title: Histomorphological evaluation of diabetic and non-diabetic plantar soft tissue.
abstract: BACKGROUND
  Diabetic foot ulceration has a complex and multifactorial etiology and can involve changes in the pathophysiology of the plantar soft tissue. In the current study, histomorphological analyses of diabetic and non-diabetic plantar tissue were performed. It was hypothesized that the diabetic tissue would have thicker skin (epidermis and dermis), less interdigitation between the dermis and epidermis, thicker elastic septa and decreased adipose cell size.
  
  
  METHODS
  Two locations of the foot (the heel and the first metatarsal) were examined, both of which have been reported to be locations with a high incidence of ulceration. Stereological methods and quantitative morphological techniques were used to evaluate the skin thickness, interdigitation index, elastic septae thickness and adipocyte cell size.
  
  
  RESULTS
  The diabetic donors had a greater body mass index (BMI) than the non-diabetic donors. The diabetic tissue had significantly thicker elastic septae and dermis. However, no significant difference was observed in the interdigitation index or adipocyte size.
  
  
  CONCLUSIONS
  These findings demonstrate that morphological changes can be evaluated histologically to give a better understanding of the pathological changes in the plantar soft tissue with diabetes. These evaluations can then be associated with biomechanical changes that occur in diabetes to provide new insight into how microstructural changes can alter macroscopic properties.
  
  
  CONCLUSIONS
  An understanding of the histomorphological changes in the soft tissue in relationship to the location on the foot could help to explain the biomechanical changes that occur in diabetes and the subsequent increase in susceptibility to breakdown.
authors: VA Puget Sound, RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, MS 151, 1660 S. Columbian Way, Seattle, WA 98108, USA.
authors: Yak-Nam
authors: YN
authors: Wang
authors: Kara
authors: K
authors: Lee
authors: William R
authors: WR
authors: Ledoux
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D015992:Body Mass Index; D003094:Collagen / Q000378:metabolism; D020405:Dermis / Q000473:pathology; D003920:Diabetes Mellitus / Q000473:pathology*; D004547:Elastic Tissue / Q000473:pathology; D004817:Epidermis / Q000473:pathology; D005260:Female; D005528:Foot; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D008297:Male; D012867:Skin / Q000473:pathology*
chemical_list: D003094:Collagen