Intrinsic foot muscle deterioration is associated with metatarsophalangeal joint angle in people with diabetes and neuropathy

Cheuy, Victor A.; Hastings, Mary K.; Commean, Paul K.; Ward, Samuel R.; Mueller, Michael J.

doi:10.1016/j.clinbiomech.2013.10.006

Cited by 61 publications

(56 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 Loss of intrinsic foot muscle volume and infiltration with fat has consistently been found in individuals with DM and peripheral neuropathy (PN) 7, 8 and intrinsic foot muscle deterioration has been associated with severity of the metatarsophalangeal joint angle. 8 Up to a 21% decrease in strength measures of extrinsic ankle plantarflexor muscles has been measured in people with DM compared to age matched controls. 9-11 In addition, posterior tibialis tendon dysfunction is often implicated in development of medial column deformity in adults without DMPN.…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesized that the key predictors of medial column alignment (i.e. Meary’s angle) would be intrinsic foot muscle deterioration, 8 posterior tibialis tendon volume, plantar fascia function, 25 and ankle dorsiflexion. We hypothesized that the key predictors of midfoot function (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesized that the key predictors of midfoot function (i.e. forefoot relative to hindfoot plantarflexion excursion during heel rise) 24 would be intrinsic muscle deterioration, 8 posterior tibialis tendon volume, extrinsic plantarflexor muscle strength, 26 and plantar fascia function 25 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acquired midfoot deformity and function in individuals with diabetes and peripheral neuropathy

Hastings

Mueller

Woodburn

et al. 2016

Clinical Biomechanics

Self Cite

View full text Add to dashboard Cite

Background Diabetes mellitus related medial column foot deformity is a major contributor to ulceration and amputation. However, little is known about the relationship between medial column alignment and function and the integrity of the soft tissues that support and move the medial column. The purposes of this study were to determine the predictors of medial column alignment and function in people with diabetes and peripheral neuropathy. Methods 23 participants with diabetes and neuropathy had radiographs, heel rise kinematics, magnetic resonance imaging and isokinetic muscle testing to measure: 1) medial column alignment (Meary’s angle- the angle between the 1st metatarsal longitudinal axis and the talar head and neck), 2) medial column function (forefoot relative to hindfoot plantarflexion during heel rise), 3) intrinsic foot muscle and fat volume, ratio of posterior tibialis to flexor digitorum tendon volume, 4) plantar fascia function (Meary’s angle change from toes flat to extended) and 5) plantarflexor peak torque. Predictors of medial column alignment and function were determined using simultaneous entry multiple regression. Findings Posterior tibialis to flexor digitorum tendon volume ratio and intrinsic foot muscle volume were significant predictors of medial column alignment (p<.05), accounting for 44% of the variance. Intrinsic foot fat volume and plantarflexor peak torque were significant predictors of medial column function (p<.05), accounting for 37% of the variance. Interpretation Deterioration of medial column supporting structures predicted alignment and function. Prospective research is required to monitor alignment, structure, and function over time to inform early intervention strategies to prevent deformity, ulceration, and amputation.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acquired midfoot deformity and function in individuals with diabetes and peripheral neuropathy

Hastings

Mueller

Woodburn

et al. 2016

Clinical Biomechanics

Self Cite

View full text Add to dashboard Cite

show abstract

“…30, 7 mm thick transverse slices spanning from the tibial plateau and progressing distally were collected, and 9 slices were analyzed for fat and lean tissue volumes based on voxel brightness. 18 Volumetric assessments were made as described by Tuttle et al, and Hilton et al for the anterior, lateral, and deep compartments, as well as the gastrocnemius and soleus muscles. 19,9 Percent IMAT tissue volume (%IMAT) was calculated from the MRI analysis as the ratio of IMAT volume to total fat volume (total = subcutaneous fat volume + IMAT volume).…”

Section: Methodsmentioning

confidence: 99%

Explanators of Sarcopenia in Individuals With Diabesity: A Cross-Sectional Analysis

