Article

Plantar ulcers pose a frequent serious complication in the
neuropathic foot. Previous studies suggested that ulcer initiation occurs within
the plantar soft tissue rather than on the plantar surface.
This study
investigated the effectiveness of different shaped silicone insoles on the
reduction of both plantar soft tissue strain and pressure. The authors have found
no previous experimental studies on the effectiveness of insole shape on reducing
plantar soft tissue strain during standing. METHODS: A custom molded silicone
insole which allowed passage of ultrasound to the plantar surface of the foot was
prototyped for this study. Soft tissue strain was computed from soft tissue
thickness measured using ultrasound in five conditions: unloaded, barefoot,
wearing a prefabricated silicone insole, wearing the custom molded silicone
insole alone then with a metatarsal pad. Plantar pressure was measured for the
same conditions. FINDINGS: The custom molded insole was found to significantly
reduce soft tissue strain and plantar pressure relative to both the barefoot
condition and the prefabricated insole under the second and third metatarsal
heads. The metatarsal pad was found to significantly reduce soft tissue strain
but not significantly affect plantar pressure. INTERPRETATION: A custom molded
silicone insole can effectively reduce both soft tissue strain and plantar
pressure and is thus preferable to a prefabricated insole. It is suggested that
quantifying the reduction of soft tissue strain is an essential design
requirement for orthotic insoles since plantar pressure may not be a sufficient
indicator of the effectiveness of an insole in preventing ulcer initiation.
CI - Copyright (c) 2012 Elsevier Ltd. All rights reserved.

Langue : ANGLAIS