Biomechanical Efficacy of Shear-Reducing Diabetic Insoles

Elaborations on Future Design Criteria

Metin Yavuz, Ali Ersen, Mike Richardson, Linda S. Adams, Clayton F. Holmes, Muthu B.J. Wijesundara, Dane K. Wukich, Javier La Fontaine

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction Increasing evidence suggests that plantar shear forces and related stresses play a major role in diabetic foot ulcerations. Several orthotic devices are commercially available to reduce plantar shear forces within the shoe. The biomechanical efficacy of these devices was not tested in vivo. To measure spatiotemporal characteristics of gait to assess the efficacy of such shear-reducing insoles (SRIs), control insoles were also tested for comparison purposes. Material and Methods Eighteen healthy volunteers walked along a 30.5-m line while wearing three types of insoles in randomized order. Spatiotemporal parameters of gait were quantified. Statistical comparisons between the control and SRIs were conducted using repeated measures analysis of variance. Intraclass correlation coefficients (ICCs) were also calculated to reveal the repeatability of the trials. Step length, gait speed, and cadence of the subjects remained similar regardless of the insole type. Results No significant difference was observed in any variable. The ICC values revealed excellent repeatability. Conclusions The lack of changes in gait parameters in these results suggest that shear-reducing diabetic inserts did not decrease plantar shear forces as intended. This might be caused by unrealistic in vitro testing conditions during the prototype development. Future designs should also consider friction at the lateral walls of the inserts, an increase in step repetition that accompanies a decrease in gait speed and/or step length, and a possible temperature increase within the shoe. We conclude that the future SRIs need to be redesigned based on comprehensive biomechanical guidelines. ©

Original languageEnglish
Pages (from-to)82-86
Number of pages5
JournalJournal of Prosthetics and Orthotics
Volume31
Issue number2
DOIs
StatePublished - 1 Apr 2019

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Gait
Shoes
Orthotics
Analysis of variance (ANOVA)
Orthotic Devices
Diabetic Foot
Friction
Analysis of Variance
Healthy Volunteers
Testing
Guidelines
Equipment and Supplies
Temperature
Walking Speed

Keywords

  • diabetic foot
  • diabetic foot ulcers
  • diabetic insoles
  • plantar shear
  • shear-reducing insoles

Cite this

Yavuz, M., Ersen, A., Richardson, M., Adams, L. S., Holmes, C. F., Wijesundara, M. B. J., ... La Fontaine, J. (2019). Biomechanical Efficacy of Shear-Reducing Diabetic Insoles: Elaborations on Future Design Criteria. Journal of Prosthetics and Orthotics, 31(2), 82-86. https://doi.org/10.1097/JPO.0000000000000241
Yavuz, Metin ; Ersen, Ali ; Richardson, Mike ; Adams, Linda S. ; Holmes, Clayton F. ; Wijesundara, Muthu B.J. ; Wukich, Dane K. ; La Fontaine, Javier. / Biomechanical Efficacy of Shear-Reducing Diabetic Insoles : Elaborations on Future Design Criteria. In: Journal of Prosthetics and Orthotics. 2019 ; Vol. 31, No. 2. pp. 82-86.
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abstract = "Introduction Increasing evidence suggests that plantar shear forces and related stresses play a major role in diabetic foot ulcerations. Several orthotic devices are commercially available to reduce plantar shear forces within the shoe. The biomechanical efficacy of these devices was not tested in vivo. To measure spatiotemporal characteristics of gait to assess the efficacy of such shear-reducing insoles (SRIs), control insoles were also tested for comparison purposes. Material and Methods Eighteen healthy volunteers walked along a 30.5-m line while wearing three types of insoles in randomized order. Spatiotemporal parameters of gait were quantified. Statistical comparisons between the control and SRIs were conducted using repeated measures analysis of variance. Intraclass correlation coefficients (ICCs) were also calculated to reveal the repeatability of the trials. Step length, gait speed, and cadence of the subjects remained similar regardless of the insole type. Results No significant difference was observed in any variable. The ICC values revealed excellent repeatability. Conclusions The lack of changes in gait parameters in these results suggest that shear-reducing diabetic inserts did not decrease plantar shear forces as intended. This might be caused by unrealistic in vitro testing conditions during the prototype development. Future designs should also consider friction at the lateral walls of the inserts, an increase in step repetition that accompanies a decrease in gait speed and/or step length, and a possible temperature increase within the shoe. We conclude that the future SRIs need to be redesigned based on comprehensive biomechanical guidelines. {\circledC}",
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Yavuz, M, Ersen, A, Richardson, M, Adams, LS, Holmes, CF, Wijesundara, MBJ, Wukich, DK & La Fontaine, J 2019, 'Biomechanical Efficacy of Shear-Reducing Diabetic Insoles: Elaborations on Future Design Criteria', Journal of Prosthetics and Orthotics, vol. 31, no. 2, pp. 82-86. https://doi.org/10.1097/JPO.0000000000000241

Biomechanical Efficacy of Shear-Reducing Diabetic Insoles : Elaborations on Future Design Criteria. / Yavuz, Metin; Ersen, Ali; Richardson, Mike; Adams, Linda S.; Holmes, Clayton F.; Wijesundara, Muthu B.J.; Wukich, Dane K.; La Fontaine, Javier.

In: Journal of Prosthetics and Orthotics, Vol. 31, No. 2, 01.04.2019, p. 82-86.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Biomechanical Efficacy of Shear-Reducing Diabetic Insoles

T2 - Elaborations on Future Design Criteria

AU - Yavuz, Metin

AU - Ersen, Ali

AU - Richardson, Mike

AU - Adams, Linda S.

AU - Holmes, Clayton F.

AU - Wijesundara, Muthu B.J.

AU - Wukich, Dane K.

AU - La Fontaine, Javier

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Introduction Increasing evidence suggests that plantar shear forces and related stresses play a major role in diabetic foot ulcerations. Several orthotic devices are commercially available to reduce plantar shear forces within the shoe. The biomechanical efficacy of these devices was not tested in vivo. To measure spatiotemporal characteristics of gait to assess the efficacy of such shear-reducing insoles (SRIs), control insoles were also tested for comparison purposes. Material and Methods Eighteen healthy volunteers walked along a 30.5-m line while wearing three types of insoles in randomized order. Spatiotemporal parameters of gait were quantified. Statistical comparisons between the control and SRIs were conducted using repeated measures analysis of variance. Intraclass correlation coefficients (ICCs) were also calculated to reveal the repeatability of the trials. Step length, gait speed, and cadence of the subjects remained similar regardless of the insole type. Results No significant difference was observed in any variable. The ICC values revealed excellent repeatability. Conclusions The lack of changes in gait parameters in these results suggest that shear-reducing diabetic inserts did not decrease plantar shear forces as intended. This might be caused by unrealistic in vitro testing conditions during the prototype development. Future designs should also consider friction at the lateral walls of the inserts, an increase in step repetition that accompanies a decrease in gait speed and/or step length, and a possible temperature increase within the shoe. We conclude that the future SRIs need to be redesigned based on comprehensive biomechanical guidelines. ©

AB - Introduction Increasing evidence suggests that plantar shear forces and related stresses play a major role in diabetic foot ulcerations. Several orthotic devices are commercially available to reduce plantar shear forces within the shoe. The biomechanical efficacy of these devices was not tested in vivo. To measure spatiotemporal characteristics of gait to assess the efficacy of such shear-reducing insoles (SRIs), control insoles were also tested for comparison purposes. Material and Methods Eighteen healthy volunteers walked along a 30.5-m line while wearing three types of insoles in randomized order. Spatiotemporal parameters of gait were quantified. Statistical comparisons between the control and SRIs were conducted using repeated measures analysis of variance. Intraclass correlation coefficients (ICCs) were also calculated to reveal the repeatability of the trials. Step length, gait speed, and cadence of the subjects remained similar regardless of the insole type. Results No significant difference was observed in any variable. The ICC values revealed excellent repeatability. Conclusions The lack of changes in gait parameters in these results suggest that shear-reducing diabetic inserts did not decrease plantar shear forces as intended. This might be caused by unrealistic in vitro testing conditions during the prototype development. Future designs should also consider friction at the lateral walls of the inserts, an increase in step repetition that accompanies a decrease in gait speed and/or step length, and a possible temperature increase within the shoe. We conclude that the future SRIs need to be redesigned based on comprehensive biomechanical guidelines. ©

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