The biomechanics of heel ulcers

Gefen, Amit

doi:10.1016/j.jtv.2010.06.003

Cited by 71 publications

(72 citation statements)

References 26 publications

(17 reference statements)

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“…the properties of the covering sheets or the patient's clothing. In this context, the modeling is a theoretical tool for identifying intrinsic and extrinsic risk factors for SPUs, much like in our previous work that employed mathematical and computational models for identifying risk factors for deep tissue injury [21e26], heel ulcers [27] and skin lesions [17].…”

Section: Discussionmentioning

confidence: 99%

How do microclimate factors affect the risk for superficial pressure ulcers: A mathematical modeling study

Gefen

2011

Journal of Tissue Viability

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105

104

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Section: Discussionmentioning

confidence: 99%

How do microclimate factors affect the risk for superficial pressure ulcers: A mathematical modeling study

Gefen

2011

Journal of Tissue Viability

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105

104

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“…The amount of internal stress and strain depends on the structure of the heel (geometry) as well as on the material properties of the tissue and also the value and direction of force. Hence, the above-mentioned changes in the structure of the heel pad can increase the internal stress and strain that are claimed to be the main causes of tissue injuries [25][26][27]. In addition, the interface between the soft tissue structure and underlying bony prominence can be the area of high stress concentration and it is claimed that tissue damage starts in deep tissue close to the bony prominences and then develops up to the skin surface [25,26,28,29].…”

Section: The Structurementioning

confidence: 99%

Viscoelasticity in Foot-Ground Interaction

Naemi¹,

Behforootan²,

Chatzistergos³

et al. 2016

Viscoelastic and Viscoplastic Materials

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Mechanical properties of the plantar soft tissue, which acts as the interface between the skeleton and the ground, play an important role in distributing the force underneath the foot and in influencing the load transfer to the entire body during weight-bearing activities. Hence, understanding the mechanical behaviour of the plantar soft tissue and the mathematical equations that govern such behaviour can have important applications in investigating the effect of disease and injuries on soft tissue function. The plantar soft tissue of the foot shows a viscoelastic behaviour, where the reaction force is not only dependent on the amount of deformation but also influenced by the deformation rate. This chapter provides an insight into the mechanical behaviour of plantar soft tissue during loading with specific emphasis on heel pad, which is the first point of contact during normal gait. Furthermore, the methods of assessing the mechanical behaviour including the in vitro/in situ and in vivo are discussed, and examples of creep, stress relaxation, rate dependency and hysteresis behaviour of the heel pad are shown. In addition, the viscoelastic models that represent the mechanical behaviour of the plantar soft tissue under load along with the equations that govern this behaviour are elaborated and discussed.

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“…The heel region is commonly associated with pain [3], and is known for risk of pressure ulcers [4,5] and diabetic foot ulcers [5]. Understanding heel pad mechanics is not only important for establishing the baseline for the healthy mechanical function of this structure, but it is also indispensable for the prescription of successful management strategies to accommodate mechanical dysfunction due to disease related changes.…”

Section: Introductionmentioning

confidence: 99%

A Three-Dimensional Inverse Finite Element Analysis of the Heel Pad

Chokhandre

Halloran

Bogert

et al. 2012

Journal of Biomechanical Engineering

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Quantification of plantar tissue behavior of the heel pad is essential in developing computational models for predictive analysis of preventive treatment options such as footwear for patients with diabetes. Simulation based studies in the past have generally adopted heel pad properties from the literature, in return using heel-specific geometry with material properties of a different heel. In exceptional cases, patient-specific material characterization was performed with simplified two-dimensional models, without further evaluation of a heel-specific response under different loading conditions. The aim of this study was to conduct an inverse finite element analysis of the heel in order to calculate heel-specific material properties in situ. Multidimensional experimental data available from a previous cadaver study by Erdemir et al. ("An Elaborate Data Set Characterizing the Mechanical Response of the Foot," ASME J. Biomech. Eng., 131(9), pp. 094502) was used for model development, optimization, and evaluation of material properties. A specimen-specific three-dimensional finite element representation was developed. Heel pad material properties were determined using inverse finite element analysis by fitting the model behavior to the experimental data. Compression dominant loading, applied using a spherical indenter, was used for optimization of the material properties. The optimized material properties were evaluated through simulations representative of a combined loading scenario (compression and anterior-posterior shear) with a spherical indenter and also of a compression dominant loading applied using an elevated platform. Optimized heel pad material coefficients were 0.001084 MPa (μ), 9.780 (α) (with an effective Poisson's ratio (ν) of 0.475), for a first-order nearly incompressible Ogden material model. The model predicted structural response of the heel pad was in good agreement for both the optimization (<1.05% maximum tool force, 0.9% maximum tool displacement) and validation cases (6.5% maximum tool force, 15% maximum tool displacement). The inverse analysis successfully predicted the material properties for the given specimen-specific heel pad using the experimental data for the specimen. The modeling framework and results can be used for accurate predictions of the three-dimensional interaction of the heel pad with its surroundings.

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The biomechanics of heel ulcers

Cited by 71 publications

References 26 publications

How do microclimate factors affect the risk for superficial pressure ulcers: A mathematical modeling study

How do microclimate factors affect the risk for superficial pressure ulcers: A mathematical modeling study

Viscoelasticity in Foot-Ground Interaction

A Three-Dimensional Inverse Finite Element Analysis of the Heel Pad

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