{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T11:56:06Z","timestamp":1793188566506,"version":"4.5.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Shanghai Science and Technology Development Funds","award":["No. 20S31901000"],"award-info":[{"award-number":["No. 20S31901000"]}]},{"name":"Shanghai Science and Technology Development Funds","award":["No. 21511102200"],"award-info":[{"award-number":["No. 21511102200"]}]},{"name":"Medical Engineering Fund of Fudan University","award":["No. yg2021-019"],"award-info":[{"award-number":["No. yg2021-019"]}]},{"name":"National Key Research and Development Project","award":["2021YFC200235"],"award-info":[{"award-number":["2021YFC200235"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Proc Inst Mech Eng H"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>To effectively mitigate detrimental tissue stresses of the diabetic foot for preventing ulceration, contemporary strategies frequently utilize pressure-relief insoles. In this study, we have developed an innovative enhanced pressure-relief insole that integrate auxetic structures with a reverse graded-stiffness property. We introduce a novel modification to the insole internal structure, exhibiting untraditional regional stiffness from the center to the periphery. We utilize a validated finite element (FE) heel model of a diabetic patient to evaluate the effectiveness of the insole, computing internal stress of the heel (peak stresses, total stress concentration exposure, pressure on the fat pad, and tensile stress on the skin) and insole deformation. In addition, we conduct in-vitro uniaxial compression and in-vivo biomechanical experiments to assess its effects in static and gait. The FE results showed a significant reduction in internal stress within high-risk ulcer areas of the heel, with peak internal stresses reduced to 232.9\u2009kPa (without insole: 374.6\u2009kPa), and notable changes in the deformation across the insole\u2019s coronal plane. Additionally, uniaxial tensile tests demonstrated optimal energy dissipation at 28.76%. During gait, the auxetic insole resulted in a 19.72% reduction in peak pressure and 15.37% reduction in peak pressures-time integral compared to the conventional insole. A novel insole with auxetic structure and reverse graded-stiffness appear to better relieve the internal loads, gait-related pressure as well as enhanced energy dissipation for the plantar soft tissue under bony prominence of calcaneus of human foot. This research also holds substantial promise for optimizing other pressure-relief orthotic devices.<\/jats:p>","DOI":"10.1177\/09544119251350412","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T03:00:03Z","timestamp":1751598003000},"page":"666-675","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["An auxetic insole design with reverse graded-stiffness to relieve detrimental tissue stresses under bony prominence of calcaneus in diabetic foot"],"prefix":"10.1177","volume":"239","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1938-0495","authenticated-orcid":false,"given":"Xingyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Huashan Hospital Affiliated to Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Huashan Hospital Affiliated to Fudan University, Shanghai, China"},{"name":"The National Center for Orthopedics, The Sixth People\u2019s Hospital Affiliated to Medical College of Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering and Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-04145-4.50013-2"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/10255842.2017.1370458"},{"key":"e_1_3_2_5_2","first-page":"50","article-title":"Diabetic heel ulcers a major risk factor for lower extremity amputation","volume":"50","author":"Younes NA","year":"2004","unstructured":"Younes NA, Albsoul AM., Awad H. 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