Sonography of the Sole of the Foot

Gooding, Gretchen A. W.; Stess, R M; Gräf, Peter; Moss, Kathy M.; Louie, Karen S.; Grünfeld, Carl

doi:10.1097/00004424-198601000-00008

Cited by 122 publications

(13 citation statements)

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“…Data consistently show that the pressure pattern of the diabetic foot refers only to forefoot, because this is the heavily loaded area where neuropathic ulcers commonly develop, especially the metatarsal heads [18]. A number of factors could explain why the forefoot may experience higher stress than the hindfoot, including soft tissue thickness [19], prominent metatarsal heads in the forefoot [20], among others. Consistently, up to 60% of the total peak pressure in our diabetic patients was located at the metatarsus; yet, there was no obvious trend in peak pressure at the metatarsus with disease progression.…”

Section: Discussionmentioning

confidence: 99%

Index of Plantar Pressure Alters with Prolonged Diabetes Duration

Zeng

Zhao

et al. 2019

Diabetes Ther

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IntroductionDiabetic foot ulcers develop with deviations in the distribution of plantar pressure. It is difficult to interpret any alteration in plantar pressure under different conditions of type 2 diabetes mellitus (T2DM). The aim of this study was to gain a better insight into the variations in plantar pressure with increased duration of diabetes.MethodsPlantar pressure was examined in 1196 participants with or without T2DM. Subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) were assigned to control groups, and those with T2DM were divided into five groups according to diabetes duration (< 2 years, 2–5 years, 5–10 years, 10–15 years, and > 15 years). The clinical characteristics, plantar peak pressure, and pressure–time integral (PTI) were compared among the seven study groups, and factors associated with peak pressure and the PTI were analyzed.ResultsAt the hallux, peak pressure exhibited an upward trend in patients with T2DM within 5 years of diabetes duration, followed by a distinct downward slope with further progression of the disease (trend analysis, p < 0.05). An uneven distribution of peak pressure was found at other locations, but this unevenness was ultimately lower than that in the two control groups (p < 0.05). No obvious trend was noted for PTI among patients with different diabetes duration; however, those with diabetes for > 10 years manifested a significantly sharper increase in the PTI at the metatarsus (11.63 Ns/cm2, p < 0.05) and heel (14.12 Ns/cm2, p < 0.05) than at the hallux (8.76 Ns/cm2). A fluctuation in the PTI was also detected at the hallux and midfoot of diabetes patients, which was broadly flat when compared with that of the two control groups. The stepwise multiple regression analysis revealed that the variation in plantar pressure was independently associated with age, body mass index, and vibration perception threshold (VPT) (p < 0.05).ConclusionsThere would appear to be an association between longer diabetes duration and decreased peak pressure for the hallux, suggesting that individuals with diabetes for > 10 years will have an increased PTI for the metatarsus and heel. The reduced pressure on the hallux is believed to be transferred to the metatarsus. Age, BMI, and VPT are distinct risk factors of abnormal plantar pressure.

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Section: Discussionmentioning

confidence: 99%

Index of Plantar Pressure Alters with Prolonged Diabetes Duration

Zeng

Zhao

et al. 2019

Diabetes Ther

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“…From 35 included studies, 20 studies evaluated PTT outcomes [36, 37, 39–43, 45, 46, 49, 50, 52, 53, 55–61], 19 studies evaluated PTS outcomes [34, 36, 40–42, 44–46, 50–53, 55, 56, 58, 59, 62–64], 9 studies evaluated ATT outcomes [33, 35, 38, 41, 47, 48, 65–67] and 5 studies evaluated ATS outcomes [33, 35, 38, 41, 68]. Heterogeneity among methods of measuring thickness and stiffness outcome metrics was observed which prohibited direct comparison across studies and precludes the possibility of conducting a meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Plantar tissue thickness PTT was measured as the distance between skin and bone in 70% of studies (14/20) [37,41,42,45,46,49,52,53,[55][56][57][58][59][60]. A slight variation in measurement was noted in one study, with the authors measuring PTT as the distance between probe and bone instead [40].…”

Section: Methods Of Measurementmentioning

confidence: 99%

Plantar soft tissues and Achilles tendon thickness and stiffness in people with diabetes: a systematic review

