Evaluation of in-shoe plantar pressure and shear during walking for diabetic foot ulcer prevention.

OBJECTIVE: To investigate reliability and changes of in-shoe plantar pressure and shear during walking at three cadences with two insole designs. This was a precursor to the investigation of plantar loading in people with diabetes for potential foot ulcer prevention. METHOD: A sensorised insole system, capable of measuring plantar pressure and shear at the heel, fifth metatarsal head (5MH), first metatarsal head (1MH) and hallux, was tested with ten healthy participants during level walking. Reliability was evaluated, using intra-class correlation coefficient (ICC), while varying the cadences and insole types. Percentage changes in pressure and shear relative to values obtained at self-selected cadence with a flat insole design were investigated. RESULTS: Mean±standard deviation of maximum pressure, medial-lateral and anterior-posterior shear of up to 380±24kPa, 46±2kPa and -71±4kPa, respectively, were measured. The ICC in ranges of 0.762-0.973, 0.758-0.987 and 0.800-0.980 were obtained for pressure, anterior-posterior and medial-lateral shear, respectively. Opposite anterior-posterior shear directions between 5MH and 1MH (stretching), and between 1MH and hallux (pinching) were observed for some participants. Increasing cadence increased pressure and anterior-posterior shear (by up to +77%) but reduced medial-lateral shear at the heel and hallux (by up to -34%). Slower cadence increased anterior-posterior shear (+114%) but decreased medial-lateral shear (-46%) at the hallux. The use of a flexible contoured insole resulted in pressure reduction at the heel and 5MH but an increase in anterior-posterior shear at the heel (+69%) and hallux (+75%). CONCLUSION: The insole system demonstrated good reliability and is comparable to reported pressure-only systems. Pressure measurements were sensitive to changes in cadence and insole designs in ways that were consistent with the literature. However, our plantar shear showed localised shear changes with cadences and insoles for the first time, as well as stretching and pinching effects on plantar tissue. This opens new possibilities to investigate plantar tissue viability, loading characteristics and orthotic designs aimed towards foot ulcer prevention.

Foot Sole Contact Forces vs. Ground Contact Forces to Obtain Foot Joint Moments for In-Shoe Gait-A Preliminary Study.

In-shoe models are required to extend the clinical application of current multisegment kinetic models of the bare foot to study the effect of foot orthoses. Work to date has only addressed marker placement for reliable kinematic analyses. The purpose of this study is to address the difficulties of recording contact forces with available sensors. Ten participants walked 5 times wearing two different types of footwear by stepping on a pressure platform (ground contact forces) while wearing in-shoe pressure sensors (foot sole contact forces). Pressure data were segmented by considering contact cells' anteroposterior location, and were used to compute 3D moments at foot joints. The mean values and 95% confidence intervals were plotted for each device per shoe condition. The peak values and times of forces and moments were computed per participant and trial under each condition, and were compared using mixed-effect tests. Test-retest reliability was analyzed by means of intraclass correlation coefficients. The curve profiles from both devices were similar, with higher joint moments for the instrumented insoles at the metatarsophalangeal joint (~26%), which were lower at the ankle (~8%) and midtarsal (~15%) joints, although the differences were nonsignificant. Not considering frictional forces resulted in ~20% lower peaks at the ankle moments compared to previous studies, which employed force plates. The device affected both shoe conditions in the same way, which suggests the interchangeability of measuring joint moments with one or the other device. This hypothesis was reinforced by the intraclass correlation coefficients, which were higher for the peak values, although only moderate-to-good. In short, both considered alternatives have drawbacks. Only the instrumented in-soles provided direct information about foot contact forces, but it was incomplete (evidenced by the difference in ankle moments between devices). However, recording ground reaction forces offers the advantage of enabling the consideration of contact friction forces (using force plates in series, or combining a pressure platform and a force plate to estimate friction forces and torque), which are less invasive than instrumented insoles (which may affect subjects' gait).

Characterization of the Kinetyx SI Wireless Pressure-Measuring Insole during Benchtop Testing and Running Gait.

