Extra-depth Shoes Research Articles

Pressure-Reducing Design of 3D-Printed Diabetic Shoe Midsole Utilizing Auxetic Lattice Structure

With the global rise in the prevalence of diabetes, diabetic patients need innovative footwear designs to reduce the risk of foot ulcers. This study examined the mechanical properties of diabetic shoe midsoles featuring auxetic lattice structures. Through the construction of finite element models and simulation, this research compared the biomechanical parameter differences in the plantar regions of the metatarsal head, midfoot, and hindfoot when wearing two types of auxetic midsoles with internal angles of 60° and 75° and a non-auxetic midsole with an internal angle of 90° under both walking and running conditions. Compared to the non-auxetic midsole, the auxetic midsoles significantly reduced the peak plantar pressure and optimized the pressure distribution across various plantar regions. Notably, the auxetic 60° midsole reduced the peak plantar pressure by 19.68–55.25% and 16.19–54.39% compared to the non-auxetic 90° midsole during walking and running, respectively. This study also verified that the auxetic midsoles exhibited greater adaptability and compliance to the plantar foot shape, contributing to reductions in plantar pressure in comparisons of deformation values and plantar contact areas across the different midsoles. Auxetic midsoles manufactured using 3D printing technology have significant potential to prevent diabetic foot ulcers and maintain human foot health. This research integrates insights and techniques from materials science and ergonomics, offering a new direction for footwear design.

Penerapan Senam Kaki Pada Penderita Diabetes Mellitus dalam Upaya Pencegahan Komplikasi Diabetes pada Kaki (Diabetic Foot)

Background: Diabetes Mellitus (DM) is a disease that is increasing every year in countries around the world. Reports from various regions in Indonesia show that the incidence and complications of DM are widespread, making it a national problem that requires more attention. A frequently encountered complication of DM is diabetic foot, which can manifest as ulcers, infection and gangrene. Actions to treat diabetic foot include preventive measures which include foot care education, diabetic shoes and foot exercises. Foot exercises are exercises carried out by DM sufferers and non-sufferers to prevent injuries and help improve blood circulation in the legs. Apart from their role in providing health education, nurses as members of the medical team can also play a role in teaching foot exercises so that DM patients are able to do foot exercises independently. Objective: To increase the knowledge and skills of DM sufferers by implementing foot exercises in an effort to prevent diabetes complications in the feet (diabetic foot). Method: Foot exercise activities are carried out on DM sufferers who do not have wounds on the feet. The methods used were lectures, questions and answers, and direct demonstrations using newspapers. Results: The results of the activities obtained were an increase in knowledge before and after providing counseling and demonstrations of foot exercises for DM sufferers. Conclusion: After carrying out this community service, the community's ability to do foot exercises has increased and can be done independently, so it is hoped that this can prevent complications in DM sufferers.

RESEARCH OF MATERIALS AND DESIGN OF ORTHOPEDIC INSOLE

The article is done to study the influence of orthopedic products based on composite materials on the comfort of shoes for diabetic patients. The purpose of the work is to identify certain preventive and therapeutic effects of orthopedic products for people with diabetes. The study focuses on various composite materials, predominantly silicone-based, the feet of diabetic patients, and the design of orthopedic products. To develop specialized insoles were utilized data derived from anthropometric investigations conducted on the feet of diabetic patients. Statistical parameters characterizing the feet were meticulously determined and subsequently employed in the design of insoles tailored for diabetic footwear. A comprehensive methodology was employed in the development of these specialized insoles, integrating a mathematical model and a computer program to simulate the insole, alongside an image analysis program that facilitated the extraction of anthropometric data. The resulting design of the insole for comfortable diabetic shoes encompasses three distinct layers: an upper layer, a lower layer, and an intermediate layer. The use of orthopedic insoles made of silicone composites allowed to reduce the pressure on the painful areas of the foot. The outcome of this study is the development of orthopedic products that not only contribute to the treatment and rehabilitation of diabetic patients but also enhance their overall quality of life. Furthermore, this research underscores the potential to elevate the level of social security for these individuals. As such, the significance of this study lies in its ability to address a pressing healthcare issue, ultimately improving the well-being of diabetic patients.

