Browsing by Author "Castro-Martins, Pedro"
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- Conceito de pressão variável para prevenção ativa da ulceração no pé diabéticoPublication . Castro-Martins, Pedro; Marques, Arcelina; Coelho, Luís; Vaz, Mário(Introdução) O pé diabético é uma designação usada para diversos problemas nos pés causados por complicações da diabetes, como neuropatia e doença vascular periférica, que aumentam o risco de lesão, infeção, ulceração e amputação. A pressão plantar elevada dentro do sapato é um fator de risco para lesões (Schaperetal, 2024). Soluções como palmilhas para monitorizar a pressão plantar e sapatos para aliviar a pressão são projetadas para minimizar esse problema. No entanto, esses dispositivos são passivos e frequentemente apresentam baixa adesão dos pacientes, resultando em elevado absentismo (Jarletal, 2020).
- In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic reviewPublication . Castro-Martins, Pedro; Marques, Arcelina; Coelho, Luís; Vaz, Mário; Baptista, João SantosIntroduction Loss of cutaneous protective sensation and high plantar pressures increase the risk for diabetic foot patients. Trauma and ulceration are imminent threats, making assessment and monitoring essential. This systematic review aims to identify systems and technologies for measuring in-shoe plantar pressures, focusing on the at-risk diabetic foot population. Methods A systematic search was conducted across four electronic databases (Scopus, Web of Science, PubMed, Oxford Journals) using PRISMA methodology, covering articles published in English from 1979 to 2024. Only studies addressing systems or sensors exclusively measuring plantar pressures inside the shoe were included. Results A total of 87 studies using commercially available devices and 45 articles proposing new systems or sensors were reviewed. The prevailing market offerings consist mainly of instrumented insoles. Emerging technologies under development often feature configurations with four, six or eight resistive sensors strategically placed within removable insoles. Despite some variability due to the inherent heterogeneity of human gait, these devices assess plantar pressure, although they present significant differences between them in measurement results. Individuals with diabetic foot conditions appears exhibit elevated plantar pressures, with reported peak pressures reaching approximately 1000 kPa. The results also showed significant differences between the diabetic and non-diabetic groups. Conclusion Instrumented insoles, particularly those incorporating resistive sensor technology, dominate the field. Systems employing eight sensors at critical locations represent a pragmatic approach, although market options extend to systems with up to 960 sensors. Differences between devices can be a critical factor in measurement and highlights the importance of individualized patient assessment using consistent measurement devices.
- A new equipment for automatic calibration of the Semmes-Weinstein monofilamentPublication . Castro-Martins, Pedro; Pinto-Coelho, LuisDiabetic foot is a complication that carries a considerable risk in diabetic patients. The consequent loss of protective sensitivity in the lower limbs requires an early diagnosis due to the imminent possibility of ulceration or amputation of the affected limb. To assess the loss of protective sensitivity, the 10 gf Semmes-Weinstein (SW) monofilament is the most used first-line procedure. However, the used device is most often non-calibrated and its feedback can lead to decision errors. In this paper we present an equipment that is able to automatically conduct a metrological verification and evaluation of the 10 gf SW monofilament in the assessment of the loss of protective sensitivity. Additionally, the pro posed equipment is able to simulate the practicioner’s procedure, or can be used for training purposes, providing force-feedback information. After calibration, displacement vs. buckling force contours were ploted for three distinct monofilaments, confirming then ability of the equipment to provide fast, detailed and precise information.
