Materials used for diabetic insoles

NewsBot · Oct 10, 2007

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The physical characteristics of materials used in the manufacture of orthoses for patients with diabetes.
Paton J, Jones RB, Stenhouse E, Bruce G.
Foot Ankle Int. 2007 Oct;28(10):1057-63.

BACKGROUND: Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues can be modified. Orthotic therapy is one practical method commonly used to maintain tissue integrity. Orthotic design must consider the materials chosen for use in fabrication and profile of the device because both aspects influence the performance and durability of the device. Published research evaluating the physical properties of materials commonly used in the manufacture of orthoses for patients with diabetes is limited. This study investigated the physical properties of materials used to fabricate orthoses designed for the prevention of neuropathic diabetic foot ulcers.

METHODS: Fifteen commonly used orthotic materials were selected for testing: four specifications of 6.4-mm Poron((R)) (Rogers Corp., Gent, Belgium), 3.2-mm Poron((R)), three densities of 12-mm Ethylene Vinyl Acetate (EVA), 12-mm low-density plastazote, two depths (6.4-mm, 3.2-mm) of Clerontrade mark (Algeo Ltd., Liverpool, UK), Professional Protective Technology (PPT), and MaxaCane (Algeo Ltd, Liverpool, UK). The density, resilience, stiffness, static coefficient of friction, durability, and compression set of each material were tested, ranked, and allocated a performance indicator score.

RESULTS: The most clinically desirable dampening materials tested were Poron((R)) 96 (6-mm) and Poron((R)) 4000 (6-mm). High density EVA (Algeo Ltd., Liverpool,~UK) and Lunacell Nora((R)) EVA (Freudenberg, Weinhein, Germany) possessed the properties most suitable to achieve motion control. The data present a simple and useful comparison and classification of the selected materials.

CONCLUSIONS: Although this information should not be used as a single indicator for assessing the suitability of an orthotic material, the results provide clinically relevant information relating to the physical properties of orthotic materials commonly used in the prevention of neuropathic diabetic foot ulcers.
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NewsBot · Dec 15, 2007

Physical properties, durability, and energy-dissipation function of dual-density orthotic materials used in insoles for diabetic patients.
Brodsky JW, Pollo FE, Cheleuitte D, Baum BS.
Foot Ankle Int. 2007 Aug;28(8):880-9.

BACKGROUND: Patients with neuropathic conditions may develop plantar bony deformities through neuropathic collapse, frequently placing the skin and soft tissues at risk. Orthoses have been used to accommodate and distribute plantar pressures over a large surface area, thereby minimizing peak loading pressures in small regions and reducing the risk of ulceration.

METHODS: A previously described bony prominence model (Brodsky et al.) was used to test the pressure-absorbing and force-transmission properties of various orthotic material combinations used in our outpatient clinic. Six materials were tested in five combinations of materials for their compressive properties: [MS]: medium plastazote (M) + soft plastazote (S); [MN]: medium plastazote (M) + nickelplast (N); [NP] nickelplast (N) + Poron (P); [MO] medium plastazote (M) + Spenco (O); and [MC] medium plastazote (M) + P-cell (C). Materials were tested for 100,000 cycles using a materials-testing system (MTS) apparatus (MTS Systems Corporation, Cary, NC) and software. Stress-strain curves comparing the measured peak pressure to the elastic deformation, or the percentage of compression a material experiences with respect to its original thickness, were plotted for each orthotic combination.

RESULTS: For MS, MN, MO, and to a lesser extent, MC, a trend was noted for decreased elastic deformation with increased testing. Additionally, the peak pressures before and after testing for each 10,000 testing cycle for each of the orthotic combinations were plotted. For both MN and NP, no demonstrable difference was noted in the peak pressures in the pretesting and post-testing for the 100,000 cycles. The MO showed a trend for increased peak pressures after each testing cycle. Both the MC and MS peak pressures markedly increased with respect to pretesting value. Also, the MN, MO, and MS all showed an overall trend for increased load cell values with increasing cycles at fast loading.

