Plantar Tissue Thickness Is Related to Peak Plantar Pressure in the High-Risk Diabetic Foot

Abouaesha, F; Schie, Carine H.M. van; Griffths, Gareth D.; Young, Robert J.; Boulton, Andrew J.M.

doi:10.2337/diacare.24.7.1270

Cited by 167 publications

(119 citation statements)

References 29 publications

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“…As noted above, previous studies have confirmed that reduction of subcutaneous tissue under the metatarsal heads of neuropathic patients is associated with increased dynamic foot pressures and consequent increased risk of foot ulcer [61,62]. Previous anecdotal reports had suggested that the injection of liquid silicone under high-pressure areas of neuropathic feet, thereby increasing the protective "padding", was associated with reduced ulcer formation [66].…”

Section: Foot Pressure Studies In Diabetesmentioning

confidence: 79%

“…The Planscan platform [60] allows dynamic ultrasound measurement of plantar tissue thickness while the patient is bearing weight. In a comparative study using this technique and plantar pressures measured using the pedobarograph [61], Abouaesha et al demonstrated that plantar tissue thickness under the metatarsal heads is inversely correlated with dynamic foot pressures. A follow-up study confirmed that high plantar pressure can be predicted from plantar tissue thickness with high sensitivity and specificity [62].…”

Section: Foot Pressure Studies In Diabetesmentioning

confidence: 99%

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The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences, with both being less common in patients of Indian subcontinent origin living in the UK. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetes, recent studies suggest that bisphosphonates reduce disease activity as judged not only by differences in skin temperature, but also by assessing markers of bone turnover. The use of the total-contact cast is demonstrated in the treatment of acute Charcot feet and of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that increasing research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

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Section: Foot Pressure Studies In Diabetesmentioning

confidence: 79%

Section: Foot Pressure Studies In Diabetesmentioning

confidence: 99%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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“…The ICCs for these variables were high (Ͼ0.98), which demonstrates that these variables can be assessed in a reproducible way. Small limits of agreement are important for regression analyses or correlation coefficients computed between variables of foot structure and/or foot function (3,5,6,15,16) because the outcomes from these analyses are determined by the scatter of individual cases.…”

Section: Discussionmentioning

confidence: 99%

“…Measures of structural changes and deformity in the diabetic foot have been obtained using different in vivo imaging techniques, such as ultrasound (3,17), radiography (18), and computed tomography (CT) (6,16,19,20). Saltzman et al (21) determined the interobserver variability of radiographic foot measurements in nondiabetic subjects and found a 95% limit for the MTP joint angle of 6°, which is higher than the limit in the present study (Ͻ3.0°).…”

Section: Discussionmentioning

confidence: 99%

“…Structural changes and deformities of the foot, such as claw/hammer toe deformity and thinning of soft tissue or fat pads underneath the metatarsal heads, are associated with increased plantar pressures in diabetic subjects (3)(4)(5)(6). Additionally, intrinsic muscle atrophy secondary to peripheral neuropathy may significantly affect foot function and lead to altered gait biomechanics (7).…”

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confidence: 99%

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Reproducibility of foot structure measurements in neuropathic diabetic patients using magnetic resonance imaging

Bus

Maas

Lindeboom

2006

Magnetic Resonance Imaging

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Purpose:To assess the intra-and interobserver agreement of commonly reported foot structure measurements in diabetic patients with neuropathy using magnetic resonance imaging (MRI). Materials and Methods:In 23 neuropathic diabetic patients and five age-matched healthy controls, sagittal-plane MR images of the forefoot were obtained to assess joint configuration and plantar fat-pad thickness on two different occasions by the same observer and once by a different observer. The degree of intrinsic muscle atrophy was scored from coronal plane images on two different occasions by two observers. Results:The intraclass correlation coefficients (ICCs) between occasions and between observers were Ͼ0.94. The mean differences (bias) and the limits of agreement (LoA ϭ mean Ϯ 2 SDs) were small for the metatarsal-phalangeal (MTP) joint angle, toe angle, and plantar fat-pad thickness (bias Յ 0.8°or 0.2 mm, LoA Յ 3.8°or 0.8 mm), but larger for interphalangeal joint angles (bias Յ 3.4°, LoA Յ 8.8°). The weighted kappa for intrinsic muscle atrophy was 0.94. Conclusion:Static foot structure data can be assessed reliably using MRI. Because changes in foot structure contribute to the development of foot ulcers in neuropathic patients, MRI may be a useful technique to assess risk of ulceration in these patients. DIABETIC FOOT ULCERATION is a frequently reported and serious complication in people with diabetes and peripheral neuropathy, and precedes the vast majority (85%) of lower-extremity amputations (1). Elevated dynamic plantar pressure has been established as a major risk factor for plantar ulceration in the diabetic foot with lack of protective sensation (2).Structural changes and deformities of the foot, such as claw/hammer toe deformity and thinning of soft tissue or fat pads underneath the metatarsal heads, are associated with increased plantar pressures in diabetic subjects (3-6). Additionally, intrinsic muscle atrophy secondary to peripheral neuropathy may significantly affect foot function and lead to altered gait biomechanics (7).Because of its multiplanar imaging capability and inherent superiority in tissue contrast, magnetic resonance imaging (MRI) is increasingly being used as a tool to assess structural pathology in the foot or lower leg of diabetic patients with peripheral neuropathy (5,7-11). These assessments are considered important for improving our understanding of the relationship between structure and function in the foot and the pathogenesis of foot ulceration.However, little is known about the reproducibility of the MRI assessments for this purpose. Therefore, the purpose of this study was to evaluate the intra-and interobserver agreement of (semi-)quantitative measurements by MRI of foot structure in neuropathic diabetic patients. MATERIALS AND METHODS SubjectsTwenty-eight subjects participated in this study and underwent MRI of the foot. The study group consisted of 23 diabetic patients with peripheral sensory neuropathy (15 men and eight women, mean age ϭ 56.8 years) and five age-matched healthy subject...

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