{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T05:43:11Z","timestamp":1770529391424,"version":"3.49.0"},"reference-count":38,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Invention for Innovation (i4i) Programme","award":["NIHR201315"],"award-info":[{"award-number":["NIHR201315"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Pressure coupled with shear stresses are the critical external factors for diabetic foot ulceration assessment and prevention. To date, a wearable system capable of measuring in-shoe multi-directional stresses for out-of-lab analysis has been elusive. The lack of an insole system capable of measuring plantar pressure and shear hinders the development of an effective foot ulcer prevention solution that could be potentially used in a daily living environment. This study reports the development of a first-of-its-kind sensorised insole system and its evaluation in laboratory settings and on human participants, indicating its potential as a wearable technology to be used in real-world applications. Laboratory evaluation revealed that the linearity error and accuracy error of the sensorised insole system were up to 3% and 5%, respectively. When evaluated on a healthy participant, change in footwear resulted in approximately 20%, 75% and 82% change in pressure, medial\u2013lateral and anterior\u2013posterior shear stress, respectively. When evaluated on diabetic participants, no notable difference in peak plantar pressure, as a result of wearing the sensorised insole, was measured. The preliminary results showed that the performance of the sensorised insole system is comparable to previously reported research devices. The system has adequate sensitivity to assist footwear assessment relevant to foot ulcer prevention and is safe to use for people with diabetes. The reported insole system presents the potential to help assess diabetic foot ulceration risk in a daily living environment underpinned by wearable pressure and shear sensing technologies.<\/jats:p>","DOI":"10.3390\/s23063126","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T05:22:59Z","timestamp":1678857779000},"page":"3126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["A Wearable Insole System to Measure Plantar Pressure and Shear for People with Diabetes"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3359-5891","authenticated-orcid":false,"given":"Jinghua","family":"Tang","sequence":"first","affiliation":[{"name":"School of Engineering, University of Southampton, Southampton SO17 1BJ, UK"}]},{"given":"Dan L.","family":"Bader","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK"}]},{"given":"David","family":"Moser","sequence":"additional","affiliation":[{"name":"School of Engineering, University of Southampton, Southampton SO17 1BJ, UK"}]},{"given":"Daniel J.","family":"Parker","sequence":"additional","affiliation":[{"name":"School of Health and Society, University of Salford, Salford M6 6PU, UK"}]},{"given":"Saeed","family":"Forghany","sequence":"additional","affiliation":[{"name":"School of Allied Health Professions, Keele University, Keele, Newcastle ST5 5BG, UK"}]},{"given":"Christopher J.","family":"Nester","sequence":"additional","affiliation":[{"name":"School of Allied Health Professions, Keele University, Keele, Newcastle ST5 5BG, UK"}]},{"given":"Liudi","family":"Jiang","sequence":"additional","affiliation":[{"name":"School of Engineering, University of Southampton, Southampton SO17 1BJ, UK"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic Foot Ulcers and Their Recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5S","DOI":"10.1016\/S0002-9610(98)00181-0","article-title":"The Burden of Diabetic Foot Ulcers","volume":"176","author":"Reiber","year":"1998","journal-title":"Am. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13047-020-00383-2","article-title":"Five Year Mortality and Direct Costs of Care for People with Diabetic Foot Complications Are Comparable to Cancer","volume":"13","author":"Armstrong","year":"2020","journal-title":"J. Foot Ankle Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/dmrr.2738","article-title":"A Shift in Priority in Diabetic Foot Care and Research: 75% of Foot Ulcers Are Preventable","volume":"32","author":"Bus","year":"2016","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e3270","DOI":"10.1002\/dmrr.3270","article-title":"Prevention of Foot Ulcers in the at-Risk Patient with Diabetes: A Systematic Review","volume":"36","author":"Raspovic","year":"2020","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Nasser, A.R., Hasan, A.M., Humaidi, A.J., Alkhayyat, A., Alzubaidi, L., Fadhel, M.A., Santamar\u00eda, J., and Duan, Y. (2021). Iot and Cloud Computing in