基于糖尿病患者步态周期足底压力的变刚度鞋垫设计

doi:10.3969/j.issn.1006-9771.2023.04.006

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (4): 408-415.doi: 10.3969/j.issn.1006-9771.2023.04.006

基于糖尿病患者步态周期足底压力的变刚度鞋垫设计

王芳¹^,²(), 杨涛¹^,², 何耀广¹^,², 曹子君¹^,², 刘国庆¹^,², 胡军¹^,², 张建国¹^,², 樊瑜波³

1.天津科技大学机械工程学院，天津市 300222
2.天津市轻工与食品工程机械装备集成设计与在线监控重点实验室，天津市300222
3.北京航空航天大学，北京市 100191

收稿日期:2022-08-18 修回日期:2022-11-02 出版日期:2023-04-25 发布日期:2023-05-19
通讯作者: 王芳，E-mail： fwang@tust.edu.cn
作者简介:王芳(1982-)，女，汉族，河北涉县人，博士，副教授，主要研究方向：机械设计，生物力学，康复工程学。
基金资助:
国家自然科学基金项目(12102301)

Design of variable stiffness insole based on diabetics plantar pressure during gait period

WANG Fang¹^,²(), YANG Tao¹^,², HE Yaoguang¹^,², CAO Zijun¹^,², LIU Guoqing¹^,², HU Jun¹^,², ZHANG Jianguo¹^,², FAN Yubo³

1. College of Mechanical Engineering, Tianjin University of Science and Technology, Tianjin 300222, China
2. TianjinKey Laboratory of Integrated Design and Online Monitoring of Light Industry and Food Machinery and Equipment, Tianjin 300222, China
3. Beihang University, Beijing 100191, China

Received:2022-08-18 Revised:2022-11-02 Published:2023-04-25 Online:2023-05-19
Contact: WANG Fang, E-mail: fwang@tust.edu.cn
Supported by:
National Natural Science Foundation of China(12102301)

摘要/Abstract

摘要：

目的分析步态周期内糖尿病患者足底压力特征，探究变刚度减压鞋垫的优化设计。
方法开展足底压力实验，建立包含157例受试者的数据库。分析糖尿病有神经病变、无神经病变患者和健康人的足底压力分布差异，划分鞋垫压力区域，并按照压力梯度在不同鞋垫区域填充多孔单元。构建糖尿病足-小腿-鞋垫有限元模型，分析足跟着地、动态中立和前掌推离3个姿态下足底压力和内部应力的分布特点，探究最合理的鞋垫刚度设计。
结果与健康组相比，糖尿病神经病变患者左、右足足跟区峰值压力和高压百分比均有下降趋势，其中左足足跟区峰值压力减少11% (P = 0.026)，高压百分比减少9.8% (P = 0.02)。鞋垫跖骨高压区、足跟高压区分别采用2.5 MPa和1.9 MPa的多孔单元时，能够使前掌推离、动态中立和足跟着地姿态的足底峰值压力分别降低42.4%、27.4%和26.4%，软组织峰值应力分别降低49.8%、43.6%和25.1%。
结论糖尿病患者跖骨区比足跟区溃疡风险更高；基于多姿态下足底压力和内部应力优化的变刚度鞋垫，能有效降低行走时足底峰值压力和软组织峰值应力，为变刚度鞋垫设计提供参考。

关键词: 糖尿病, 步态周期, 足底压力, 内部应力, 变刚度

Abstract:

Objective To analyze the characteristics of plantar pressure of diabetic patients during gait cycle, and to design a offloading insole with variable stiffness.
Methods The plantar pressure experiment was carried out and a database including 157 subjects was established. The differences of plantar pressure distribution were analyzed among diabetic patients with and without peripheral neuropathy, and healthy people. The insole pressure area was divided, and porous units were filled in different insole areas according to the pressure gradient. The fed-calf-insole finite element model of diabetic patients was constructed. The simulation analysis of different insole schemes was carried out under the conditions of push-off, footheel-strike and dynamic neutrality posture, and to explore the most reasonable insole stiffness design.
Results Compared with the healthy group, the percentage of peak pressure and high pressure in the left and right heel areas of diabetic neuropathy patients showed a decreasing trend, in which the left peak pressure was significantly reduced by 11% (P = 0.026) and the percentage of high pressure was significantly reduced by 9.8% (P = 0.02). When the porous elements of 2.5 MPa and 1.9 MPa were used in the high pressure area of the insole metatarsal and high pressure area of the heel, the peak plantar pressure of footheel-strike, dynamic neutral and push-off was reduced by 42.4%, 27.4% and 26.4%, and the peak stress of the soft tissue was reduced by 49.8%, 43.6% and 25.1%, respectively.
Conclusion There is a higher risk of ulcer in the metatarsal region than in the heel region for diabetic patients. The variable stiffness insoles based on the optimization of plantar pressure and internal stress under multi-posture can effectively reduce the peak pressure of plantar and peak stress of soft tissue during walking, which provides a reference for the design of variable stiffness insoles.

