Assessment of the diabetic foot using spiral computed tomography imaging and plantar pressure measurements: A technical report

Persons with diabetes mellitus (DM) and peripheral neuropathy are at high r isk for skin breakdown due to unnoticed excessive pressures to the plantar foot during walking. We developed methods that combined spiral x-ray comput ed tomography (SXCT) imaging and plantar pressure analysis to quantify inte rnal foot structure and external pressure during plantar loading. Methods w ere tested using a subject with DM who had a plantar ulcer, and a healthy c ontrol. SXCT measurements were within 2 mm of truth and SXCT plantar record ings were within 6.5% of walking trials. Hammer toe deformity (second toe), severe atrophy of the intrinsic muscles and less contact area during plant ar 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 c ontrol. This preliminary investigation suggests that these methods are accu rate for structural and pressure measurements of diabetic and healthy feet.