This study characterized the absolute pressure measurement error and reliability of a new fully integrated (Kinetyx, SI) plantar-pressure measurement system (PPMS) versus an industry-standard PPMS (F-Scan, Tekscan) during an established benchtop testing protocol as well as via a research-grade, instrumented treadmill (Bertec) during a running protocol. Benchtop testing results showed that both SI and F-Scan had strong positive linearity (Pearson's correlation coefficient, PCC = 0.86-0.97, PCC = 0.87-0.92; RMSE = 15.96 ± 9.49) and mean root mean squared error RMSE (9.17 ± 2.02) compared to the F-Scan on a progressive loading step test. The SI and F-Scan had comparable results for linearity and hysteresis on a sinusoidal loading test (PCC = 0.92-0.99; 5.04 ± 1.41; PCC = 0.94-0.99; 6.15 ± 1.39, respectively). SI had less mean RMSE (6.19 ± 1.38) than the F-Scan (8.66 ±2.31) on the sinusoidal test and less absolute error (4.08 ± 3.26) than the F-Scan (16.38 ± 12.43) on a static test. Both the SI and F-Scan had near-perfect between-day reliability interclass correlation coefficient, ICC = 0.97-1.00) to the F-Scan (ICC = 0.96-1.00). During running, the SI pressure output had a near-perfect linearity and low RMSE compared to the force measurement from the Bertec treadmill. However, the SI pressure output had a mean hysteresis of 7.67% with a 28.47% maximum hysteresis, which may have implications for the accurate quantification of kinetic gait measures during running.

Healthcare Application of In-Shoe Motion Sensor for Older Adults: Frailty Assessment Using Foot Motion during Gait.

Frailty poses a threat to the daily lives of healthy older adults, highlighting the urgent need for technologies that can monitor and prevent its progression. Our objective is to demonstrate a method for providing long-term daily frailty monitoring using an in-shoe motion sensor (IMS). We undertook two steps to achieve this goal. Firstly, we used our previously established SPM-LOSO-LASSO (SPM: statistical parametric mapping; LOSO: leave-one-subject-out; LASSO: least absolute shrinkage and selection operator) algorithm to construct a lightweight and interpretable hand grip strength (HGS) estimation model for an IMS. This algorithm automatically identified novel and significant gait predictors from foot motion data and selected optimal features to construct the model. We also tested the robustness and effectiveness of the model by recruiting other groups of subjects. Secondly, we designed an analog frailty risk score that combined the performance of the HGS and gait speed with the aid of the distribution of HGS and gait speed of the older Asian population. We then compared the effectiveness of our designed score with the clinical expert-rated score. We discovered new gait predictors for HGS estimation via IMSs and successfully constructed a model with an "excellent" intraclass correlation coefficient and high precision. Moreover, we tested the model on separately recruited subjects, which confirmed the robustness of our model for other older individuals. The designed frailty risk score also had a large effect size correlation with clinical expert-rated scores. In conclusion, IMS technology shows promise for long-term daily frailty monitoring, which can help prevent or manage frailty for older adults.

Grip socks improve slalom course performance and reduce in-shoe foot displacement of the forefoot in male and female sports players.

This study assessed whether grip socks reduce in-shoe foot motion and improve change of direction performance in team sports players and compared the effects between males and females. A sledge and pulley system confirmed the static coefficient of friction was increased in the grip socks (1.17) compared to the regular socks (0.60). Performance during a slalom course was faster in the grip socks compared to regular socks (p = .001). Yet, there was no difference in the utilised coefficient of friction between the shoe-floor interface during a side-cut and turn change of direction manoeuvre. Three-dimensional motion capture revealed the grip socks reduced in-shoe foot displacement during the braking phase, with greater effect during the sharper turn manoeuvre. The magnitude of natural foot spreading within the shoe was greater in the calcaneus region than the metatarsals which suggests in-shoe sliding may only occur at the forefoot. Males tended to have increased in-shoe displacement, which is associated with larger foot spreading due to their increased mass. Findings provide guidance for product developers to enhance the support inside the shoe at the forefoot, and change of direction performance.

