Can plantar soft tissue mechanics enhance prognosis of diabetic foot ulcer?

Naemi, Roozbeh; Chatzistergos, Panagiotis; Suresh, Sivagami; Sundar, Lakshmi; Chockalingam, Nachiappan; Ramachandran, Ambady

doi:10.1016/j.diabres.2017.02.002

Cited by 40 publications

(25 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed our previous study show a direct link between plantar soft tissue mechanical properties and the risk of ulceration using ultrasound strain elastography technique [17]. We also showed that this mechanical properties can be used to enhance the prediction of diabetic foot ulceration [18].…”

Section: A Introductionsupporting

confidence: 53%

Diabetes Status is Associated With Plantar Soft Tissue Stiffness Measured Using Ultrasound Reverberant Shear Wave Elastography Approach

Naemi

Gutierrez

Allan

et al. 2020

J Diabetes Sci Technol

View full text Add to dashboard Cite

Introduction: The purpose of this study was to investigate the association between the mechanical properties of plantar soft tissue and diabetes status. Method: 51 (M/F: 21/30) participants with prediabetes onset (fasting blood sugar [FBS] level > 100 mg/dL), age >18 years, and no lower limb amputation were recruited after ethical approval was granted from Pontificia Universidad Catolica del Peru ethical review board. Ultrasound reverberant shear wave elastography was used to assess the soft tissue stiffness at the 1st metatarsal head (MTH), 3rd MTH, and the heel at both feet. Results: Spearman’s rank-order correlation (rho) test indicated a significant ( P < .05) positive correlations between FBS level and the plantar soft tissue shear wave speed at the 1st MTH: rho = 0.402 (@400 Hz), rho = 0.373 (@450 Hz), rho = 0.474 (@500 Hz), rho= 0.395 (@550 Hz), and rho = 0.326 (@600 Hz) in the left foot and rho = 0.364 (@450 Hz) in the right foot. Mann-Whitney U test indicated a significantly ( P < .05) higher shear wave speed in the plantar soft tissue at the 1st MTH of the left foot at all tested frequencies with the following effect sizes: r = 0.297 (@450 Hz), r = 0.345 (@500 Hz), r = 0.322 (@550 Hz), and r = 0.275 (@600 Hz), and in the right foot r = 0.286 (@400 Hz) in diabetes as compared with the age and body mass index matched prediabetes group. Conclusion: An association between fasting blood sugar level and the stiffness of the plantar soft tissue with higher values of shear wave speed in diabetes versus prediabetes group was observed. This indicated that the proposed approach can improve the assessment of the severity of diabetic foot complications with potential implications in patient stratification.

show abstract

Section: A Introductionsupporting

confidence: 53%

Diabetes Status is Associated With Plantar Soft Tissue Stiffness Measured Using Ultrasound Reverberant Shear Wave Elastography Approach

Naemi

Gutierrez

Allan

et al. 2020

J Diabetes Sci Technol

View full text Add to dashboard Cite

show abstract

“…Particularly in the area of computer modelling the proposed method can support the use of subject-specific material properties which would significantly improve the reliability and clinical relevance of FE models of the foot (Akrami et al, 2018). Moreover, previous research has highlighted the potential value of measuring plantar soft tissue biomechanics in the clinic for the management of conditions such as diabetic foot (Akrami et al, 2018;Naemi et al, 2017). With regards to clinical use, the main disadvantage of this method against previous ultrasound-based techniques (Sara Behforootan et al, 2017a;Erdemir et al, 2006) is the cost of SW elastography which remains relatively high compared to conventional ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Shear wave elastography can assess the in-vivo nonlinear mechanical behavior of heel-pad

Chatzistergos

Behforootan

Allan

et al. 2018

Journal of Biomechanics

View full text Add to dashboard Cite

This study combines non-invasive mechanical testing with finite element (FE) modelling to assess for the first time the reliability of shear wave (SW) elastography for the quantitative assessment of the in-vivo nonlinear mechanical behavior of heel-pad. The heel-pads of five volunteers were compressed using a custom-made ultrasound indentation device. Tissue deformation was assessed from B-mode ultrasound and force was measured using a load cell to calculate the force - deformation graph of the indentation test. These results were used to design subject specific FE models and to inverse engineer the tissue's hyperelastic material coefficients and its stress - strain behavior. SW speed was measured for different levels of compression (from 0% to 50% compression). SW speed for 0% compression was used to assess the initial stiffness of heel-pad (i.e. initial shear modulus, initial Young's modulus). Changes in SW speed with increasing compressive loading were used to quantify the tissue's nonlinear mechanical behavior based on the theory of acoustoelasticity. Statistical analysis of results showed significant correlation between SW-based and FE-based estimations of initial stiffness, but SW underestimated initial shear modulus by 64%(±16). A linear relationship was found between the SW-based and FE-based estimations of nonlinear behavior. The results of this study indicate that SW elastography is capable of reliably assessing differences in stiffness, but the absolute values of stiffness should be used with caution. Measuring changes in SW speed for different magnitudes of compression enables the quantification of the tissue's nonlinear behavior which can significantly enhance the diagnostic value of SW elastography.

