Computational modeling of the plantar tissue stresses induced by the clinical practice of off-loading of the diabetic foot

Diabetic foot ulceration is among the most common, serious, and destructive complications of diabetes. This condition is mainly caused by peripheral neuropathy, leads to difficulties in ambulation, and is detrimental to the quality of life of the affected individuals. If a foot ulcer develops, or if the clinical assessment is that a certain foot region is highly susceptible to tissue breakdown, direct pressure on that plantar site is often reduced by using standard therapeutic shoes or custom-made insoles to off-load the high plantar pressures and to accommodate foot deformities. One specific common medical off-loading device is a custom-made insole designed with a hole under the active wound site, to reduce normal and shear stresses on the ulcer and redistribute them among other more peripheral foot regions. Here we present a patient-specific computational method, based on finite element (FE) analysis and available patient information, to investigate the internal tissue loads induced by off-loading method used in clinical practice. Our present method enables patient-specific examination of the biomechanical efficiency of off-loading solutions to prevent and treat diabetic foot ulcers.