No. | Author (year) | Study Design | Aim | Setting; Recruitment timeframe; Sample size and comparison groups | Parameters assessed and assessment tools utilised | Anatomical sites examined |
---|---|---|---|---|---|---|
Plantar soft tissues | ||||||
1 | Kwak (2020) [34] | – | To compare the mechanical properties and stress-strain behaviours of plantar heel soft tissues between people with Type 2 diabetes, young and old control participants. | Foot and ankle tertiary referral clinic at the Seoul National University Bundang Hospital, Seoul, South Korea; Recruitment time-frame: – ■ 10 young ctrls ■ 10 older ctrls ■ 10 T2DM | PTS: Subject-specific finite element model | Heel |
2 | Lechner (2019) [36] | Descriptive, exploratory study | To compare the structure, function and molecular markers of dry and cracked foot skin between people with and without diabetes. | Department of Dermatology and allergy; Charité-Universitätsmedizin Berlin, Germany; September 2016 – April 2017; ■ 20 ctrls ■ 40 T2DM | PTT: Optical coherence tomography PTS: Cutometer | MTH 1, Heel |
3 | Oh (2018) [37] | Retrospective | To investigate the severity of pedal soft tissue atrophy caused by diabetes and aging. | Hospital, Daegu, South Korea; February 2009 – February 2016; ■ 47 ctrls ■ 52 T2DM | PTT: MRI | MTH 1, 2, 3, 4, 5 |
4 | Kumar (2015) [39] | Observational | To evaluate the thickness of intrinsic foot muscles, plantar skin, plantar fascia and plantar fat pad in people with Type 2 diabetes (with and without DPN). | Tertiary hospital, Manipal, India; July 2013 – January 2014; ■ 30 ctrls ■ 12 T2DM ■ 18 T2-DPN | PTT: US | MTH 1, 2, 3, 4, 5 |
5 | Chatzistergos (2014) [40] | – | To investigate the correlation between the mechanical properties of the heel pad of people with Type 2 diabetes and the clinical parameters used to monitor their health and ulceration risk (e.g. ABI, duration of diabetes, FBS, HbA1c, triglycerides and VPT) | Diabetic referral centre, Chennai, India; Recruitment time-frame: – ■ 17 ctrls ■ 35 T2DM | PTT and PTS: US probe connected with a dynamometer | Heel |
6 | Jan (2013) [42] | – | To investigate the effect of diabetes on the biomechanical properties and plantar pressure distribution in the pathogenesis of DFU. | Recruitment setting: – Recruitment timeframe: – ■ 6 ctrls ■ 7 T2-DPN | PTT and PTS: TUPS | MTH 1 |
7 | Chao (2012) [43] | – | To evaluate the association between skin blood flow and oedema and epidermal thickness in the feet of people with and without diabetes. | Diabetic clinic of a local hospital, Hong Kong; January 2009 – November 2010; ■ 33 ctrls ■ 35 T2DM ■ 19 T2-DPN with DFU (active or a history of DFU) | PTT: US | Hallux |
8 | Periyasamy (2012) [44] | Pilot study | To investigate the feasibility of measuring PTS variation in people with diabetes. | Outpatient clinics of Biomedical and Endocrinology Lab, All India Institute of Medical Sciences, New Delhi, India; January – March 2011; ■ 10 ctrls ■ 10 T2DM ■ 10 T2-DPN | PTS: Durometer | Hallux, MTH 1, 2, 3–5, midfoot, heel |
9 | Chao (2011) [45] | – | To examine the changes in epidermal thickness and biomechanical properties of plantar soft tissue in people with Type 2 diabetes (with and without either DPN or DFU). | Diabetic clinic of a local hospital, Hong Kong; Recruitment time-frame: – ■ 40 ctrls ■ 34 T2DM ■ 32 T2-DPN ■ 16 T2-DFU (active or a history of) | PTT: US (epidermis only); TUPS (total plantar soft tissue thickness) PTS: TUPS (total plantar soft tissue stiffness) | Hallux, MTH 1, 3, 5, heel |
10 | Sun (2011) [55] | Cross-sectional study | To compare the thickness and stiffness of plantar soft tissues between people with DPN and healthy participants. | University research laboratory, Hong Kong; Participants recruited from a local outpatient diabetes clinic; Recruitment time-frame: – ■ 54 ctrls ■ 70 DPN (early-stage) | PTT and PTS: TUPS | Hallux, MTH 1, 2, heel |
11 | Hsu (2009) [46] | – | To compare micro- and macrochambers mechanical properties between people with Type 2 diabetes and age-matched healthy participants. | Tertiary care hospital, Taiwan; Recruitment time-frame: – ■ 16 ctrls ■ 18 T2DM (2 with DPN; all nil history of DFUs) | PTT and PTS: US with a load cell | Heel |
12 | Hsu (2007) [49] | Pilot study | To compare the energy dissipation ratio in the plantar soft tissue under the metatarsal heads between people with Type 2 diabetes and age-matched healthy participants. | Recruitment setting: – Recruitment timeframe: – ■ 8 ctrls ■ 13 T2DM (nil with DPN) | PTT: US with a load cell | MTH 1, 2, 3, 4, 5 |