Khor

Woodburn

Newcombe

et al. 2021

Journal of Foot and Ankle Research

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Background Diabetes mellitus is associated with changes in soft tissue structure and function. However, the directionality of this change and the extent to which either tissue thickness or stiffness contributes to the pathogenesis of diabetes-related foot ulcerations is unclear. Hence, this systematic review aims to summarise the existing evidence for soft tissue structural differences in the feet of people with and without diabetes. Methods In compliance with MOOSE and PRISMA guidelines, AMED, CINAHL, MEDLINE, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database, and Web of Science electronic databases were systematically searched for studies published from database inception until 1st October 2020 [Prospero CRD42020166614]. Reference lists of included studies were further screened. Methodological quality was appraised using a modified critical appraisal tool for quantitative studies developed by McMaster University. Results A total of 35 non-randomised observational studies were suitable for inclusion. Within these, 20 studies evaluated plantar tissue thickness, 19 studies evaluated plantar tissue stiffness, 9 studies evaluated Achilles tendon thickness and 5 studies evaluated Achilles tendon stiffness outcomes. No significant differences in plantar tissue thickness were found between people with and without diabetes in 55% of studies (11/20), while significantly increased plantar tissue stiffness was found in people with diabetes in 47% of studies (9/19). Significantly increased Achilles tendon thickness was found in people with diabetes in 44% of studies (4/9), while no significant differences in Achilles tendon stiffness were found between people with and without diabetes in 60% of studies (3/5). Conclusions This systematic review found some evidence of soft tissue structural differences between people with and without diabetes. However, uncertainty remains whether these differences independently contribute to diabetes-related foot ulcerations. The heterogeneity of methodological approaches made it difficult to compare across studies and methodological quality was generally inadequate. High-quality studies using standardised and validated assessment techniques in well-defined populations are required to determine more fully the role of structural tissue properties in the pathogenesis of diabetes-related foot ulcerations.

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“…Unfortunately, the literature data on the predisposing factors of soft tissue atrophy remain inconsistent [12]. In several studies, diabetes mellitus [10] or previous ulceration [13] has been associated with fat pad atrophy; in other investigations, no significant differences were observed between patients with diabetes and those without diabetes [14] with or without previous ulceration [15]. We believe that soft tissue atrophy could be an unresolved risk factor of reulceration, although the risk would be determined by the location of the ulcer.…”

Section: Introductionmentioning

confidence: 92%

Differences in the Sub-Metatarsal Fat Pad Atrophy Symptoms between Patients with Metatarsal Head Resection and Those without Metatarsal Head Resection: A Cross-Sectional Study

Molines-Barroso

García‐Álvarez

García-Klepzig

et al. 2020

JCM

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We aimed to evaluate the differences in the sub-metatarsal skin and fat pad atrophy between patients at a high risk of ulceration with and without previous metatarsal head resection. A cross-sectional study was performed in a diabetic foot unit involving 19 participants with a history of metatarsal head resection (experimental group) and 19 (control group) without a history of metatarsal head resection but with an ulcer in other locations in the metatarsal head. No participants had active ulcerations at study inclusion. Sub-metatarsal skin thickness and fat pad thickness in the first and second metatarsals were evaluated by an ultrasound transducer. The experimental group showed sub-metatarsal fat pad atrophy (3.74 ± 1.18 mm and 2.52 ± 1.04 mm for first and second metatarsal, respectively) compared with the control group (5.44 ± 1.12 mm and 4.73 ± 1.59 mm) (p < 0.001, confidence interval: (CI): 0.943–2.457 and p < 0.001, CI: 1.143–3.270 for first and second metatarsal, respectively); however, sub-metatarsal skin thickness was not different between groups (experimental 2.47 ± 0.47 mm vs. control 2.80 ± 0.58 mm (p = 0.063, CI: −0.019–0.672) and 2.24 ± 0.60 mm vs. 2.62 ± 0.50 mm (p = 0.066, CI: −0.027–0.786) for first and second metatarsal, respectively). Patients with previous metatarsal head resection showed sub-metatarsal fat pad atrophy, which could be associated with the risk of reulceration in the metatarsal head.

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Sonography of the Sole of the Foot

Cited by 122 publications

References 0 publications

Index of Plantar Pressure Alters with Prolonged Diabetes Duration

Index of Plantar Pressure Alters with Prolonged Diabetes Duration

Plantar soft tissues and Achilles tendon thickness and stiffness in people with diabetes: a systematic review

Differences in the Sub-Metatarsal Fat Pad Atrophy Symptoms between Patients with Metatarsal Head Resection and Those without Metatarsal Head Resection: A Cross-Sectional Study

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