Method for Estimating Temporal Gait Parameters Concerning Bilateral Lower Limbs of Healthy Subjects Using a Single In-Shoe Motion Sensor through a Gait Event Detection Approach.

To expand the potential use of in-shoe motion sensors (IMSs) in daily healthcare or activity monitoring applications for healthy subjects, we propose a real-time temporal estimation method for gait parameters concerning bilateral lower limbs (GPBLLs) that uses a single IMS and is based on a gait event detection approach. To validate the established methods, data from 26 participants recorded by an IMS and a reference 3D motion analysis system were compared. The agreement between the proposed method and the reference system was evaluated by the intraclass correlation coefficient (ICC). The results showed that, by averaging over five continuous effective strides, all time parameters achieved precisions of no more than 30 ms and agreement at the "excellent" level, and the symmetry indexes of the stride time and stance phase time achieved precisions of 1.0% and 3.0%, respectively, and agreement at the "good" level. These results suggest our method is effective and shows promise for wide use in many daily healthcare or activity monitoring applications for healthy subjects.

Comparison between the plantar pressure effects of toe separators and insoles in patients with hallux valgus at a one-month follow-up.

BACKGROUND: Various designs of foot orthoses for hallux valgus have been developed to reduce foot pain. The plantar pressure assessment can determine the better intervention. This study aimed to compare the effectiveness of plantar pressure distribution in patients with hallux valgus during walking with toe separator and insole. METHOD: Patients with hallux valgus were randomized into one of two interventions: prefabricated toe separator or customized insole. The plantar pressure distribution of the participants was measured during walking with the devices after use for one month with an in-shoe measurement system. RESULTS: Twenty-three participants were analyzed. After 1-month, significant peak pressures and pressure-time integral reductions were observed during walking in the middle forefoot (64.28 kPa and 28.97 kPa s, respectively) and lateral forefoot regions (54.03 kPa and 22.30 kPa s, respectively) after insole use compared with a toe separator. CONCLUSIONS: After one month of use, the customized insole was more effective in plantar pressure reduction than the toe separator for a hallux deformity.

Outcomes and potential mechanism of a protocol to optimize foot orthoses in patients with rheumatoid arthritis.

BACKGROUND: Foot problems are highly prevalent in patients with rheumatoid arthritis. Treatment of foot problems related to rheumatoid arthritis often consists of custom made foot orthoses. One of the assumed working mechanisms of foot orthoses is redistribution of plantar pressure by creating a larger weight bearing area. Overall, the reported treatment effect of foot orthoses on foot pain in rheumatoid arthritis is small to medium. Therefore, we developed a foot orthoses optimization protocol for evaluation and adaptation of foot orthoses by using the feedback of in-shoe plantar pressure measurements. The objectives of the present study were: 1) to evaluate the 3-months outcomes of foot orthoses developed according to the protocol on pain, physical functioning and forefoot plantar pressure in patients with foot problems related to rheumatoid arthritis, and 2) to determine the relationship between change in forefoot plantar pressure and change in pain and physical functioning. METHODS: Forty-five patients with foot problems related to rheumatoid arthritis were included and received foot orthoses developed according to the protocol. Outcome measures were assessed at baseline and after three months of wearing foot orthoses in 38 patients. Change scores and effect sizes (ES) were calculated for pain, physical functioning and plantar pressure. In a subgroup of patients with combined forefoot pain and high plantar pressure, the relationship between change in plantar pressure and change in pain and physical functioning was analyzed. RESULTS: In the total group of 38 patients, statistically significant changes in pain (ES 0.69), physical functioning (ES 0.82) and forefoot plantar pressure (ES 0.35) were found. In the subgroup (n = 23) no statistically significant relationships were found between change in plantar pressure and change in pain or physical functioning. CONCLUSION: Foot orthoses developed according to a protocol for improving the plantar pressure redistribution properties lead to medium to large improvements in pain and physical functioning. The hypothesis that more pressure reduction would lead to better clinical outcomes could not be proven.