Implementation of LoRa Wireless Communication in Smart Diabetic Shoes Design

Diabetes is a widespread medical condition affecting a substantial portion of the global population. It is a metabolic disorder known as diabetes mellitus, characterized by severe fluctuations in blood glucose levels due to inadequate insulin production in the human body. The effective monitoring of diabetes is of paramount importance to researchers as it holds the potential to enhance the quality of healthcare services. Among the challenges faced by individuals with diabetes, one prevalent issue is the development of ulcers, which can be challenging to detect promptly. Technological advancements offer a promising avenue for cost-effective and continuous monitoring of chronic diseases like diabetes. This study centers on the development of IoT-based intelligent diabetic footwear that incorporates pressure sensors and temperature monitoring for individuals with diabetic feet. In the evaluation of SX1278 (Ra-02) Lora Module communication, deployed at eight different locations, it was observed that two of these points achieved a flawless transmission success rate of 100%. Conversely, the communication failed at points 6 and 7, with a success rate falling below 50%. Some of these failures can be attributed to signal obstructions, including natural elements such as trees and terrain, as well as man-made structures like buildings and machinery workshops, which hinder the efficient transmission of signals from the end node to the gateway. The results of this research provide positive implications in the form of developing IoT-based diabetes shoes that can be applied with alternative Lora communication connections in areas with poor internet signal.

Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear

IntroductionOptimising the cushioning stiffness of diabetic footwear/orthoses can significantly enhance their offloading capacity. This study explores whether optimum cushioning stiffness can be predicted using simple demographic and anthropometric parameters. MethodsSixty-nine adults with diabetes and loss of protective sensation in their feet were recruited for this cross-sectional observational study. In-shoe plantar pressure was measured using Pedar® for a neutral diabetic shoe (baseline) and after adding cushioning footbeds of varying stiffness. The cushioning stiffness that achieved maximum offloading was identified for each participant. The link between optimum cushioning stiffness and plantar loading or demographic/anthropometric parameters was assessed using multinomial regression. ResultsPeople with higher baseline plantar loading required stiffer cushioning materials for maximum offloading. Using sex, age, weight, height, and shoe-size as covariates correctly predicted the cushioning stiffness that minimised peak pressure across the entire foot, or specifically in the metatarsal heads, midfoot and heel regions in 70%, 72%, 83% and 66% of participants respectively. ConclusionsIncreased plantar loading is associated with the need for stiffer cushioning materials for maximum offloading. Patient-specific optimum cushioning stiffness can be predicted using five simple demographic/anthropometric parameters. These results open the way for methods to optimise cushioning stiffness as part of clinical practice.

Charcot Ankle Deformity: Can the Limb be Salvaged?

Category: Diabetes; Ankle Introduction/Purpose: Diabetes mellitus (DM) may result in Charcot arthropathy (CA) in 0.1% to 2.5% of diabetic patients. Complications may arise including joint dislocation, deformities, ulcerations, and limb amputation. Surgical intervention has been shown to improve patient's walking ability and health-related quality of life compared to use of orthotics in addition to reduction of ulcer, bone infection, use of orthoses, and amputation. A retrospective review of patients with ankle charcot arthropathy was performed with hindfoot nail fixation. The aim of the study was to determine radiographic healing, complication rates of surgical intervention, and patients' ability to ambulate with therapeutic inserts or boots. The results obtained from this study serve to provide evidence for intervention via operative fixation and limb salvage in this cohort of patients. Methods: A retrospective review of patients treated with hindfoot nail with CA of the ankle was performed between 2016 to 2022. The demographic data, BMI, cause of the charcot arthropathy, the pre-operative radiographic deformity, and prior wounds and infection data was recorded. We identified 18 consecutive patients that underwent surgical intervention. The surgical technique included bimalleolar exposure, correction of the deformity, hindfoot fusion nail with or without structural femoral head graft. The follow up data collected included post-operative complications, radiographic evaluation of union, and clinical data on type of shoe wear or boots used for ambulation. Results: We identified 17 consecutive patients undergoing hindfoot deformity correction with hindfoot nail. The average follow- up for the patients was 1.7 year. The cause of neuropathy was diabetes in 15 patient and idiopathic in 2 patients. The average BMI for the cohort was 29.5. The initial 90-day complications rate for surgical intervention was 17%; with one superficial infection, one deep infection, and one death related to a cardiac event. At latest follow up 12 patients were ambulating with a CROW boot, 3 in diabetic shoes with therapeutic inserts, 1 below knee prosthesis, and 1 patient is in the initial perioperative period of healing. Radiographic union was seen in 12 patient, 3 patients had stable pseudo-union of the ankle joint with neutral alignment. Conclusion: The development of an acquired ankle deformity is associated with a poor quality of life. Traditional treatment of CA has shown to be effective when resolving infection and avoiding amputation. Our study supports the use of hindfoot nail for deformity correction/fixation and limb salvage of ankle CA patients. This patient population is highly comorbid but can have meaningful improvement in ambulator status post-surgery in a CROW boot or shoes with therapeutic insoles.

