Increased exposure to loading is associated with increased plantar soft tissue hardness in people with diabetes and neuropathy

TY - JOUR

T1 - Increased exposure to loading is associated with increased plantar soft tissue hardness in people with diabetes and neuropathy

AU - Allan, D.

AU - Chatzistergos, P. E.

AU - Mahadevan, S.

AU - Healy, A.

AU - Sundar, L.

AU - Ramachandran, A.

AU - Kumar, S.

AU - Punnoose, A.

AU - Chockalingam, N.

AU - Naemi, R.

N1 - Publisher Copyright: © 2022 The Authors

PY - 2022/5

Y1 - 2022/5

N2 - Aims: Literature indicates that altered plantar loading in people with diabetes could trigger changes in plantar soft tissue biomechanics which, in turn, could affect the risk for ulceration. To stimulate more research in this area, this study uses in vivo testing to investigate the link between plantar loading and tissue hardness. Methods: Tissue hardness and plantar pressure distribution were measured for six plantar areas in 39 people with diabetes and peripheral neuropathy. Results: Spearman correlation analysis revealed that increased pressure time integral at the 1st metatarsal-head region (r = -0.354, n = 39, P = 0.027) or at the heel (r = -0.378, n = 39, P = 0.018) was associated with reduced hardness in the same regions. After accounting for confounding parameters, generalised estimating equations analysis also showed that 10% increase in pressure time integral at the heel was associated with ≈ 1 unit reduction in hardness in the same region. Conclusions: For the first time, this study reveals that people with diabetes and neuropathy who tend to load their feet more heavily also tend to have plantar soft tissues with lower hardness. The observed difference in tissue hardness is likely to affect the tissue's vulnerability to overload injury. More research will be needed to explore the implications of the observed association for the risk of ulceration.

AB - Aims: Literature indicates that altered plantar loading in people with diabetes could trigger changes in plantar soft tissue biomechanics which, in turn, could affect the risk for ulceration. To stimulate more research in this area, this study uses in vivo testing to investigate the link between plantar loading and tissue hardness. Methods: Tissue hardness and plantar pressure distribution were measured for six plantar areas in 39 people with diabetes and peripheral neuropathy. Results: Spearman correlation analysis revealed that increased pressure time integral at the 1st metatarsal-head region (r = -0.354, n = 39, P = 0.027) or at the heel (r = -0.378, n = 39, P = 0.018) was associated with reduced hardness in the same regions. After accounting for confounding parameters, generalised estimating equations analysis also showed that 10% increase in pressure time integral at the heel was associated with ≈ 1 unit reduction in hardness in the same region. Conclusions: For the first time, this study reveals that people with diabetes and neuropathy who tend to load their feet more heavily also tend to have plantar soft tissues with lower hardness. The observed difference in tissue hardness is likely to affect the tissue's vulnerability to overload injury. More research will be needed to explore the implications of the observed association for the risk of ulceration.

KW - Diabetic foot

KW - Heel pad

KW - Plantar pressure

KW - Plantar soft tissue

KW - Shore hardness

KW - Stiffness

UR - https://www.scopus.com/pages/publications/85129413246

U2 - 10.1016/j.diabres.2022.109865

DO - 10.1016/j.diabres.2022.109865

M3 - Article

C2 - 35398144

AN - SCOPUS:85129413246

SN - 0168-8227

VL - 187

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

M1 - 109865

ER -