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ECR 2015 / C-1005
Sonoelastography on diabetic heel pads: a feasibility study
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Congress: ECR 2015
Poster No.: C-1005
Type: Scientific Exhibit
Keywords: Outcomes, Diagnostic procedure, Ultrasound, Elastography, Musculoskeletal system, Musculoskeletal soft tissue, Extremities
Authors: S. Matteoli, L. Forzoni, F. Vannetti, A. Virga, A. Corvi, R. Molino-Lova; Firenze/IT



A. B-Mode ultrasound

An example of heel pad scanned by US is shown in Figure 2, where the yellow dashed line indicates the UHPT. Table 2 shows UHPT values of both feet grouped by gender and expressed as mean ± one standard deviation.



Table 2 Average heel pad thickness of right and left heels for controls and diabetic patients




Diabetic subjects

UHPT (mm) right heel 



UHPT (mm) left heel 





Paired t-test showed no significant difference between right and left heel pads in UHPT within the same group (P-value=0.61); unpaired t-test showed no significant difference in UHPT between diabetic and healthy heel pads (P-value=0.49).


B. Sonoelastography

Sonoelastography images showed two characteristic layers: a soft one (red color) close to the bone, and a hard/medium one (blue/green colors) close to the heel skin. This finding confirms the anatomy of the heel pad which consists of layers of macrochambers (near the bone) and microchambers (near the heel skin) [6].

Due to the difference between images (Figure 3), it was necessary to divide them into three classes depending on the homogenity of the soft tissue, considering the soft (red) and medium hardness (blue/green) area. The homogeneity was evaluated depending on the visual control of the density of the central area of the heel tissue: 1) high homogeneity - red area more present than the blue/green one (Figure 3a); 2) medium homogenity (Figure 3b) - red area comparable to the blue/green one; 3) scarse or absent homogeneity (Figure 3c) - more blue/green area than the red one.

Table 3 reports the percentage of soft tissue measured for controls and diabetic subjects. Paired t-test showed no significant difference between right and left heel pads (P-value=0.64) in case of healthy subjects, whereas there was a significant difference (P-value=0.007) in case of diabetic subjects.  

Unpaired t-test showed no significant difference between healthy and diabetic heel pads (P-value=0.25) when comparing the right heels, whereas a significant difference (P-value=0.02) in case of the left heels.



Table 3 Percentage of soft tissue measured from ElaXto images of right and left heels for controls and diabetic subjects




Diabetic subjects

Soft tissue right heel (%)



Soft tissue left  heel (%)





One important finding was the evident difference between ElaXto images belonging to healthy and diabetic subjects: the latter had often a larger hard layer close to the bone, as shown in Figure 4.

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