Research on Developing a Size System and Designing Shoe Lasts for Men with Diabetes in Vietnam

This paper presents the method and results of developing a shoe last sizing system on the basis of the foot parameter system, designing shoe lasts for men with diabetes in Vietnam. Diabetic patients often have foot complications and need to use extra depth shoes or custom shoes to protect their feet and prevent foot ulcers. The parameters of 5 shoe last sizes by length and 3 sizes by width according to the French sizing system have been developed. The results show that the shoe last parameters for men with diabetes are much larger than those for healthy men, especially the ball girth and width are larger by about 20 mm and 5 mm, respectively. Afterward, shoe lasts were designed and modified using 3D CAD tools for style, fit and comfort specifically suited for men with diabetes. Using shoe last design software, 3D printing technology to design and fabricate a shoe last, the proposed approach proved the viability of designing and manufacturing extra depth shoes for men with diabetes in Vietnam.

Studying Proposes Requirements for Deabetics’ Shoes in Viet Nam

Complications of Foot’s diabetics such as foot pain, skin changes, callus, foot deformity, foot ulcer, amputation are common. Diabetic shoes play an important role in protecting the feet from injury. The article was based on the opinions of 412 female diabetic patients, 110 male diabetic patients and 20 doctors at medical centers on shoe evaluation criteria such as structural features, materials, and comfort. From that result, the requirements for diabetic shoes were proposed in Vietnam. This requirement is an important basis for the design and selection of suitable materials for diabetics.

Tibiotalocalcaneal arthrodesis for the treatment of midfoot Charcot neuroarthropathy

Charcot neuroarthropathy of the foot and ankle is a destructive disorder resulting in severe and debilitating deformity. The goal of surgical reconstruction in Charcot neuroarthropathy is to create a stable, plantigrade foot that is amenable to bracing and offloading. Many reconstruction methods have been described in the literature including ostectomy of osseous prominences, realignment ostoeotmies, intramedullary midfoot beaming, plate fixation and external fixation. In this study we describe the use of tibiotalocalcaneal arthrodesis with intramedullary nail fixation for the treatment of midfoot Charcot neuroarthropathy in 12 consecutive patients. The mean age of our patient population was 61.33 years, mean BMI was 37.03 kg/m2, 9 patients were type II diabetics, 2 patients were type I diabetics and 1 patient had a diagnosis of idiopathic neuropathy without underlying diabetes mellitus (DM). The mean duration of DM diagnosis was 24.73 years. 9 patients within the study population had suffered from chronic or recurrent ulcerations secondary to osseous deformity that had failed conservative treatment and 3 patients had residual ulceration at the time of surgery. Fusion was observed in 10 of 12 patients within the study. All patients had a functional, plantigrade foot post-operatively. Overall, 5 patients are ambulating in custom diabetic shoes without assistive devices while the remaining patients are ambulating with assistive devices. The results of this study indicate that tibiotalocalcaneal arthrodesis with retrograde intramedullary nail fixation for midfoot Charcot neuroarthropathy is a reliable treatment option to provide a stable, plantigrade, braceable foot.

Nurse practitioners and barriers to diabetic foot treatment.

