Ultrasound Assessment of Pedal Soft Tissue Thickness in Diabetic Patients With and Without Peripheral Neuropathy

Abstract Background: Foot ulcer is a serious complication of diabetes which can cause patient disability. High plantar pressure is one of the risk factors for ulcer formation. Pedal Soft Tissue (PST) thickness is essential in keeping its cush-ioning effect. Atrophy of PST leads to increase in the plantar pressure, which subsequently leads to ischemia and ulceration. Aim of Study: To compare the PST thickness opposite the Metatarsal Heads (MTHs) in diabetic patients with and without peripheral neuropathy using Ultrasound (US) as an easy, available, and non-invasive tool. Material and Methods: We examined the feet (n=96) of 48 diabetic patients using high-frequency US imaging (10- 13MHz). We divided the patients into 2 groups. The first group included 24 diabetic patients with peripheral neuropathy (mean age 56±6 years), and the second group included 24 diabetic patients without peripheral neuropathy (mean age 57±5 years). We measured and compared the vertical thickness of PST superficial to flexor tendons opposite all MTHs in between the 2 groups using independent-sample-t-test. Results: There was statistically significant difference in mean PST thickness under all left MTHs (first 5 vs. 6.4; second 6.1 vs. 7.8; third 6.2 vs. 7.4; fourth 5.6 vs. 6.9; fifth 4 vs. 5.7mm; p < 0.05), and the first, second, third and fifth right MTHs (first 5.1 vs. 6.3; second 6.1 vs. 7.5; third 5.8 vs. 7.3; fifth 4.4 vs. 5.9mm; p < 0.05) between the first and second groups, respectively. Age, Body Mass Index (BMI) and sex had no significant effect on PST thickness in both groups. Conclusion: Our study confirmed that US is effective, easy, available, harmless, low cost, non-invasive imaging tool that detects more PST atrophy in diabetic patients with pe-ripheral neuropathy than that occurs in diabetic patients without peripheral neuropathy.