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Castro-Martins P, Marques A, Coelho L, Vaz M, Baptista JS. In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic review. Heliyon 2024; 10:e29672. [PMID: 38699042 PMCID: PMC11064085 DOI: 10.1016/j.heliyon.2024.e29672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
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.
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Affiliation(s)
- Pedro Castro-Martins
- CIETI, ISEP, Polytechnic of Porto, Portugal
- Faculty of Engineering, University of Porto, Portugal
| | - Arcelina Marques
- CIETI, ISEP, Polytechnic of Porto, Portugal
- Institute for Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Luís Coelho
- CIETI, ISEP, Polytechnic of Porto, Portugal
- INESC-TEC, Centre for Robotics in Industry and Intelligent Systems, Porto, Portugal
| | - Mário Vaz
- Faculty of Engineering, University of Porto, Portugal
- Institute for Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
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Castro-Martins P, Marques A, Coelho L, Vaz M, Costa JT. Plantar pressure thresholds as a strategy to prevent diabetic foot ulcers: A systematic review. Heliyon 2024; 10:e26161. [PMID: 38390156 PMCID: PMC10882031 DOI: 10.1016/j.heliyon.2024.e26161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/22/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Background The development of ulcers in the plantar region of the diabetic foot originates mainly from sites subjected to high pressure. The monitoring of these events using maximum allowable pressure thresholds is a fundamental procedure in the prevention of ulceration and its recurrence. Objective The aim of this review was to identify data in the literature that reveal an objective threshold of plantar pressure in the diabetic foot, where pressure is classified as promoting ulceration. The aim is not to determine the best and only pressure threshold for ulceration, but rather to clarify the threshold values most used in clinical practice and research, also considering the devices used and possible applications for offloading plantar pressure. Design A systematic review. Methods The search was performed in three electronic databases, by the PRISMA methodology, for studies that used a pressure threshold to minimize the risk of ulceration in the diabetic foot. The selected studies were subjected to eligibility criteria. Results Twenty-six studies were included in this review. Seven thresholds were identified, five of which are intended for the inside of the shoe: a threshold of average peak pressure of 200 kPa; 25 % and 40-80 % reduction from initial baseline pressure; 32-35 mm Hg for a capillary perfusion pressure; and a matrix of thresholds based on patient risk, shoe size and foot region. Two other thresholds are intended for the barefoot, 450 and 750 kPa. The threshold of 200 kPa of pressure inside the shoe is the most agreed upon among the studies. Regarding the prevention of ulceration and its recurrence, the efficacy of the proposed threshold matrix and the threshold of reducing baseline pressure by 40-80 % has not yet been evaluated, and the evidence for the remaining thresholds still needs further studies. Conclusions Some heterogeneity was found in the studies, especially regarding the measurement systems used, the number of regions of interest and the number of steps to be considered for the threshold. Even so, this review reveals the way forward to obtain a threshold indicative of an effective steppingstone in the prevention of diabetic foot ulcer.
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Affiliation(s)
- Pedro Castro-Martins
- CIETI, ISEP, Polytechnic of Porto, Portugal
- Faculty of Engineering, University of Porto, Portugal
| | - Arcelina Marques
- CIETI, ISEP, Polytechnic of Porto, Portugal
- Institute for Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Luís Coelho
- CIETI, ISEP, Polytechnic of Porto, Portugal
- INESC-TEC, Centre for Robotics in Industry and Intelligent Systems, Porto, Portugal
| | - Mário Vaz
- Faculty of Engineering, University of Porto, Portugal
- Institute for Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - José Torres Costa
- Faculty of Engineering, University of Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
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Li Y, Fan Y. EFFECTS OF ATHLETIC WALKING ON THE PHYSICAL ENDURANCE OF ATHLETES. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ABSTRACT Introduction Athletic walking is a physical endurance test. This sport has a long competition time and a high load intensity. The long-term continuous movement of muscles is the most prominent characteristic of this sport. Strength and endurance are essential physical factors that determine the performance of the runners who do it. Physical endurance is an essential indicator to evaluate the level of physical training in athletic walking. Objective This study aims to analyze the effect of endurance training on the physical fitness and competition performance of athletic walkers. Methods This work selects four athletes as the research object. The athletes undergo one month of resistance training. The athletes recorded their physiological and biochemical indicators before and after resistance training. Then, the mathematical statistics method was used to analyze their physiological and biochemical indicators. Results Hemoglobin levels in the last three weeks of resistance training were significantly higher than in the first week (P<0.01). During endurance training, the athletes’ morning blood urea peak appeared in the first test after going to high altitude (P<0.05). Conclusion Endurance training can improve the fitness of athletic walkers. Resistance training effectively stimulates the blood system of athletes for at least two weeks. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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Hamilton RI, Williams J, Holt C. Biomechanics beyond the lab: Remote technology for osteoarthritis patient data-A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005000. [PMID: 36451804 PMCID: PMC9701737 DOI: 10.3389/fresc.2022.1005000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/05/2022] [Indexed: 01/14/2024]
Abstract
