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Abstract-In diabetic foot, sensation loss predisposes to skin Madras as shown in Fig.1. This being connected to an IBM
ulceration which may result in amputation, the most feared PCAT, grabs the image and load data as the subject stands
complication. Therefore, understanding and detection of factors or walks over a glass platform mounted on the wooden box
responsible for plantar ulceration and their measurement standing on load cells.
reproducibly is necessary to save the foot at risk As peak foot
pressure were not sufficiently sensitive, Power Ratio(PR), a new
diagnostic parameter, by analysis of foot pressure distribution
The image acquisition involves three stages. The first, where
in standing and walking images of foot has been developed. PR the applied pressure on the glassplastic interface is
is related to different levels of sensation loss in the diabetic foot. converted to a high-resolution intensity image (obtained by
Algorithm is developed (in MATLAB) to automatically separate scattering of light at the glass and plastic sheet interface as
(crop) bitmap files of different foot sizes. Algorithm is also explained in Betts et al., 1980d), the intensity being
developed (in Visual C ++) to calculate PR of cropped images proportional to the applied pressure. The second, where the
and display simultaneously PR of all foot sole areas. This light image is converted to an analog electrical signal. The
display of PR simultaneously in all foot areas helps clinician to third, where the analog electrical signal is digitized and
effectively discriminate between normal, early and advanced
stages of diabetic neuropathic subjects and also in detecting foot stored.
sole areas at risk.
Each footprint is divided into ten anatomically significant
I. INTRODUCTION areas as per the detailed method indicated in Cavanagh et al.
(1987), Patil et al. (1996).The material required for
The diabetic foot ulcer is a serious medical problem with far- quantification of sensation levels of different areas of the
reaching consequences. Foot ulcers need to be managed foot is SemmesWeinstein colored nylon monofilaments
carefully. Notwithstanding the best care, many patients have (Weinstein, 1993). Foot areas of diabetic subjects are
foot complications that necessitate hospitalization and scanned in ten specified areas using SemmesWeinstein
treatment. There is a constant need to understand the nylon monofilaments to determine quantitatively the degree
mechanisms of diabetic foot ulcers in order to manage and of neuropathy as per the following classification (Elftman,
prevent ulceration. Diabetic feet develop calluses, which in 1991; BellKrotoski et al., 1993; Malaviya et al., 1994):
turn lead to ulcers. Higher foot pressures are associated with
callus development. The method of measuring foot pressures (a) Normal: Sensation level of 3 gm force exerted by the
is of prime importance in this area of endeavor. nylon monofilament.
Diabetes is a disorder caused by decreased production of (b) Diminished light touch: Sensation level of 4.5 gm force
insulin, or by decreased ability to use insulin. Insulin is a exerted by the nylon monofilament.
hormone produced by the pancreas that is necessary for the (c) Diminished protective sensation: Sensation level of 7.5
cells to be able to use blood sugar. The diabetes population is gm force exerted by the nylon monofilament.
ever increasing and studies both in advanced and developing (d) Loss of protective sensation: Sensation level of 10 gm
nations indicate high prevalence of diabetes. force exerted by the nylon monofilament.
The complications of diabetes that are most relevant to
lower-extremity are distal peripheral neuropathy and, to a From the above classification it is clear that higher the force
lesser extent, peripheral vascular disease. The most feared used for sensation level, more is the sensation loss and
lower-extremity problem among patients with diabetes is neuropathy. When the foot sole sensation loss is determined,
amputation, and the sequence of events leading to
amputation is initiated by skin ulceration. This occurs most The sensation levels in adjacent areas or other areas (1 to 10)
frequently because of loss of sensation. were found to be between 3 gm, 4.5 gm, 7.5 gm, 10 gm
(depending upon the progress of neuropathy) or it can be 10
II. DATA ACQUITITION AND QUANTIFICATION OF NEUROPATHY gm in all the areas or > 10 gm in advanced levels of
neuropathy.
The data acquisition for foot pressure involves the use of an
optical pedobarograph developed earlier (Patil et al., 1996;
Bhatia, 1996) in the Biomedical Engineering laboratory, IIT,
0-7803-8709-0/05/$20.002005 IEEE
v
it gives only the average value of the image intensity. The
power spectrum is obtained by squaring the magnitudes of
Fourier spectrum (Gonzalez and Wintz, 1987) of light
intensity variations of foot images and the total power, TP
(Volt2) in an image is obtained using (2).
M N
2 2 (2)
2
TP = F ( u , v ) F ( 0 ,0 ) 2
M N
u = 2 v = 2
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[2] Bhatia M.M. Online imaging system for acquition and
analysis of barefoot pressure patterns of normal and
VI. RESULTS leprosy patients M.S.thesis, IIT Madras.
[3] Cavanagh, P.R., M.M.Rodgers and A.Limboshi Pressure
Statistical analysis is done by, finding correlation distribution under symptom-free during barefoot
coefficients r between PR values results obtained by standing Foot and Ankle, 7, pp 262-276
[4] Elftman. N., clinical management of neuropathic limb,
previous software (MATLAB) and the newly developed Journal of Prosthesis and Orthosis,4, pp8-11
software (Using Visual C++). Fig.4 compares the PR values [5] Patil K.M., V.M.Bhat, M.M.Bhatia, V.B.Narayanamurthy
obtained by both the methods (using MATLAB and Visual C and R.Parivalan New online methods for analysis of
++) in area 8 of a standing normal subject. Table 1 represents foot preesures in diabetic neuropathy, Frontiers Me.
Biol.Engg.,9, pp 49-62,1999.
coefficient of correlation between PR values obtained by
previous method (using MATLAB) and newly developed
method (using Visual C++) in foot sole area 8. It is clear
from the table 6.1 that they have moderate to good
correlations (r ranging from 0.64 to 0.93), obtained from
the data of 11 normal subjects in all 10 areas of the
foot.
16
Area 8
14 PR VC ++ = 1.11*PR MAT LAB -3.96
r = 0.77
Visual C++ PR Values
12
10
4
7 8 9 10 11 12 13 14 15
M atlab PR Values
REFERENCES
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