Assessment of tissue glycation on plantar soft tissue stiffness

Introduction Tissue glycation, that occurs naturally through ageing and can be sometimes accelerated by disease such as diabetes mellitus, is clinically claimed to have induced irregular collagen alignment and increased collagen fibril density in patients [1]. This hence increases tissue stiffness and leads to plantar injury, i.e. ulcer. In the USA, 85% of all non-traumatic amputations in diabetes patients arise from non-healing ulcers [2]. This tells the need to assess and to detect tissue abnormality early, in order to prevent problematic tissue rupture especially in elderly and diabetes subjects. Currently, there are several existing tools used by clinicians like monofilament, tuning forks, biothesiometers, neurothesiometers etc. However, majority of them only measure subjective sensing ability but not the mechanical property of the plantar tissue. The objective of this study is to investigate the effects of (i) natural tissue glycation (ageing) and (ii) accelerated tissue glycation (diabetes mellitus) on plantar soft tissue stiffness using the proposed indenter [3].