Cheuy VA, Hastings MK, Commean PK, Ward SR, Mueller MJ.
Metatarsophalangeal joint deformity is associated with skin breakdown
and amputation. The aims of this study were to compare intrinsic foot muscle
deterioration ratios (ratio of adipose to muscle volume), and physical
performance in subjects with diabetic neuropathy to controls, and determine their
associations with 1) metatarsophalangeal joint angle and 2) history of foot
23 diabetic, neuropathic subjects [59 (SD 10) years] and 12 age-matched
controls [57 (SD 14) years] were studied. Radiographs and MRI were used to
measure metatarsophalangeal joint angle and intrinsic foot muscle deterioration
through tissue segmentation by image signal intensity. The Foot and Ankle Ability
Measure evaluated physical performance.
The diabetic, neuropathic group had a higher muscle deterioration ratio
[1.6 (SD 1.2) vs. 0.3 (SD 0.2), P<0.001], and lower Foot and Ankle Ability
Measure scores [65.1 (SD 24.4) vs. 98.3 (SD 3.3) %, P<0.01]. The correlation
between muscle deterioration ratio and metatarsophalangeal joint angle was
r=-0.51 (P=0.01) for all diabetic, neuropathic subjects, but increased to r=-0.81
(P<0.01) when only subjects with muscle deterioration ratios >1.0 were included.
Muscle deterioration ratios in individuals with diabetic neuropathy were higher
for those with a history of ulcers.
Individuals with diabetic neuropathy had increased intrinsic foot
muscle deterioration, which was associated with second metatarsophalangeal joint
angle and history of ulceration. Additional research is required to understand
how foot muscle deterioration interacts with other impairments leading to
forefoot deformity and skin breakdown.
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