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.

项目摘要/摘要 脚是运动过程中身体与地面之间相互作用的主要物理手段。这 脚的形状或结构与内在的组织特征结合起来决定 各种组织层（即内部应力）。异常内部压力被认为会导致糖尿病， 神经性溃疡。该提案的成功完成将更好地理解如何 脚部畸形和由于糖尿病引起的组织特征的变化改变了这些应力。适用于糖尿病患者 谁失去了保护性的感觉，并且可能有畸形的脚，高压力会导致溃疡 开发和潜在的截肢。可能会减少这些应力的干预措施是广泛的。 但是，测量内部组织变形以比较各种方式在技术上非常具有挑战性 治疗策略降低了内部压力。因此，这项研究的目的是发展患者 特定的计算模型，以探讨脚部畸形和较硬的糖尿病组织如何导致增加 内部压力，并量化保守和手术治疗方案如何调节这些选择 压力。我们的具体目的是：[1]开发具有A的患者特定于患者的计算脚模型 脚部条件的范围，包括：i）健康，ii）糖尿病神经性，iii）糖尿病性神经性和爪脚趾， iv）具有溃疡病史的糖尿病神经性疗法；在适当的情况下，术前和术后和/或 保守的治疗方案也将进行建模。 [2]探索这些条件和治疗方法 增加或减轻脚内的内部压力。 [3]减少产生患者所需的时间 特定的计算脚模型。特定于患者的计算脚模型将是由高度生成的 详细的CT扫描和专门的装载设备将用于量化软组织解剖学和 MRI扫描的机械性能。保守的（即鞋子插入）和外科手术（即校正 爪脚趾）还将建模治疗方案，以确定这些技术是否实际上是由于内部较低的 压力。这项研究的一个长期目标是提高计算脚模型的临床可用性。作为 这样的高级数学技术将用于减少创建特定患者所需的时间 型号。这项研究与VA任务和退伍军人人口有关，这一般年龄较大， 与整个人群相比，糖尿病和足部并发症的发生率更高。