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

Abstract

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

CLC Number:

R496

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.

Figures/Tables 13

References 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

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