Plantar tissue stiffness in patients with diabetes mellitus and peripheral neuropathy

Abstract

Klaesner JW, Hastings MK, Zou D, Lewis C, Mueller MJ. Plantar tissue stiffness in patients with diabetes mellitus and peripheral neuropathy. Arch Phys Med Rehabil 2002;83:1796-801. Objective: To determine if a difference exists in the plantar soft tissue of patients with diabetes mellitus (DM) and peripheral neuropathy (PN) compared with age-matched controls. Design: Case-control study with a parallel 3-element 1-dimensional viscoelastic model developed to characterize indentation data. Setting: Data collection performed in an academic physical therapy laboratory. Participants: Forty subjects were recruited into 2 groups (20 subjects with DM, PN, and history of plantar ulcers; 20 control subjects), matched for age (DM: 55.22±9.39y; control: 55.91±10.97y), gender (DM: 14 men, 6 women; control: 14 men, 6 women), and body mass index (DM: 32.96±8.39kg/m2; control: 32.58±7.69kg/m2). Interventions: The plantar soft tissue stiffness was measured over the first, third, and fifth metatarsals, and heel of each subject using an indentor system that accurately measures force/displacement (F/D) data. A parallel 3-element viscoelastic mechanical model was then used to transform the F/D data into values that were used to make stiffness assessments. Main Outcome Measures: The element coefficients of our model indicated the stiffness of the plantar tissue. Results: The plantar tissue of the subjects with DM over the metatarsal heads was stiffer than the control population as indicated by one of the spring constants in the parallel 3-element model (first: 1.13±0.55N/mm vs .72±.32N/mm; third: .96±.32 N/mm vs .79±.17N/mm; fifth: .90±.31N/mm vs .69±.28N/mm; P<.05). Conclusions: The plantar tissue of subjects with DM, PN, and a history of ulcers was stiffer than control subjects. However, additional research is needed to determine the relationship among increased soft tissue stiffness, plantar pressures, and skin breakdown. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation