Altered heel-pad mechanical properties in patients with Type 2 diabetes mellitus

Hsu, T.-C.<sup>1</sup>; Wang, C.-L.<sup>2</sup>; Shau, Y.-W.<sup>3</sup>; Tang, F.-T.<sup>1</sup>; Li, K.-L.<sup>4</sup>; Chen, C.-Y.<sup>5</sup>

Affiliations

¹Department of Rehabilitation Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan

²Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan

³Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan

⁴Department of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan

⁵Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan

Abstract and keywords

Aims: To compare the heel-pad mechanical properties in patients with Type 2 diabetes mellitus with forefoot ulceration, without forefoot ulceration and age-matched healthy subjects.

Methods: Heel-pad mechanical properties in 40 heels of 20 healthy subjects (group I) age-matched with the other groups, 42 heels of 21 diabetic patients without forefoot ulceration (group II), and 14 heels of 12 diabetic patients with active forefoot ulceration (group III) were assessed using a self-constructed loading–unloading device and a 10-MHz linear-array ultrasound transducer.

Results: There were no differences in the unloaded heel-pad thickness, compressibility index and elastic modulus between the three groups. When compared with group I subjects (mean – sd, 27.9 – 6.1%), a significant increase (P < 0.001) was found in both group II (36.1 – 8.7%) and group III patients (43.2 – 6.6%) for the energy dissipation ratio. This ratio was also significantly different (P = 0.003) between groups II and III.

Conclusions: The higher impact energy dissipated in the heel-pad may put patients with Type 2 diabetes at higher risk for developing foot ulceration.

Keywords: biomechanics, diabetic foot, heel, ulceration, ultrasonography

Links

DOI: 10.1046/j.1464-5491.2000.00394.x

PubMed: 11168328

WoS: 000166525600008

History

Accepted: 2000-08-31

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Cited By (13)

Year	Entry
2002	Hsu T-C, Lee Y-S, Shau Y-W. Biomechanics of the heel pad for type 2 diabetic patients. Clin Biomech (Bristol, Avon). May 2002;17(4):291-296.
2006	Spears IR, Miller-Young JE. The effect of heel-pad thickness and loading protocol on measured heel-pad stiffness and a standardized protocol for inter-subject comparability. Clin Biomech (Bristol, Avon). February 2006;21(2):204-212.
2010	Chao CYL, Zheng Y-P, Huang Y-P, Cheing GLY. Biomechanical properties of the forefoot plantar soft tissue as measured by an optical coherence tomography-based air-jet indentation system and tissue ultrasound palpation system. Clin Biomech (Bristol, Avon). 2010;25(6):594-600.
2003	Tong J, Lim CS, Goh OL. Technique to study the biomechanical properties of the human calcaneal heel pad. Foot. June 2003;13(2):83-91.
2006	Erdemir A, Viveiros ML, Ulbrecht JS, Cavanagh PR. An inverse finite-element model of heel-pad indentation. J Biomech. 2006;39(7):1279-1286.
2010	Pai S, Ledoux WR. The compressive mechanical properties of diabetic and non-diabetic plantar soft tissue. J Biomech. June 18, 2010;43(9):1754-1760.
2011	Chen W-M, Shim VP-W, Park S-B, Lee T. An instrumented tissue tester for measuring soft tissue property under the metatarsal heads in relation to metatarsophalangeal joint angle. J Biomech. June 3, 2011;44(9):1801-1804.
2012	Pai S, Ledoux WR. The shear mechanical properties of diabetic and non-diabetic plantar soft tissue. J Biomech. January 10, 2012;45(2):364-370.
2004	Ledoux WR, Meaney DF, Hillstrom HJ. A quasi-linear, viscoelastic, structural model of the plantar soft tissue with frequency-sensitive damping properties. J Biomech Eng. 2004;126(6):831-837.
2012	Chokhandre S, Halloran JP, van den Bogert AJ, Erdemir A. A three-dimensional inverse finite element analysis of the heel pad. J Biomech Eng. March 2012;134(3):031002.
2010	Gu Y, Li J, Ren X, Lake MJ, Zeng Y. Heel skin stiffness effect on the hind foot biomechanics during heel strike. Skin Res Tech. 2010;16(3):291-296.
2009	Sirimamilla PA. Elaborate Experimentation for Mechanical Characterization of Human Foot Using Inverse Finite Element Analysis [Master's thesis]. Cleveland, OH: Case Western Reserve University; January 2009.
2003	Miller-Young JE. Factors Affecting Human Heel Pad Mechanics: A Finite Element Study [PhD thesis]. Calgary, AB: University of Calgary; April 2003.