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

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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 pre-diabetes onset (Fasting Blood Sugar
Level-FBS>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 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 vs 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.