Abstract
Mechanical loading acting on the foot plantar soft-tissue in the form of focal stress plays a central pathogenic role in the onset of diabetic neuropathic ulcers. Current instruments which merely allow superficial estimate of plantar loading acting on the foot, severely limit the scope of many biomechanical/clinical studies on this issue. Recent studies have suggested that peak plantar pressure may be only 65% specific for the development of ulceration. These limitations are at least partially due to surface pressures not being representative of the complex mechanical stress developed inside the subcutaneous plantar soft-tissue, which are potentially more relevant for tissue breakdown. This study established a threedimensional and nonlinear finite element model of a human foot complex with comprehensive skeletal and soft-tissue components capable of predicting both the external and internal stresses and deformations of the foot. The model was validated by experimental data of subject-specific plantar foot pressure measures. The stress analysis indicated the internal stresses doses were site-dependent and the observation found a change between 1.5 to 4.5 times the external stresses on the foot plantar surface. In the forefoot, peak external stress was found in the medial region (the first metatarsal heads). Peak internal stress, however, was shifted to the lateral forefoot region (the fourth and fifth metatarsal heads). It suggested that the normal protective plantar soft-tissue has the potential to redistribute the plantar load such that the internal peak stress can have a significantly different location than the external. The results yielded insights into the internal loading conditions of the plantar soft-tissue, which is important in enhancing our knowledge on the causes of foot ulceration and related stressinduced tissue breakdown in diabetic foot.
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References
Singh N, Armstrong DG, Lipsky BA. (2005) Preventing foot ulcers in patients with diabetes. Jama 293:217–228.
Veves A, Murray HJ, Young MJ et al. (1992) The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia 35:660–3.
Duckworth T, Boulton AJ, Betts RP et al. (1985) Plantar pressure measurements and the prevention of ulceration in the diabetic foot. J Bone Joint Surg Br 67:79–85.
Morag E, Cavanagh PR. (1999) Structural and functional predictors of regional peak pressures under the foot during walking. J Biomech 32:359–370.
Brash PD, Foster JE, Vennart W et al. (1996) Magnetic resonance imaging reveals micro-haemorrhage in the feet of diabetic patients with a history of ulceration. Diabet Med 13:973–8.
Athanasiou KA, Liu GT, Lavery LA et al. (1998) Biomechanical topography of human articular cartilage in the first metatarsophalangeal joint. Clin Orthop Relat Res 348:269–281.
Stess RM, Jensen SR, Mirmiran R. (1997) The role of dynamic plantar pressures in diabetic foot ulcers. Diabetes Care 20:855–858.
Delbridge L, Perry P, Marr S et al. (1988) Limited joint mobility in the diabetic foot: relationship to neuropathic ulceration. Diabet Med 5:333–337.
Pham H, Armstrong DG, Harvey C et al. (2000) Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care 23:606–611.
Gefen A, Megido-Ravid M, Azariah M et al. (2001) Integration of plantar soft tissue stiffness measurements in routine MRI of the diabetic foot. Clin Biomech (Bristol, Avon) 16:921–925.
Bus SA, Maas M, Cavanagh PR et al. (2004) Plantar fat-pad displacement in neuropathic diabetic patients with toe deformity: a magnetic resonance imaging study. Diabetes Care 27:2376–2381.
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© 2009 International Federation of Medical and Biological Engineering
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Chen, WM., Lee, P.VS., Lee, SJ., Lee, T. (2009). Investigation of Plantar Barefoot Pressure and Soft-tissue Internal Stress: A Three-Dimensional Finite Element Analysis. In: Lim, C.T., Goh, J.C.H. (eds) 13th International Conference on Biomedical Engineering. IFMBE Proceedings, vol 23. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-92841-6_451
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DOI: https://doi.org/10.1007/978-3-540-92841-6_451
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-92840-9
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