Is There Histomorphological Evidence of Plantar Metatarsal Fat Pad Atrophy in Patients with Diabetes?

Waldecker, Ute; Lehr, Hans‐Anton

doi:10.1053/j.jfas.2009.07.008

Cited by 24 publications

(19 citation statements)

References 23 publications

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“…This agreed with Waldeker et al, 41 who found no difference in adipocyte size between diabetic and non-diabetic specimens, but is in contrast with Buschmann et al, 8 who reported a 30% decrease in adipocyte mean area and a 16% decrease in mean adipocyte diameter in diabetic plantar soft tissue. However, the later study used samples from limbs that were amputated due to various complications associated with diabetes.…”

Section: Discussionsupporting

confidence: 90%

“…8,24,39 These observations were also made in the current study with the mean arithmetic thickness of elastic septae being 76% greater in the diabetic tissue and with aberrant extra cellular matrix characteristics (Figure 5). This finding was in contrast to that of Waldeker et al who did not observe any qualitative difference in collagen or elastin fiber characteristics; 41 however, that study examined biopsied metatarsal fat rather than the entire tissue cross section (e.g., skin, elastic septae, adipocytes, etc. ).…”

Section: Discussioncontrasting

confidence: 69%

“…12,23 Earlier studies reported thicker, fragmented septal walls and a decrease in adipocyte area and diameter; 8,24 however, all diabetic tissue from these studies came from limbs that were amputated due to vascular compromise. More recently, Waldecker and Lehr 41 examined biopsied metatarsal fat pad tissue but found no difference in adipocyte size between diabetic and non-diabetic tissue. Others have found that skin (on the dorsum of the foot and elsewhere) is thicker in people with diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…However, there have been limited histomorphometric studies on impaired plantar soft tissue. 8,24,41 Of these, most have focused on the heel or a non-specified location, despite the variations in the incidence of ulceration in different locations of the foot. 12,23 Earlier studies reported thicker, fragmented septal walls and a decrease in adipocyte area and diameter; 8,24 however, all diabetic tissue from these studies came from limbs that were amputated due to vascular compromise.…”

Section: Introductionmentioning

confidence: 99%

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Histomorphological Evaluation of Diabetic and Non-Diabetic Plantar Soft Tissue

2011

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Background Diabetic foot ulceration has a complex and multi-factorial etiology and can involve changes in the pathophysiology of the plantar soft tissue. In the current study, histomorphological analyses of diabetic and non-diabetic plantar tissue were performed. It was hypothesized that the diabetic tissue would have thicker skin (epidermis and dermis), less interdigitation between the dermis and epidermis, thicker elastic septa and decreased adipose cell size. Materials and Methods Two locations of the foot (the heel and the first metatarsal) were examined, both of which have been reported to be locations with a high incidence of ulceration. Stereological methods and quantitative morphological techniques were used to evaluate the skin thickness, interdigitation index, elastic septae thickness and adipocyte cell size. Results The diabetic donors had a greater body mass index (BMI) than the non-diabetic donors. The diabetic tissue had significantly thicker elastic septae and dermis. However, no significant difference was observed in the interdigitation index or adipocyte size. Conclusion These findings demonstrate that morphological changes can be evaluated histologically to give a better understanding of the pathological changes in the plantar soft tissue with diabetes. These evaluations can then be associated with biomechanical changes that occur in diabetes to provide new insight into how microstructural changes can alter macroscopic properties. Clinical Relevance An understanding of the histomorphological changes in the soft tissue in relationship to the location on the foot could help to explain the biomechanical changes that occur in diabetes and the subsequent increase in susceptibility to breakdown.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Histomorphological Evaluation of Diabetic and Non-Diabetic Plantar Soft Tissue

2011

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“…A few clinical observations on PFP conflict with each other regarding the role of PFP in heel pain (Prichasuk, 1994;Waldecker & Lehr, 2009;Thomas et al 2010). The biochemistry and histomorphology of PFP in aging and diabetes have been studied using human cadaveric tissues (Jahss et al 1992;Waldecker & Lehr, 2009;Wang et al 2011), which are most relevant to PFP-related diseases but provide only sectional information of the pathology. Furthermore, these studies are limited by the inherent variations of human PFP tissues influenced by daily activities, body weight, genetics, genders, and other co-morbidities (Rchallis et al 2008).…”

Section: Introductionmentioning

confidence: 99%

A stereologic study of the plantar fat pad in young and aged rats

Molligan

Schon

2013

Journal of Anatomy

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Plantar fat pad (PFP) is a tissue structure that absorbs the initial impact of walking and running and ultimately bears body weight at standing. This study was designed to quantify the histomorphological changes of the PFP in aged rats. The most medial PFP was dissected from the hind feet of young rats (4 months old, n = 6) and aged rats (24 months old, n = 6). Histological structure and cellular senescence of PFP were analyzed stereologically and histomorphometrically. Immunohistochemistry of matrix metalloproteinase 9 (MMP9) was also performed on PFP tissue sections. Compared with young rats, the thickness of epidermis, dermis and septa of the PFP were significantly reduced in the aged rats. The total volume of adipose tissue in the PFP of aged rats was only about 65% of that in the young rats. The microvascular density and the number of fat pad units (FPU), a cluster of adipocytes enclosed by elastin septa, in the PFP were unchanged in the aged rats. In the aged rats, the number of adipocytes per FPU was reduced but the number of simple adipocyte clusters, without surrounding septa, was increased. The shift of the types of adipocyte clusters in the aged PFP was accompanied by degradation of elastin fibers and increased expression of MMP9. In conclusion, the PFP, particularly the elastic septa, degenerates significantly in aged rats and this may contribute to the pathology of PFP-related diseases.

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The Biomechanics of Aging and Diabetic Plantar Soft Tissue

Ledoux¹

2014

Engineering Materials and Processes

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Is There Histomorphological Evidence of Plantar Metatarsal Fat Pad Atrophy in Patients with Diabetes?

Cited by 24 publications

References 23 publications

Histomorphological Evaluation of Diabetic and Non-Diabetic Plantar Soft Tissue

Histomorphological Evaluation of Diabetic and Non-Diabetic Plantar Soft Tissue

A stereologic study of the plantar fat pad in young and aged rats

The Biomechanics of Aging and Diabetic Plantar Soft Tissue

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