title: Clinical workflow for personalized foot pressure ulcer prevention.
abstract: Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and "cluster volumes" (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer.
authors.affiliation: TexiSense, Montceau-les-Mines, France . Electronic address: marek.bucki@texisense.com.
authors.forename: M
authors.initials: M
authors.lastname: Bucki
authors.affiliation: TexiSense, Montceau-les-Mines, France . Electronic address: vincent.luboz@texisense.com.
authors.forename: V
authors.initials: V
authors.lastname: Luboz
authors.affiliation: TexiSense, Montceau-les-Mines, France ; Univ. Grenoble Alpes & CNRS, TIMC-IMAG, F-38000 Grenoble, France; UJF-Grenoble1/AGEIS, Grenoble F-38041, France. Electronic address: antoine.perrier@texisense.com.
authors.forename: A
authors.initials: A
authors.lastname: Perrier
authors.affiliation: TexiSense, Montceau-les-Mines, France . Electronic address: eric.champion@texisense.com.
authors.forename: E
authors.initials: E
authors.lastname: Champion
authors.affiliation: UJF-Grenoble1/AGEIS, Grenoble F-38041, France; IDS, Montceau-les-Mines, France. Electronic address: b.diot@ids-assistance.com.
authors.forename: B
authors.initials: B
authors.lastname: Diot
authors.affiliation: UJF-Grenoble1/AGEIS, Grenoble F-38041, France; Institut Universitaire de France, Paris, France. Electronic address: Nicolas.Vuillerme@agim.eu.
authors.forename: N
authors.initials: N
authors.lastname: Vuillerme
authors.affiliation: Univ. Grenoble Alpes & CNRS, TIMC-IMAG, F-38000 Grenoble, France. Electronic address: yohan.payan@imag.fr.
authors.forename: Y
authors.initials: Y
authors.lastname: Payan
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D005528:Foot / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D066230:Patient-Specific Modeling; D003668:Pressure Ulcer / Q000000981:diagnostic imaging / Q000517:prevention & control*; D018570:Risk Assessment; D013314:Stress, Mechanical; D014057:Tomography, X-Ray Computed
keywords: Finite element method; Foot pressure ulcer; Patient-specific; Soft tissues