Even with full practice authority, nurse practitioners (NPs) face limitations in care and treatment options. An example of this is current federal law prohibiting NPs from ordering diabetic shoes. This study reviewed the background of this problem, potential impacts on patient health and NP practice, and viable solutions for consideration. This was a descriptive study of NPs in a northwestern state with full practice authority. An anonymous online survey was used. There were 54 total NP respondents. The potential negative patient outcomes associated with restricted NP ability to prescribe diabetic footwear were supported through the literature review and the survey, including increased foot complications and acuity, translating to increased costs. Of the NPs queried, 80% felt inability to prescribe diabetic footwear was limiting to their practice, and 92% felt this affected patient outcomes. Federal legislative changes with support of bipartisan bills allowing NPs to prescribe diabetic footwear could facilitate timeliness and access to care while reducing costs. Legislation affecting NP scope of practice is an important issue with implications related to patient outcomes. Nurse practitioners should continue to support legislation at the federal level to pass bills allowing for NPs to certify orders for diabetic shoes.

Contribution of Nanotechnology and Nanomaterials to the Treatment of Diabetic Patients by Aid of Novel Inventions

Nanoscience and Nanotechnology are highly growing their significance in diabetic supplies and research nowadays. It is an area that included nanomaterials, nanosensors and nanostructures as well as nanoparticle projects and also their usage in human health research. Particularly, nanotechnology helps to the production of diabetic supplies, materials together with the development of novel glucose and insulin injection devices as well as their measurement sensors by the aid of nanomaterials. These materials mostly could be metal nanoparticles together with carbon nanostructures by nano dimension delivery mechanisms modalities which hold the potential to vividly recover the excellence of life of diabetic patients. Nanoscience and nanotechnology in diabetic research have facilitated and provided more truthful data for identifying diabetes mellitus. It is also worth mentioning that the nanotechnology could highly enhance the impact of drug delivery by addition of nanoscale materials and increase the glucose feeling, temporal response as well as glucose nursing. Furthermore, it is proposing novel nanoscale methods named closed-loop insulin delivery approaches which mechanically release insulin drug in reply to fluctuating blood glucose heights. Besides, the mixture of nanotechnology by medication has shaped a novel field of nanomedicine which could enhance human health level. It is worthwhile to mention that some of the applications of nanotechnology for the treatment of diabetic patients can be the production of diabetic supplies by nanotechnology. One of the most important diabetic instruments that could highly relieve the life of patients these days could be nano diabetic shoes which will describe here. In this research, applications of nanoscience and nanotechnology in treating diabetic patients were discussed.

Magnetic hydrogel based shoe insoles for prevention of diabetic foot

Currently, plastic/rubber/silicone based shoe inserts are used as preventive approach against diabetic foot which are non-degradable, non-absorbent and contains magnet protrusions, making them highly uncomfortable. These are discarded and thrown away after their service life, causing soil and marine pollution. Thus, the objective of this study was to evaluate polyvinyl alcohol/carboxymethyl cellulose (PVA/CMC) based magnetic hydrogels prepared by physical crosslinking as an alternative for diabetic shoe inserts. Hydrogels prepared by moist heat treatment with different concentration of strontium ferrite nanoparticles (MG) are evaluated based on their structural, physico-chemical, morphological, thermal, mechanical, thermo-mechanical, swelling behavior, surface wetting, magnetic and rheological properties. It was observed that incorporation of MG resulted in improvement in overall properties. Infrared spectroscopy revealed strong hydrogen bonding interaction between CMC and PVA. The surface micrographs showed uniform dispersion of MG throughout PVA/CMC matrix. The results showed the improvement in flexibility and tensile strength of the PVA/CMC hydrogels with the incorporation of MG by ~40 and ~20%, respectively. Moreover, the magnetic hydrogels could absorb ~300% moisture of their original weight which is necessary to avoid growth of microbes on skin. Thus, PVA/CMC/MG hydrogels can be considered as a biodegradable alternative for diabetic shoe insoles.

Overview of Diabetic Foot Care for the Nurse Practitioner

Foot and ankle complications of diabetes result in significant morbidity, mortality, and health care expenditure. Diabetes may result in foot deformity, neuropathy, and peripheral artery disease with risk of callus, foot ulcer, infection, and subsequent amputation. Appropriate patient education, medical management, and use of therapeutic footwear can prevent many diabetic foot complications. Nurse practitioners are key members of foot care teams in both primary and specialty care. The nurse practitioner managing a patient’s diabetes is an appropriate provider to certify the need for diabetic shoes and should be authorized to do so to provide quality care without unnecessary delay.

