{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T16:16:00Z","timestamp":1784650560081,"version":"3.55.0"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian Government Research Training Program"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Ultrasound can be used to assess injury and structural changes to the soft-tissue structure of the foot. It may be useful to assess the feet of people with diabetes who are at increased risk of plantar soft-tissue pathological changes. The aim of this study was to determine if ultrasound measurements of plantar soft-tissue thickness and assessments of tissue acoustic characteristics are reliable in people with and without diabetes mellitus. A repeated measures design was used to determine intra-observer reliability for ultrasound measurements of plantar skin and fat pad thickness and intra- and inter-observer reliability of plantar skin and fat pad tissue characterisation assessments made at foot sites which are at risk of tissue injury in people with diabetes. Thickness measurements and tissue characterisation assessments were obtained at the heel and forefoot in both the unloaded and compressed states and included discrete layers of the plantar tissues: skin, microchamber, horizontal fibrous band, macrochamber and total soft-tissue depth. At each site, relative intra-observer reliability was achieved for the measurement of at least one plantar tissue layer. The total soft-tissue thickness measured in the unloaded state (ICC 0.925\u20130.976) demonstrated intra-observer reliability and is the most sensitive for detecting small change on repeated measures. Intra-observer agreement was demonstrated for tissue characteristic assessments of the skin at the heel (k = 0.70), fat pad at the lateral sesamoid region (k = 0.70) and both skin and fat pad at the second (k = 0.80, k = 0.70 respectively) and third metatarsal heads (k = 0.90, k = 0.79 respectively). However, acceptable inter-observer agreement was not demonstrated for any tissue characteristic assessment, therefore the use of multiple observers should be avoided when making these assessments.<\/jats:p>","DOI":"10.1371\/journal.pone.0257790","type":"journal-article","created":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T18:10:51Z","timestamp":1632420651000},"page":"e0257790","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Reliability of ultrasound in evaluating the plantar skin and fat pad of the foot in the setting of diabetes"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0748-1324","authenticated-orcid":true,"given":"Troy","family":"Morrison","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan Scott","family":"Causby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry","family":"Thoirs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"issue":"5","key":"pone.0257790.ref001","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/107110079201300501","article-title":"Investigations into the fat pads of the sole of the foot: heel pressure studies","volume":"13","author":"MH Jahss","year":"1992","journal-title":"Foot Ankle Int"},{"issue":"1","key":"pone.0257790.ref002","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1146\/annurev.med.46.1.223","article-title":"Advanced protein glycosylation in diabetes and aging","volume":"46","author":"MDM Brownlee","year":"1995","journal-title":"Annu Rev Medicine"},{"issue":"9","key":"pone.0257790.ref003","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.4239\/wjd.v6.i9.1108","article-title":"Limited joint mobility syndrome in diabetes mellitus: A minireview","volume":"6","author":"EG Gerrits","year":"2015","journal-title":"World J Diabetes"},{"issue":"6","key":"pone.0257790.ref004","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.2337\/diacare.25.6.1055","article-title":"Advanced Glycation End Products and Endothelial Dysfunction in Type 2 Diabetes.","volume":"25","author":"KCB Tan","year":"2002","journal-title":"Diabetes care"},{"issue":"2","key":"pone.0257790.ref005","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s001250051591","article-title":"Advanced glycation end-products: a review","volume":"44","author":"R Singh","year":"2001","journal-title":"Diabetologia"},{"issue":"1","key":"pone.0257790.ref006","doi-asserted-by":"crossref","first-page":"1 e","DOI":"10.1016\/j.jaad.2013.07.048","article-title":"Diabetic foot ulcers: Part I. Pathophysiology and