Biomechanical assessment of plantar soft tissues in diabetic patients with and without an ulcer history

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Biomechanical assessment of plantar soft tissues in diabetic patients with and without an ulcer history

 

Author: Cheung, Yuen-kui
Title: Biomechanical assessment of plantar soft tissues in diabetic patients with and without an ulcer history
Degree: M.Sc.
Year: 2011
Subject: Diabetes -- Treatment
Diabetes -- Complications
Foot -- Ulcers
Tissues -- Analysis
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Health Technology and Informatics
Pages: viii, 54 leaves : col. ill. ; 30 cm.
InnoPac Record: http://library.polyu.edu.hk/record=b2445328
URI: http://theses.lib.polyu.edu.hk/handle/200/6137
Abstract: Diabetes Mellitus (DM) is reaching epidemic in China. Foot ulceration is a common diabetic complication. Unstable DM control and poor ulcer care may lead to leg amputation. Therefore, identifying high risk DM patients and providing special care can prevent diabetic foot ulceration, and consequently, the overall amputation rate can be decreased. Tissue Ultrasound Palpation System (TUPS) was developed for biomechanical assessment of soft tissue in vivo and it can be potentially used as a screening tool to identify diabetic foot at risk of ulceration. In this study, TUPS was used to determine whether any significant difference exists in the plantar tissue thickness and stiffness of 3 groups of subjects: diabetic patients with foot ulcer history, diabetes without ulcer previously and healthy subjects. Total 30 (n = 10 for each group) age matched subjects were recruited from Podiatry clinic. The soft tissue thickness and stiffness at 3 plantar sites (1st metatarsal head, 3rd metatarsal head and heel) were measured. The results showed that there was no significant difference in thickness of plantar soft tissues among the 3 groups of subjects. However, the plantar soft tissues of DM ulcer group was significantly stiffer than that of the DM no ulcer group (p < 0.05), which in turn was significantly greater than that of control group (p < 0.05). The thinner diabetic foot could develop ulcers more easily due to less cushioning of plantar soft tissues. However, no significant correlation was found between the stiffness and thickness of the diabetic foot in our study (p > 0.05). The glycosylation of structural protein and callus formation could be the reasons for the stiffness increase of plantar soft tissues of diabetic feet. Stiffer and thinner plantar soft tissue makes the feet less able to tolerate the stress and pressure, which could be an important contributing factor in the development of foot ulceration. In summary, diabetic feet with ulceration history had significantly stiffer plantar soft tissues than those of age matched patients without ulcer history and age matched healthy subjects. A negative correlation was found between soft tissue thickness and stiffness at the 3rd metatarsal head region, although it did not reach a significant level (p > 0.05). The results implied that thinner diabetic foot could develop ulcers more easily due to elevated stiffness of plantar soft tissues. Further studies with a large sample size and different age groups would be needed to define a "cut-off" value of stiffness and thickness of the diabetic feet at risk of ulceration. Except for the identification of the diabetic feet at risk of ulceration, TUPS can also be used to help the management of foot ulcer and to facilitate the design of foot orthosis. As a result, the overall rate of leg amputation of diabetic patients can be potentially reduced.

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