13 | Cheung (2006) [62] | Preliminary / pilot study | To test the feasibility of applying magnetic resonance elastography to map the elastic modulus of the plantar fat pads, in participants with and without diabetes. | Department of Radiology, Dartmouth Medical Centre, Lebanon; Recruitment timeframe: – ■ 12 ctrls† ■ 4 DPN | PTS: Magnetic resonance elastography | Heel |
14 | Hashmi (2006) [50] | Investigative report | To quantify specific glycation products generated in plantar epidermal proteins in individuals with Type 2 diabetes and age-matched controls, and to compare these data with the viscoelastic properties of the epidermis. | Diabetes Unit and the Diabetes Eye Screening Unit at Whittington hospital, London, UK; Recruitment timeframe: – ■ 87 ctrls ■ 103 T2DM | PTT: US PTS: Cutometer | MTH 3 |
15 | Puri (2005) [51] | – | To examine changes in tissue echogenicity due to the altered material properties of the plantar foot in diabetes. | Recruitment setting: – Recruitment timeframe: – ■ 8 ctrls ■ 16 T2DM (3 with neuropathic DFUs) | PTS: Durometer | Hallux, MTH 1, 3–5, medial and lateral heel |
16 | Mueller (2003) [56] | – | To determine the primary forefoot structural factors which predict regional PPP during walking in groups of people with and without DPN. | Multidisciplinary tertiary-care diabetic foot clinic and the database from the Institution Diabetes Research Training Centre, Washington University School of Medicine, St. Louis, USA; Recruitment timeframe: – ■ 20 ctrls ■ 20 DPN with a history of DFUs | PTT and PTS: SXCT | PTT: MTH 1, 2, 3, 4, 5 PTS: MTH 1, 3, 5 |
17 | Thomas (2003) [52] | Preliminary study | To identify relationships between foot pressure, tissue stiffness and thickness at different severities of DPN. | Recruitment setting: – Recruitment timeframe: – ■ 9 ctrls ■ 18 T2-DPN (5 with active DFU). | PTT: US PTS: Durometer | Hallux, MTH 2, 3–5, heel |
18 | Klaesner (2002) [63] | Case-control study | To determine if a difference exists in the plantar soft tissues of people with DPN compared with age-matched controls. | Data collection performed in an academic physical therapy laboratory; Participants recruited from multiple sources including those who had participated in previous studies in the laboratory, Washington University’s volunteers for Health subject database, the Diabetic Foot Centre at Barnes-Jewish Hospital, and physician referral, St. Louis, USA; Recruitment timeframe: – ■ 20 ctrls ■ 20 DPN with a history of DFU | PTS: Indentor system; | MTH 1, 3, 5, heel |
19 | Robertson (2002) [57] | – | To investigate relationships between structural changes of the forefoot in people with diabetes with a prior plantar DFU and in matched controls. | Multi-disciplinary tertiary-care diabetes clinic, Washington University School of Medicine, St. Louis, USA; Recruitment timeframe: – ■ 16 ctrls ■ 16 DPN with a history of DFU | PTT: Computed tomography | MTH 1–5 |
20 | Hsu (2000) [53] | – | To compare the heel-pad mechanical properties in people with Type 2 diabetes (with and without forefoot DFU)and age-matched healthy participants using a specially designed loading-unloading device. | Recruitment setting: – Recruitment timeframe: – ■ 20 ctrls ■ 21 T2DM (38% with DPN) ■ 12 T2-DFU (all active, Wagner grade 2 or 3; 75% with DPN) | PTT and PTS: US with a loading/unloading device | Heel |
21 | Zheng (2000) [58] | – | To investigate the biomechanical properties of plantar tissues between older participants with DPN and healthy younger participants. | Recruitment setting: – Recruitment timeframe: – ■ 4 young ctrls ■ 4 elderly DPN | PTT and PTS: US indentation system | Hallux, MTH 1, 2, heel |
22 | Piaggesi (1999) [64] | – | To investigate if neuropathy-associated modification of skin elasticity is found before the occurrence of DFU. | Outpatient diabetic clinic, Pisa, Italy; June – December 1996; ■ 36 ctrls ■ 36 DM ■ 36 DPN | PTS: Durometer | Midfoot (median and lateral), heel, posterior mid-calf (as a control site) |
23 | Brink (1995) [59] | – | To investigate potential differences in periarticular soft tissues at the plantar pedis between people without diabetes and people with a history of neuropathic DFUs. | Recruitment setting: – Recruitment timeframe: – ■ 15 young ctrls ■ 10 older ctrls ■ 10 DPN with a history of recurrent DFUs | PTT: US PTS: Durometer | MTH 1, 2, 3, 4, 5, heel |
24 | Gooding (1986) [60] | – | To quantify the loss of foot pad thickness and investigate its relationship to ulceration of the foot. | Recruitment setting: – Recruitment timeframe: – ■ 24 ctrls ■ 38 DM ■ 11 DFUs (active or a history of) | PTT: US | MTH 1, 2, 3, 4, 5, heel |
