A flexible-spoke non-pneumatic tyre for manual wheelchairs.

This study combines laboratory testing with computer modelling to demonstrate, for the first time, the applicability of flexible-spoke non-pneumatic tyre (FS-NPT) technology in wheelchairs. Like existing solid non-pneumatic tyres, FS-NPTs are puncture-proof and will reduce the burden of tyre maintenance. Unlike existing solid tyres, FS-NPT performance is based on the properties of flexible structures (spokes), such as honeycombs, which can deform to offer superior cushioning and return to their original shape upon unloading.

The Importance of Preconditioning for the Sonographic Assessment of Plantar Fascia Thickness and Shear Wave Velocity.

Plantar fasciopathy is a very common musculoskeletal complaint that leads to reduced physical activity and undermines the quality of life of patients. It is associated with changes in plantar fascia structure and biomechanics which are most often observed between the tissue's middle portion and the calcaneal insertion. Sonographic measurements of thickness and shear wave (SW) elastography are useful tools for detecting such changes and guide clinical decision making.

Reliability of enhanced paper grip test for testing foot strength in volleyball and soccer players.

Objectives: To evaluate the reliability of the Enhanced Paper Grip Test (EPGT) for assessing foot strength in volleyball and soccer players.

Design: A cross-sectional observational study with repeated measurements.

Setting: Field-based study.

Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study.

Background: Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes.

Reliability and Validity of Shore Hardness in Plantar Soft Tissue Biomechanics.

Shore hardness (SH) is a cost-effective and easy-to-use method to assess soft tissue biomechanics. Its use for the plantar soft tissue could enhance the clinical management of conditions such as diabetic foot complications, but its validity and reliability remain unclear. Twenty healthy adults were recruited for this study.

The enhanced paper grip test can substantially improve community screening for the risk of falling.

Background: Lower-limb strength measures can enhance falls risk assessment but due to the lack of clinically applicable methods, such measures are not included in current screening. The enhanced paper grip test (EPGT) is a simple-to-use and cost-effective test that could fill this gap. However, its outcome measure (EPGT force) has not yet been directly linked to the risk of falling.

An exploration of the mechanistic link between the enhanced paper grip test and the risk of falling.

The enhanced paper grip test (EPGT) offers an easy-to-use measure of hallux plantar-flexion strength that does not need expensive specialised equipment. Literature suggests that it could be a useful screening tool to assess the risk of falling in older people. However, research on a specific mechanistic link to the risk of falling is lacking.

Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear.

Introduction: Optimising the cushioning stiffness of diabetic footwear/orthoses can significantly enhance their offloading capacity. This study explores whether optimum cushioning stiffness can be predicted using simple demographic and anthropometric parameters.

Methods: Sixty-nine adults with diabetes and loss of protective sensation in their feet were recruited for this cross-sectional observational study.

Screening for the loss of protective sensation in people without a history of diabetic foot ulceration: Validation of two simple tests in India.

The ability of the Ipswich touch test (IpTT) and Vibratip to detect loss of protective sensation (LOPS) was tested against a neurothesiometer in an outpatient diabetic population without a history for ulceration. Our results support the use of the IpTT as a screening tool for LOPS, but not of Vibratip.

A quantitative analysis of optimum design for rigid ankle foot orthoses: The effect of thickness and reinforcement design on stiffness.

Background: An ankle foot orthosis (AFO) which is prescribed to be rigid should only deform a small amount to achieve its clinical goals. Material thickness and the design of reinforcing features can significantly affect AFO rigidity, but their selection remains based on anecdotal evidence.

Objectives: To quantify the effect of these parameters on AFO stiffness and to set the basis for quantitative guidelines for the design optimisation of rigid AFOs.

Supersonic shear wave elastography of human tendons is associated with in vivo tendon stiffness over small strains.

Supersonic shear wave (SW) elastography has emerged as a useful imaging modality offering researchers and clinicians a fast, non-invasive, quantitative assessment of tendon biomechanics. However, the exact relationship between SW speed and in vivo tendon stiffness is not intuitively obvious and needs to be verified. This study aimed to explore the validity of supersonic SW elastography against a gold standard method to measure the Achilles tendon's in vivo tensile stiffness by combining conventional ultrasound imaging with dynamometry.

Understanding occipital pressure sores in UK military casualties: a pilot study in healthy military personnel.

Introduction: The high prevalence of occipital ulcers in UK military casualties observed during the conflict in Afghanistan is a multifactorial phenomenon. However, the consensus is that ulceration is triggered by excessive pressure that is maintained for too long during the use of the general service military stretcher. Thresholds for capillary occlusion are accepted benchmarks to define excessive pressure, but similar thresholds for safe/excessive duration of pressure application do not exist.

Assessment of the effect of a total contact cast on lower limb kinematics and joint loading.

Background: Total contact casts (TCCs) are used to immobilize and unload the foot and ankle for the rehabilitation of ankle fractures and for the management of diabetic foot complications. The kinematic restrictions imposed by TCCs to the foot and ankle also change knee and hip kinematics, however, these changes have not been quantified before. High joint loading is associated with discomfort and increased risk for injuries.

