Integration of plantar soft tissue stiffness measurements in routine MRI of the diabetic foot

Gefen, Amit; Megido-Ravid, M.; Azariah, M Biju; Itzchak, Y; Arcan, M.

doi:10.1016/s0268-0033(01)00074-2

Cited by 88 publications

(61 citation statements)

References 12 publications

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“…The plantar soft tissues were found to be stiffer and thinner in elderly subjects with diabetes than in healthy young subjects [24,25]. The increase in stiffness seems particularly to occur in the soft tissue under the first metatarsal head.…”

Section: Mechanical Loading Of the Diabetic Footmentioning

confidence: 90%

Mechanical Loading and Off-Loading of the Plantar Surface of the Diabetic Foot

Deursen

2004

Clinical Infectious Diseases

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During weight-bearing activities, the feet are exposed to large forces, particularly when the activity is dynamic, such as walking. The pressure under the plantar surface during walking varies per foot area because of a number of factors related to the normal rollover during the stance phase of gait. Diabetes mellitus often results in loss of protective sensation and in structural changes that make the feet more susceptible to injury. Increased plantar pressure is an important factor in the development and maintenance of diabetic foot ulceration. Increased plantar pressures and associated ulcers need to be treated by off-loading of the plantar surface. Useful off-loading mechanisms include reduction of walking speed, alteration of foot rollover during gait, and transfer of load from affected areas to other areas of the foot or the lower leg. These plantar off-loading mechanisms could result in an optimization of treatment, but clinical effectiveness must be demonstrated.Plantar ulceration is a common complication of diabetic neuropathy. Given the fact that plantar ulceration often initiates a process of further ulceration and ultimately amputation [1], it is crucial to prevent any such complications from the very beginning. Internal factors, such as loss of protective sensation, substantially contribute to the risk of ulceration [2]. On the other hand, mechanical loading of the feet as an external factor plays an equally important role in this process.Here, I discuss the different aspects of mechanical loading of the foot and the ways of reducing mechanical load in biomechanical terms: first, the biomechanics of the normal foot during basic activities of daily living and the magnitude of the mechanical load the feet have to endure; second, the changes in the diabetic foot that lead to an increase of mechanical loading, compared with the normal foot; and third, the various interventions used to prevent and treat plantar ulceration in terms of their biomechanical mechanisms.

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Section: Mechanical Loading Of the Diabetic Footmentioning

confidence: 90%

Mechanical Loading and Off-Loading of the Plantar Surface of the Diabetic Foot

Deursen

2004

Clinical Infectious Diseases

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“…Instead, the slope of the piecewise linear F-D curve, which represents tissue stiffness, can be used to classify the various classes of tissue. Plantar tissue stiffness can be used to identify the pathological stiffening of plantar tissue of the diabetic foot [43] or conditions related to plantar heel pain [44]. Thus, the F-D curves are useful to the clinician to assess bone and soft tissue changes or damage in patients.…”

Section: Indentation Of Foot Tissuementioning

confidence: 99%

An indentation apparatus for evaluating discomfort and pain thresholds in conjunction with mechanical properties of foot tissue in vivo

Xiong

Goonetilleke²,

Witana³

et al. 2010

JRRD

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Abstract-The mechanical properties of human foot tissue in vivo as well as discomfort and pain thresholds are important for various applications. In this study, an apparatus for measuring the discomfort and pain thresholds and the mechanical properties of human tissues is presented. The apparatus employs a stepper motor that controls the indentation speed, as well as a load cell and potentiometer that determine the corresponding reaction force and tissue deformation (displacement), respectively. A LabVIEW program (LabVIEW 8, National Instruments Corporation; Austin, Texas) was developed to control the indentation via a data acquisition card. The apparatus can accommodate indentor displacements up to 35 mm and can impart forces up to 150 N at a controlled indentation speed in the range of 0 to 10 mm/s. Tests showed that the displacement measurement error is 0.17 mm in the nominal range (0.5% in the full scale) and the measurement error of force is 1.6 N in the nominal range (1.1% in the full scale). Experimental results indicate that the apparatus is reliable and flexible for measuring the mechanical properties of foot tissue in vivo in conjunction with pain and discomfort thresholds.

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“…In a study focused on plantar soft tissue stiffness measurements, the authors found shear and elastic moduli to be significantly higher in diabetic patients than in normal controls, with the largest stiffness in proximity to the first metatarsal head (11). Plantar fat pad stiffness was associated with tissue ulceration at this location.…”

Section: Discussionmentioning

confidence: 98%

Soft tissue enhancement on time‐resolved peripheral magnetic resonance angiography

Zhang

Kent

Bush

et al. 2004

Magnetic Resonance Imaging

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Purpose: To evaluate the incidence and locations of soft tissue enhancement on time-resolved two-dimensional projection magnetic resonance angiography (MRA) of the calf and foot. Materials and Methods:Time-resolved two-dimensional projection MRA of the knee, calf, and foot, performed at 1.5 Tesla using the head coil, was retrospectively reviewed in 326 patients. Soft tissue enhancement of the foot was identified and graded by blinded review. Subsequently, patient medical records were reviewed to determine the presence or absence of diabetes, cellulitis, gangrene, and ulceration of the foot and presence of neuropathic joints.Results: Enhancing spots were identified in 228 patients. For those feet without clinical abnormalities, diabetic patients had an average of 1.2 enhancing spots per foot, while nondiabetics had only 0.6 (P Ͻ 0.001). Higher-grade lesions were more prevalent in diabetics and in heavier patients. Of 64 patients with follow-up, 8 (13%) developed cellulitis (N ϭ 4) or ulceration (N ϭ 4) at the location of an enhancing spot, including 5 diabetic and 3 nondiabetic patients. Conclusion:Pedal soft tissue enhancement frequently occurs on time-resolved gadolinium (Gd):MRA of the feet. The etiology is uncertain, but the high frequency in diabetic patients and observation of progression to cellulitis/ulceration suggest this soft tissue enhancement may identify sites of subclinical pedal soft tissue injury.

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Integration of plantar soft tissue stiffness measurements in routine MRI of the diabetic foot

Cited by 88 publications

References 12 publications

Mechanical Loading and Off-Loading of the Plantar Surface of the Diabetic Foot

Mechanical Loading and Off-Loading of the Plantar Surface of the Diabetic Foot

An indentation apparatus for evaluating discomfort and pain thresholds in conjunction with mechanical properties of foot tissue in vivo

Soft tissue enhancement on time‐resolved peripheral magnetic resonance angiography

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