A state-of-the-art review of foot pressure.

The science of foot pressure studies the forces acting on the bottom and different regions of the foot along with the pressure exerted on the plantar surface with the interacting surface in contact. The information derived gave impact to human biomechanical assessment on body balance and ergonomics posture during gait. Various experiments designed at generating foot pressure data returns only with limited knowledge generated. Obviously, the procedure for experiment design needs to be properly understood from the foot morphology aspects; healthiness, footwear, surface in contact, load and forces impacts, and the foot sensitivity as well as the specification for the foot pressure. This paper reviews the proper preliminary experimental setups for foot pressure measurement analysis during static or dynamic gait. The strength and limitations of recent devices used and considerable variables are also discussed. The overall review explains that the comfortable natural gait in relation to the aspects of sensitivity, load, time duration, and stability are the standard considerations for plantar pressure experiments.

The Reliability and Validity of the Loadsol® under Various Walking and Running Conditions.

The assessment of loading during walking and running has historically been limited to data collection in laboratory settings or with devices that require a computer connection. This study aims to determine if the loadsol®-a single sensor wireless insole-is a valid and reliable method of assessing force. Thirty (17 male and 13 female) recreationally active individuals were recruited for a two visit study where they walked (1.3 m/s) and ran (3.0 and 3.5 m/s) at a 0%, 10% incline, and 10% decline, with the visits approximately one week apart. Ground reaction force data was collected on an instrumented treadmill (1440 Hz) and with the loadsol® (100 Hz). Ten individuals completed the day 1 protocol with a newer 200 Hz loadsol®. Intraclass correlation coefficients (ICC3,k) were used to assess validity and reliability and Bland⁻Altman plots were generated to better understand loadsol® validity. Across conditions, the peak force ICCs ranged from 0.78 to 0.97, which increased to 0.84⁻0.99 with the 200 Hz insoles. Similarly, the loading rate ICCs improved from 0.61 to 0.97 to 0.80⁻0.96 and impulse improved from 0.61 to 0.97 to 0.90⁻0.97. The 200 Hz insoles may be needed for loading rate and impulse in running. For both walking and running, the loadsol® has excellent between-day reliability (>0.76).

Plantar Pressures During Long Distance Running: An Investigation of 10 Marathon Runners.

The objective of this study was to record plantar pressures using an in-shoe measuring system before, during, and after a marathon run in ten experienced long-distance runners with a mean age of 37.7 ± 11.5 years. Peak and mean plantar pressures were recorded before, after, and every three km during a marathon race. There were no significant changes over time in peak and mean plantar pressures for either the dominant or non-dominant foot. There were significant between foot peak and mean plantar pressure differences for the total foot (p = 0.0001), forefoot (p = 0.0001), midfoot (p = 0.02 resp. p = 0.006), hindfoot (p = 0.0001), first ray (p = 0.01 resp. p = 0.0001) and MTP (p = 0.05 resp. p = 0.0001). Long-distance runners do not demonstrate significant changes in mean or peak plantar foot pressures over the distance of a marathon race. However, athletes consistently favoured their dominant extremity, applying significantly higher plantar pressures through their dominant foot over the entire marathon distance. Key pointsFatigue does not increase foot pressuresEvery runner has a dominant foot where pressures are higher and that he/she favoursFoot pressures do not increase over the distance of a marathon run.

Preventing Diabetic Foot Re-Ulceration Through an Innovative Pressure and Temperature Monitoring Clinical Device.

This study compared the outcome of an innovative in-shoe pressure and temperature measuring device as an adjunct to standard clinical care for diabetic foot versus standard clinical care alone. It included 88 participants with Type 2 diabetes mellitus with a history of one or more plantar foot ulceration who were already using prescription orthoses. These were randomly divided into the control group (n = 44, standard care only) and the experimental group (n = 44, standard care plus the innovative device). Both groups were monitored for re-ulceration for one year. Overall, the control group exhibited a higher number of re-ulcerations (n = 14) with 2 amputations in comparison with the experimental group (only 2 ulcerations and no amputations) at the end of the study. In conclusion, this innovative in-shoe pressure and temperature measuring device appears to reduce re-ulcerations by offering objective data for clinical decision making in the management of the diabetic high-risk foot.