Health-Care: A New Wearable Device and Cloud-Based Deep Learning Algorithm for Monitoring of Diabetes. Electronics, 10.","DOI":"10.3390\/electronics10212719"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"732753","DOI":"10.3389\/fbioe.2021.732753","article-title":"The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes","volume":"9","author":"Balasubramanian","year":"2021","journal-title":"Front. Bioeng. Biotechnol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"107815","DOI":"10.1016\/j.jdiacomp.2020.107815","article-title":"In-Shoe Pressure Thresholds for People with Diabetes and Neuropathy at Risk of Ulceration: A Systematic Review","volume":"35","author":"Jones","year":"2021","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e308","DOI":"10.1016\/S2589-7500(19)30128-1","article-title":"Innovative Intelligent Insole System Reduces Diabetic Foot Ulcer Recurrence at Plantar Sites: A Prospective, Randomised, Proof-of-Concept Study","volume":"1","author":"Abbott","year":"2019","journal-title":"Lancet Digit. Health"},{"key":"ref_10","unstructured":"Haesler, E. (2014). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide, NPUAP."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12938-018-0470-z","article-title":"Technologies to Monitor the Health of Loaded Skin Tissues","volume":"17","author":"Bader","year":"2018","journal-title":"Biomed. Eng. Online"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e3269","DOI":"10.1002\/dmrr.3269","article-title":"Guidelines on the Prevention of Foot Ulcers in Persons with Diabetes (Iwgdf 2019 Update)","volume":"36","author":"Bus","year":"2020","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.clinbiomech.2013.11.003","article-title":"American Society of Biomechanics Clinical Biomechanics Award 2012: Plantar Shear Stress Distributions in Diabetic Patients with and without Neuropathy","volume":"29","author":"Yavuz","year":"2014","journal-title":"Clin. Biomech."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100298","DOI":"10.1016\/j.sbsr.2019.100298","article-title":"A Low-Cost and Highly Integrated Sensing Insole for Plantar Pressure Measurement","volume":"26","author":"Zhang","year":"2019","journal-title":"Sens. Bio-Sens. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1038\/s41378-020-0171-1","article-title":"Real-Time Pressure Mapping Smart Insole System Based on a Controllable Vertical Pore Dielectric Layer","volume":"6","author":"Tao","year":"2020","journal-title":"Microsyst. Nanoeng."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Martini, E., Fiumalbi, T., Dell, F., Ivanic, Z., Munih, M., Vitiello, N., and Crea, S. (2020). Pressure-Sensitive Insoles for Real-Time Gait-Related Applications. Sensors, 20.","DOI":"10.3390\/s20051448"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"9104","DOI":"10.1109\/JSEN.2022.3162713","article-title":"A Portable Insole System to Simultaneously Measure Plantar Pressure and Shear Stress","volume":"22","author":"Wang","year":"2022","journal-title":"IEEE Sens. J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Amemiya, A., Noguchi, H., Oe, M., Sanada, H., and Mori, T. (2016, January 16\u201320). Establishment of a Measurement Method for in-Shoe Pressure and Shear Stress in Specific Regions for Diabetic Ulcer Prevention. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Orlando, FL, USA.","DOI":"10.1109\/EMBC.2016.7591187"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40648-014-0004-9","article-title":"Development and Evaluation of a System to Assess the Effect of Footwear on the in Shoe Plantar Pressure and Shear During Gait","volume":"1","author":"Takano","year":"2014","journal-title":"ROBOMECH J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.medengphy.2016.04.007","article-title":"A Pressure and Shear Sensor System for Stress Measurement at Lower Limb Residuum\/Socket Interface","volume":"38","author":"Laszczak","year":"2016","journal-title":"Med. Eng. Phys."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1177\/09544119221110712","article-title":"Analysis of Lower Limb Prosthetic Socket Interface Based on Stress and Motion Measurements","volume":"236","author":"Tang","year":"2022","journal-title":"Proc. Inst. Mech. Eng. Part H"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.medengphy.2014.10.002","article-title":"Development and Validation of a 3d-Printed Interfacial Stress Sensor for Prosthetic Applications","volume":"37","author":"Laszczak","year":"2015","journal-title":"Med. Eng. Phys."