TY - JOUR
T1 - A novel graded-stiffness footwear device for heel ulcer prevention and treatment
T2 - a finite element-based study
AU - Shaulian, Hadar
AU - Gefen, Amit
AU - Solomonow-Avnon, Deborah
AU - Wolf, Alon
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/12
Y1 - 2022/12
N2 - Diabetic heel ulceration is a serious, destructive, and costly complication of diabetes. In this study, a novel “graded-stiffness” offloading method was proposed. This method consists of heel support with multi-increasing levels of stiffness materials, to prevent and treat heel ulcers. A three-dimensional finite element model of the heel was used to evaluate the novel “graded-stiffness” orthotic device compared to two existing solutions: (1) an insole with a hole under the active ulcer and (2) an insole with a hole filled with a soft material (elastic modulus of 15 kPa). Volumetric exposure evaluation of internal tissues to stress was performed at two volume-of-interests: (1) the area of the heel soft tissues typically at high risk for ulceration, and (2) the soft tissues surrounding the high-risk area. The models predict that the “graded-stiffness” offloading solution is more effective than existing solutions in distributing and reducing heel internal loads, considering both volume-of-interests. Comparing different material gradient combinations for the offloading support reveals considerable variation of the heel stress distribution. In clinical practice, the “graded-stiffness” technological solution enables to form an adaptable and flexible system that can be customized to a specific patient, through adequate selection of the offloading materials, to fit the shape and size of the ulcer. This solution can be made as an off-the-shelf product or alternatively, be manufactured by-demand using 3D printing tools. The proposed novel practical offloading solution has the potential for streamlining and optimizing the prevention and treatment of diabetic heel ulcers.
AB - Diabetic heel ulceration is a serious, destructive, and costly complication of diabetes. In this study, a novel “graded-stiffness” offloading method was proposed. This method consists of heel support with multi-increasing levels of stiffness materials, to prevent and treat heel ulcers. A three-dimensional finite element model of the heel was used to evaluate the novel “graded-stiffness” orthotic device compared to two existing solutions: (1) an insole with a hole under the active ulcer and (2) an insole with a hole filled with a soft material (elastic modulus of 15 kPa). Volumetric exposure evaluation of internal tissues to stress was performed at two volume-of-interests: (1) the area of the heel soft tissues typically at high risk for ulceration, and (2) the soft tissues surrounding the high-risk area. The models predict that the “graded-stiffness” offloading solution is more effective than existing solutions in distributing and reducing heel internal loads, considering both volume-of-interests. Comparing different material gradient combinations for the offloading support reveals considerable variation of the heel stress distribution. In clinical practice, the “graded-stiffness” technological solution enables to form an adaptable and flexible system that can be customized to a specific patient, through adequate selection of the offloading materials, to fit the shape and size of the ulcer. This solution can be made as an off-the-shelf product or alternatively, be manufactured by-demand using 3D printing tools. The proposed novel practical offloading solution has the potential for streamlining and optimizing the prevention and treatment of diabetic heel ulcers.
KW - Diabetic heel ulcer
KW - Finite element analysis
KW - Graded stiffness
KW - Heel support
KW - Multi-materials insoles
KW - Offloading
UR - http://www.scopus.com/inward/record.url?scp=85142462707&partnerID=8YFLogxK
U2 - 10.1007/s10237-022-01614-0
DO - 10.1007/s10237-022-01614-0
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C2 - 35908097
AN - SCOPUS:85142462707
SN - 1617-7959
VL - 21
SP - 1703
EP - 1712
JO - Biomechanics and Modeling in Mechanobiology
JF - Biomechanics and Modeling in Mechanobiology
IS - 6
ER -