Detection of Diabetic Foot Skin Damage Using Plantar Mechanical Parameters

An Exploratory Study on the Detection of Diabetic Foot Skin Damage Using Quantitative Mechanical Parameters of Plantar Skin

Diabetes represents one of the major chronic diseases, with diabetic ulcers being a significant adverse prognosis. Approximately 80% of lower limb amputations are attributed to diabetic foot ulcers, which constitute a primary cause of patient disability and mortality, while also imposing a substantial burden on healthcare systems. Although standardized Western medical protocols for diabetic foot management exist, clinical outcomes remain suboptimal. The amputation rate due to diabetic foot ulcers continues to rise annually, underscoring the urgent need for novel and effective interventions to address this condition.

Quantitative assessment of cutaneous biomechanical parameters may indirectly reflect the cumulative damage inflicted by diabetes on foot tissues. Such evaluation provides critical guidance for predicting susceptibility to recurrent ulceration and determining the necessity of enhanced offloading strategies to prevent ulcer development. By applying specific mechanical loads to the skin and measuring deformation, rebound characteristics, and displacement dynamics under pressure, it becomes possible to quantitatively evaluate parameters such as elastic modulus and viscoelastic properties.

This case-control study aims to investigate the feasibility of utilizing plantar skin quantitative mechanical parameters as objective biomarkers for biomechanical impairment in diabetic foot. Furthermore, it seeks to establish a standardized operating procedure (SOP) for quantitative measurements tailored to diabetic foot scenarios. The study is designed to bridge critical evidence gaps between theoretical consensus and clinically applicable quantitative tools, demonstrating clear innovation and potential clinical value.

Study Overview

• Status: Not yet recruiting
• Conditions: Diabete Mellitus; Mechanical Factor; Diabetic Foot Disease
• Intervention / Treatment: Diagnostic test: Detection of the elastic modulus of the plantar skin

• Study Type: Observational
• Enrollment (Estimated): 200

Contacts and Locations

• Study Contact: Name: Long Zhang Executive Deputy Director, Medical Doctor; Phone Number: +86 010-82266699; Email: longzh2000@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

both healthy people and diabetic foot patient.

Description

Inclusion Criteria:

• For healthy one: Fasting blood glucose < 6.1 mmol/L and glycated hemoglobin < 6.0%, with no history of diabetes; Foot condition: normal appearance of both feet, without wounds, deformities, trauma, infections, or dermatological disorders; voluntary participation in this study with signed informed consent.
• For diabetic one: Confirmation of type 1 or type 2 diabetes mellitus as defined by the World Health Organization (WHO) diagnostic standards; Diagnosis of diabetic foot disease* consistent with the criteria established by the International Working Group on the Diabetic Foot (IWGDF); Voluntary participation in the present study with provision of signed informed consent.

Exclusion Criteria:

