Utilization of the foot load monitor for evaluating deep plantar tissue stresses in patients with diabetes: Proof-of-concept studies

Eran Atlas, Ziva Yizhar, Sam Khamis, Noa Slomka, Shlomo Hayek, Amit Gefen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


The purposes of the present study were to (1) determine the internal plantar mechanical stresses in diabetic and healthy subjects during everyday activities, and (2) identify stress parameters potentially capable of distinguishing between diabetic and healthy subjects. A self-designed, portable, real-time and subject-specific foot load monitor which employs the Hertz contact theory was utilized to determine the internal dynamic plantar tissue stresses in 10 diabetic patients and 6 healthy subjects during free walking and outdoors stair climbing. Internal stress parameters and average stress-doses were evaluated, and the results obtained from the two groups were compared. Internal plantar stresses and averaged stress-doses during free walking and outdoors stairs climbing in the diabetic group were 2.5-5.5-fold higher than in the healthy group (p < 0.001; stair climbing comparisons incorporated data from five diabetic patients). The interfacial pressures measured during free walking were slightly higher (∼1.5-fold) in the diabetic group (p < 0.05), but there was no significant difference between the two groups during stairs climbing. We conclude that during walking and stair climbing, internal plantar tissue stresses are considerably higher than foot-shoe interface pressures, and in diabetic patients, internal stresses substantially exceed the levels in healthy. The proposed method can be used for rating performances or design of footwear for protecting sub-dermal plantar tissues in patients who are at risk for developing foot ulcers. It may also be helpful in providing biofeedback to neuropathic diabetic patients.

Original languageEnglish
Pages (from-to)377-382
Number of pages6
JournalGait and Posture
Issue number3
StatePublished - Apr 2009


FundersFunder number
Ministry of Health, State of Israel


    • Biomechanical model
    • Diabetic footwear
    • Foot ulceration
    • Plantar pressure
    • Tissue injury


    Dive into the research topics of 'Utilization of the foot load monitor for evaluating deep plantar tissue stresses in patients with diabetes: Proof-of-concept studies'. Together they form a unique fingerprint.

    Cite this