Abstract
BackgroundThe accurate and reliable measurement of foot bone density is challenging and there is currently no gold standard technique. Such measurement is particularly valuable in populations at risk of foot bone pathology such as in those with long term diabetes. With research and development, computed tomography may prove to be a useful tool for this assessment. The aim of this study was to establish the reliability of a novel method of foot bone density measurement in people with diabetes using computed tomography.MethodsTen feet in people with diabetes were scanned with computed tomography twice with repositioning. Bone density (in Hounsfield units) was assessed in the trabecular and cortical bone in all tarsals and metatarsals. Reliability was assessed with intra-class correlation coefficients (95% confidence intervals), limits of agreement and standard error of measurement.ResultsThe reliability of the trabecular density of most bones was excellent with intra-class correlation coefficients ranging from 0.68 to 0.91. Additionally, cortical bone density showed fair to good reliability at the talus (0.52), calcaneus (0.59), navicular (0.70), cuboid (0.69), intermediate cuneiform (0.46) and first metatarsal (0.61).ConclusionsThe study established the reliability of a practical method of assessing the trabecular and cortical foot bone density using computed tomography scanning. This methodology may be useful in the investigation of foot bone disease occurring in diabetes and its early diagnosis, intervention and assessment of treatment efficacy. Further development of this method is warranted.
Highlights
The accurate and reliable measurement of foot bone density is challenging and there is currently no gold standard technique
Ultrasound has been used to assess the integrity of the calcaneus, but is impractical to use on the rest of the bones of the foot, which are prone to fracture and Charcot neuroarthropathy in people with diabetes [9]
Trabecular measurements displayed excellent reliability with intra-class correlation coefficients (ICC)’s ranging from 0.81 to 0.91, except for the navicular (0.70), cuboid (0.68) and fourth metatarsal (0.69) which displayed fair to good reliability
Summary
The accurate and reliable measurement of foot bone density is challenging and there is currently no gold standard technique. Diabetes has been shown to affect bone mineral density (BMD) and its microstructure [4], reduce fracture resistance, and impair bone regeneration [5] These generalised changes to bone regulation, in addition to presence of peripheral diabetes complications, are proposed to leave individuals susceptible to Charcot neuroarthropathy [6]. This is a disease characterised by extreme alterations to bone throughout its Traditional techniques of assessing BMD lack the accuracy to establish density in foot bones due to the intricate nature of foot bone morphology [8]. Ultrasound has been used to assess the integrity of the calcaneus, but is impractical to use on the rest of the bones of the foot, which are prone to fracture and Charcot neuroarthropathy in people with diabetes [9]
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