Virtually optimized insoles for offloading the diabetic foot: a randomized crossover study

S. Telfer, J. Woodburn, A. Collier, P.R. Cavanagh

Research output: Contribution to journalArticle

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Abstract

Integration of objective biomechanical measures of foot function into the design process for insoles has been shown to provide enhanced plantar tissue protection for individuals at-risk of plantar ulceration. The use of virtual simulations utilizing numerical modeling techniques offers a potential approach to further optimize these devices. In a patient population at-risk of foot ulceration, we aimed to compare the pressure offloading performance of insoles that were optimized via numerical simulation techniques against shape-based devices. Twenty participants with diabetes and at-risk feet were enrolled in this study. Three pairs of personalized insoles: one based on shape data and subsequently manufactured via direct milling; and two were based on a design derived from shape, pressure, and ultrasound data which underwent a finite element analysis-based virtual optimization procedure. For the latter set of insole designs, one pair was manufactured via direct milling, and a second pair was manufactured through 3D printing. The offloading performance of the insoles was analyzed for forefoot regions identified as having elevated plantar pressures. In 88% of the regions of interest, the use of virtually optimized insoles resulted in lower peak plantar pressures compared to the shape-based devices. Overall, the virtually optimized insoles significantly reduced peak pressures by a mean of 41.3 kPa (p < 0.001, 95% CI [31.1, 51.5]) for milled and 40.5 kPa (p < 0.001, 95% CI [26.4, 54.5]) for printed devices compared to shape-based insoles. The integration of virtual optimization into the insole design process resulted in improved offloading performance compared to standard, shape-based devices.
Original languageEnglish
Pages (from-to)157-161
Number of pages5
JournalJournal of Biomechanics
Volume60
Early online date26 Jun 2017
DOIs
Publication statusPublished - 26 Jul 2017

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Diabetic Foot
Cross-Over Studies
Pressure
Equipment and Supplies
Foot
Finite Element Analysis
Computer simulation
Medical problems
Printing
Ultrasonics
Tissue
Finite element method

Keywords

  • 3D printing
  • diabetic foot disease
  • finite element analysis
  • insoles

Cite this

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title = "Virtually optimized insoles for offloading the diabetic foot: a randomized crossover study",
abstract = "Integration of objective biomechanical measures of foot function into the design process for insoles has been shown to provide enhanced plantar tissue protection for individuals at-risk of plantar ulceration. The use of virtual simulations utilizing numerical modeling techniques offers a potential approach to further optimize these devices. In a patient population at-risk of foot ulceration, we aimed to compare the pressure offloading performance of insoles that were optimized via numerical simulation techniques against shape-based devices. Twenty participants with diabetes and at-risk feet were enrolled in this study. Three pairs of personalized insoles: one based on shape data and subsequently manufactured via direct milling; and two were based on a design derived from shape, pressure, and ultrasound data which underwent a finite element analysis-based virtual optimization procedure. For the latter set of insole designs, one pair was manufactured via direct milling, and a second pair was manufactured through 3D printing. The offloading performance of the insoles was analyzed for forefoot regions identified as having elevated plantar pressures. In 88{\%} of the regions of interest, the use of virtually optimized insoles resulted in lower peak plantar pressures compared to the shape-based devices. Overall, the virtually optimized insoles significantly reduced peak pressures by a mean of 41.3 kPa (p < 0.001, 95{\%} CI [31.1, 51.5]) for milled and 40.5 kPa (p < 0.001, 95{\%} CI [26.4, 54.5]) for printed devices compared to shape-based insoles. The integration of virtual optimization into the insole design process resulted in improved offloading performance compared to standard, shape-based devices.",
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author = "S. Telfer and J. Woodburn and A. Collier and P.R. Cavanagh",
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Virtually optimized insoles for offloading the diabetic foot: a randomized crossover study. / Telfer, S.; Woodburn, J.; Collier, A.; Cavanagh, P.R.

In: Journal of Biomechanics, Vol. 60, 26.07.2017, p. 157-161.

Research output: Contribution to journalArticle

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T1 - Virtually optimized insoles for offloading the diabetic foot: a randomized crossover study

AU - Telfer, S.

AU - Woodburn, J.

AU - Collier, A.

AU - Cavanagh, P.R.

N1 - Acceptance date from journal webpage AAM: 12m embargo Funding note from AAM: Funding: ST was funded through the People Programme (Marie Sklodowska-Curie Actions) of the European Union’s Seventh Framework Programme (FP7 2007-2013) under REA Grant Agreement No. PIOF-GA-2012-329133. The funders had no input into the design, analysis, or decision to publish. Embargo period of journal longer than required by funder.

PY - 2017/7/26

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KW - 3D printing

KW - diabetic foot disease

KW - finite element analysis

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