Innovative CT in diabetic foot disease A multidisciplinary approach

Diabetic foot disease is a common complication of diabetes mellitus. A multidisciplinary approach towards diabetic foot disease has proven vital for optimal prevention, diagnostics and treatment. New forms of computed tomography (CT) can be a part of this multidisciplinary method and accelerate the diagnostic process. Additionally, CT can be used to assess the effect of interventions, such as a flexor tenotomy, or preventive measures. Dual-energy CT (DECT) and weight-bearing CT (WBCT) are two of these new CT modalities. In this thesis, we evaluate the use of innovative CT in diabetic foot disease. This thesis is divided in three parts. Part I focuses on claw and hammer toe deformity, a common deformity that can elevate plantar pressure underneath the toe apex and metatarsal heads. In order to create a measurement method to quantify toe deformity, we investigate the use of WBCT in the toe. In part II, the flexor tenotomy is researched. The minimally invasive percutaneous needle flexor tenotomy is a small operation where the tendon of the long flexor muscle of the toe is severed in patients with claw or hammer toe deformity. This can reduce foot ulcer recurrence. Part III involves the use of DECT to detect bone marrow edema in complications of diabetic foot disease including osteomyelitis and Charcot neuro-osteoarthropathy. DECT is used to evaluate plantar fat pad changes in diabetic peripheral neuropathy as well.