title: Wear and biomechanical characteristics of a novel shear-reducing insole with implications for high-risk persons with diabetes.
abstract: OBJECTIVE
  This study was designed to measure pressure and shear reduction of a novel insole design.
  
  
  METHODS
  We compared three multilayer viscoelastic insoles to a novel insole design (Glide-Soft, Xilas Medical, Inc., San Antonio, TX). The bottom pad of each insole was fabricated from firm-density Plastazote [Apex Foot Products (now Aetrex), South Hackensack, NJ] with an upper of Plastazote, ethyl vinyl acetate, or PORON (Langer Biomechanics Group, Inc., Deer Park, NY). The GlideSoft design used the same materials with two intervening thin sheets of a low friction material. We measured foot pressures, shear, and material stiffness prospectively as the insoles aged during daily usage in 30 healthy adults. We used the F-Scan (Tekscan, Inc., Boston, MA) to determine in-shoe foot pressures and the Automated Stress-relaxation Creep Indenter System (Xilas Medical) to measure material stiffness. To evaluate shear force, the insole was placed on the slide assembly of a custom-designed shear tester equipped with a reciprocating mechanism and force transducers.
  
  
  RESULTS
  The GlideSoft exhibited 57% less peak shear force than the standard insole (P < 0.05) in laboratory testing under simulated conditions. Ethyl vinyl acetate had higher compressive stiffness values than Plastazote and PORON at all test intervals (P < 0.05). There were no statistical differences between any of the insoles for peak in-shoe pressure measurements (P > 0.05).
  
  
  CONCLUSIONS
  The GlideSoft design demonstrated a significant reduction in shear while maintaining equivalent pressure reduction compared with standard insole designs with three different material combinations for up to 320,000 steps.
authors.affiliation: Texas A&M Health Science Center College of Medicine, Department of Surgery, Scott and White Hospital, Temple, TX 76508, USA. llavery@swmail.sw.org
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.forename: Dan R
authors.initials: DR
authors.lastname: Lanctot
authors.forename: George
authors.initials: G
authors.lastname: Constantinides
authors.forename: Ruben G
authors.initials: RG
authors.lastname: Zamorano
authors.forename: Kyriacos A
authors.initials: KA
authors.lastname: Athanasiou
authors.forename: C Mauli
authors.initials: CM
authors.lastname: Agrawal
mesh_terms: D017719:Diabetic Foot / Q000503:physiopathology*; D004548:Elasticity; D016523:Foot Ulcer / Q000517:prevention & control*; D006801:Humans; D033081:Shear Strength; D012775:Shoes; D013718:Tensile Strength; D014783:Viscosity