Plantar pressure reduction in the heel region through self-adjusting insoles with a heel cup in standard and individualized rocker shoes

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL Clinical Biomechanics Pub Date : 2024-06-01 DOI:10.1016/j.clinbiomech.2024.106281

Athra Malki , Mahdieh Hajibozorgi , Gijsbertus J. Verkerke , Rienk Dekker , Juha M. Hijmans

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Abstract

Background

Effectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed.

Methods

In-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole.

Findings

Generalized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe.

Interpretation

The new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.

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在标准和个性化摇摆鞋中使用带后跟杯的自动调节鞋垫，减轻后跟部位的足底压力

背景治疗鞋在降低糖尿病患者的峰值压力和保护性感觉丧失以预防糖尿病足溃疡方面的效果因手工制作和可能发生的足部结构变化而各不相同。以前解决这一问题的双向方法，即个性化 3D 打印摇杆中底和自动调节鞋垫，被证明对前足有效，但对后跟效果较差。方法测量鞋内压力，糖尿病患者和保护性感觉缺失且足跟压力峰值较高（≥ 200 kPa）的患者在跑步机上行走时，分别穿上对照组和个性化摇摆鞋，再搭配对照组和新鞋垫。结果广义估算方程显示，与单独穿摇摆鞋相比，单独使用新鞋垫和与摇摆鞋组合使用新鞋垫可显著降低足跟近端压力峰值。就远端脚跟而言，与对照鞋相比，新鞋垫和摇摆鞋组合的压力峰值明显下降。就前脚掌和脚趾（不包括脚后跟）而言，与对照鞋相比，单独使用摇摆鞋或与跟杯结合使用摇摆鞋可显著降低压力峰值。要想在脚跟近端取得类似（或更多）的效果，可以用顺应性更强的材料代替摇摆中底。单独使用或与跟杯结合使用的摇摆鞋可有效降低前脚掌和其他脚趾的压力峰值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.