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Evaluation of in-shoe plantar pressure and shear during walking for diabetic foot ulcer prevention.

Tang, Jinghua; Bader, Dan L; Parker, Daniel J; Forghany, Saeed; Nester, Christopher J; Moser, David; Jiang, Liudi

Evaluation of in-shoe plantar pressure and shear during walking for diabetic foot ulcer prevention. Thumbnail


Authors

Jinghua Tang

Dan L Bader

Saeed Forghany

Christopher J Nester

David Moser

Liudi Jiang



Abstract

To investigate reliability and changes of in-shoe plantar pressure and shear during walking at three cadences with two insole designs. This was a precursor to the investigation of plantar loading in people with diabetes for potential foot ulcer prevention. A sensorised insole system, capable of measuring plantar pressure and shear at the heel, fifth metatarsal head (5MH), first metatarsal head (1MH) and hallux, was tested with ten healthy participants during level walking. Reliability was evaluated, using intra-class correlation coefficient (ICC), while varying the cadences and insole types. Percentage changes in pressure and shear relative to values obtained at self-selected cadence with a flat insole design were investigated. Mean±standard deviation of maximum pressure, medial-lateral and anterior-posterior shear of up to 380±24kPa, 46±2kPa and -71±4kPa, respectively, were measured. The ICC in ranges of 0.762-0.973, 0.758-0.987 and 0.800-0.980 were obtained for pressure, anterior-posterior and medial-lateral shear, respectively. Opposite anterior-posterior shear directions between 5MH and 1MH (stretching), and between 1MH and hallux (pinching) were observed for some participants. Increasing cadence increased pressure and anterior-posterior shear (by up to +77%) but reduced medial-lateral shear at the heel and hallux (by up to -34%). Slower cadence increased anterior-posterior shear (+114%) but decreased medial-lateral shear (-46%) at the hallux. The use of a flexible contoured insole resulted in pressure reduction at the heel and 5MH but an increase in anterior-posterior shear at the heel (+69%) and hallux (+75%). The insole system demonstrated good reliability and is comparable to reported pressure-only systems. Pressure measurements were sensitive to changes in cadence and insole designs in ways that were consistent with the literature. However, our plantar shear showed localised shear changes with cadences and insoles for the first time, as well as stretching and pinching effects on plantar tissue. This opens new possibilities to investigate plantar tissue viability, loading characteristics and orthotic designs aimed towards foot ulcer prevention.

Citation

Tang, J., Bader, D. L., Parker, D. J., Forghany, S., Nester, C. J., Moser, D., & Jiang, L. (2023). Evaluation of in-shoe plantar pressure and shear during walking for diabetic foot ulcer prevention. Journal of Wound Care, 32(9), 587-596. https://doi.org/10.12968/jowc.2023.32.9.587

Journal Article Type Article
Acceptance Date Sep 2, 2023
Publication Date Sep 2, 2023
Deposit Date Oct 10, 2023
Publicly Available Date Oct 12, 2023
Journal Journal of wound care
Print ISSN 0969-0700
Publisher MA Healthcare
Peer Reviewed Peer Reviewed
Volume 32
Issue 9
Pages 587-596
DOI https://doi.org/10.12968/jowc.2023.32.9.587
Keywords Humans, Walking, Diabetic Foot - prevention & control, shear, Diabetes Mellitus, wound dressing, walking, Reproducibility of Results, wound care, insole, plantar, in-shoe, wound, wound healing, Shoes, pressure, Healthy Volunteers

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