Insole-Based Systems for Health Monitoring: Current Solutions and Research Challenges

Wearable health monitoring devices allow for measuring physiological parameters without restricting individuals’ daily activities, providing information that is reflective of an individual’s health and well-being. However, these systems need to be accurate, power-efficient, unobtrusive and simple to use to enable a reliable, convenient, automatic and ubiquitous means of long-term health monitoring. One such system can be embedded in an insole to obtain physiological data from the plantar aspect of the foot that can be analyzed to gain insight into an individual’s health. This manuscript provides a comprehensive review of insole-based sensor systems that measure a variety of parameters useful for overall health monitoring, with a focus on insole-based PPD measurement systems developed in recent years. Existing solutions are reviewed, and several open issues are presented and discussed. The concept of a fully integrated insole-based health monitoring system and considerations for future work are described. By developing a system that is capable of measuring parameters such as PPD, gait characteristics, foot temperature and heart rate, a holistic understanding of an individual’s health and well-being can be obtained without interrupting day-to-day activities. The proposed device can have a multitude of applications, such as for pathology detection, tracking medical conditions and analyzing gait characteristics.

Evaluating Alternatives to Locomotion Scoring for Lameness Detection in Pasture-Based Dairy Cows in New Zealand: Infra-Red Thermography

Lameness in cattle is a complex condition with huge impacts on welfare, and its detection is challenging for the dairy industry. The present study aimed to evaluate the association between foot skin temperature (FST) measured using infrared thermography (IRT) and locomotion scoring (LS) in dairy cattle kept at pasture. Data were collected from a 940-cow dairy farm in New Zealand. Cows were observed at two consecutive afternoon milkings where LS was undertaken at the first milking (4-point scale (0–3), DairyNZ). The next day, cows were thermally imaged from the plantar aspect of the hind feet using a handheld T650sc forward-looking infrared camera (IRT). The association between FST and locomotion score was analysed using a generalised linear model with an identity link function and robust estimators. ROC curves were performed to determine optimal threshold temperature cut-off values by maximising sensitivity and specificity for detecting locomotion score ≥ 2. There was a linear association between individual locomotion scores and FST. For mean temperature (MT), each one-unit locomotion score increase was associated with a 0.944 °C rise in MT. Using MT at a cut-off point of 34.5 °C produced a sensitivity of 80.0% and a specificity of 92.4% for identifying cows with a locomotion score ≥ 2 (lame). Thus, IRT has a substantial potential to be used on-farm for lameness detection. However, automation of the process will likely be necessary for IRT to be used without interfering with farm operations.

A Huge Plantar Intramuscular Hemangioma in the Plantar Area Treated Surgically: A Case Report and Literature Review

Intramuscular hemangioma (IH) is rare, accounting for only 0.8% of all hemangioma cases. In particular, IH of the foot has only been reported a few times. In such cases, the symptoms typically include tenderness and swelling, often in relation to physical activity, but tingling or impaired function may also be present. Here, we report a patient who presented with a significant IH in the plantar area treated surgically. A 25-year-old female visited our hospital with pain in the plantar aspect of the right foot. She had noticed a mass about 10 years prior. She had previously experienced pain only when pressing the mass, but the pain subsequently became more regular pain and was exacerbated by exercise. In fact, the pain became so intense that she could not sleep well. Upon physical examination, mild swelling and tenderness of the plantar area were noted in the second to the fourth metatarsal. Sensation and motor reflexes were normal and the results of Tinel’s test were negative. Plain radiographs of the right foot revealed phleboliths scattered throughout the first to third intermetatarsal spaces. Magnetic resonance imaging revealed a space-occupying multilobulated mass (5.6 × 2.8 × 2.5 cm) located in the flexor digitorum brevis (FDB) muscle, which penetrated the plantar fascia and spread to the subcutaneous layer. In T2-weighted images, the lesion displayed a hyperintense signal compared to the surrounding skeletal muscle. Based on radiological findings, we suspected IH. The mass surrounded by the FDB muscle was exposed and completely removed via wide excision. IH consisting of cavernous-like vascular structures was diagnosed on pathology. At 1-year follow-up, the patient was almost asymptomatic and had recovered almost full range of motion in the plantar area. Histological analysis and surgery are recommended to remove intramuscular hemangiomas in the plantar area, but if the patient is not suitable for surgery, sclerotherapy or combination treatment should also be considered.

