The role of tissue biomechanics in improving the clinical management of diabetic foot ulcers

Diabetes alters the mechanical characteristics of plantar soft tissue. These changes can compromise the tissue’s ability to uniformly distribute forces and increase the likelihood of overloading and of injury. In the presence of neuropathy, this injury can go unnoticed leading to ulceration or even to amputation. It is counterintuitive to assume that vulnerability to overloading and to injury is not linked to the tissue’s ability to deform under load (i.e., to its stiffness) or to the tissue’s capacity to carry load without damage (i.e., to its strength). With the development of novel clinically applicable methods to study plantar soft tissue biomechanics, evidence in support of this causal link between tissue biomechanics and ulceration is starting to emerge. However, a definitive proof is still missing and the noninvasive measurement of the mechanical properties of soft tissue remains a challenging task. In this context, this chapter will highlight the potential value of tissue biomechanics for improving the clinical management of diabetic foot ulcers and will discuss methods that can open the way for integrating tissue biomechanics into everyday clinical practice. These methods include the use of ultrasound elastography and the combined use of in vivo testing and computer modeling.