Novel Pressure-Sensing Smart Insole System Used for the Prevention of Pressure Ulceration in the Insensate Foot

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Wounds of the foot challenge reconstructive surgeons to manage multiple factors: sensibility, stability, and durability. In this article, we focus on the insensate foot, which poses challenges to wound prevention with its propensity to develop pressure ulceration. The authors present the innovative use of a pressure-sensing smart insole system (SurroSense Rx, Orpyx Medical Technologies Inc., Calgary, Canada) in the management of the insensate foot in a patient following foot reconstruction. The pressure-sensing smart insole system provided unique feedback to both patient and provider in ways that contributed to the prevention of pressure ulcer recurrence, as well as highlight the importance of prescribed footwear in both the affected and unaffected foot. Wearable real-time monitoring and feedback faces the challenge of patient adherence. Future studies are indicated to examine the specific behaviors that are associated with favorable outcomes and long-term behavior changes.

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Pressure ulcers: Current understanding and newer modalities of treatment

Surajit Bhattacharya, R. K. Mishra (2015)

This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described.

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Plantar pressures in diabetic patients with foot ulcers which have remained healed.

James Bus, J S Ulbrecht, Amy Becker … (2009)

The recurrence of foot ulcers is a significant problem in people with diabetic neuropathy. The purpose of this study was to measure in-shoe plantar pressures and other characteristics in a group of neuropathic patients with diabetes who had prior foot ulcers which had remained healed. This was an epidemiological cohort study of patients from diabetes clinics of two Swedish hospitals. From a database of 2625 eligible patients, 190 surviving patients with prior plantar ulcers of the forefoot (hallux or metatarsal heads) caused by repetitive stress were identified and 49 patients agreed to participate. Barefoot and in-shoe plantar pressures were measured during walking. Data on foot deformity, activity profiles and self-reported behaviour were also collected. Mean barefoot plantar peak pressure at the prior ulcer site (556 kPa) was lower than in other published series, although the range was large (107-1192 kPa). Mean in-shoe peak pressure at this location averaged 207 kPa when measured with an insole sensor. Barefoot peak pressure only predicted approximately 35% of the variance of in-shoe peak pressure, indicating variation in the efficacy of the individual footwear prescriptions (primarily extra-depth shoes with custom insoles). We propose that the mean value for in-shoe pressures reported in these patients be used as a target in footwear prescription for patients with prior ulcers. Although plantar pressure is only one factor in a multifaceted strategy to prevent ulcer recurrence, the quantitative focus on pressure reduction in footwear is likely to have beneficial effects.

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Smarter Sole Survival: Will Neuropathic Patients at High Risk for Ulceration Use a Smart Insole-Based Foot Protection System?

Bijan Najafi, Eyal Ron, Ana Enriquez … (2016)

This study examined adherence to alert-based cues for plantar pressure offloading in patients with diabetic foot disease.

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Author and article information

Journal

Journal ID (nlm-ta): Plast Reconstr Surg Glob Open

Journal ID (iso-abbrev): Plast Reconstr Surg Glob Open

Journal ID (publisher-id): GOX

Title: Plastic and Reconstructive Surgery Global Open

Publisher: Wolters Kluwer Health

ISSN (Electronic): 2169-7574

Publication date (Electronic): 05 December 2017

Publication date Collection: December 2017

Volume: 5

Issue: 12

Electronic Location Identifier: e1568

Affiliations

[1]From the *Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y.; †Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, N.Y.; and ‡University of Calgary, Section of Plastic Surgery and Orpyx Medical Technologies.

Author notes

Ernest S. Chiu, MD, FACS, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, 240 East 38th Street, 13 ^th Floor, New York, NY 10016, E-mail: ernest.chiu@ 123456nyumc.org

Article

Accession ID: 00036

DOI: 10.1097/GOX.0000000000001568

PMC ID: 5889445

PubMed ID: 29632760

SO-VID: dcafbc94-5069-4320-b0c0-908d1764178a

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Date received : 26 April 2017

Date accepted : 22 September 2017

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Novel Pressure-Sensing Smart Insole System Used for the Prevention of Pressure Ulceration in the Insensate Foot

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Negative Pressure Wound Therapy

Most cited references 9

Pressure ulcers: Current understanding and newer modalities of treatment

Plantar pressures in diabetic patients with foot ulcers which have remained healed.

Smarter Sole Survival: Will Neuropathic Patients at High Risk for Ulceration Use a Smart Insole-Based Foot Protection System?

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