Plantar Papules and Plaques: A Dermoscopic-Histopathological Correlation

Background: Painful lesions affecting the plantar aspect of the foot are routinely encountered in daily practice, and plantar wart, corn, and callus are the most common conditions. Although the clinical examination is sufficient to clinch an accurate diagnosis, atypical presentations indicate the need for invasive investigations like skin biopsy. Here we evaluated dermoscopic patterns of painful lesions affecting the plantar surface. Objectives: The current study aimed to, firstly, investigate the dermoscopic patterns and differentiate between painful papules and plaques on the foot, and, secondly, to analyze the histopathological correlation of these dermoscopic patterns. Methods: Following a cross-sectional design, the current study was carried out on patients with the clinical diagnosis of painful lesions of foot suggestive of plantar wart, corn, and callus referring to a tertiary care center from June 2019 to Jan 2020. Dermoscopy analysis and biopsy were performed for all participants. Results: Among 92 patients with painful plantar lesions, 56, 22, and 15 had a plantar wart, corn, and callus, respectively. Dermoscopy of warts revealed red dots (89.28%) and yellow halo (82.14%). A translucent central core (100%) and whitish ring (81.81%) on dermoscopy of patients with corn. Dermoscopy of callus demonstrated opaque yellow area in all (100%) the patients. Dermatoglyphics were absent in plantar wart in contrast to corn and callus, wherein they were preserved. Conclusions: Dermoscopy can be considered as a rapid, non-invasive, diagnostic tool in the daily practice of a dermatologist. Here, it assisted in distinguishing clinically akin painful plantar papules and plaques. These dermoscopic patterns also were well correlated histopathologically.

An Ayurvedic Approach to Vipadika (Palmoplantar Psoriasis): A Case Study

Ayurveda includes all the skin diseases under the broad name Kushta (Skin Diseases). There are 18 types of skin diseases were described in Ayurved Samhitas. Out of which 11 are Kshudra Kushta. Vipadika (Palmoplantar psoriasis) is one of them. Different Acharyas have given different presentations of signs and symptoms of Vipadika. According to Ashtang hridaya, Panipadsputana (Cracks over palms and soles), Tivra Vedana (severe Pain), Manda Kandu (Mild Itching), and Sarag Pidika (Red-colored Macule) are the symptoms of Vipadika. This skin disease hampers day-to-day activity and depresses patients because of cosmetic issues. This case was about a woman of age 55 years having Itching on the plantar aspect of both feet, cracks over soles, burning sensation, and pain during walking. There was no previous history of any systemic disease. The patient had not undergone any surgical procedure. The patient used to eat pickles twice a day on daily basis. At the first follow-up, the burning sensation was reduced. Then the cracks, itching, and pain during walking reduced with consecutive follow-ups. Raktmokshan (Leech therapy) was planned after every 15 days. Total treatment was about 3 months with a follow-up of 15 days. With this treatment protocol, the patient got completely relieved from all parameters.

A COMPARATIVE STUDY OF PLATELET RICH PLASMA DRESSING VS NORMAL SALINE DRESSING IN THE MANAGEMENT OF DIABETIC FOOT ULCER

90 patients with diabetic foot ulcer admitted in Department of General Surgery R. L. JALAPPA HOSPITAL, TAMAKA, KOLAR, in between the study period of December 2017 to June 2019. The study is estimated to include diabetic foot ulcer patients satisfying inclusion criteria who are admitted in surgical wards of RLJH and RC. A complete detailed history, as per standard proforma will be obtained and documented. All patients will undergo clinical examination with relevant investigations after obtaining an informed consent. Patients are divided into 2 groups using even-odd method to include similar type of cases in both groups, where even group is study group and odd group is control group. RESULTS: Predisposition of diabetic foot ulcer was common among males than in females, More number of diabetic patients presented with diabetic foot ulcer arising from trauma than those occurring spontaneously. The spontaneous onset ulcers healed better with PRP than those arising due to traumatic onset. The ulcers on dorsal aspect heal faster than on plantar aspect, PRP dressing improved the rate of healing in lower Wagner grade ulcer than in higher grade ulcer, Patients who were on insulin alone showed better healing than those on OHA. Over all PRP dressing group showed higher rate of ulcer size reduction than those on saline dressing. CONCLUSION: The diabetic ulcer in the study group treated with PRP dressing contracted in wound size more than in the control group. This indicates that PRP dressing is an effective method to facilitate wound contraction in diabetic patients with foot ulcer. PRP dressing is found to be more effective, cost efcient and safe promoter of ulcer wound healing and can be used as an adjunct to saline dressings for enhanced healing of diabetic wounds.

