Structural integrity of custom-designed additive manufactured prosthetic sockets compared to traditional sockets

Over the past decades, the number of patients with lower extremity amputation increased world-wide. The increasing rate of patients, particularly in developing countries, has led to limited access to clinics and services for prosthetic and orthotic care. Additive manufacturing has rapidly evolved over the last decade and is opening new possibilities for prosthetics and orthotics. 3D printed prosthetic sockets are a promising solution to reduce access- or cost-related barriers to prosthesis use since 3D printed prosthetic sockets can be manufactured at an affordable cost and quickly delivered to patients. We sought to compare the ultimate strength of 3D printed sockets made of different filaments (polyethylene terephthalate glycol, polycarbonate, and co-polymer polypropylene) with that of traditionally fabricated sockets (laminated composite sockets and thermoplastic sockets) and to examine whether the strength of 3D printed sockets could be improved through iterative design changes focused on reinforcing the distal end of the socket. All sockets were mechanically tested in accordance with ISO 10328 standards. Although the strength of all of the 3D printed sockets was weaker than that of laminated composite sockets, design modifications to reinforce the distal end improved the strength of 3D printed sockets made of polycarbonate and polypropylene (but not polyethylene terephthalate glycol), resulting in ultimate strengths and stiffnesses that were comparable to the traditionally fabricated thermoplastic socket. In addition, our results demonstrated that socket failure occurred mainly at the distal end regardless of material type. The strength of some 3D printed sockets under limited testing conditions showed promise to be used for clinical purpose, especially when the socket was reinforced with distal struts

A Growing Troubling Triad: Diabetes, Aging, and Falls

There is a significant and troubling link between diabetes (DM) and falls in the elderly. Individuals with DM are prone to fall for reasons such as decreased sensorimotor function, musculoskeletal/neuromuscular deficits, foot and body pain, pharmacological complications, and specialty (offloading) footwear devices. Additionally, there is some concern that DM patients are prone to have more severe problems with falls than non-DM individuals. Fractures, poorer rehabilitation, and increased number of falls are all concerns. Fortunately, efforts to mitigate falls by DM patients show promise. A number of studies have shown that balance, strength, and gait training may be utilized to successfully reduce fall risk in this population. Furthermore, new technologies such as virtual reality proprioceptive training may be able to provide this reduced risk within a safe training environment

A Growing Troubling Triad: Diabetes, Aging, and Falls

There is a significant and troubling link between diabetes (DM) and falls in the elderly. Individuals with DM are prone to fall for reasons such as decreased sensorimotor function, musculoskeletal/neuromuscular deficits, foot and body pain, pharmacological complications, and specialty (offloading) footwear devices. Additionally, there is some concern that DM patients are prone to have more severe problems with falls than non-DM individuals. Fractures, poorer rehabilitation, and increased number of falls are all concerns. Fortunately, efforts to mitigate falls by DM patients show promise. A number of studies have shown that balance, strength, and gait training may be utilized to successfully reduce fall risk in this population. Furthermore, new technologies such as virtual reality proprioceptive training may be able to provide this reduced risk within a safe training environment

An immediate effect of custom-made ankle foot orthoses on postural stability in older adults

AbstractBackgroundFoot and ankle problems are highly prevalent fall risks in the elderly. Ankle foot orthoses designed to stabilize the foot and ankles have been studied within specific patient groups, but their efficacy with a less restrictive elderly population is unknown. This study investigated if custom-made ankle foot orthoses improve postural stability in older adults.MethodsThirty ambulatory older adults averaged 73 (standard deviation=6.5) years completed Romberg's balance (eyes-open/eyes-closed), functional reach, and Timed Up and Go tests while wearing validated kinematic sensors. Each test was completed in standardized shoes with and without bilateral orthoses. Additionally, barefoot trials were conducted for the Romberg's and functional reach tests.FindingsCompared to the barefoot and ‘shoes alone’ conditions, the orthoses reduced center of mass sway on average by 49.0% (P=0.087) and 40.7% (P=0.005) during eyes-open balance trials. The reduction was amplified during the eyes-closed trials with average reductions of 65.9% (P=0.000) and 47.8% (P=0.004), compared to barefoot and ‘shoes alone’ conditions. The orthoses did not limit functional reach distance nor timed-up and go completion times. However, the medial-lateral postural coordination while reaching was improved significantly with orthoses compared to barefoot (14.3%; P=0.030) and ‘shoes alone’ (13.5%; P=0.039) conditions.InterpretationAnkle foot orthoses reduced postural sway and improved lower extremity coordination in the elderly participants without limiting their ability to perform a standard activity of daily living. Additional studies are required to determine if these benefits are retained and subsequently translate into fewer falls

Control of lower extremity edema in patients with diabetes: double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks

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Feasibility of a low intensity, technology-based intervention for increasing physical activity in adults at risk for a diabetic foot ulcer: a mixed methods study.

Symposium/Special IssueBackground: Among adults with diabetes, 19-34% will develop a diabetic foot ulcer (DFU), which increases amputation risk and health care costs, and worsens quality of life. Regular physical activity, when increased gradually, may help prevent DFUs. In this mixed-methods study, we examined the feasibility of a low-intensity, technology-based behavioral intervention to increase activity in adults at risk for DFUs. Method: Participants at risk for a DFU (n = 12; 66% female; mean age = 59.9 years) received four in-person exercise and behavioral counseling sessions over 2-3 weeks, supplemented with use of an activity monitor (to track steps) and text messages (to reinforce behavioral strategies) for an added 8 weeks. Pre- and postintervention assessments of accelerometer measured activity, daily mobility, and glycemic control (A1C) were completed. Treatment acceptability was assessed by questionnaire and via key informant interview. Results: The program appears feasible since all but one participant attended all four sessions, all used the activity monitor and all responded to text messages. Treatment acceptability (scale: 1 = very dissatisfied, 5 = extremely satisfied) was high; average item ratings were 4.79 (SD = 0.24). Participants increased their steps by an average of 881.89 steps/day (d = 0.66). A1C decreased on average by 0.33% (d = 0.23). Daily mobility did not change. Interview results suggest that participants perceived benefits from the intervention. Participant recommended improvements included providing more physical activity information, addressing pain, and intervention delivery in a podiatry clinic. Conclusion: Individuals at risk for a DFU might benefit from a minimally intensive, technology-based intervention to increase their physical activity. Future research comparing the intervention to usual care is warranted.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by a DePaul University–Rosalind Franklin University of Medicine and Science Collaborative Pilot Project to KLSchneider, RTCrews, EMoxley, and SHwang