Bittel

Tuttle

et al. 2017

Journal of Geriatric Physical Therapy

Self Cite

View full text Add to dashboard Cite

Background and Purpose Excess lower extremity intermuscular adipose tissue (IMAT), reduced strength, and functional limitations are common in obese individuals with and without diabetes (the former termed diabesity). Individuals with diabesity are particularly susceptible to accelerated sarcopenia, which may be under-diagnosed. The purpose of this study was to determine critical values for leg IMAT volume, plantar flexor muscle strength, and physical performance that help identify individuals with diabesity who have sarcopenia. Methods 43 age- and sex-matched obese adults were studied; 12 with type 2 diabetes, 21 with diabetes and peripheral neuropathy, and 10 non-diabetic controls. Dual-energy x-ray absorptiometry (DXA)-derived skeletal muscle index determined classification of sarcopenia. Leg fat (%IMAT), ankle plantar flexor (PF) peak torque and power while ascending 10 steps were used as explanators of sarcopenia. Receiver operating curves (ROC) identified critical values for each explanator individually. Logistic regression models using all 3 explanators, and only PF torque and stair power, were also created. ROC analyses identified the predicted probability that maximized each model’s sensitivity and specificity. A leave one out cross validation was used to simulate the models’ performance in an independent sample. Results & Discussion 32 participants were sarcopenic, 11 were not. Critical values for individual explanators were: 21% IMAT, 68 Nm PF torque, and 441 watts of stair power. Predicted probabilities of .76 and .67 were chosen as the optimal cutoff probabilities for the model combining all 3 explanators, and the model combining PF torque and stair power respectively. The cross validation analysis produced an accuracy of 82.4%, using the cutoff probability of .5, and an accuracy of 76.5%, using the cutoff of .76. The area under the curve (AUC) for the cross validation ROC analysis was .82. Critical values of leg %IMAT, PF torque, and stair power can classify individuals with diabesity as sarcopenic. The results of the cross validation give us confidence that the sample used in this study was representative of the target population, and suggests models created from this sample may perform well in externally derived datasets Conclusion Clinicians may be able to use these critical values to select interventions that specifically target sarcopenia. Measures of %IMAT, PF torque, and stair power may offer a customized alternative to traditional sarcopenic classification systems, which may not be optimally suited to the common impairments among individuals with diabesity.

show abstract

“…(Sinacore 2001) We speculate that medial column deformities often begin as a result of pathology to structures that support the medial longitudinal arch [e.g. intrinsic foot muscles,(Cheuy et al 2013) plantar fascia(Bolton et al 2005), ligaments, and bone(Hastings et al 2013a)] or development of limited joint mobility, particularly the talocrural joint that produces a deforming force at the arch. (Mueller et al 1989) It is plausible that injury or damage to foot structures, critical in forming and supporting the medial longitudinal arch, is first apparent as changes in the kinematics and kinetics of the foot during weight-bearing activities and that repetition of abnormal joint kinematics and kinetics plays a role in deformity progression.…”

Section: Introductionmentioning

confidence: 99%

Kinematics and kinetics of single-limb heel rise in diabetes related medial column foot deformity

Hastings

Woodburn

Mueller

et al. 2014

Clinical Biomechanics

Self Cite

View full text Add to dashboard Cite

Background Diabetes-related medial column foot deformities contribute to high plantar pressure, joint instability, ulceration and amputation. Impaired foot function may be an early indicator of foot structural incompetence and contribute to deformity progression. This study examines the ability of single-limb heel rise multi-segmental kinematics and kinetics to identify midfoot and hindfoot dysfunction in those with diabetes-related medial column foot deformity. Methods Single-limb heel rise foot kinematics and kinetics were examined in adults with diabetes mellitus and peripheral neuropathy with and without medial column foot deformity and age-, weight-matched controls. Findings Hindfoot relative to shank plantarflexion, peak and excursion, were reduced in bothdiabetes groups compared to controls (P<0.017). Controls' initial forefoot relative to hindfoot position was plantarflexed 31 degrees and plantarflexed an additional 13 degrees during heel rise. The initial forefoot relative to hindfoot position for the diabetes group without deformity was similarly plantarflexed as controls (34 degrees) while the diabetes deformity group was less plantarflexed (lower arch position: 23 degrees, P<0.017). During the heel rise task both diabetes groups demonstrated less ability to plantarflex the forefoot relative to the hindfoot compared to controls (2 and 5 degrees respectively, P<0.017). Ankle plantarflexion power was reduced in the diabetes deformity group compared to controls (P<0.017). Interpretation The single-limb heel rise task identified movement dysfunction in those with diabetes mellitus and peripheral neuropathy. Failure to plantarflex the forefoot relative to hindfoot may compromise midfoot joint stability and increase the risk of injury and arch collapse.

show abstract

Intrinsic foot muscle deterioration is associated with metatarsophalangeal joint angle in people with diabetes and neuropathy

Cited by 61 publications

References 30 publications

Acquired midfoot deformity and function in individuals with diabetes and peripheral neuropathy

Acquired midfoot deformity and function in individuals with diabetes and peripheral neuropathy

Explanators of Sarcopenia in Individuals With Diabesity: A Cross-Sectional Analysis

Kinematics and kinetics of single-limb heel rise in diabetes related medial column foot deformity

Contact Info

Product

Resources

About