prevention","volume":"70","author":"A Alavi","year":"2014","journal-title":"J Am Acad Dermatol"},{"issue":"10","key":"pone.0257790.ref007","first-page":"2382","article-title":"Atrophy of Foot Muscles","volume":"27","author":"H Andersen","year":"2004","journal-title":"A measure of diabetic neuropathy"},{"issue":"10","key":"pone.0257790.ref008","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.2337\/diacare.27.10.2376","article-title":"Plantar fat-pad displacement in neuropathic diabetic patients with toe deformity: A magnetic resonance imaging study","volume":"27","author":"SA Bus","year":"2004","journal-title":"Diabetes care"},{"key":"pone.0257790.ref009","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1111\/iwj.12173","article-title":"The plantar fat pad and the diabetic foot\u2013a review","volume":"12","author":"S Dalal","year":"2015","journal-title":"Int Wound J"},{"issue":"7","key":"pone.0257790.ref010","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.ultrasmedbio.2011.04.004","article-title":"Epidermal thickness and biomechanical properties of plantar tissues in diabetic foot","volume":"37","author":"CYL Chao","year":"2011","journal-title":"Ultrasound in medicine & biology"},{"issue":"9","key":"pone.0257790.ref011","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1016\/j.jbiomech.2010.02.021","article-title":"The compressive mechanical properties of diabetic and non-diabetic plantar soft tissue","volume":"43","author":"S Pai","year":"2010","journal-title":"J Biomech"},{"key":"pone.0257790.ref012","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/978-3-319-03970-1_8","volume-title":"Mechanical Properties of Aging Soft Tissues","author":"WR Ledoux","year":"2015"},{"issue":"7","key":"pone.0257790.ref013","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1007\/BF00400259","article-title":"The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study","volume":"35","author":"A Veves","year":"1992","journal-title":"Diabetologia"},{"issue":"1","key":"pone.0257790.ref014","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.mpmed.2014.10.006","article-title":"The diabetic foot","volume":"43","author":"AJM Boulton","year":"2015","journal-title":"Medicine"},{"issue":"4","key":"pone.0257790.ref015","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S1067-2516(98)80066-5","article-title":"Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration?","volume":"37","author":"DG Armstrong","year":"1998","journal-title":"J Foot Ankle Surg"},{"issue":"5","key":"pone.0257790.ref016","doi-asserted-by":"crossref","first-page":"606","DOI":"10.2337\/diacare.23.5.606","article-title":"Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial","volume":"23","author":"H Pham","year":"2000","journal-title":"Diabetes care"},{"issue":"2","key":"pone.0257790.ref017","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1001\/jama.293.2.217","article-title":"Preventing foot ulcers in patients with diabetes","volume":"293","author":"N Singh","year":"2005","journal-title":"JAMA"},{"key":"pone.0257790.ref018","first-page":"1","volume-title":"The Foot in Diabetes","author":"E Boyko","year":"2020"},{"key":"pone.0257790.ref019","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/9781119445821.ch6","volume-title":"The Foot in Diabetes","author":"AJM Boulton","year":"2020","edition":"5"},{"issue":"8","key":"pone.0257790.ref020","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.2337\/dc08-9021","article-title":"Comprehensive Foot Examination and Risk Assessment: A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists","volume":"31","author":"AJM Boulton","year":"2008","journal-title":"Diabetes care"},{"issue":"3","key":"pone.0257790.ref021","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.gaitpost.2011.06.005","article-title":"Calculation of plantar pressure time integral, an alternative approach","volume":"34","author":"T Melai","year":"2011","journal-title":"Gait & Posture"},{"issue":"4","key":"pone.0257790.ref022","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S0021-9290(98)00188-2","article-title":"Structural and functional predictors of regional peak pressures under the foot during walking","volume":"32","author":"E Morag","year":"1999","journal-title":"J Biomech"},{"issue":"6","key":"pone.0257790.ref023","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1111\/1753-0407.12254","article-title":"Intrinsic foot muscle