Pressure-sensing devices for assessment of soft tissue loading under bony prominences: technological concepts and clinical utilization.

Pressure-related chronic wounds, such as diabetic neuropathic foot ulcers and pressure ulcers, are an important health concern that affect millions of patients and accumulate billions in annual costs. Pressure-related chronic wounds may occur when soft tissues are mechanically compressed between bony prominences and a supporting surface. Interface pressure measurements allow the determination of the spatial and temporal mechanical loads that are transferred to soft tissues. These measurements are a basic engineering tool for evaluating the susceptibility of an individual to suffer a pressure-related wound. The purpose of this review is to: 1) describe the current techniques for body-support interface pressure measurements, 2) list the pressure value ranges measured under the foot in standing and walking, and under the buttocks in sitting (with particular emphasis on abnormal alterations in foot pressures as a result of diabetic neuropathy and alterations in sitting pressures in paralyzed patients), and 3) discuss clinical utilization of interface pressure measurements in the fitting of diabetic footwear and wheelchair cushions.

[1]  K A Athanasiou,et al.  Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration? , 1998, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[2]  A Pedotti,et al.  Comparative biomechanical evaluation of different wheelchair seat cushions. , 2000, Journal of rehabilitation research and development.

[3]  M Arcan,et al.  Biomechanical analysis of the three-dimensional foot structure during gait: a basic tool for clinical applications. , 2000, Journal of biomechanical engineering.

[4]  A. Gefen,et al.  Pressure-time cell death threshold for albino rat skeletal muscles as related to pressure sore biomechanics. , 2006, Journal of biomechanics.

[5]  M J Coggrave,et al.  A specialist seating assessment clinic: changing pressure relief practice , 2003, Spinal Cord.

[6]  Robert Ragan,et al.  Seat-interface pressures on various thicknesses of foam wheelchair cushions: a finite modeling approach. , 2002, Archives of physical medicine and rehabilitation.

[7]  Stephanie Wu,et al.  Risk assessment of the diabetic foot and wound , 2005, International wound journal.

[8]  A Gefen,et al.  [Diffusion of ulcers in the diabetic foot is promoted by stiffening of plantar muscular tissue under excessive bone compression]. , 2004, Der Orthopade.

[9]  T. McPoil,et al.  Plantar pressure assessment. , 2000, Physical therapy.

[10]  A. de Lange,et al.  Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity. , 2005, Journal of biomechanics.

[11]  Akihiro Tokuhiro,et al.  Finding the optimal setting of inflated air pressure for a multi-cell air cushion for wheelchair patients with spinal cord injury. , 2004, Acta medica Okayama.

[12]  C. I. Franks,et al.  The Measurement of Pressures under the Foot , 1982, Foot & ankle.

[13]  P. Cavanagh,et al.  The Mechanism of Plantar Unloading in Total Contact Casts: Implications for Design and Clinical Use , 1997, Foot & ankle international.

[14]  A. Gefen Plantar soft tissue loading under the medial metatarsals in the standing diabetic foot. , 2003, Medical engineering & physics.

[15]  A. J. Nevill,et al.  In-shoe foot pressure measurement system utilising piezoelectric film transducers , 2006, Medical and Biological Engineering and Computing.

[16]  N. Hotta,et al.  The reduction and redistribution of plantar pressures using foot orthoses in diabetic patients. , 1996, Diabetes research and clinical practice.

[17]  A Gefen,et al.  In vivo muscle stiffening under bone compression promotes deep pressure sores. , 2005, Journal of biomechanical engineering.

[18]  S. Urry Plantar pressure-measurement sensors , 1999 .

[19]  D S Drummond,et al.  A study of pressure distributions measured during balanced and unbalanced sitting. , 1982, The Journal of bone and joint surgery. American volume.

[20]  C E Brubaker,et al.  Reduction of sitting pressures with custom contoured cushions. , 1990, Journal of rehabilitation research and development.

[21]  F. Abouaesha,et al.  Plantar tissue thickness is related to peak plantar pressure in the high-risk diabetic foot. , 2001, Diabetes care.

[22]  Amit Gefen,et al.  Stress analysis of the standing foot following surgical plantar fascia release. , 2002, Journal of biomechanics.

[23]  Folke Sjöberg,et al.  Sitting Pressure and Perfusion of Buttock Skin in Paraplegic and Tetraplegic Patients, and in Healthy Subjects: A Comparative Study , 2002, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[24]  Ahmet Erdemir,et al.  Local plantar pressure relief in therapeutic footwear: design guidelines from finite element models. , 2005, Journal of biomechanics.

