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- 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.
- 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.
- Diabetic Shoe Upper Pressures: Preliminary Approach to Identify Relative Levels of Comfort and InjuryPublication . Martins, Pedro; Marques, A.Diabetic foot is one of the most serious complications affecting the feet of diabetic patients. It is characterized by a progressive loss of protective skin sensitivity and requires an early diagnosis due to the imminent possibility of infection, ulceration, and amputation [1]. Frequently, the anatomical deformation of the foot and the use of misfit shoes compromise the biomechanics of the foot, causing abnormal overload and minor trauma that can precipitate ulceration. The most critical pressure points, located in the plantar and dorsal region of the foot, are already well identified. In this sense, in addition to increased clinical attention, the use of appropriate footwear is also an essential factor in preventing injuries. The shoe must have an internal length between 1 and 2 cm greater than the foot, it must be adapted to the widest part of the foot and the height of the toecap must guarantee sufficient space for the toes. The choice of shoes should be evaluated with the patient standing and preferably at the end of the day when the feet are more likely to be swollen. In more complex cases, the use of custom-made shoes should be advised
- Análise Objetiva ao Desempenho do Monofilamento de Semmes-Weinstein de 10 gf para Avaliação da Sensibilidade Cutânea Protetora no Pé DiabéticoPublication . Martins, Pedro; Coelho, LuisA perda de sensibilidade protetora no pé diabético obriga a um diagnóstico precoce devido à eminente possibilidade de ulceração e amputação do membro afetado. Na avaliação da perda de sensibilidade protetora, o monofilamento de Semmes-Weinstein (MSW) de 10 gf é o instrumento de primeira linha mais utilizado. Este estudo foi conduzido com o objetivo de realizar uma análise objetiva e metrológica ao desempenho do MSW de 10 gf, recorrendo a um equipamento de medição previamente desenvolvido para o efeito. Procedeu-se a uma verificação metrológica de três MSW de 10 gf através de um método automatizado sob condições controladas. A força de compressão dos MSW revelou-se altamente dependente do número de utilizações, da temperatura ambiente e da velocidade de deslocamento e contacto com a região cutânea a avaliar. Efetivamente todos os MSW testados manifestaram dependência de fatores externos na sua força de compressão e registaram erros relativos superiores a 10 %, valor considerado crítico para discriminar uma possível evolução da patologia.
- 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).
- Conductive ink vs force sensing resistors in plantar pressure soles: WalkinSense®, MyCareShoe® and DIAPODALPublication . Morales, Isabel; Martins, Pedro; Silva, Carolina; Marques, Arcelina; Mendes, Joaquim; Simini, FrancoWe compare plantar pressure data obtained by MyCareShoe® (nine sensors), which uses a proprietary variable resistance conductive ink with DIAPODAL (eight sensors), which utilizes standard force sensing resistors. Both sys tems are then compared to WalkinSense®, a well established pressure system that uses eight force sensing piezoresistors. Our objective is to validate the pressure measurements of DIAPODAL. The assessment protocol consisted of different combinations of the three sensing systems (Test 1 to Test 5). We repeated six times of eight steps each, taken by a healthy volunteer. We analized the signals of the eight common loca tions of the three systems. We detected plantar pressure peaks and calculated the pressure time integral. The pressure for DIAPODAL ranged from 43 to 477 kPa, and the pressure time integral from 75 to 375 kPas over the tests. The equivalence of MyCareShoe® and DIAPODAL with WalkinSense®, taken as the standard for peak plantar pressure measurements was found to be 34% for MyCareShoe® and 69% for DIAPODAL. Considering pressure time integral, the equivalence was 92% to DIAPODAL and 68% to MyCareShoe® which confirm consistency. Record ing of simultaneous plantar soles WalkinSense®/ MyCareShoe® and WalkinSense®/DIAPODAL was consistent for repeatability and linearity (Pearson correlation coefficient, > 0.85 in 80% of the eight-stride series). These findings confirm equivalence between force sensing resistors and conductive ink for pressure measurements. A reliable pressure distribution pattern at 100 Hz can therefore be used as basic information to design a multi variable approach to detect foot conditions by means of real time step detection.
- 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.
- Integrated shoe upper system for accessing dorsal pressures in the diabetic foot: A preliminary approachPublication . Martins, Pedro; Coelho, Luis; Marques, Maria ArcelinaDiabetic foot is one of the most serious complications affecting the feet of diabetic patients; These patients begin to lose protective skin sensitivity in their feet and are at risk for trauma, infection, ulceration and, in more serious cases, amputation.
- Preliminary Tests with Screen-Printed Piezoresistive Pressure Sensors on PET and Textile SubstratesPublication . Martins, Pedro; Silva, Carolina; Oliveira, Juliana; Marques, Maria ArcelinaThe search for more practical and economically advantageous solutions to produce flexible and printable pressure sensors, is giving rise to new approaches with promising results. The production of conductive and piezoresistive inks for application on flexible and stretchable substrates is a sign of this evolution. In this paper, we propose to analyze the results of some calibration tests, performed with pressure-sensitive piezoresistive sensors screen-printed on PET and textile substrates. The results showed that these sensors generally follow a trend with a strong approximation to the linear model. The textile sensor is the most linear (R 2 = 0.99), and PET sensor (S1) has a higher sensitivity (40.4 mV/kPa) than the other sensors. Results obtained are, in general, within the expected behavior for the piezoresistive ink used and allowed for comparing between sensors printed in PET and textile substrates. A positive factor to consider lies in the possibility of using the screen-printing technology on different substrates, preferably in textile fabric.