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13047-020-0369-3","article-title":"Ulcer Metastasis? Anatomical Locations of Recurrence for Patients in Diabetic Foot Remission","volume":"13","author":"Petersen","year":"2020","journal-title":"J. Foot Ankle Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.clinbiomech.2016.07.003","article-title":"Foot Dimensions and Morphology in Healthy Weight, Overweight and Obese Males","volume":"37","author":"Price","year":"2016","journal-title":"Clin. Biomech."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13047-018-0271-4","article-title":"An Anatomically-Based Masking Protocol for the Assessment of in-Shoe Plantar Pressure Measurement of the Forefoot","volume":"11","author":"Forghany","year":"2018","journal-title":"J. Foot Ankle Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.fas.2009.05.006","article-title":"Repeatability of the Pedar-X in-Shoe Pressure Measuring System","volume":"16","author":"Ramanathan","year":"2010","journal-title":"Foot Ankle Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2116","DOI":"10.1016\/j.jbiomech.2012.05.038","article-title":"Spatial Resolution in Plantar Pressure Measurement Revisited","volume":"45","author":"Pataky","year":"2012","journal-title":"J. Biomech."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Pabon-Carrasco, M., Reina-Bueno, M., Vilar-Palomo, S., Palomo-Toucedo, I.C., Ramos-Ortega, J., and Juarez-Jimenez, J.M. (2020). Analysis and Assessment through Mechanical Static Compression Tests of Damping Capacity in a Series of Orthosis Plantar Materials Used as Supports. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18010115"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"15395","DOI":"10.1038\/s41598-022-19814-0","article-title":"Effects of Contoured Insoles with Different Materials on Plantar Pressure Offloading in Diabetic Elderly During Gait","volume":"12","author":"Shi","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Parker, D., Andrews, J., and Price, C. (2023). Validity and Reliability of the Xsensor in-Shoe Pressure Measurement System. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0277971"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13047-017-0208-3","article-title":"Optimisation of Rocker Sole Footwear for Prevention of First Plantar Ulcer: Comparison of Group-Optimised and Individually-Selected Footwear Designs","volume":"10","author":"Preece","year":"2017","journal-title":"J. Foot Ankle Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1007\/s13300-017-0295-y","article-title":"Diabetic Neuropathy and Gait: A Review","volume":"8","author":"Alam","year":"2017","journal-title":"Diabetes Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"025701","DOI":"10.1088\/1361-6501\/ab4453","article-title":"Plantar Pressure and Shear Measurement Using Surface Stress-Sensitive Film","volume":"31","author":"Goss","year":"2020","journal-title":"Meas. Sci. Technol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1186\/s40064-016-3405-9","article-title":"Kinetics and Kinematics of Diabetic Foot in Type 2 Diabetes Mellitus with and without Peripheral Neuropathy: A Systematic Review and Meta-Analysis","volume":"5","author":"Hazari","year":"2016","journal-title":"Springerplus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"543","DOI":"10.2147\/RMHP.S361698","article-title":"The Evaluation of Gait and Balance for Patients with Early Diabetic Peripheral Neuropathy: A Cross-Sectional Study","volume":"15","author":"Jiang","year":"2022","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1016\/j.clinbiomech.2011.05.001","article-title":"Twelve Steps Per Foot Are Recommended for Valid and Reliable in-Shoe Plantar Pressure Data in Neuropathic Diabetic Patients Wearing Custom Made Footwear","volume":"26","author":"Arts","year":"2011","journal-title":"Clin. Biomech."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/dmrr.2702","article-title":"Footwear and Offloading Interventions to Prevent and Heal Foot Ulcers and Reduce Plantar Pressure in Patients with Diabetes: A Systematic Review","volume":"32","author":"Bus","year":"2016","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e3258","DOI":"10.1002\/dmrr.3258","article-title":"The Role of Foot Pressure Measurement in the Prediction and Prevention of Diabetic Foot Ulceration-a Comprehensive Review","volume":"36","author":"Chatwin","year":"2020","journal-title":"Diabetes Metab. Res. Rev."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/6\/3126\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:55:19Z","timestamp":1760122519000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/6\/3126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,15]]},"references-count":38,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["s23063126"],"URL":"https:\/\/doi.org\/10.3390\/s23063126","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,15]]}}}