Plantar pressure image fusion for comfort fusion in diabetes mellitus using an improved fuzzy hidden Markov model

Diabetes mellitus is a clinical syndrome caused by the interaction of genetic and environmental factors. The change of plantar pressure in diabetic patients is one of the important reasons for the occurrence of diabetic foot. The abnormal increase of plantar pressure is a predictor of the common occurrence of foot ulcers. The feature extraction of plantar pressure distribution will be beneficial to the design and manufacture of diabetic shoes that will be beneficial for early protection of diabetes mellitus patients. In this research, texture-based features of the angular second moment (ASM), moment of inertia (MI), inverse difference monument (IDM), and entropy (E) have been selected and fused by using the up–down algorithm. The fused features are normalized to predict comfort plantar pressure imaging dataset using an improved fuzzy hidden Markov model (FHMM). In FHMM, type-I fuzzy set is proposed and fuzzy Baum–Welch algorithm is also applied to estimate the next features. The results are discussed, and by comparing with other back–forward algorithms and different fusion operations in FHMM. Improved HMMs with up–down fusion using type-I fuzzy definition performs high effectiveness in prediction comfort plantar pressure distribution in an image dataset with an accuracy of 82.2% and the research will be applied to the shoe-last personalized customization in the industry.

Chromium Cross-Linking Based Immobilization of Silver Nanoparticle Coating on Leather Surface with Broad-Spectrum Antimicrobial Activity and Durability.

Leather with durable and broad-spectrum antimicrobial properties is very attractive in applications to produce diabetic shoes. In this work, gallic acid stabilized silver nanoparticles (GA@AgNPs) were prepared as water-borne finishing agent to be spray-coated on leather surface, with subsequent immobilization onto skin collagen via chromium(III) cross-linking. Such chemical anchoring of AgNPs onto microscaled collagen fibers not only enhanced the hydrophobicity of leather surface but also converted the surface ζ-potential from a positive charge to a negative charge, resulting in the excellent microbial antiadhesive ability of GA@AgNP-coated leather because of its dual-hydrophobic and electrostatic repelling of microbial adhesion. Such GA@AgNP coating also exhibited broad-spectrum antimicrobial activity against Escherichia coli, Staphylococcus aureus, methicillin-resistant S. aureus, and Candida albicans, with killing efficiencies all higher than 99%. Moreover, the killed microbes could be easily released from this anionic GA@AgNP spray coating by simply washing, preserving, and giving long-term antimicrobial activity to leather products. Most of all, the robust immobilization of AgNPs guaranteed the durably antimicrobial activity of such GA@AgNP-coated leather against laundry, perspiration, and mechanical abrasion in real daily use.

Using Gray Relational and Artificial Neural Network in Insole Design and Development for Diabetes

1. Abstract The purpose of this research is to design Insole for the diabetic patients. Using the multiplex system analysis, it compares the foot pressure data of 20 testers (Including a Diabetic Patient) plus insole measurement with six different materials and shapes to obtain the best diabetic shoes. In addition to the detailed discussion of the application of various methods in this unit, the questionnaire is also used. Based on these, the biomechanical experiments are used between patients and healthy people to prove the theory of this method’s feasibility. Taking The “Comfort Rating” of diabetics is the research direction. General products of clinically-used foot treatment insoles are used to design a “Grey Relational” assessment model which is based on foot pressure measurement as the precondition. The model used is to find the most relevant insoles and foot shapes as practicing samples for “Artificial Neural Network (ANN)”. Through multiple iteration calculations and automatic grouping of the data input the most suitable patient insole pattern will be found from the samples. Then, the selected pathological insole as well as its design features are to be analyzed and discussed in detail for subsequent research, development and design. 2. Keywords : Diabetic Insole; Design Feature Foot Pressure Measurement; Grey Relational; Neural Networks