and plantar tissue changes in Type 2 diabetes mellitus","volume":"7","author":"CGS Kumar","year":"2015","journal-title":"Journal of diabetes"},{"issue":"7","key":"pone.0257790.ref024","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.2337\/diacare.24.7.1270","article-title":"Plantar tissue thickness is related to peak plantar pressure in the high-risk diabetic foot","volume":"24","author":"F Abouaesha","year":"2001","journal-title":"Diabetes care"},{"issue":"6","key":"pone.0257790.ref025","doi-asserted-by":"crossref","first-page":"e0199055","DOI":"10.1371\/journal.pone.0199055","article-title":"Can ultrasound measures of intrinsic foot muscles and plantar soft tissues predict future diabetes-related foot disease? A systematic review","volume":"13","author":"T Morrison","year":"2018","journal-title":"PLOS ONE"},{"issue":"6","key":"pone.0257790.ref026","doi-asserted-by":"crossref","first-page":"e0219057","DOI":"10.1371\/journal.pone.0219057","article-title":"Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients","volume":"14","author":"J Castro","year":"2019","journal-title":"PLOS ONE"},{"issue":"5","key":"pone.0257790.ref027","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1177\/1759720X12442112","article-title":"Role of diagnostic ultrasound in the assessment of musculoskeletal diseases","volume":"4","author":"P Patil","year":"2012","journal-title":"Ther Adv Musculoskelet Dis"},{"issue":"1","key":"pone.0257790.ref028","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1136\/ard.2005.037382","article-title":"Interobserver reliability in musculoskeletal ultrasonography: results from a \"Teach the Teachers\" rheumatologist course","volume":"65","author":"E Naredo","year":"2006","journal-title":"Ann Rheum Dis"},{"key":"pone.0257790.ref029","unstructured":"PASS 16 Power Analysis and Sample Size Software. NCSS, LLC, Kaysville, Utah, USA, ncss.com\/software\/pass; 2018."},{"issue":"3","key":"pone.0257790.ref030","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1093\/ptj\/85.3.257","article-title":"The kappa statistic in reliability studies: use, interpretation, and sample size requirements","volume":"85","author":"J Sim","year":"2005","journal-title":"Phys Ther"},{"issue":"6","key":"pone.0257790.ref031","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.jdiacomp.2013.07.004","article-title":"Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location","volume":"27","author":"WR Ledoux","year":"2013","journal-title":"J Diabetes Complications"},{"issue":"3","key":"pone.0257790.ref032","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1177\/1534734605280587","article-title":"A review of the biomechanics of the diabetic foot","volume":"4","author":"CHM van Schie","year":"2005","journal-title":"Int J Low Extrem Wounds"},{"issue":"2","key":"pone.0257790.ref033","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1080\/16501970410017215","article-title":"Reliability of gait performance tests in men and women with hemiparesis after stroke","volume":"37","author":"D Downham","year":"2005","journal-title":"J Rehabil Med"},{"issue":"1","key":"pone.0257790.ref034","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.gaitpost.2013.07.118","article-title":"Measurement of functional heel pad behaviour in-shoe during gait using orthotic embedded ultrasonography","volume":"39","author":"S Telfer","year":"2014","journal-title":"Gait & posture"},{"issue":"2","key":"pone.0257790.ref035","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/0958-2592(95)90016-0","article-title":"Weight bearing ultrasound in diabetic and rheumatoid arthritis patients","volume":"5","author":"M Young","year":"1995","journal-title":"The Foot"},{"issue":"12","key":"pone.0257790.ref036","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1046\/j.1464-5491.2002.00850.x","article-title":"Ultrasonography of plantar soft tissues thickness in young people with diabetes","volume":"19","author":"AC Duffin","year":"2002","journal-title":"Diabetic medicine: a journal of the British Diabetic Association"},{"issue":"6","key":"pone.0257790.ref037","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1007\/s00167-014-3270-4","article-title":"Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale","volume":"24","author":"K Sunding","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"11","key":"pone.0257790.ref038","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1007\/s00330-004-2448-4","article-title":"Ultrasound