Skin Morphology and Its Mechanical Properties Associated with Loading

Hagisawa, Satsue; Shimada, Toshio

doi:10.1007/3-540-28804-x_11

Cited by 13 publications

(15 citation statements)

References 42 publications

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“…The epidermal layer of plantar skin serves as the front line in the biological barrier protecting the foot from physical wear and tear. 32 This may explain why people with diabetic neuropathy or a history of ulceration have a higher incidence of ulceration or re-ulceration. However, one should bear in mind that the present study used the 10-g monofilament test and vibration perception threshold as screening tools for neuropathy and that subjects in our DU group may have relatively severe neuropathy.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Skin Blood Flow and Edema on Epidermal Thickness in the Diabetic Foot

Chao

Zheng

Cheing

2012

Diabetes Technology & Therapeutics

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Background: Skin blood flow plays an important role in maintaining the health of the skin. The development of interstitial edema may impede oxygen diffusion to the skin. The aim of this study was to evaluate the association of skin blood flow and edema and epidermal thickness in the feet of people with and without diabetic neuropathy compared with a healthy control group. Subjects and Methods: Eighty-seven subjects (19 people with diabetic neuropathy and foot ulceration, 35 people with diabetes but without neuropathy, and 33 healthy controls without diabetes) participated in the study. High-frequency ultrasonography was used to measure the epidermal thickness and edema in papillary skin at the big toe as reflected by the thickness of the subepidermal low echogenic band (SLEB). The capillary nutritive blood flow was measured by the use of video capillaroscopy, and skin blood flux was monitored by laser Doppler flowmetry.Results: There was a 7.2% increase in epidermal thickness in those with diabetes but without neuropathy and a 16.5% decrease in people with diabetic neuropathy and foot ulceration compared with the healthy controls (all P < 0.05). The SLEB thickness increased in all subjects with diabetes to a greater degree in those with neuropathy and ulceration than in those without (64.7% vs. 11.8%, P < 0.001). Skin blood flux was shown to be higher in the diabetes groups than in the controls (all P < 0.05), but no significant differences were found in the resting nutritive capillary blood flow (P > 0.05). A significant negative correlation (P = 0.002, r = -0.366) was demonstrated between the SLEB and epidermal thickness at the pulp of the big toe, whereas no significant correlation was demonstrated between skin blood flow and epidermal thickness (all P > 0.05). Conclusions: An increase in subepidermal edema was demonstrated in people with diabetic neuropathy and ulceration, which may partly contribute to reduced epidermal thickness at the pulp of the big toe. This may subsequently lead to the breaking down of skin in the diabetic foot.

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Section: Discussionmentioning

confidence: 99%

The Association Between Skin Blood Flow and Edema on Epidermal Thickness in the Diabetic Foot

Chao

Zheng

Cheing

2012

Diabetes Technology & Therapeutics

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“…The dermis consists of papillary and reticular layers of collagen and elastic fibers. It consists of a microvascular network that provides tissues with nutrients and eliminates waste products [13]. Skin microcirculation is composed of nutritive capillary blood flow and thermoregulatory arteriovenous shunt flow.…”

Section: Anatomy Of Skin Morphology and Microcirculationmentioning

confidence: 99%

Microvascular dysfunction in diabetic foot disease and ulceration

Chao

Cheing

2009

Diabetes Metabolism Res

166

129

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Diabetic foot disease and ulceration is a major complication that may lead to the amputation of the lower limbs. Microangiopathy may play a significant role in the pathogenesis of tissue breakdown in the diabetic foot. However, the precise mechanisms of this process remain unclear and poorly understood. Microvasculature in the skin is comprised of nutritive capillaries and thermoregulatory arteriovenous shunt flow. It is regulated through the complex interaction of neurogenic and neurovascular control. The interplay among endothelial dysfunction, impaired nerve axon reflex activities, and microvascular regulation in the diabetic patient results in the poor healing of wounds. Skin microvasculature undergoes both morphologic changes as well as functional deficits when parts of the body come under stress or injury. Two important theories that have been put forward to explain the abnormalities that have been observed are the haemodynamic hypothesis and capillary steal syndrome. With advances in medical technology, microvasculature can now be measured quantitatively. This article reviews the development of microvascular dysfunction in the diabetic foot and discusses how it may relate to the pathogenesis of diabetic foot problems and ulceration. Common methods for measuring skin microcirculation are also discussed.

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“…F A s = (1) where σ represents stress, F is the load and A is the cross-section area. The unit of the stress is Nm −2 .…”

Section: Principles Of Mechanics Of Materialsmentioning

confidence: 99%

“…The soft tissue structure, which is located underneath the calcaneus (heel bone) consists of fat pad and skin. While this fat pad, also known as corpus adiposum, works as shock absorber and dampens the ground reaction forces during weight-bearing activities like standing and walking, the skin has another important role to prevent tear and to work as an impermeable barrier to protect the underlying soft tissue [1]. Reported heel pad thickness varies from 12.5 to 24.5mm in different studies [2][3][4][5][6][7][8] using different imaging modalities including ultrasound [2][3][4], magnetic resonance imaging (MRI) [5] and radiography [6,7].…”

Section: Introductionmentioning

confidence: 99%

Viscoelasticity in Foot-Ground Interaction

Naemi¹,

Behforootan²,

Chatzistergos³

et al. 2016

Viscoelastic and Viscoplastic Materials

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Mechanical properties of the plantar soft tissue, which acts as the interface between the skeleton and the ground, play an important role in distributing the force underneath the foot and in influencing the load transfer to the entire body during weight-bearing activities. Hence, understanding the mechanical behaviour of the plantar soft tissue and the mathematical equations that govern such behaviour can have important applications in investigating the effect of disease and injuries on soft tissue function. The plantar soft tissue of the foot shows a viscoelastic behaviour, where the reaction force is not only dependent on the amount of deformation but also influenced by the deformation rate. This chapter provides an insight into the mechanical behaviour of plantar soft tissue during loading with specific emphasis on heel pad, which is the first point of contact during normal gait. Furthermore, the methods of assessing the mechanical behaviour including the in vitro/in situ and in vivo are discussed, and examples of creep, stress relaxation, rate dependency and hysteresis behaviour of the heel pad are shown. In addition, the viscoelastic models that represent the mechanical behaviour of the plantar soft tissue under load along with the equations that govern this behaviour are elaborated and discussed.

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Skin Morphology and Its Mechanical Properties Associated with Loading

Cited by 13 publications

References 42 publications

The Association Between Skin Blood Flow and Edema on Epidermal Thickness in the Diabetic Foot

The Association Between Skin Blood Flow and Edema on Epidermal Thickness in the Diabetic Foot

Microvascular dysfunction in diabetic foot disease and ulceration

Viscoelasticity in Foot-Ground Interaction

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