Reducing Internal Stresses in Deformed Diabetic Feet

减少糖尿病足变形的内应力

• 批准号: 7888156
• 负责人: William R. Ledoux
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7888156
• 关键词: 20 year old; Afghanistan; Age; Age-Years; American; Amputation; Bone callus; Bunion; Censuses; Characteristics; Clawtoe; Clinical; Complications of Diabetes Mellitus; Computer Simulation; Conflict (Psychology); Development; Devices; Diabetes Mellitus; Diabetic Foot; Esthesia; Foot Deformities; General Population; Goals; Hammer Toes; Incidence; Infection; Intervention; Iraq; Lead; Link; Locomotion; Lower Extremity; MRI Scans; Measures; Mechanics; Metatarsal bone structure; Mission; Modeling; Morbidity - disease rate; Neuropathy; Older Population; Operative Surgical Procedures; Patients; Population; Prevalence; Property; Recording of previous events; Research; Risk; Shapes; Shoes; Stress; Structure; Techniques; Time; Tissues; Traumatic Amputation; Ulcer; United States National Institutes of Health; Vascular Diseases; Veterans; X-Ray Computed Tomography; abstracting; diabetic; diabetic patient; foot; human old age (65+); multiple chronic conditions; pressure; soft tissue; treatment strategy; usability

Project Summary/Abstract The foot is the primary physical means of interaction between the body and the ground during locomotion. The shape or structure of the foot combined with the intrinsic tissue characteristics dictates the forces between various tissue layers (i.e., internal stresses). Aberrant internal stresses are thought to cause diabetic, neuropathic ulceration. The successful completion of this proposal will provide a better understanding of how foot deformity and changes in tissue characteristics due to diabetes alter these stresses. For diabetic patients who have lost protective sensation and who may have misshapen feet, high stresses can lead to ulcer development and potentially amputation. Interventions that might reduce these stresses are widely desired. However, it is technically very challenging to measure internal tissue deformation to compare how various treatment strategies lower internal stresses. Therefore, the purpose of this study is to develop a patient- specific computational model to explore how foot deformity and stiffer diabetic tissues can lead to increased internal stresses, and to quantify how conservative and surgical treatment options can modulate these stresses. Our specific aims are: [1] To develop patient-specific computational foot models of subjects with a range of foot conditions, including: i) healthy, ii) diabetic neuropathic, iii) diabetic neuropathic with claw toes, and iv) diabetic neuropathic with a history of ulceration; where appropriate, both pre- and post-surgical and/or conservative treatment options will also be modeled. [2] To explore how these conditions and treatments increase or decrease the internal stress in the foot. [3] To reduce the time required to generate a patient- specific computational foot model. Patient-specific computational foot models will be generated from highly detailed CT scans, and specialized loading devices will be used to quantify soft tissue anatomical and mechanical properties from MRI scans. Both conservative (i.e., shoe inserts) and surgical (i.e., correction of clawed toes) treatment options will also be modeled to determined if these techniques due in fact lower internal stresses. A long-term goal of this research is to increase the clinical usability of computational foot models. As such, advanced mathematical techniques will be used to reduce the time needed to create the patient-specific models. This research is relevant to the VA mission and the veteran population, which is in general older and has higher incidences of diabetes and foot complications than the population as a whole.

项目概要/摘要 脚是运动过程中身体与地面相互作用的主要物理手段。这 脚的形状或结构与内在组织特征相结合决定了之间的力 各种组织层（即内应力）。异常的内应力被认为会导致糖尿病， 神经性溃疡。该提案的成功完成将使人们更好地了解如何 糖尿病引起的足部畸形和组织特征的变化会改变这些压力。对于糖尿病患者 对于失去保护感觉的人以及脚部可能畸形的人，高压力会导致溃疡 发育和潜在的截肢。人们广泛期望可以减轻这些压力的干预措施。 然而，测量内部组织变形以比较不同组织的变形在技术上非常具有挑战性。 治疗策略可降低内应力。因此，本研究的目的是开发一种患者- 特定的计算模型来探索足部畸形和僵硬的糖尿病组织如何导致增加 内应力，并量化保守和手术治疗方案如何调节这些 压力。我们的具体目标是： [1] 开发具有特定患者特征的计算足部模型 一系列足部疾病，包括：i) 健康，ii) 糖尿病神经病变，iii) 糖尿病神经病变伴爪状趾， iv) 有溃疡病史的糖尿病性神经病；在适当的情况下，手术前和手术后和/或 保守治疗方案也将被建模。 [2] 探索这些条件和治疗方法如何 增加或减少足部的内应力。 [3] 为了减少生成患者所需的时间- 具体的计算脚模型。患者特定的计算足部模型将从高度生成 详细的 CT 扫描和专门的加载设备将用于量化软组织解剖学和 MRI 扫描的机械特性。保守治疗（即鞋垫）和手术治疗（即矫正 爪状脚趾）治疗方案也将被建模，以确定这些技术是否实际上由于内部较低 压力。这项研究的长期目标是提高计算足部模型的临床可用性。作为 因此，将使用先进的数学技术来减少创建患者特定数据所需的时间 模型。这项研究与退伍军人事务部使命和退伍军人群体相关，退伍军人群体通常年龄较大， 糖尿病和足部并发症的发病率高于总人口。