Automated Method for Tracking Human Muscle Architecture on Ultrasound Scans during Dynamic Tasks.

Existing approaches for automated tracking of fascicle length (FL) and pennation angle (PA) rely on the presence of a single, user-defined fascicle (feature tracking) or on the presence of a specific intensity pattern (feature detection) across all the recorded ultrasound images. These prerequisites are seldom met during large dynamic muscle movements or for deeper muscles that are difficult to image. Deep-learning approaches are not affected by these issues, but their applicability is restricted by their need for large, manually analyzed training data sets.

Shore hardness is a more representative measurement of bulk tissue biomechanics than of skin biomechanics.

To support the effective use of Shore hardness (SH) in research and clinical practice this study investigates whether SH should be interpreted as a measurement of skin or of bulk tissue biomechanics. A 3D finite element model of the heel and a validated model of a Shore-00 durometer were used to simulate testing for different combinations of stiffness and thickness in the skin and subcutaneous tissue. The results of this numerical analysis showed that SH is significantly more sensitive to changes in skin thickness, relatively to subcutaneous tissue, but equally sensitive to changes in the stiffness of either tissue.

An in vivo model for overloading-induced soft tissue injury.

This proof-of-concept study demonstrates that repetitive loading to the pain threshold can safely recreate overloading-induced soft tissue damage and that localised tissue stiffening can be a potential marker for injury. This concept was demonstrated here for the soft tissue of the sole of the foot where it was found that repeated loading to the pain threshold led to long-lasting statistically significant stiffening in the overloaded areas. Loading at lower magnitudes did not have the same effect.

Increased exposure to loading is associated with decreased plantar soft tissue hardness in people with diabetes and neuropathy.

Aims: Literature indicates that altered plantar loading in people with diabetes could trigger changes in plantar soft tissue biomechanics which, in turn, could affect the risk for ulceration. To stimulate more research in this area, this study uses in vivo testing to investigate the link between plantar loading and tissue hardness.

Methods: Tissue hardness and plantar pressure distribution were measured for six plantar areas in 39 people with diabetes and peripheral neuropathy.

A quantitative comparison of plantar soft tissue strainability distribution and homogeneity between ulcerated and non-ulcerated patients using ultrasound strain elastography.

The primary objective of this study was to develop a method that allows accurate quantification of plantar soft tissue stiffness distribution and homogeneity. The secondary aim of this study was to investigate if the differences in soft tissue stiffness distribution and homogeneity can be detected between ulcerated and non-ulcerated foot. Novel measures of individual pixel stiffness, named as quantitative strainability (QS) and relative strainability (RS) were developed.

A novel concept for low-cost non-electronic detection of overloading in the foot during activities of daily living.

Identifying areas in the sole of the foot which are routinely overloaded during daily living is extremely important for the management of the diabetic foot. This work showcases the feasibility of reliably detecting overloading using a low-cost non-electronic technique. This technique uses thin-wall structures that change their properties differently when they are repeatedly loaded above or below a tuneable threshold.

Reliability and validity of an enhanced paper grip test; A simple clinical test for assessing lower limb strength.

Background: The paper-grip-test (PGT) involves pulling a small card from underneath the participant's foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail outcome of the PGT with a continuous measurement of the pulling force that is needed to remove the card (EPGT-force).

Comparative study of the strength characteristics of a novel wood-plastic composite and commonly used synthetic casting materials.

Background: Woodcast® is a wood-plastic composite casting material that becomes pliable and self-adhesive when heated to 65 °C and returns to being weightbearing as it cools down. The present study aims to test whether this novel non-toxic casting material is strong enough for clinical use by comparing its strength against materials that are already used in weightbearing casting applications such as total contact casts.

Methods: The strength of Woodcast® samples was compared against the strength of two commonly used synthetic casting materials (Delta-Cast®, OrthoTape).

Optimised cushioning in diabetic footwear can significantly enhance their capacity to reduce plantar pressure.

Background: Plantar pressure reduction with the use of cushioning materials play an important role in the clinical management of the diabetic foot. Previous studies in people without diabetes have shown that appropriate selection of the stiffness of such materials can significantly enhance their capacity to reduce pressure. However the significance of optimised cushioning has not been yet assessed for people with diabetic foot syndrome.

Localized pressure stimulation using turf-like structures can improve skin perfusion in the foot.

Objective: Improving perfusion under the skin can potentially reduce ulceration and amputation risk in people with diabetic foot. Localized pressure stimulation has been proven capable of improving skin perfusion in the scalp but its effectiveness for the foot has not been tested. In this study, localized pressure stimulation was realized using flexible turf-like structures (TLS) with dense vertical fibers and their ability to increase perfusion was assessed.

The relationship between hallux grip force and balance in people with diabetes.

Background: Diabetes accelerates the decline in muscle strength in older people and substantially increases the risk for fall and injury. Weakening of lower extremity muscles, in particular, is a strong predictor for falls, but currently there is no established method for its assessment in clinics. The paper grip test (PGT) offers a qualitative assessment of hallux plantar flexor strength and its usefulness for predicting falls has been demonstrated in non-diabetic populations.