• For healthy one: (1) History of foot surgery, trauma, or fractures resulting in skin scars or irreversible cutaneous damage; (2) Active chronic dermatological conditions affecting skin integrity, such as tinea pedis, eczema, or psoriasis; (3) Vascular diseases of the lower extremities (e.g., arteriosclerosis obliterans) causing muscular or cutaneous atrophy in the feet; (4) Systemic diseases impacting the skin or connective tissues, including systemic sclerosis, rheumatoid arthritis, or vasculitis; (5) Prolonged engagement in heavy physical labor or professional sports leading to abnormal thickening or hyperkeratosis of the plantar skin; (6) Presence of extensive, hyperkeratotic lesions (e.g., calluses, corns) or wounds at the measurement site impairing probe contact accuracy; (7) Inability to cooperate or diagnosed psychiatric disorders; (8) Investigator-determined unsuitability for the study or inability to comply with protocol requirements.
• For diabetic one: (1) Uncontrolled severe acute foot infections; (2) Dermatological conditions that interfere with measurement procedures; (3) Irreversible foot skin damage due to non-diabetic etiologies such as trauma or surgical intervention; (4) Coexisting systemic disorders (excluding diabetes) that compromise skin elasticity, including systemic sclerosis, rheumatoid arthritis, or vasculitis; (5) History of above-knee amputation on the measured foot; (6) Inability to cooperate or presence of psychiatric disorders; (7) Investigator-determined ineligibility due to non-compliance concerns or unsuitability for study participation.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
group of diabetic foot; patient with diabetic foot， with or without ulcer，ulcer has been healing or not	Diagnostic test: Detection of the elastic modulus of the plantar skin; This study utilizes a quantitative mechanical measurement apparatus, developed by Professor Cao's research team at Tsinghua University. The device employs the principles of straw mechanics and indentation mechanics to apply standardized mechanical loads-such as negative pressure and mechanical contact pressure-to the skin surface while quantitatively measuring its deformation. This enables the precise assessment of skin hardness and viscoelasticity, thereby facilitating the digitization and standardization of skin biomechanical property evaluations.
group of healthy people; people not with diabetic foot	Diagnostic test: Detection of the elastic modulus of the plantar skin; This study utilizes a quantitative mechanical measurement apparatus, developed by Professor Cao's research team at Tsinghua University. The device employs the principles of straw mechanics and indentation mechanics to apply standardized mechanical loads-such as negative pressure and mechanical contact pressure-to the skin surface while quantitatively measuring its deformation. This enables the precise assessment of skin hardness and viscoelasticity, thereby facilitating the digitization and standardization of skin biomechanical property evaluations.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Skin elastic modulus (kPa)	Baseline

Secondary Outcome Measures

Outcome Measure	Time Frame
Degree of skin creep	Baseline

Collaborators and Investigators

• Sponsor: Peking University Third Hospital

Publications and helpful links

General Publications

• [1] Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross-sectional study. BMJ. 2020 Apr 28;369:m997. [2] Edmonds M. A renaissance in diabetic foot care: new evidence-based treatments. Lancet Diabetes Endocrinol. 2018;6(11):837-838. [3] Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63(2)(suppl):3S-21S. [4] McDermott K, Fang M, Boulton AJM, et al. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2023 Jan 1;46(1):209-221. [5] Argyropoulos AJ, Robichaud P, Balimunkwe RM, Fisher GJ, Hammerberg C, Yan Y, Quan T. Alterations of Dermal Connective Tissue Collagen in Diabetes: Molecular Basis of Aged-Appearing Skin. PLoS One. 2016 Apr 22;11(4):e0153806. [6] Boulton AJ, Hardisty CA, Betts RP, Franks CI, Worth RC, Ward JD, Duckworth T. Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care. 1983 Jan-Feb;6(1):26-33. [7] Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and healing. J Vasc Surg. 2010 Sep;52(3 Suppl):37S-43S. [8] Bus SA, de Lange A. A comparison of the 1-step, 2-step, and 3-step protocols for obtaining barefoot plantar pressure data in the diabetic neuropathic foot. Clin Biomech (Bristol). 2005 Nov;20(9):892-9. [9] van Netten JJ, Price PE, Lavery LA, Monteiro-Soares M, Rasmussen A, Jubiz Y, Bus SA; International Working Group on the Diabetic Foot. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev. 2016 Jan;32 Suppl 1:84-98. [10] Abbott CA, Chatwin KE, Foden P, Hasan AN, Sange C, Rajbhandari SM, Reddy PN, Vileikyte L, Bowling FL, Boulton AJM, Reeves ND. Innovat

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): April 1, 2028

Study Registration Dates

• First Submitted: March 7, 2026
• First Submitted That Met QC Criteria: March 12, 2026
• First Posted (Actual): March 13, 2026

Study Record Updates

• Last Update Posted (Actual): March 13, 2026
• Last Update Submitted That Met QC Criteria: March 12, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Diabetic Foot Disease; Diabete Mellitus; Mechanical factor; plantar skin
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Nutritional and Metabolic Diseases; Diabetes Mellitus
• Other Study ID Numbers: Long2026-DFU-Quantit plantar

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No