The Quasi-Linear Viscoelastic Properties of Diabetic and Non-Diabetic Plantar Soft Tissue

The purpose of this study was to characterize the viscoelastic behavior of diabetic and non-diabetic plantar soft tissue at six ulcer-prone/load-bearing locations beneath the foot to determine any changes that may play a role in diabetic ulcer formation and subsequent amputation in this predisposed population. Four older diabetic and four control fresh frozen cadaveric feet were each dissected to isolate plantar tissue specimens from the hallux, first, third, and fifth metatarsals, lateral midfoot, and calcaneus. Stress relaxation experiments were used to quantify the viscoelastic tissue properties by fitting the data to the quasi-linear viscoelastic (QLV) theory using two methods, a traditional frequency-insensitive approach and an indirect frequency-sensitive approach, and by measuring several additional parameters from the raw data including the rate and amount of overall relaxation. The stress relaxation response of both diabetic and non-diabetic specimens was unexpectedly similar and accordingly few of the QLV parameters for either fit approach and none of raw data parameters differed. Likewise, no differences were found between plantar locations. The accuracy of both fit methods was comparable, however, neither approach predicted the ramp behavior. Further, fit coefficients varied considerably from one method to the other, making it hard to discern meaningful trends. Future testing using alternate loading modes and intact feet may provide more insight into the role that time-dependent properties play in diabetic foot ulceration.