- Plantar pressure thresholds as a strategy to prevent diabetic foot ulcers: A systematic reviewPublication . Castro-Martins, Pedro; Marques, Arcelina; Coelho, Luís; Vaz, Mário; Costa, José TorresBackground The development of ulcers in the plantar region of the diabetic foot originates mainly from sites subjected to high pressure. The monitoring of these events using maximum allowable pressure thresholds is a fundamental procedure in the prevention of ulceration and its recurrence. Objective The aim of this review was to identify data in the literature that reveal an objective threshold of plantar pressure in the diabetic foot, where pressure is classified as promoting ulceration. The aim is not to determine the best and only pressure threshold for ulceration, but rather to clarify the threshold values most used in clinical practice and research, also considering the devices used and possible applications for offloading plantar pressure. Design A systematic review. Methods The search was performed in three electronic databases, by the PRISMA methodology, for studies that used a pressure threshold to minimize the risk of ulceration in the diabetic foot. The selected studies were subjected to eligibility criteria. Results Twenty-six studies were included in this review. Seven thresholds were identified, five of which are intended for the inside of the shoe: a threshold of average peak pressure of 200 kPa; 25 % and 40–80 % reduction from initial baseline pressure; 32–35 mm Hg for a capillary perfusion pressure; and a matrix of thresholds based on patient risk, shoe size and foot region. Two other thresholds are intended for the barefoot, 450 and 750 kPa. The threshold of 200 kPa of pressure inside the shoe is the most agreed upon among the studies. Regarding the prevention of ulceration and its recurrence, the efficacy of the proposed threshold matrix and the threshold of reducing baseline pressure by 40–80 % has not yet been evaluated, and the evidence for the remaining thresholds still needs further studies. Conclusions Some heterogeneity was found in the studies, especially regarding the measurement systems used, the number of regions of interest and the number of steps to be considered for the threshold. Even so, this review reveals the way forward to obtain a threshold indicative of an effective steppingstone in the prevention of diabetic foot ulcer.
- Segurança na decisão clínica baseada no desempenho do monofilamento de Semmes-Weinstein no diagnóstico do pé diabético: Uma análise metrológicaPublication . Castro-Martins, Pedro; Pinto-Coelho, Luis; Marques, Arcelina(Excerto da introdução) A diabetes é uma doença crónica incurável e estima-se que existam em todo o mundo mais de 500 milhões de pessoas com diabetes, sendo declarada pela International Diabetes Federation (IDF, Federação Internacional da Diabetes) como um problema de saúde pública [1]. A Figura 1 traduz de relance os números desta doença.
- Towards a pneumatic insole concept to offloading plantar pressure in diabetic foot pathologyPublication . Castro-Martins, Pedro; Pinto-Coelho, Luis; Vaz, Mário; Marques, ArcelinaDiabetic foot is a serious complication of diabetes that affects millions of people worldwide. It is characterized by poor circulation, nerve damage and high plantar pressure that can lead to the development of foot ulcers and amputations. Offloading plantar pressure in certain regions is extremely important. In this paper we propose a preliminary methodology for a new concept of a pneumatic insole to offloading pressure on critical points in the plantar region of the diabetic foot. It is expected that this pneumatic insole will have an intelligent and differentiated performance in result of the pressures imposed inside the shoe. The proposed methodology consists of producing an insole with pockets, located in critical regions of the foot, which can be inflated with air to maintain a stable pressure. If any region is identified with a pressure above the defined threshold, these pockets can empty until the pressure is uniform. This pneumatic insole will promote a better redistribution of plantar pressure in the diabetic foot, it does not add significant weight or volume to the shoe and should bring greater comfort to the user.
- Towards an in-shoe pneumatic insole to plantar injury prevention in diabetic footPublication . Castro-Martins, Pedro; Coelho, Luis; Vaz, Mário; Pinto, Marcelino; Marques, Maria ArcelinaDiabetic foot is a serious complication of diabetes that affects millions of people around the world. It is characterized by poor circulation, nerve damage and high plantar pressure that can lead to the development of foot ulcers and amputations. Offloading plantar pressure in certain regions is extremely important. In this paper we propose a preliminary methodology for a new concept of pneumatic insole for plantar pressure offloading. It consists of an insole with pockets, located in critical regions of the diabetic foot, which can be inflated or deflated to maintain adequate pressure. The main goal of this work is to select the most suitable fluid for the system and that provides a better applicability for this new solution, describing its pros and cons. When analyzing the results, the use of compressed air as a fluid to regulate the pressure in the insole pockets stood out as the most appropriate and advantageous option compared to other gaseous or liquid fluids. Liquid fluids have negative aspects, such as the risk of damaging electronic components in case of leaks and the need for additional reservoirs. In addition, air has a better thermal insulation capacity and does not pose a risk of toxicity, an important aspect for a system that will be in direct contact with the diabetic foot. The availability and zero cost of air, its lightness, and the absence of the need for reservoirs make the pneumatic insole more accessible and low cost, also providing greater cushioning, shock absorption and pressure redistribution.