25 | Gooding (1985) [61] | – | To investigate whether it is feasible for US to evaluate heel pad thickness without the use of radiation. | Recruitment setting: – Recruitment timeframe: – ■ 10 ctrls ■ 38 DM | PTT: US | Heel |
Plantar soft tissues and Achilles tendon | ||||||
26 | Cheing (2013) [41] | – | To compare the biomechanical properties of the ankle–foot complex of people with diabetes (with and without DPN) with healthy individuals, and to examine its correlation with postural control. | Two local outpatient diabetes clinics, Hong Kong; Recruitment timeframe: – ■ 32 ctrls ■ 23 T2DM ■ 9 T2-DPN | PTT, PTS, ATT and ATS: TUPS | Hallux, MTH 1, 3, 5, heel; AT: Distal portion |
Achilles tendon | ||||||
27 | Harish (2020) [33] | – | To evaluate sonographic changes in the AT of people with Type 2 diabetes including thickening, hypoechogenicity, loss of fibrillary pattern and alterations in the elasticity of the AT. | Recruitment setting: – Recruitment timeframe: – ■ 61 ctrls ■ 81 T2DM (30 with symptoms suggestive of DPN, 7 with active DFUs, 8 with leg amputations) | ATT: US ATS: Elastography (Shear wave elasticity imaging) | ATT: Proximal, mid- and distal portions ATS: Distal portion only |
28 | İyidir (2019) [35] | Cross-sectional study | To evaluate the elastographic features of AT with Acoustic Radiation Force Impulse in people with and without DPN. | Endocrinology and radiology departments of Başkent University, Ankara, Turkey; March 2016 – July 2017; ■ 30 ctrls ■ 23 T2DM ■ 22 T2-DPN | ATT: US ATS: Elastography (Acoustic Radiation Force Impulse) | Mid-portion |
29 | Couppé (2016) [68] | Cross-sectional study | To compare the effect of glycaemic control (based on 2-yr average HbA1c) in two groups of men with diabetes (Type 1 and Type 2) and either well or poorly controlled diabetes. | Recruitment setting: – Recruitment timeframe: – ■ 11 ctrls ■ 44 DM (22 well-controlled DM, 22 poorly-controlled DM) | ATS: US Collagen tendon fibril density: Electron microscopy Collagen cross-links: Biopsy specimens | Distal |
30 | Evranos (2015) [38] | Cross-sectional study | To evaluate ATT and ATS in people with Type 2 diabetes (with and without foot disease) and to investigate the factors that influence these. | Study conducted at endocrinology and radiology departments of a university hospital; Subjects recruited from diabetes clinics, Ankara, Turkey; July 2012 – December 2014; ■ 33 ctrls ■ 43 T2DM ■ 35 T2-DFU | ATT: US ATS: Elastography (strain) | Proximal, mid- and distal portions |
31 | Papanas (2009) [47] | – | To study AT morphology on MRI in people with Type 2 diabetes (with and without DPN). | Outpatient clinic of the diabetic foot, tertiary care setting, Greece; Recruitment timeframe: – ■ 16 ctrls ■ 19 T2DM ■ 19 T2-DPN | ATT and AT volume: MRI | – |
32 | Batista (2008) [65] | – | To identify any inherent structural pathology in a consecutive group of asymptomatic individuals with diabetes that might be associated with increased stiffness and the development of forefoot DFUs. | Department of Orthopaedic Surgery at the Federal University of São Paulo, Brazil, and Orthopaedic Surgery Clinic at Carmino Caricchio Hospital, Brazil; Recruitment timeframe: – ■ 10 ctrls ■ 60 DM | ATT: US Morphology: US | – |
33 | Akturk (2007) [48] | – | To investigate the effect of diabetes on the AT that may contribute to the long-term complications in the foot-ankle complex and to investigate the factors relating to its thickening. | Endocrinology clinic; Recruitment timeframe: – ■ 34 ctrls ■ 55 T2DM | ATT: US | Mid-portion |
34 | D’Ambrogi (2005) [66] | – | To examine foot function in the presence of diabetes-induced alterations of the anatomical and biomechanical unit formed by the AT, plantar fascia and MTPJs. | Outpatient clinics of the Metabolic Diseases Department at the University of Rome “Tor Vergata”, Italy; Recruitment timeframe: – ■ 21 ctrls ■ 27 DM ■ 19 DPN ■ 15 DPN with a history of DFU (up to 3 months) | ATT: US | Proximal, mid- and distal portions |
35 | Giacomozzi (2005) [67] | – | To examine the effects that diabetes-induced alterations of AT, plantar fascia and 1st MTPJ — both anatomical and functional — may have on foot loading. | Outpatient clinics of the Metabolic Diseases Department at the University of Rome “Tor Vergata”, Italy; Recruitment timeframe: – ■ 21 ctrls ■ 27 DM ■ 19 DPN ■ 15 DPN with a history of DFU (up to 3 months) | ATT: US | Proximal, mid- and distal portions |