In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic review.

Introduction: Loss of cutaneous protective sensation and high plantar pressures increase the risk for diabetic foot patients. Trauma and ulceration are imminent threats, making assessment and monitoring essential. This systematic review aims to identify systems and technologies for measuring in-shoe plantar pressures, focusing on the at-risk diabetic foot population. Methods: A systematic search was conducted across four electronic databases (Scopus, Web of Science, PubMed, Oxford Journals) using PRISMA methodology, covering articles published in English from 1979 to 2024. Only studies addressing systems or sensors exclusively measuring plantar pressures inside the shoe were included. Results: A total of 87 studies using commercially available devices and 45 articles proposing new systems or sensors were reviewed. The prevailing market offerings consist mainly of instrumented insoles. Emerging technologies under development often feature configurations with four, six or eight resistive sensors strategically placed within removable insoles. Despite some variability due to the inherent heterogeneity of human gait, these devices assess plantar pressure, although they present significant differences between them in measurement results. Individuals with diabetic foot conditions appears exhibit elevated plantar pressures, with reported peak pressures reaching approximately 1000 kPa. The results also showed significant differences between the diabetic and non-diabetic groups. Conclusion: Instrumented insoles, particularly those incorporating resistive sensor technology, dominate the field. Systems employing eight sensors at critical locations represent a pragmatic approach, although market options extend to systems with up to 960 sensors. Differences between devices can be a critical factor in measurement and highlights the importance of individualized patient assessment using consistent measurement devices.

Innovative single-sensor, in-shoe pressure and temperature monitoring device: A static laboratory validation study.

BACKGROUND: To perform laboratory static validation of pressures from an innovative, single-sensor pressure and temperature monitoring device for the early detection of complications in the high-risk foot. RESEARCH QUESTION: Can an innovative, newly developed, in-shoe pressure and temperature measuring device, detect and measure the in-shoe peak plantar pressures and skin temperature as accurately as the reference standard? METHODS: A pressure generating rig, the Tekscan™ Equilibration 'bladder calibrator', was used to produce a known force, against the gold standard, FScan™ in-shoe pressure mapping system by Tekscan™ and a newly developed prototype. The F-scan® system was used to record the pressure readings and establish a baseline for the readings recorded utilising the prototype. A total of 20 pressure values were recorded with 100 samples each. RESULTS: Exploratory data analysis was conducted to gain insights and analyse the prototype's behaviour at different pressure points. Pre-processing and data cleaning were also performed to remove any anomalies. Support Vector Regressor with a polynomial kernel and Grid-Search algorithm was used to fit the recorded data curve. The best combination of parameters had a Mean Squared Error of 2.59 and a Root Mean Squared Error of 1.61. A simple linear equation was used to convert raw readings to pressure values. SIGNIFICANCE: The results of this study conclude that the pressure measurements taken with the prototype are congruent to the gold standard, F-scan® in-shoe system. This confirms that the prototype is a valid device that can be used safely as a low-cost alternative to current costly commercial in-shoe pressure mapping devices.

Innovative single-sensor, in-shoe pressure and temperature monitoring device: A dynamic laboratory validation study.

