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

Allan, D.; Chatzistergos, P.E.; Mahadevan, S.; Healy, A.; Sundar, L.; Ramachandran, A.; Kumar, S.; Punnoose, A.; Chockalingam, N.; Naemi, R.

Abstract

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.

Citation

Allan, D., Chatzistergos, P., Mahadevan, S., Healy, A., Sundar, L., Ramachandran, A., …Naemi, R. (2022). Increased exposure to loading is associated with decreased plantar soft tissue hardness in people with diabetes and neuropathy. Diabetes Research and Clinical Practice, 187, 109865. https://doi.org/10.1016/j.diabres.2022.109865

• Journal Article Type: Article
• Acceptance Date: Apr 2, 2022
• Publication Date: 2022-05
• Deposit Date: Apr 9, 2024
• Publicly Available Date: Apr 10, 2024
• Journal: Diabetes Research and Clinical Practice
• Print ISSN: 0168-8227
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 187
• Pages: 109865
• DOI: https://doi.org/10.1016/j.diabres.2022.109865
• Keywords: Endocrinology; General Medicine; Endocrinology, Diabetes and Metabolism; Internal Medicine
• Additional Information: This article is maintained by: Elsevier; Article Title: Increased exposure to loading is associated with decreased plantar soft tissue hardness in people with diabetes and neuropathy; Journal Title: Diabetes Research and Clinical Practice; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.diabres.2022.109865; Content Type: article; Copyright: © 2022 The Authors. Published by Elsevier B.V.