A quantitative comparison of plantar soft tissue strainability distribution and homogeneity between ulcerated and non-ulcerated patients using strain elastography

TL;DR

This study introduces a new method to quantify plantar soft tissue stiffness distribution and homogeneity, revealing differences between ulcerated and non-ulcerated diabetic patients that could help assess ulceration risk.

Contribution

The paper develops novel measures of pixel stiffness, QS and RS, and demonstrates their effectiveness in distinguishing tissue properties in diabetic foot ulcer patients.

Findings

Ulcerated patients show higher tissue homogeneity in the forefoot.

Significant differences in tissue stiffness distribution were detected between groups.

Potential for improved assessment of ulceration vulnerability in diabetic patients.

Abstract

The primary objective of this study was to develop a method that allows accurate quantification of plantar soft tissue stiffness distribution and homogeneity. The secondary aim of this study is to investigate if the differences in soft tissue stiffness distribution and homogeneity can be detected between ulcerated and non-ulcerated foot. Novel measures of individual pixel stiffness, named as quantitative strainability (QS) and relative strainability (RS) were developed. SE data obtained from 39 (9 with active diabetic foot ulcers) patients with diabetic neuropathy. The patients with active diabetic foot ulcer had wound in parts of the foot other than the first metatarsal head and the heel where the elastography measures were conducted. RS was used to measure changes and gradients in the stiffness distribution of plantar soft tissues in participants with and without active diabetic foot ulcer. The plantar soft tissue homogeneity in superior-inferior direction in the left forefoot was significantly (p<0.05) higher in ulcerated group compared to non-ulcerated group. The assessment of homogeneity showed potentials to further explain the nature of the change in tissue that can increase internal stress . This can have implications in assessing the vulnerability to soft tissue damage and ulceration in diabetes.