications for assessing the risk of mechanical trauma

A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad, implications for assessing the risk of mechanical trauma

A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers

Compliance display using a tilting-plate tactile feedback device

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