title: Assessment of the diabetic foot using spiral computed tomography imaging and plantar pressure measurements: a technical report.
abstract: Persons with diabetes mellitus (DM) and peripheral neuropathy are at high risk for skin breakdown due to unnoticed excessive pressures to the plantar foot during walking. We developed methods that combined spiral x-ray computed tomography (SXCT) imaging and plantar pressure analysis to quantify internal foot structure and external pressure during plantar loading. Methods were tested using a subject with DM who had a plantar ulcer, and a healthy control. SXCT measurements were within 2 mm of truth and SXCT plantar recordings were within 6.5% of walking trials. Hammer toe deformity (second toe), severe atrophy of the intrinsic muscles and less contact area during plantar loading, and a peak plantar pressure three times greater at the site of the ulcer were measured in the diabetic foot as compared with the healthy control. This preliminary investigation suggests that these methods are accurate for structural and pressure measurements of diabetic and healthy feet.
authors.affiliation: The Mallinckrodt Institute of Radiology, Department of Orthopaedic Surgery at the Washington University School of Medicine, St. Louis, MO 63110, USA. smithki@mir.wustl.edu
authors.forename: K E
authors.initials: KE
authors.lastname: Smith
authors.forename: P K
authors.initials: PK
authors.lastname: Commean
authors.forename: M J
authors.initials: MJ
authors.lastname: Mueller
authors.forename: D D
authors.initials: DD
authors.lastname: Robertson
authors.forename: T
authors.initials: T
authors.lastname: Pilgram
authors.forename: J
authors.initials: J
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D017719:Diabetic Foot / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D010808:Physical Examination; D011312:Pressure; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016474:Weight-Bearing