BACKGROUND: Available technology to detect the 2 primary predictors of ulceration is not being used as it is deemed as costly and time-consuming. Thus, the aim of this study was to determine dynamic laboratory validation, of an innovative, single-sensor in-shoe device that can read peak pressure and temperature simultaneously. RESEARCH QUESTION: Can an innovative, newly developed, in-shoe pressure and temperature measuring device, detect and measure the in-shoe peak plantar pressures and skin temperature of healthy participants, as accurately as the reference standard? METHODS: Five healthy adult participants were recruited. The prototype was validated against the gold standard FScan™ in-shoe system for pressures and the Flir® T630sc thermographic camera for temperatures. Participants were asked to walk at a comfortable pace on an electric treadmill for 13 min. The prototype and the FScan in-shoe sensors™ were superimposed inside the shoe of the participant, with the prototype on top, to ensure direct contact with the area of interest. Two thermographic images were captured using the Flir® T630sc thermographic camera, before and after the walk. During the trials, the participants wore 100 % cotton socks and their own sports shoes and pressures were recorded at 50 readings a second. RESULTS: The raw readings of pressure were passed to the regressor, which returned the estimated kPa value. Several evaluations metrics were used to evaluate the performance of the modal. The prototype gave equal results to that of the gold standard, the FScan™ in-shoe system. With regards to temperature measurements, both devices gave similar readings. SIGNIFICANCE: This innovative single-sensor, in-shoe pressure and temperature monitoring device showed similar measurements of pressure to the FScan™ system and temperature measurements were equivalent to the Flir® T630sc thermographic camera. The authors are confident that the innovative, low cost, single-sensor, in-shoe pressure and temperature monitoring device can be used as an alternative to the costly available commercial devices that measure pressure and temperature separately to detect early signs of complications in the high-risk foot.

The Effectiveness of Hard Insoles for Plantar Pressure in Cycling: A Crossover Study.

BACKGROUND: Hard insoles have been proposed to decrease plantar pressure and prevent foot pain and paresthesia due to repetitive loading. The aim of this research was to analyze the effect of three different hard insoles in cycling on healthy subjects. METHODS: A crossover randomized trial was carried out. The mean age of the subjects was 35 ± 3.19 years, and all of them were men. While the subjects were cycling on a stationary bicycle, their plantar pressure was recorded with nine in-shoe sensors placed in nine specific foot areas to test a standard ethylene-vinyl-acetate 52° Shore A hardness insole, a polypropylene 58° Shore D insole, and a polypropylene 580 Shore D insole with selective aluminum 60 HB Brinell hardness in the metatarsal head and hallux. RESULTS: The maximum plantar pressure decreased significantly with the polypropylene insole containing selective aluminum in the metatarsal head and hallux areas. The maximum plantar data of the polypropylene aluminum insole in the M2 area (5.56 kgF/cm2), fifth metatarsal styloid process (6.48 kgF/cm2), M3-M4 area (4.97 kgF/cm2), and hallux (8.91 kgF/cm2) were of particular interest compared to the other insoles. CONCLUSIONS: The use of insoles made of polypropylene with aluminum in the metatarsal head and hallux areas decreases the maximum plantar pressure in cycling compared to standard EVA and polypropylene insoles.

Sensor number in simplified insole layouts and the validity of ground reaction forces during locomotion.

Research attempted to validate simplified insoles with a reduced number of sensors to facilitate clinical application. However, the ideal sensor number is yet to be determined. The purpose was to investigate the validity of vertical ground reaction forces in various simplified pressure sensor insoles and to identify an optimal compromise between sensor number and measurement performance. A Kistler force plate (1000 Hz) and 99-sensor Pedar-X insole (100 Hz) obtained force data of 15 participants during walking and jogging. Eight simplified insole layouts (3-17 sensors) were simulated. Layout performances were expressed as Pearson's correlation coefficients (r) with force plate as reference and coefficient of variation. Differences were assessed via repeated-measures ANOVA as partial eta square (ηp2) at p < .05. All layouts correlated with the force plate (r = .70-.99, p < .01). All layout performances were higher in jogging than in walking by r = +.07 ± .04 (ηp2=.28-.66, p < .05). The three- and five-sensor layouts yielded the lowest correlation (r = .70-.88) and the highest coefficient of variation (11-22%). Layout performances improved constantly from 7 to 11 sensors. The optimal compromise between simplification and measurement performance, quantified via change in correlation per sensor number, was found in the 11-sensor layout, recommendable for practical settings to improve monitoring and adjusting protocols.

Does in-shoe pressure analysis to assess and modify medical grade footwear improve patient adherence and understanding? A mixed methods study.

