Altered heel-pad mechanical properties in patients with Type 2 diabetes mellitus

Aims To compare the heel-pad mechanical properties in patients with Type 2 diabetes mellitus with forefoot ulceration, without forefoot ulceration and age-matched healthy subjects. Methods Heel-pad mechanical properties in 40 heels of 20 healthy subjects ( group I) age-matched with the other groups, 42 heels of 21 diabetic patient s without forefoot ulceration (group II), and 14 heels of 12 diabetic patie nts with active forefoot ulceration (group III) were assessed using a self- constructed loading-unloading device and a 10-MHz linear-array ultrasound t ransducer. Results There were no differences in the unloaded heel-pad thickness, compr essibility index and elastic modulus between the three groups. When compare d with group I subjects (mean +/- SD, 27.9 +/- 6.1%), a significant increas e (P < 0.001) was found in both group II (36.1 +/- 8.7%) and group III pati ents (43.2 +/- 6.6%) for the energy dissipation ratio. This ratio was also significantly different (P = 0.003) between groups II and III. Conclusions The higher impact energy dissipated in the heel-pad may put pat ients with Type 2 diabetes at higher risk for developing foot ulceration.