Diabetes Status is Associated With Plantar Soft Tissue Stiffness Measured Using Ultrasound Reverberant Shear Wave Elastography Approach

R. Naemi, S.E. Romero Gutierrez, D. Allan, G. Flores, J. Ormaechea, E. Gutierrez, J. Casado-Pena, S. Anyosa-Zavaleta, M. Juarez, F. Casado, B. Castaneda Aphan

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5 Citations (Scopus)

Abstract

Introduction: The purpose of this study was to investigate the association between the mechanical properties of plantar soft tissue and diabetes status. Method: 51 (M/F: 21/30) participants with prediabetes onset (fasting blood sugar [FBS] level > 100 mg/dL), age >18 years, and no lower limb amputation were recruited after ethical approval was granted from Pontificia Universidad Catolica del Peru ethical review board. Ultrasound reverberant shear wave elastography was used to assess the soft tissue stiffness at the 1st metatarsal head (MTH), 3rd MTH, and the heel at both feet. Results: Spearman’s rank-order correlation (rho) test indicated a significant (P <.05) positive correlations between FBS level and the plantar soft tissue shear wave speed at the 1st MTH: rho = 0.402 (@400 Hz), rho = 0.373 (@450 Hz), rho = 0.474 (@500 Hz), rho= 0.395 (@550 Hz), and rho = 0.326 (@600 Hz) in the left foot and rho = 0.364 (@450 Hz) in the right foot. Mann-Whitney U test indicated a significantly (P <.05) higher shear wave speed in the plantar soft tissue with the following effect sizes (r) at the 1st MTH of the left foot at all tested frequencies: r = 0.297 (@450 Hz), r = 0.345 (@500 Hz), r = 0.322 (@550 Hz), and r = 0.275 (@600 Hz), and at the 1st MTH of right foot r = 0.286 (@400 Hz) in diabetes as compared with the age and body mass index matched prediabetes group. Conclusion: An association between fasting blood sugar level and the stiffness of the plantar soft tissue with higher values of shear wave speed in diabetes versus prediabetes group was observed. This indicated that the proposed approach can improve the assessment of the severity of diabetic foot complications with potential implications in patient stratification.

Original languageEnglish
Pages (from-to)478-490
Number of pages13
JournalJournal of Diabetes Science and Technology
Volume16
Issue number2
Early online date23 Oct 2020
DOIs
Publication statusPublished online - 23 Oct 2020

Bibliographical note

Funding Information:
We are grateful to Elastance Imaging for the loan of the vibration sources equipment. We also thank Dr Kevin J. Parker for his advice regarding the implementation and application of the reverberant shear wave elastography. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this study is supported by the Newton Fund Institutional Links grant, under the project title: “Development of an ultrasound-based diagnostic tool to identify diabetic foot ulceration risk in Peruvian population”. This was a collaboration between Staffordshire University (UK) and Pontifical Catholic University of Peru (March 2019-February 2020), grant agreement number: 414703139.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this study is supported by the Newton Fund Institutional Links grant, under the project title: “Development of an ultrasound-based diagnostic tool to identify diabetic foot ulceration risk in Peruvian population”. This was a collaboration between Staffordshire University (UK) and Pontifical Catholic University of Peru (March 2019-February 2020), grant agreement number: 414703139.

Publisher Copyright:
© 2020 Diabetes Technology Society.

Keywords

  • biomechanics
  • elastography
  • plantar soft tissue
  • reverberant
  • shear wave
  • ultrasonography

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