  The primary objective of this study was to develop a method that allows
accurate quantification of plantar soft tissue stiffness distribution and
homogeneity. The secondary aim of this study is to investigate if the
differences in soft tissue stiffness distribution and homogeneity can be
detected between ulcerated and non-ulcerated foot. Novel measures of individual
pixel stiffness, named as quantitative strainability (QS) and relative
strainability (RS) were developed. SE data obtained from 39 (9 with active
diabetic foot ulcers) patients with diabetic neuropathy. The patients with
active diabetic foot ulcer had wound in parts of the foot other than the first
metatarsal head and the heel where the elastography measures were conducted. RS
was used to measure changes and gradients in the stiffness distribution of
plantar soft tissues in participants with and without active diabetic foot
ulcer. The plantar soft tissue homogeneity in superior-inferior direction in
the left forefoot was significantly (p<0.05) higher in ulcerated group compared
to non-ulcerated group. The assessment of homogeneity showed potentials to
further explain the nature of the change in tissue that can increase internal
stress . This can have implications in assessing the vulnerability to soft
tissue damage and ulceration in diabetes.
