Li Yiming, Wu Wei, Xue Liyun, Zhao Tianyu, Lu Yucheng, Qiao Xiaohui, Ding Hong
Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China.
Department of Endocrine, Huashan Hospital, Fudan University, Shanghai, China.
J Diabetes. 2025 May;17(5):e70094. doi: 10.1111/1753-0407.70094.
Diabetic peripheral neuropathy (DPN) may affect the biomechanical properties and morphology of the plantar tissue. This study aimed to compare plantar stiffness and thickness in individuals with diabetes with and without DPN and develop a novel explanatory model for DPN risk assessment by integrating these measures with clinical parameters.
MATERIALS & METHODS: Thirty-two healthy controls and 84 people with diabetes (41 with DPN and 43 without DPN) were included. Shear wave elastography evaluated plantar thickness and stiffness at the heel, hallux, and first and fifth metatarsal heads (1st MTH, 5th MTH). An integrated thickness or stiffness index was generated at multiple locations by principal component analysis (PCA).
People with DPN showed a significant increase in plantar thickness (heel, 1st MTH) (p < 0.001) and stiffness (all tested locations) compared to healthy controls (p < 0.05). Moreover, plantar thickness at 1st MTH, plantar stiffness at 5th MTH, and integrated stiffness index generated by PCA were significantly higher in DPN than in the non-DPN group (p < 0.05). A DPN explanatory model was developed using multivariate logistic regression, incorporating the integrated plantar stiffness index, diabetes duration, and gender. The model showed high discriminative ability (AUROC: 97.7%), with an optimal cutoff of 0.56 yielding 92.7% sensitivity and 95.3% specificity.
The integrated plantar stiffness index, combined with gender and diabetes duration, offers a novel approach for DPN, providing a noninvasive tool for DPN risk assessment.
糖尿病周围神经病变（DPN）可能会影响足底组织的生物力学特性和形态。本研究旨在比较有和没有DPN的糖尿病患者的足底硬度和厚度，并通过将这些测量值与临床参数相结合，开发一种用于DPN风险评估的新型解释模型。
纳入32名健康对照者和84名糖尿病患者（41名患有DPN，43名未患有DPN）。剪切波弹性成像评估了足跟、拇趾以及第一和第五跖骨头（第一跖骨头、第五跖骨头）处的足底厚度和硬度。通过主成分分析（PCA）在多个位置生成综合厚度或硬度指数。
与健康对照者相比，患有DPN的患者足底厚度（足跟、第一跖骨头）显著增加（p < 0.001），硬度在所有测试位置均显著增加（p < 0.05）。此外，第一跖骨头处的足底厚度、第五跖骨头处的足底硬度以及PCA生成的综合硬度指数在DPN组中显著高于非DPN组（p < 0.05）。使用多因素逻辑回归开发了一个DPN解释模型，纳入了综合足底硬度指数、糖尿病病程和性别。该模型显示出高辨别能力（曲线下面积：97.7%），最佳截断值为0.56，灵敏度为92.7%，特异度为95.3%。
综合足底硬度指数，结合性别和糖尿病病程，为DPN提供了一种新方法，为DPN风险评估提供了一种非侵入性工具。