show abstract

“…Although in the current study a vast range of parameters were collected from each participant, the inclusion of further parameters to reflect the microcirculatory 49 and Pathophysiology/Complications mechanical properties of the plantar soft tissue 50 could have resulted in achieving a higher prognosis power in predicting the DFU occurrence.…”

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania

Naemi

Chockalingam

Lutale

et al. 2020

BMJ Open Diab Res Care

View full text Add to dashboard Cite

ObjectivesThe aim of this study was to identify the parameters that predict the risk of future foot ulcer occurrence in patients with diabetes.Research design and methods1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer at baseline, participated in this study. Data from a set of 28 parameters were collected at baseline. During follow-up, 123 (M/F: 68/55) patients ulcerated. Survival analyses together with logistic regression were used to identify the parameters that could predict the risk of future diabetic foot ulcer occurrence.ResultsA number of parameters (HR (95% CI)) including neuropathy (2.525 (1.680 to 3.795)); history of ulceration (2.796 (1.029 to 7.598)); smoking history (1.686 (1.097 to 2.592)); presence of callus (1.474 (0.999 to 2.174)); nail ingrowth (5.653 (2.078 to 15.379)); foot swelling (3.345 (1.799 to 6.218)); dry skin (1.926 (1.273 to 2.914)); limited ankle (1.662 (1.365 to 2.022)) and metatarsophalangeal (MTP) joint (2.745 (1.853 to 4.067)) ranges of motion; and decreased (3.141 (2.102 to 4.693)), highly decreased (5.263 (1.266 to 21.878)), and absent (9.671 (5.179 to 18.059)) sensation to touch; age (1.026 (1.010 to 1.042)); vibration perception threshold (1.079 (1.060 to 1.099)); duration of diabetes (1.000 (1.000 to 1.000)); and plantar pressure at the first metatarsal head (1.003 (1.001 to 1.005)), temperature sensation (1.019 (1.004 to 1.035)) and temperature tolerance (1.523 (1.337 to 1.734)) thresholds to hot stimuli and blood sugar level (1.027 (1.006 to 1.048)) were all significantly associated with increased risk of ulceration. However, plantar pressure underneath the fifth toe (0.990 (0.983 to 0.998)) and temperature sensation (0.755 (0.688 to 0.829)) and temperature tolerance (0.668 (0.592 to 0.0754)) thresholds to cold stimuli showed to significantly decrease the risk of future ulcer occurrence. Multivariate survival model indicated that nail ingrowth (4.42 (1.38 to 14.07)); vibration perception threshold (1.07 (1.04 to 1.09)); dry skin status (4.48 (1.80 to 11.14)); and temperature tolerance threshold to warm stimuli (1.001 (1.000 to 1.002)) were significant predictors of foot ulceration risk in the final model. The mean time to ulceration was significantly (p<0.05) shorter for patients with: dry skin (χ2=11.015), nail ingrowth (χ2=14.688), neuropathy (χ2=21.284), or foot swelling (χ2=16.428).ConclusionNail ingrowth and dry skin were found to be strong indicators of vulnerability of patients to diabetic foot ulceration. Results highlight that assessments of neuropathy in relation to both small and larger fiber impairment need to be considered for predicting the risk of diabetic foot ulceration.

show abstract

Can plantar soft tissue mechanics enhance prognosis of diabetic foot ulcer?

Cited by 40 publications

References 25 publications

Diabetes Status is Associated With Plantar Soft Tissue Stiffness Measured Using Ultrasound Reverberant Shear Wave Elastography Approach

Diabetes Status is Associated With Plantar Soft Tissue Stiffness Measured Using Ultrasound Reverberant Shear Wave Elastography Approach

Shear wave elastography can assess the in-vivo nonlinear mechanical behavior of heel-pad

Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania

Contact Info

Product

Resources

About