The objective of this project is to produce a review of available and validated technologies suitable for gathering biomechanical and functional research data in patients with osteoarthritis (OA), outside of a traditionally fixed laboratory setting. A scoping review was conducted using defined search terms across three databases (Scopus, Ovid MEDLINE, and PEDro), and additional sources of information from grey literature were added. One author carried out an initial title and abstract review, and two authors independently completed full-text screenings. Out of the total 5,164 articles screened, 75 were included based on inclusion criteria covering a range of technologies in articles published from 2015. These were subsequently categorised by technology type, parameters measured, level of remoteness, and a separate table of commercially available systems. The results concluded that from the growing number of available and emerging technologies, there is a well-established range in use and further in development. Of particular note are the wide-ranging available inertial measurement unit systems and the breadth of technology available to record basic gait spatiotemporal measures with highly beneficial and informative functional outputs. With the majority of technologies categorised as suitable for part-remote use, the number of technologies that are usable and fully remote is rare and they usually employ smartphone software to enable this. With many systems being developed for camera-based technology, such technology is likely to increase in usability and availability as computational models are being developed with increased sensitivities to recognise patterns of movement, enabling data collection in the wider environment and reducing costs and creating a better understanding of OA patient biomechanical and functional movement data.
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Affiliation(s)
- Rebecca I. Hamilton
- Musculoskeletal Biomechanics Research Facility, School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Jenny Williams
- Musculoskeletal Biomechanics Research Facility, School of Engineering, Cardiff University, Cardiff, United Kingdom
| | | | - Cathy Holt
- Musculoskeletal Biomechanics Research Facility, School of Engineering, Cardiff University, Cardiff, United Kingdom
- Osteoarthritis Technology NetworkPlus (OATech+), EPSRC UK-Wide Research Network+, United Kingdom
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Semjonova G, Davidovica A, Kozlovskis N, Okss A, Katashevs A. Smart Textile Sock System for Athletes’ Self-Correction during Functional Tasks: Formative Usability Evaluation. SENSORS 2022; 22:s22134779. [PMID: 35808274 PMCID: PMC9268753 DOI: 10.3390/s22134779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
Abstract
(1) Background: The development of a lightweight, easy-to-use system that measures the foot’s plantar pressure is becoming an increasingly important area of research in physiotherapy. For further development of the smart sock system, a formative usability study was conducted, where the smart textile sock sensor system was used for self-correction during functional tasks; (2) Methods: Five athletes from the football school participated in the formative usability study. Athletes performed pre-defined functional tasks for self-correction when interacting with the smart textile sock system. Formative usability evaluation methods: effectiveness (task success rate, error rate), efficiency (time-based), satisfaction evaluated by System Usability Scale (SUS); (3) Results: Formative usability indicators: task completeness effectiveness ranged from 40% to 100% in the first- and second-stage tasks. Completed task efficiency time: Stage 1, from 4.2 s (SD 1.3) to 88.8 s (SD 19.8); Stage 2, from 7.2 s (SD 1.9) to 9.6 s (SD 2.1). Satisfaction was assessed by the SUS system user group with 76 points (SD 7.42), which indicates “good” satisfaction; (4) Conclusions: formative usability indicators showed the need for technical improvements to the smart textile sock pressure sensor system. The SUS results indicate “good” satisfaction with the smart textile sock pressure sensor system and its application.
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Affiliation(s)
- Guna Semjonova
- Department of Rehabilitation, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia;
- Correspondence:
| | - Anna Davidovica
- Department of Rehabilitation, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia;
| | - Nikita Kozlovskis
- Institute of Applied Computer Systems, Riga Technical University, LV-1658 Riga, Latvia;
| | - Aleksandrs Okss
- Institute of Design Technologies, Riga Technical University, LV-1048 Riga, Latvia;
| | - Aleksejs Katashevs
- Institute of Biomedical Engineering and Nanotechnology, Riga Technical University, LV-1048 Riga, Latvia;
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Amitrano F, Coccia A, Ricciardi C, Donisi L, Cesarelli G, Capodaglio EM, D’Addio G. Design and Validation of an E-Textile-Based Wearable Sock for Remote Gait and Postural Assessment. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6691. [PMID: 33238448 PMCID: PMC7700449 DOI: 10.3390/s20226691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022]
Abstract
This paper presents a new wearable e-textile based system, named SWEET Sock, for biomedical signals remote monitoring. The system includes a textile sensing sock, an electronic unit for data transmission, a custom-made Android application for real-time signal visualization, and a software desktop for advanced digital signal processing. The device allows the acquisition of angular velocities of the lower limbs and plantar pressure signals, which are postprocessed to have a complete and schematic overview of patient's clinical status, regarding gait and postural assessment. In this work, device performances are validated by evaluating the agreement between the prototype and an optoelectronic system for gait analysis on a set of free walk acquisitions. Results show good agreement between the systems in the assessment of gait cycle time and cadence, while the presence of systematic and proportional errors are pointed out for swing and stance time parameters. Worse results were obtained in the comparison of spatial metrics. The "wearability" of the system and its comfortable use make it suitable to be used in domestic environment for the continuous remote health monitoring of de-hospitalized patients but also in the ergonomic assessment of health workers, thanks to its low invasiveness.
