title: Integration of plantar soft tissue stiffness measurements in routine MRI of the diabetic foot.
abstract: OBJECTIVE
  A method of measuring mechanical properties of plantar soft tissues in vivo by integrating a photoelastic technique into an MRI system is presented.
  
  
  BACKGROUND
  Plantar tissue stiffening in the diabetic foot is associated with development of ulcers at the highest-pressure sites. MRI is used as an effective means of demonstrating tissue damage caused by diabetic ulceration.
  
  
  METHODS
  The new measurement method uses the indentation of a sphere into the plantar tissue, which is simultaneously scanned by MRI. The indentation force is obtained using the photoelastic technique while tissue deflection is measured on the MRI scans, to yield a characteristic load-displacement curve.
  
  
  METHODS
  Applicability of the proposed method in characterizing the plantar tissue stiffness and indentation patterns of two young normal subjects and two older diabetic patients was tested.
  
  
  RESULTS
  Significantly higher effective shear and elastic moduli were measured for the diabetic plantar tissue compared with that of normal. For the diabetic patients, local stiffness in proximity of the 1st metatarsal head was substantially larger than in other sites, and this could be associated with initial tissue ulceration at this location.
  
  
  CONCLUSIONS
  The present method seems applicable as a practical means of identifying regions in the diabetic plantar tissue that are vulnerable to ulceration, and can be easily integrated into routine MRI scans for assessing tissue damage in these patients.
authors.affiliation: Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, 69978, Tel Aviv, Israel. gefen@eng.tau.ac.il
authors.forename: A
authors.initials: A
authors.lastname: Gefen
authors.forename: M
authors.initials: M
authors.lastname: Megido-Ravid
authors.forename: M
authors.initials: M
authors.lastname: Azariah
authors.forename: Y
authors.initials: Y
authors.lastname: Itzchak
authors.forename: M
authors.initials: M
authors.lastname: Arcan
mesh_terms: D016022:Case-Control Studies; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004548:Elasticity; D006365:Heel / Q000293:injuries / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012016:Reference Values; D012680:Sensitivity and Specificity; D017695:Soft Tissue Injuries / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D013314:Stress, Mechanical; D016474:Weight-Bearing