[25]  M Lord,et al.  Plantar pressures are elevated in the neuroischemic and the neuropathic diabetic foot. , 1999, Diabetes care.

[26]  A Gefen,et al.  How do normals move during prolonged wheelchair-sitting? , 2007, Technology and health care : official journal of the European Society for Engineering and Medicine.

[27]  Helena Saraste,et al.  Measuring seating pressure, area, and asymmetry in persons with spinal cord injury , 2004, European Spine Journal.

[28]  D M Brienza,et al.  Seat cushion design for elderly wheelchair users based on minimization of soft tissue deformation using stiffness and pressure measurements. , 1996, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[29]  B. Kuhn,et al.  Balancing the pressure ulcer cost and quality equation. , 1992, Nursing economic$.

[30]  L. Lavery,et al.  1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers. , 1997, Journal of the American Podiatric Medical Association.

[31]  M Arcan,et al.  A fundamental characteristic of the human body and foot, the foot-ground pressure pattern. , 1976, Journal of biomechanics.

[32]  I. D. Swain,et al.  The effects of posture, body mass index and wheelchair adjustment on interface pressure , 1997 .

[33]  M Arcan,et al.  Modeling the body/chair interaction - an integrative experimental-numerical approach. , 2000, Clinical biomechanics.

[34]  I. Swain,et al.  The effectiveness of a pressure clinic in preventing pressure sores , 1992, Paraplegia.

[35]  J. B. Reswick,et al.  Experience at Rancho Los Amigos Hospital With Devices and Techniques to Prevent Pressure Sores , 1976 .

[36]  Y. Itzchak,et al.  Assessment of mechanical conditions in sub-dermal tissues during sitting: a combined experimental-MRI and finite element approach. , 2007, Journal of biomechanics.

[37]  Hideki Yamamoto,et al.  The study of pressure distribution in sitting position on cushions for patient with SCI (Spinal Cord Injury) , 1998, IEEE Trans. Instrum. Meas..

[38]  A. Gefen,et al.  Biomechanical analysis of fatigue-related foot injury mechanisms in athletes and recruits during intensive marching , 2002, Medical and Biological Engineering and Computing.

[39]  J. Derr,et al.  The use of running shoes to reduce plantar pressures in patients who have diabetes. , 1995, The Journal of bone and joint surgery. American volume.

[40]  M J Peterson,et al.  Measurement and redistribution of excessive pressures during wheelchair sitting. , 1982, Physical therapy.

[41]  C I Franks,et al.  Plantar pressure measurements and the prevention of ulceration in the diabetic foot. , 1985, The Journal of bone and joint surgery. British volume.

[42]  P. Cavanagh,et al.  Pressure Distribution under Symptom-Free Feet during Barefoot Standing , 1987, Foot & ankle.

[43]  K. Harding,et al.  Plantar pressure in off‐loading devices used in diabetic ulcer treatment , 2005, Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society.

[44]  E Trefler,et al.  The relationship between pressure ulcer incidence and buttock-seat cushion interface pressure in at-risk elderly wheelchair users. , 2001, Archives of physical medicine and rehabilitation.

[45]  R. Minns,et al.  Pressure under the forefoot in rheumatoid arthritis. A comparison of static and dynamic methods of assessment. , 1984, Clinical orthopaedics and related research.

[46]  M. Brandstater,et al.  Efficacy of three measures to relieve pressure in seated persons with spinal cord injury. , 1994, Archives of physical medicine and rehabilitation.

[47]  Hideki Yamamoto,et al.  Pressure measurement of air cushions for SCI patients , 2000, IEEE Trans. Instrum. Meas..

[48]  D. Armstrong,et al.  The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. , 2002, Diabetes care.

[49]  E. Landis,et al.  Micro-injection studies of capillary blood pressure in human skin , 1930 .

[50]  Y. Itzchak,et al.  Integration of plantar soft tissue stiffness measurements in routine MRI of the diabetic foot. , 2001, Clinical biomechanics.

[51]  J. Assal,et al.  Plantar pressure distribution in Type 2 diabetic patients without peripheral neuropathy and peripheral vascular disease , 2005, Diabetic medicine : a journal of the British Diabetic Association.

[52]  Kristina D. O'Shaughnessy,et al.  Chronic Wound Pathogenesis and Current Treatment Strategies: A Unifying Hypothesis , 2006, Plastic and reconstructive surgery.

[53]  J A de Guise,et al.  Analysis of pressure distribution at the body-seat interface in able-bodied and paraplegic subjects using a deformable active contour algorithm. , 2001, Medical engineering & physics.