A review of foot finite element modelling for pressure ulcer prevention in bedrest: Current perspectives and future recommendations. Issue 1 (February 2022)

• Record Type: Journal Article
• Authors: Keenan, Bethany E.; Evans, Sam L.; Oomens, Cees W.J.
• Is Part Of: Journal of tissue viability. Volume 31:Issue 1(2022)
• Page Start: 73
• Page End: 83
• Publication Date: 2022-02
• Subjects: Biomechanics -- Decubitus -- Finite element modelling -- Pressure ulcers -- Prevention; Wounds and injuries -- Periodicals; Ulcers -- Periodicals; Bedsores -- Periodicals; Bedsores; Ulcers; Wounds and injuries; Electronic journals; Periodicals; 617.1406
• DOI: 10.1016/j.jtv.2021.06.004
• Languages: English
• ISSNs: 0965-206X

Abstract

Abstract: Pressure ulcers (PUs) are a major public health challenge, having a significant impact on healthcare service and patient quality of life. Computational biomechanical modelling has enhanced PU research by facilitating the investigation of pressure responses in subcutaneous tissue and skeletal muscle. Extensive work has been undertaken on PUs on patients in the seated posture, but research into heel ulcers has been relatively neglected. The aim of this review was to address the key challenges that exist in developing an effective FE foot model for PU prevention and the confusion surrounding the wide range of outputs reported. Nine FE foot studies investigating heel ulcers in bedrest were identified and reviewed. Six studies modelled the posterior part of the heel, two included the calf and foot, and one modelled the whole body. Due to the complexity of the foot anatomy, all studies involved simplification or assumptions regarding parts of the foot structure, boundary conditions and material parameters. Simulations aimed to understand better the stresses and strains exhibited in the heel soft tissues of the healthy foot. The biomechanical properties of soft tissue derived from experimental measurements are critical for developing a realistic model and consequently guiding clinical decisions. Yet, little to no validation was reported in each of the studies. If FE models are to address future research questions and clinical applications, then sound verification and validation of these models is required to ensure accurate conclusions and prediction of patient outcomes. Recommendations and considerations for future FE studies are therefore proposed. Highlights: Nine FE foot models for pressure ulcer prevention in bedrest exist, yet all produce conflicting results. It is difficult to draw clear clinical conclusions due to the methodological limitations. Internal soft tissue strains are influenced by foot posture, slope and stiffness of the mattress. The limited number of studies emphasise the need for further research in order to provide valuable clinical conclusions. Recommendations for future FEA of the foot in bedrest are presented.