Differences in the mechanical characteristics of plantar soft tissue between ulcerated and non-ulcerated foot

Aims: The purpose of this study was to investigate the differences in mechanical properties of the plantar soft tissue between the ulcerated and non-ulcerated feet in patients with diabetic neuropathy. Methods: Thirty nine patients who met the inclusion criteria participated in this study. Ten out of 39 participants had an active ulcer at a site other than the plantar heel and the first metatarsal head. Real time ultrasound elastography was performed to measure the soft tissue thickness and stiffness of the heel pad and sub-metatarsal fat pad. To account for the qualitative nature of conventional real time elastography, relative tissue stiffness was assessed against that of a standardised ultrasound standoff material. Results: The results indicated that the ulcerated group had a significantly lower heel pad relative stiffness (t (37) = 2.559, P = 0.015, eta 2 = 0.150) in the left foot. Conclusions: The observed difference in the stiffness of the heel pad between the ulcerated and non-ulcerated feet indicates a possible link between tissue mechanics and ulceration. Further analysis of the data proposed in this study provided a quantitative assessment of plantar fat pad deformability which can contribute to understanding the role of tissue biomechanics in ulceration. (C) 2016 Elsevier Inc. All rights reserved.