FOREFOOT PLANTAR SOFT TISSUE

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。糖尿病足溃疡是一个多方面的问题，涉及足底软组织对施加于表皮的外力(压力和摩擦力)和足部内部变化(如血管供应、神经病变)的反应。这项研究项目将结合最先进的磁共振成像(MRI)定量技术、足底压力测量和详细的有限元建模(FEM)来研究糖尿病患者足底软组织的变化过程。核磁共振将被用来描绘软组织以及糖尿病患者在过去经历过足部溃疡的前脚骨骼。这些结构信息以及足底压力测量将被用来生成针对患者的详细的前足横断面有限元分析，以预测内部组织应力。这些预测将与一年期间评估的患者队列中溃疡的发生情况进行比较。除了脚的结构和压力变化外，受试者还根据他们的脚的感觉能力进行评估，以评估他们患神经病变的风险。通过测量经皮氧分压来检查微循环的生存能力和足部充足的血流量，以排除外周血管疾病。他们脚上的荧光测量也被用来评估他们患糖尿病时皮肤的变化。将对这些数据进行检查，以确定导致溃疡形成的初始步骤，因为它们与各种足底软组织所经历的压力有关，如皮肤层和脚后跟脂肪垫。随着对机械应力和病理组织变化之间相互作用的了解，糖尿病足溃疡的病因将得到更好的理解。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Diabetic foot ulceration is a multi-faceted problem involving the response of plantar soft tissue to both external forces (pressure and frictional forces) applied to the epidermis and internal changes (e.g., vascular supply, neuropathy) of the foot. This research project will combine state-of-the-art techniques for magnetic resonance imaging (MRI) quantification, plantar pressure measurement, and detailed finite element modeling (FEM) to examine the course of diabetes related changes in the plantar soft tissues. The MRI will be used to delineate soft tissues as well as the bones in the forefoot of diabetic patients who have experienced a foot ulcer in the past. This structural information as well as the plantar pressure measurements will be used to generate detailed patient-specific FEM of transverse sections of the forefoot to predict internal tissue stresses. These predictions will be compared with the occurrence of ulcers in the patient cohort evaluated over a period of one year. In addition to the structural and pressure changes of the foot, the subjects are evaluated in terms of the sensory ability of their foot in order to assess their risk of neuropathy. Viability of microcirculation and adequate blood flow to their foot is examined by measuring transcutanous oxygen tension to rule out peripheral vascular disease. Measurement of fluorescence from their feet is also used to assess alterations in their skin with diabetes. The data will be examined to identify the initial steps resulting in ulcer formation as they relate to stresses experienced by various plantar soft tissues such as skin layers and heel fat pad. With knowledge of the interactions between mechanical stresses and pathological tissue changes, the etiology of diabetic foot ulceration will be better understood.