CONCLUSIONS: These data showed that some orthotic combinations are more effective than others at reducing peak pressures during compression testing using our bony prominence model. Further studies are needed to test the orthotic combinations for shear and combined shear and compression modes.
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Admin2 · Dec 15, 2007

Related thread:
Construction of custom made insoles for neuropathic feet

NewsBot · Jun 16, 2020

Effect of different orthotic materials on plantar pressures: a systematic review
James M. Gerrard, Daniel R. Bonanno, Glen A. Whittaker & Karl B. Landorf
Journal of Foot and Ankle Research volume 13, Article number: 35 (2020)

Background
The effect of different orthotic materials on plantar pressures has not been systematically investigated. This study aimed to review and summarise the findings from studies that have evaluated the effect of orthotic materials on plantar pressures.

Methods
We conducted a systematic review of experimental studies that evaluated the effect of foot orthotic materials or shoe insole materials on plantar pressures using in-shoe testing during walking. The following databases were searched: MEDLINE, CINAHL, Embase and SPORTDiscus. Included studies were assessed for methodological quality using a modified Quality Index. Peak pressure, pressure-time integral, maximum force, force-time integral, contact area, and contact time were variables of interest. Data were synthesised descriptively as studies were not sufficiently homogeneous to conduct meta-analysis. Standardised mean differences (Cohen’s d) were calculated to provide the size of the effect between materials found in each study.

Results
Five studies were identified as meeting the eligibility criteria. All five studies were laboratory-based and used a repeated measures design. The quality of the studies varied with scores ranging between 20 and 23 on the modified Quality Index (maximum index score 28). The included studies investigated the effects of polyurethane (including PORON®), polyethylene (including Plastazote®), ethyl vinyl acetate (EVA) and carbon graphite on plantar pressures. Polyurethane (including PORON®), polyethylene (including Plastazote®) and EVA were all found to reduce peak pressure.

Conclusion
Based on the limited evidence supplied from the five studies included in this review, some orthotic materials can reduce plantar pressures during walking. Polyurethane (including PORON®), polyethylene (including Plastazote®) and EVA reduce peak pressure beneath varying regions of the foot. Future well-designed studies will strengthen this evidence.
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NewsBot · Sep 29, 2022

Effects of contoured insoles with different materials on plantar pressure offloading in diabetic elderly during gait
Qiu Qiong Shi et al
Sci Rep. 2022 Sep 13;12(1):15395

To investigate the effect of contoured insoles constructed of different insole materials, including Nora Lunalastik EVA, Nora Lunalight A fresh, Pe-Lite, and PORON Medical 4708 with Langer Biomechanics longitudinal PPT arch pads on offloading plantar pressure on the foot of the elderly with Type 1 or 2 diabetes during gait. Twenty-two elderly with Type 1 or 2 diabetes participated in the study. Their plantar pressure was measured by using an insole measurement system, while the participants walked 10 m in their bare feet or used each experimental insole in random order. The plantar surface was divided into four specific regions including the toes, forefoot, midfoot, and rearfoot. The mean peak pressure (MPP) and pressure-time integral (PTI) of ten steps with or without wearing one of the four insoles were analyzed on the dominant foot and the four specific plantar regions. After completion of the activities, the participants scored each insole from 1 (the least comfortable) to 10 (the most comfortable). The analysis of variance (ANOVA) factor of the insoles had significant effects on the MPP (P < 0.001) and PTI (P = 0.004) in the dominant foot during gait. Pairwise comparison results showed that the MPP and PTI in the dominant foot were significantly lower (P < 0.001) with PORON Medical 4708 than barefoot, Nora Lunalight A fresh, and Pe-Lite. Additionally, the insole materials had a significant effect for the forefoot (P < 0.001) and rearfoot (P < 0.001) in terms of the MPP and PTI compared with the barefoot condition during gait. Regardless of the plantar region, the MPP and PTI values were the lowest when PORON Medical 4708 was used as the insole material among four insole materials. Meanwhile, a significantly lower MPP and PTI can be found in the forefoot and rearfoot with the use of the four experimental insoles when compared with barefoot. The soft insole materials (i.e., PORON medical 4708 and Nora Lunalastik EVA) had a better performance than the rigid insole materials (i.e., Nora Lunalight A fresh, and Pe-Lite) on plantar pressure offloading for diabetic elderly.
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