Abstract
Diabetic foot ulcers are a significant complication in people with diabetes mellitus. The changes of mechanical properties of plantar tissues associated with diabetes may contribute to a high incidence of diabetic foot ulcers. This study investigated the feasibility of using three-dimensional (3D) elastography to measure 3D elasticity of the fat pad and then calculate 3D elasticity gradients of the foot. This method may improve the detection of people at risk for diabetic foot ulcer. Elastography with a soft ratio measurement may provide a visualization of plantar soft tissues for clinicians to diagnose foot ulcer risk. In this study, we measured B-mode and elastic ultrasound images at the first metatarsal head in five volunteers. The soft tissue contains four layers, including inner layer (Q1, near bone surface), sub-inner layer (Q2), sub-outer layer (Q3), and outer layer (Q4, near skin surface). The elasticity values were significantly greater in the Q3 layer compared to the Q1 layer. The elasticity gradient values were significantly smaller in the Q3 layer compared to the Q2 layer. The correlation between the elasticity and elasticity gradient was r = −0.88 in the Q3 layer.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Burns, S., Jan, Y.K.: Diabetic foot ulceration and amputation. In: Kim, C.T. (ed.) Rehabilitation Medicine, pp. 1–20. InTech Publisher, Croatia (2012)
Hsu, T.C., Lee, Y.S., Shau, Y.W.: Biomechanics of the heel pad for type 2 diabetic patients. Clin. Biomech. 17, 291–296 (2002)
Chatzistergos, P.E., Naemi, R., Sundar, L., Ramachandran, A., Chockalingam, N.: The relationship between the mechanical properties of heel-pad and common clinical measures associated with foot ulcers in patients with diabetes. J. Diabetes Complications 28, 488–493 (2014)
Jan, Y.K., Lung, C.W., Cuaderes, E., Rong, D., Boyce, K.: Effect of viscoelastic properties of plantar soft tissues on plantar pressures at the first metatarsal head in diabetics with peripheral neuropathy. Physiol. Meas. 34, 53–66 (2013)
Jan, Y.K., Shen, S., Foreman, R.D., Ennis, W.J.: Skin blood flow response to locally applied mechanical and thermal stresses in the diabetic foot. Microvascular research (2013)
Buschmann, W.R., Jahss, M.H., Kummer, F., Desai, P., Gee, R.O., Ricci, J.L.: Histology and histomorphometric analysis of the normal and atrophic heel fat pad. Foot Ankle Int. 16, 254–258 (1995)
Waldecker, U., Lehr, H.-A.: Is there histomorphological evidence of plantar metatarsal fat pad atrophy in patients with diabetes? J. Foot Ankle Surg. 48, 648–652 (2009)
Bus, S.A., Maas, M., Cavanagh, P.R., Michels, R.P.J., Levi, M.: Plantar fat-pad displacement in neuropathic diabetic patients with toe deformity. Diabetes Care 27, 2376–2381 (2004)
Naemi, R., Chatzistergos, P., Suresh, S., Sundar, L., Chockalingam, N., Ramachandran, A.: Can plantar soft tissue mechanics enhance prognosis of diabetic foot ulcer? Diabetes Res. Clin. Pract. 126, 182–191 (2017)
Naemi, R., Chatzistergos, P., Sundar, L., Chockalingam, N., Ramachandran, A.: Differences in the mechanical characteristics of plantar soft tissue between ulcerated and non-ulcerated foot. J. Diabetes Complications 30, 1293–1299 (2016)
Cheung, J.T.M., Zhang, M., Leung, A.K.L., Fan, Y.B.: Three-dimensional finite element analysis of the foot during standing - a material sensitivity study. J. Biomech. 38, 1045–1054 (2005)
Gefen, A.: Plantar soft tissue loading under the medial metatarsals in the standing diabetic foot. Med. Eng. Phys. 25, 491–499 (2003)
Armstrong, D.G., Lavery, L.A., Bushman, T.R.: Peak foot pressures influence the healing time of diabetic foot ulcers treated with total contact casts. J. Rehabil. Res. Dev. 35, 1–5 (1998)
Robertson, D.D., Mueller, M.J., Smith, K.E., Commean, P.K., Pilgram, T., Johnson, J.E.: Structural changes in the forefoot of individuals with diabetes and a prior plantar ulcer. J. Bone Jt. Surg. Am. 84-A, 1395–1404 (2002)
Tohno, E., Umemoto, T., Sasaki, K., Morishima, I., Ueno, E.: Effect of adding screening ultrasonography to screening mammography on patient recall and cancer detection rates: a retrospective study in Japan. Eur. J. Radiol. 82, 1227–1230 (2013)
Wasadikar, A.P., Jadhav, M.B., Rote-Kaginalkar, V.J., Wasadikar, P.P., Jha, P.S.: Differentiation of solid breast masses into benign and malignant by using gray scale ultrasonography and strain elastography. J. Med. Sci. Clin. Res. 5, 31456–31463 (2017)
Maurer, C.L., Sprigle, S.: Effect of seat inclination on seated pressures of individuals with spinal cord injury. Phys. Ther. 84, 255–261 (2004)
Lung, C.W., Yang, T.D., Crane, B.A., Elliott, J., Dicianno, B.E., Jan, Y.K.: Investigation of peak pressure index parameters for people with spinal cord injury using wheelchair tilt-in-space and recline: methodology and preliminary report. Biomed. Res. Int. 2014, 508583 (2014)
Lung, C.W., Hsiao-Wecksler, E.T., Burns, S., Lin, F., Jan, Y.K.: Quantifying dynamic changes in plantar pressure gradient in diabetics with peripheral neuropathy. Front. Bioeng. Biotechnol. 4, 54 (2016)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this paper
Cite this paper
Liau, BY., Chen, CL., Jan, YK., Chiu, HY., Huang, YW., Lung, CW. (2019). Three-Dimensional Elastography Gradient of the Plantar Soft Tissue: Methodology and Preliminary Study. In: Goossens, R. (eds) Advances in Social and Occupational Ergonomics. AHFE 2018. Advances in Intelligent Systems and Computing, vol 792. Springer, Cham. https://doi.org/10.1007/978-3-319-94000-7_33
Download citation
DOI: https://doi.org/10.1007/978-3-319-94000-7_33
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-93999-5
Online ISBN: 978-3-319-94000-7
eBook Packages: EngineeringEngineering (R0)