assessment of tendons in asymptomatic volunteers: a study of reproducibility","volume":"14","author":"PJ O\u2019Connor","year":"2004","journal-title":"Eur Radiol"},{"issue":"1","key":"pone.0257790.ref039","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1002\/jcu.20903","article-title":"Reproducibility of sonographic measurement of thickness and echogenicity of the plantar fascia","volume":"40","author":"JW Cheng","year":"2012","journal-title":"J Clin Ultrasound"},{"issue":"12","key":"pone.0257790.ref040","first-page":"2681","article-title":"Comparison between clinical evaluation and ultrasonography in detecting hydrarthrosis of the knee","volume":"26","author":"J-P Hauzeur","year":"1999","journal-title":"J Rheumatol"},{"issue":"6","key":"pone.0257790.ref041","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1136\/ard.2003.007971","article-title":"Grey scale and power Doppler sonographic changes induced by intra-articular steroid injection treatment","volume":"63","author":"E Filippucci","year":"2004","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"pone.0257790.ref042","first-page":"621","article-title":"Wrist joint involvement in systemic lupus erythematosus. An ultrasonographic study","volume":"22","author":"A Iagnocco","year":"2004","journal-title":"Clin Exp Rheumatol"},{"issue":"5","key":"pone.0257790.ref043","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.2214\/ajr.183.5.1831465","article-title":"Sonography of the rotator cuff: analysis of interobserver variability","volume":"183","author":"WD Middleton","year":"2004","journal-title":"AJR Am J Roentgenol"},{"issue":"1","key":"pone.0257790.ref044","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1148\/rg.331125096","article-title":"Medical imaging displays and their use in image interpretation","volume":"33","author":"GC Kagadis","year":"2013","journal-title":"Radiographics"},{"issue":"1","key":"pone.0257790.ref045","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2214\/AJR.13.10952","article-title":"Inter-and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training","volume":"203","author":"A Melsaether","year":"2014","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"pone.0257790.ref046","first-page":"1376","article-title":"OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 4: an international multicenter longitudinal study using the RA-MRI Score","volume":"30","author":"P Conaghan","year":"2003","journal-title":"J Rheumatol"},{"key":"pone.0257790.ref047","author":"JA Jacobson","year":"2012"},{"key":"pone.0257790.ref048","author":"V Gibbs","year":"2009"},{"issue":"4","key":"pone.0257790.ref049","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4081\/bam.2010.4.145","article-title":"Skeletal muscle ultrasound","volume":"20","author":"S Pillen","year":"2010","journal-title":"Eur J Transl Myol"},{"issue":"9","key":"pone.0257790.ref050","doi-asserted-by":"crossref","first-page":"2520","DOI":"10.1016\/j.ultrasmedbio.2015.04.021","article-title":"Advances in quantitative muscle ultrasonography using texture analysis of ultrasound images","volume":"41","author":"F Molinari","year":"2015","journal-title":"Ultrasound in Med Biol"},{"issue":"1","key":"pone.0257790.ref051","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1046\/j.1464-5491.1999.00005.x","article-title":"Magnetic resonance imaging techniques demonstrate soft tissue damage in the diabetic foot","volume":"16","author":"PD Brash","year":"1999","journal-title":"Diabetic medicine: a journal of the British Diabetic Association"},{"issue":"1","key":"pone.0257790.ref052","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/jmri.20601","article-title":"Reproducibility of foot structure measurements in neuropathic diabetic patients using magnetic resonance imaging","volume":"24","author":"SA Bus","year":"2006","journal-title":"Journal of Magnetic Resonance Imaging"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257790","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T08:31:21Z","timestamp":1699518681000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257790"}},"subtitle":[],"editor":[{"given":"Fabio","family":"Santanelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,9,23]]},"references-count":52,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0257790","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,23]]}}}