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
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.