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Affiliation(s)
- Federica Amitrano
- Department of Information Technologies and Electrical Engineering, University of Naples ‘Federico II’, 80125 Naples, Italy; (F.A.); (A.C.)
- Scientific Clinical Institutes ICS Maugeri SPA SB, 27100 Pavia (PV), Italy; (C.R.); (L.D.); (G.C.); (E.M.C.)
| | - Armando Coccia
- Department of Information Technologies and Electrical Engineering, University of Naples ‘Federico II’, 80125 Naples, Italy; (F.A.); (A.C.)
- Scientific Clinical Institutes ICS Maugeri SPA SB, 27100 Pavia (PV), Italy; (C.R.); (L.D.); (G.C.); (E.M.C.)
| | - Carlo Ricciardi
- Scientific Clinical Institutes ICS Maugeri SPA SB, 27100 Pavia (PV), Italy; (C.R.); (L.D.); (G.C.); (E.M.C.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Leandro Donisi
- Scientific Clinical Institutes ICS Maugeri SPA SB, 27100 Pavia (PV), Italy; (C.R.); (L.D.); (G.C.); (E.M.C.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giuseppe Cesarelli
- Scientific Clinical Institutes ICS Maugeri SPA SB, 27100 Pavia (PV), Italy; (C.R.); (L.D.); (G.C.); (E.M.C.)
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, 80125 Naples, Italy
| | - Edda Maria Capodaglio
- Scientific Clinical Institutes ICS Maugeri SPA SB, 27100 Pavia (PV), Italy; (C.R.); (L.D.); (G.C.); (E.M.C.)
| | - Giovanni D’Addio
- Scientific Clinical Institutes ICS Maugeri SPA SB, 27100 Pavia (PV), Italy; (C.R.); (L.D.); (G.C.); (E.M.C.)
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Drăgulinescu A, Drăgulinescu AM, Zincă G, Bucur D, Feieș V, Neagu DM. Smart Socks and In-Shoe Systems: State-of-the-Art for Two Popular Technologies for Foot Motion Analysis, Sports, and Medical Applications. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4316. [PMID: 32748872 PMCID: PMC7435916 DOI: 10.3390/s20154316] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/25/2022]
Abstract
The present paper reviews, for the first time, to the best of our knowledge, the most recent advances in research concerning two popular devices used for foot motion analysis and health monitoring: smart socks and in-shoe systems. The first one is representative of textile-based systems, whereas the second one is one of the most used pressure sensitive insole (PSI) systems that is used as an alternative to smart socks. The proposed methods are reviewed for smart sock use in special medical applications, for gait and foot pressure analysis. The Pedar system is also shown, together with studies of validation and repeatability for Pedar and other in-shoe systems. Then, the applications of Pedar are presented, mainly in medicine and sports. Our purpose was to offer the researchers in this field a useful means to overview and select relevant information. Moreover, our review can be a starting point for new, relevant research towards improving the design and functionality of the systems, as well as extending the research towards other areas of applications using sensors in smart textiles and in-shoe systems.
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Affiliation(s)
- Andrei Drăgulinescu
- Electronics Technology and Reliability Department, Faculty of Electronics, Telecommunications and Information Technology, University Politehnica of Bucharest, 061071 Bucharest, Romania;
| | - Ana-Maria Drăgulinescu
- Telecommunications Department, Faculty of Electronics, Telecommunications and Information Technology, University Politehnica of Bucharest, 061071 Bucharest, Romania;
| | - Gabriela Zincă
- Automation and Industrial Informatics Department, Faculty of Automatic Control and Computer Science, University Politehnica of Bucharest, 061071 Bucharest, Romania;
| | - Doina Bucur
- Mechatronics Department, Faculty of Mechanical Engineering and Mechatronics, Biomedical Engineering and Biotechnology Department, Faculty of Medical Engineering, University Politehnica of Bucharest, 061071 Bucharest, Romania;
| | - Valentin Feieș
- Electronics Technology and Reliability Department, Faculty of Electronics, Telecommunications and Information Technology, University Politehnica of Bucharest, 061071 Bucharest, Romania;
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Editorial. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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