BACKGROUND: Medical grade footwear (MGF) with demonstrated plantar-pressure reducing effect is recommended to reduce the risk of diabetes-related foot ulceration (DFU). Efficacy of MGF relies on high adherence (≥ 80%). In-shoe pressure analysis (IPA) is used to assess and modify MGF, however, there is limited evidence for the impact on patient adherence and understanding of MGF. The primary aim of this study was to determine if self-reported adherence to MGF usage in patients with previous DFU improved following IPA compared to adherence measured prior. The secondary aim was to determine if patient understanding of MGF improved following in-shoe pressure analysis. METHODS: Patients with previous DFU fitted with MGF in the last 12 months were recruited. The first three participants were included in a pilot study to test procedures and questionnaires. MGF was assessed and modified at Week 0 based on findings from IPA using the Pedar system (Novel). Patients completed two questionnaires, one assessing patient adherence to MGF at Week 0 and Week 4, the other assessing patient understanding of MGF before and after IPA at week 0. Patient understanding was measured using a 5-point Likert scale (strongly disagree 1 to strongly agree 5). Patient experience was assessed via a telephone questionnaire administered between Weeks 0-1. RESULTS: Fifteen participants were recruited, and all completed the study. Adherence of ≥ 80% to MGF usage inside the home was 13.3% (n = 2) pre-IPA and 20.0% (n = 3) at Week 4. Outside the home, ≥ 80% adherence to MGF was 53.3% (n = 8) pre-IPA, and 80.0% (n = 12) at Week 4. Change in scores for understanding of MGF were small, however, all participants reported that undergoing the intervention was worthwhile and beneficial. CONCLUSIONS: Self-reported adherence inside the home demonstrated minimal improvement after 4 weeks, however, adherence of ≥ 80% outside the home increased by 27%, with 80% of all participants reporting high adherence at Week 4. Participants rated their learnings from the experience of IPA as beneficial.

Development of a low-cost textile sensor based insole to monitor foot pressure of diabetic patients.

A common but preventable complication of diabetes is diabetic foot ulcer. If appropriate care is not provided such foot lesions progress to the most severe diabetic foot complication, like infection, gangrene, amputation and even death. Diabetic neuropathy results abnormal planter pressure points under the foot and triggers the tendency of foot ulcer. The aim of this paper is to present the development of a low cost, power efficient, soft, lightweight and simple in-shoe planter pressure measurement system. The system is capable to determine the average static pressure under ball and heel of the foot. The insole is comfortable due to the use of textile pressure sensor and its simple data acquisition method makes operation easy for the users. An experiment with 10 participants with and without diabetes was carried out to observe the outcome of the system. The practical implication of this study is to minimise the damage caused by foot ulcer by determining the pressure abnormality at earliest with a fully developed cost effective design. The system is capable to identify the difference in average planter pressure values in different groups of participants. To monitor the foot health proactively, the proposed system is found to be a useful device and can successfully scan the planter pressure under ball and heel of the foot.

Is in-Shoe Microclimate a Neglected Contributor in the Pathway to Diabetic Foot Ulceration?

The identification of the key contributing factors which predispose the foot to ulceration, increasing the risk of recurrence and slow wound healing in diabetes mellitus (DM), has led to some significant research studies over the last 30 years, providing valuable insight into the mechanism leading to diabetic foot ulceration (DFU). Although, these contributory factors are similar to those identified in pressure ulceration occurring in other parts of the body (such as "bed pressure sores') where magnitude and/or duration of mechanical stress in the presence of sensory deficits are key causal factors, research investigating pressure ulceration has also included measurement of temperature and relative humidity at the interface between the skin and supporting surface. The possible influence of these parameters (in-shoe temperature and humidity) does not appear frequently in diabetic foot ulceration research. Referred to as "microclimate", this has an important role in the pathway to tissue breakdown evidenced in pressure ulcer research and may be particularly relevant in countries with warm and humid climates. As the microclimate is influential in the ulceration pathway for other body sites, its role in the DFU causal pathway justifies further investigation.