Lower extremity amputation in people with diabetes continues to be a major public health problem. More than 65,000 amputations are performed annually on diabetic patients in the US and, despite recent efforts, this number is increasing. Ulceration in the neuropathic foot is a major precursor of amputation and therapeutic footwear has been shown to be an important component of ulcer prevention. Unfortunately, there are still no overall guidelines to help with the prescription and construction of such shoes. The investigators believe that a comprehensive understanding of the problem of matching a given """"""""at risk"""""""" neuropathic foot to a given therapeutic footwear intervention is unlikely flow just from human experimental work. Based on encouraging pilot results, they therefore propose in this application to develop in ABAQUS a series of increasingly complex finite element models of the forefoot based upon individual high resolution MRI images. The models will include the action of the flexor tendons, the plantar fascia, the transverse tarsal ligament, the major joints of the forefoot and a sliding interface between the foot and the ground or the footwear. A number of mechanical tests are proposed to develop material properties and model boundary conditions. The models will be validated using both a unique cadaver model and by measurements of pressure and plantar tissue thickness in walking human subjects. Once accurate predictions are achieved under these simple conditions, a series of typical footwear modifications will be examined. These will include insoles of different thickness and stiffness, """"""""plugs"""""""" for local stress relief, metatarsal pads, and insoles with a molded forefoot. These results will again be validated against cadaver and human subject measurements. This work should result in significant advances in the modeling of the foot, and should provide. a detailed understanding of the design principles for footwear interventions that can reduce plantar pressure under the forefoot

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
7R01HD037433-04
Application #
6782469
Study Section
Geriatrics and Rehabilitation Medicine (GRM)
Program Officer
Quatrano, Louis A
Project Start
2000-09-10
Project End
2006-07-31
Budget Start
2003-08-01
Budget End
2006-07-31
Support Year
4
Fiscal Year
2002
Total Cost
$337,971
Indirect Cost
Name
Cleveland Clinic Lerner
Department
Other Basic Sciences
Type
Schools of Medicine
DUNS #
135781701
City
Cleveland
State
OH
Country
United States
Zip Code
44195
Spirka, Thomas A; Erdemir, Ahmet; Ewers Spaulding, Susan et al. (2014) Simple finite element models for use in the design of therapeutic footwear. J Biomech 47:2948-55
Bennetts, Craig J; Owings, Tammy M; Erdemir, Ahmet et al. (2013) Clustering and classification of regional peak plantar pressures of diabetic feet. J Biomech 46:19-25
Petre, Marc; Erdemir, Ahmet; Panoskaltsis, Vassilis P et al. (2013) Optimization of nonlinear hyperelastic coefficients for foot tissues using a magnetic resonance imaging deformation experiment. J Biomech Eng 135:61001-12
Erdemir, Ahmet; Guess, Trent M; Halloran, Jason et al. (2012) Considerations for reporting finite element analysis studies in biomechanics. J Biomech 45:625-33
Tadepalli, Srinivas C; Erdemir, Ahmet; Cavanagh, Peter R (2011) Comparison of hexahedral and tetrahedral elements in finite element analysis of the foot and footwear. J Biomech 44:2337-43
Petre, Marc; Erdemir, Ahmet; Cavanagh, Peter R (2008) An MRI-compatible foot-loading device for assessment of internal tissue deformation. J Biomech 41:470-4
Budhabhatti, Sachin P; Erdemir, Ahmet; Petre, Marc et al. (2007) Finite element modeling of the first ray of the foot: a tool for the design of interventions. J Biomech Eng 129:750-6
Cavanagh, Peter R; Owings, Tammy M (2006) Nonsurgical strategies for healing and preventing recurrence of diabetic foot ulcers. Foot Ankle Clin 11:735-43
Petre, M T; Erdemir, A; Cavanagh, P R (2006) Determination of elastomeric foam parameters for simulations of complex loading. Comput Methods Biomech Biomed Engin 9:231-42
Erdemir, Ahmet; Viveiros, Meredith L; Ulbrecht, Jan S et al. (2006) An inverse finite-element model of heel-pad indentation. J Biomech 39:1279-86

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