Conservative Treatment for Primary Metatarsalgia

Metatarsalgia is one of the most common causes of forefoot pain, and it is characterized by pain in the front part of the foot under the head of the metatarsal bones. Primary metatarsalgia is idiopathic, but it has been suggested to be related to forefoot plantar compression. Because of the various causes of metatarsalgia, there is the need to thoroughly consider the etiology of metatarsalgia to find novel, effective, and conservative treatments for metatarsalgia to avoid surgical treatment. Pressure reduction or redistribution can be achieved using toe exercise, flat shoe inserts, metatarsal pads, custom-molded inserts, and rockerbars. There was no need for one treatment. If toe function was poor, toe exercises were recommended. If dorsiflexion of the ankle joint was limited, the Achilles tendon was stretched. If the pain was localized to the plantar aspect of the 2nd MTP, a decompression insole was applied. If the pain was limited to the plantar aspect of the 2nd MTP, a decompression insole was worn. If swelling occurred, anti-inflammatory drugs were indicated to reduce inflammation. The combination of the two was appropriate for this condition. Toe exercises can improve balance and are worth trying. An in-depth understanding of the various etiologies of metatarsal and toe deformities is essential for successful treatment.

546 Management of Pediatric Pavement Burns

Introduction Pavement burns are common in a dry high heat climate. This study reviews the etiology, management and outcome of pavement burns in children. Methods All patients age < 18 who suffered contact burns from hot pavement from Jan 1, 2014 to Dec 31, 2019 were reviewed. A total of 45 patient charts met inclusion criteria. High ambient temperature on each date, and zip code of each injury was extracted from Weather Underground (www.wunderground.com) Results In this study, 45 patients met criteria and were reviewed, of whom 27 patients (60%) were male. Average age was 3.29 years (SD 0.69), made up two discrete age groups: age under 3 (n= 40, 89%) and 14+ (n=5, 11%). 38 patients (84%) had no known medical history. All had 2nd degree burns and one patient (2%) had third degree burns. Mean total body surface area (TBSA) was 2.5% (SD 1.4%, range 0.75% to 5.5%). Burn etiology included 31 patients (69%) walking barefoot on pavement, 6 (13%) falling onto pavement, and other/unknown etiology for the remaining 8 patients (18%). 30 patients (67%) had injuries on the plantar aspect of bilateral feet, 2 (4%) to bilateral palms of hands, 4 (9%) to other parts of upper extremities and 10 (22%) to other parts of lower extremities. Thirty-four (34) patients (76%) were managed without any hospitalization. Those that were hospitalized had an average length of stay (LOS) of 2.72 days (range 1–9 days). All burns were managed non-operatively with topical therapy alone. 35 patients (78%) were managed initially with Silvadene, and 6 (13%) with bacitracin. Aquacel was utilized in 10 patients at a follow-up visit (22%). Three patients (6.7%) were treated with collagenase enzyme therapy. One patient developed a superficial infection requiring oral antibiotic therapy. There were no mortalities in this group. The high ambient temperature on date and location of each injury was 101 F (SD 1.10 F, range 73F-111F). Of the thirty that continued to follow up in clinic, the average time to the burn being 95% healed was 10.50 days (SD 8.97 days, range 2–40 days). Conclusions Pavement burns in children are partial thickness and are safely managed with topical therapy alone, with good outcomes. Patients age 3 and under are a vulnerable population and therefore at particular risk of injury.

Three-dimensional analysis of anterior talofibular ligament strain patterns during cadaveric ankle motion using a miniaturized ligament performance probe

Background Measuring the strain patterns of ligaments at various joint positions informs our understanding of their function. However, few studies have examined the biomechanical properties of ankle ligaments; further, the tensile properties of each ligament, during motion, have not been described. This limitation exists because current biomechanical sensors are too big to insert within the ankle. The present study aimed to validate a novel miniaturized ligament performance probe (MLPP) system for measuring the strain patterns of the anterior talofibular ligament (ATFL) during ankle motion. Methods Six fresh-frozen, through-the-knee, lower extremity, cadaveric specimens were used to conduct this study. An MLPP system, comprising a commercially available strain gauge (force probe), amplifier unit, display unit, and logger, was sutured into the midsubstance of the ATFL fibers. To measure tensile forces, a round, metal disk (a “clock”, 150 mm in diameter) was affixed to the plantar aspect of each foot. With a 1.2-Nm load applied to the ankle and subtalar joint complex, the ankle was manually moved from 15° dorsiflexion to 30° plantar flexion. The clock was rotated in 30° increments to measure the ATFL strain detected at each endpoint by the miniature force probe. Individual strain data were aligned with the neutral (0) position value; the maximum value was 100. Results Throughout the motion required to shift from 15° dorsiflexion to 30° plantar flexion, the ATFL tensed near 20° (plantar flexion), and the strain increased as the plantar flexion angle increased. The ATFL was maximally tensioned at the 2 and 3 o’clock (inversion) positions (96.0 ± 5.8 and 96.3 ± 5.7) and declined sharply towards the 7 o’clock position (12.4 ± 16.8). Within the elastic range of the ATFL (the range within which it can return to its original shape and length), the tensile force was proportional to the strain, in all specimens. Conclusion The MLPP system is capable of measuring ATFL strain patterns; thus, this system may be used to effectively determine the relationship between limb position and ATFL ankle ligament strain patterns.