Temperature Regulating Shoes for Prevention of Diabetic Foot Ulcers

Diabetic foot ulcers (DFU) continue to burden Americans with over 100,000 amputations every year. We believe that better understanding of the etiology and a multi-factorial approach that combines in-shoe temperature regulation along with plantar stress reduction could dramatically improve this outcome. Previous research indicated that soft tissue is prone to ulceration at warmer temperatures. Likewise, animal studies indicate higher tissue resistance to break-down when cooled to 25 °C to 28 °C. Insulated diabetic footwear and load-bearing activity lead to high plantar tissue temperatures and increased risk of DFU. The purpose of this study was to design/develop a novel temperature regulating footwear and test cooling effectiveness. An extra-depth diabetic shoe was instrumented with temperature control apparatus set to cool to 28 °C. Three subjects wore this shoe and a non-cooling (control) shoe while walking for 10 minutes. Post-walking thermographs of the regulated foot revealed: forefoot temperatures below 28 °C; heel temperatures around 28 °C with a 3.9 °C bilateral cooling effect; midfoot regions 2.9 °C less than the control foot but still over 28 °C, perhaps due to poor contact with the cooling insole or a need for increased localized control of cooling. These results suggest feasibility of in-shoe temperature regulation. Further research is needed to improve our design and ultimately explore DFU prevention in a clinical trial. Disclosure A. Ersen: Other Relationship; Self; Vivonics Inc. L.S. Adams: Other Relationship; Self; Vivonics, Inc. R.T. Myers: Employee; Self; Vivonics, Inc. G.B. Hirschman: Stock/Shareholder; Self; Vivonics, Inc.. Employee; Self; Vivonics, Inc.. Board Member; Self; Vivonics, Inc. L.A. Lavery: Speaker's Bureau; Self; Osiris Therapeutics, Inc., Integra LifeSciences. Research Support; Self; Cardinal. Speaker's Bureau; Self; Smith & Nephew. Research Support; Self; EO2. Consultant; Self; Aplion, Harbor MedTech, Boehringer Ingelheim GmbH, Medline Industries, Inc. M. Yavuz: Research Support; Self; Derma Sciences, PulseFlow Technologies. Other Relationship; Self; vivonics.

Orders and Documentation Are Vital to Diabetic Shoe Coverage

Orders and Documentation Are Vital to Diabetic Shoe Coverage

Resolutions for 2018

Happy New Year! I wish you joy, happiness and hope in 2018. What are your resolutions for the new year? The history of New Year resolutions dates back to ancient times which make me wonder how many resolutions have ever been met. This year I have some personal resolutions and some resolutions for AANP. On the personal side I will take a daily walk, eat healthier, worry less, become more mindful, and celebrate successes. Taking a daily walk is a good way to clear your mind and focus your thoughts. I set a timer and stand every 20 minutes when I am at my desk, so now I am also going to spend some of that time walking. Eating healthier is not always easy with a busy travel schedule, but I am finding more fruits and vegetables at airports. Less worry is difficult, but I am going to concentrate on items under my control and manage my time. To have less worry I will need to be more mindful. I am going to take the time to be aware of the present and enjoy life’s moments. I am thankful for the many blessings I have had, and taking time to celebrate even the smallest of those blessings is an important resolution. For AANP, I hope you will make a resolution to join me in efforts to reduce barriers to full practice in every state and help educate fellow NPs as to why this message is important to everyone’s practice. I will continue to work with AANP to remove barriers to reimbursement and to those that restrict NPs from ordering home health and diabetic shoes. I’ll continue to be aware of the need to represent our diversity in membership. The AANP Board of Directors and I will continue to move our agenda forward in areas of Practice, Education, Advocacy, Research and Leadership (PEARL). I hope you will make a resolution to become a member or renew your AANP membership so that you can be a part of moving AANP’s agenda forward!

A Stacked Dual-Frequency Microstrip Patch Antenna for Simultaneous Shear and Pressure Displacement Sensing

This paper presents a simultaneous shear and pressure displacement sensor based on the microstrip patch antenna technology. The antenna sensor consists of a dual-frequency patch antenna, a superstrate, and a rectangular director. The two fundamental resonant frequencies of the patch antenna are influenced by the lateral and vertical positions of the director with respect to its radiation patch. Therefore, the shear and pressure displacements of the director can be determined simultaneously from two fundamental antenna resonant frequencies. The antenna sensor was designed, fabricated, and tested to characterize its sensing performance. An algorithm was developed to inversely determine the shear and pressure displacements from the measured antenna frequencies. We validated that the typical measurement uncertainties of the antenna sensor is ±0.3 mm for the shear displacement and ±0.15 mm for the pressure displacement. The presented shear/pressure displacement sensor is intended for monitoring the interaction between the human body and assistive medical devices (e.g., prosthetic liners, diabetic shoes, seat cushions, and so on).