Change of plantar tissue and aponeurosis characteristics in diabetes and its indication for ulcer risk.

Abstract

Diabetic foot ulcers (DFUs) remain a major complication of diabetes, yet the biomechanical role of plantar soft tissues in DFU pathogenesis is unclear. This study investigated mechanical and morphological changes in plantar tissues among diabetic peripheral neuropathy (DPN) patients (n = 21), diabetics without neuropathy (DM, n = 21), and healthy controls (n = 21) using shear wave elastography (SWE) and finite element (FE) gait simulation. SWE revealed significantly reduced shear modulus in DPN plantar soft tissues versus the DM group (p < 0.05), and region-specific increases in tissue thickness, particularly in the midfoot and forefoot areas. FE simulations demonstrated that DPN feet exhibited approximately 23 % higher deep tissue strain despite lower plantar pressure compared with other groups. DM feet showed higher plantar pressure and internal stress due to increased tissue modulus. These findings suggest that reduced plantar tissue modulus in DPN may concentrate mechanical stress in deeper layers, increasing vulnerability to deep tissue injury. The combined SWE-FE approach provides new insight into diabetic foot biomechanics, highlighting its potential for early risk screening and personalized prevention strategies. Future work should incorporate subject-specific geometries and longitudinal validation to strengthen clinical.