Key words: diabetes, gait period, plantar pressure, soft tissue stress, variable stiffness

中图分类号:

R496

王芳, 杨涛, 何耀广, 曹子君, 刘国庆, 胡军, 张建国, 樊瑜波. 基于糖尿病患者步态周期足底压力的变刚度鞋垫设计[J]. 《中国康复理论与实践》, 2023, 29(4): 408-415.

WANG Fang, YANG Tao, HE Yaoguang, CAO Zijun, LIU Guoqing, HU Jun, ZHANG Jianguo, FAN Yubo. Design of variable stiffness insole based on diabetics plantar pressure during gait period[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(4): 408-415.

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参考文献 36

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组别	n	性别(男/女)	年龄/岁	身高/cm	体质量指数/ kg·m^-2
健康组	66	33/33	47.5±19.2	167.0±6.7	23.5±3.1
DM组	32	21/11	59.1±10.3	165.5±8.9	25.6±3.3
DPN组	38	21/17	55.8±12.4	167.9±8.2	26.9±2.9

名称	杨氏模量/MPa	泊松比	横截面积/mm²
骨骼	7300.0	0.30	-
软骨	50.0	0.10	-
韧带	260.0	-	18.4
足底筋膜	350.0	0.45	-
支撑板	17000.0	0.10	-
热塑性聚氨酯	11.7	0.45	-
EVA	μ₁ = 0.213, μ₂ = -0.062, α₁ = 10.3, α₂ = -3.349, β₁ = 0.32, β₂ = 0.32
健康人软组织	C₁₀ = 0.08556, C₀₁ = -0.05841, C₂₀ = 0.03900, C₁₁ = -0.02319, C₀₂= 0.00851, D₁= 3.65273, D₂= 0
DM患者软组织	C₁₀ = 0.17113, C₀₁ = -0.11683, C₂₀ = 0.07800, C₁₁ = -0.04638, C₀₂ = 0.01702, D₁ = 1.82636, D₂ = 0

项目	壁厚
项目	0.8 mm	1.0 mm	1.2 mm	1.4 mm
等效模量	1.9	2.5	3.1	3.6

方案	区域Ⅰ	区域Ⅱ	区域Ⅲ	区域Ⅳ	区域Ⅴ
方案1	1.0	0.8	0.8	1.2	1.4
方案2	1.0	1.0	0.8	1.2	1.4
方案3	1.0	1.2	0.8	1.0	1.4

足区	左足			右足			F值^a	P值^a	F值^b	P值^b
足区	健康组	DM组	DPN组	健康组	DM组	DPN组	F值^a	P值^a	F值^b	P值^b
趾骨区	30.3±11.8	31.9±8.7	29.5±12.2	33.3±13.6	33.9±10.2	33.7±20.0	0.371	0.690	0.990	0.374
跖骨区	44.9±14.2	48.6±11.4	49.4±11.5	48.3±12.0	49.4±13.3	49.1±11.3	0.002	0.998	0.592	0.554
足中区	15.7±10.0	15.0±7.5	14.5±8.9	14.8±11.6	14.2±10.4	14.9±12.1	0.202	0.817	0.182	0.830
足跟区	47.8±13.2	45.6±11.2	43.1±13.3^c	50.8±10.2	47.5±10.5	45.2±9.9	2.607	0.077	0.941	0.393
F值	126.282	65.790	54.781	95.141	78.930	77.408
P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

基于糖尿病患者步态周期足底压力的变刚度鞋垫设计

Design of variable stiffness insole based on diabetics plantar pressure during gait period

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足区	左足			右足			F值^a	P值^a	F值^b	P值^b
足区	健康组	DM组	DPN组	健康组	DM组	DPN组	F值^a	P值^a	F值^b	P值^b
趾骨区	16.5±12.6	18.8±12.0	12.5±14.0^c	14.2±12.1	16.0±10.8	12.2±10.4	2.953	0.063	1.548	0.216
跖骨区	41.4±16.0	40.3±16.0	42.2±15.2	35.1±15.7	36.0±14.4	38.3±13.2	0.236	0.790	0.505	0.605
足中区	1.8±5.0	1.5±3.4	2.0±4.3	1.6±4.1	0.9±1.7	1.9±3.8	0.400	0.671	0.959	0.386
足跟区	43.7±12.7	40.0±13.8	37.9±9.7^d	37.8±13.2	37.4±14.2	33.4±13.3	2.517	0.089	0.615	0.542
F值	168.139	66.335	114.893	138.940	71.375	112.245
P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001