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

Hastings, Mary K.; Woodburn, James; Mueller, Michael J.; Strube, Michael; Johnson, Jeffrey E.; Sinacore, David R.

doi:10.1016/j.clinbiomech.2014.08.011

Cited by 18 publications

(5 citation statements)

References 28 publications

(28 reference statements)

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“…The data for the heel rise task in this group of participants have been reported in detail in previous publications. 24 …”

Section: Methodsmentioning

confidence: 99%

“…19-23 We have also identified that some individuals with DM have limited ability to plantarflex their forefoot on their hindfoot during the heel rise task, potentially compromising midfoot joint stability during loading. 24 …”

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%

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

Hastings

Mueller

Woodburn

et al. 2016

Clinical Biomechanics

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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.

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“…The data for the heel rise task in this group of participants have been reported in detail in previous publications. 24 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hastings

Mueller

Woodburn

et al. 2016

Clinical Biomechanics

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“…Marker placement followed methods previously described. 27 Ankle dorsiflexion was calculated from the hindfoot on shank from the target lower extremity. Participants were positioned long sitting with knees extended and feet off the end of the plinth.…”

Section: Methodsmentioning

confidence: 99%

Muscle and Joint Factors Associated With Forefoot Deformity in the Diabetic Neuropathic Foot

Cheuy¹,

Hastings

Commean

et al. 2015

Foot Ankle Int.

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Background Diabetic forefoot joint deformities are a known risk factor for skin breakdown and amputation, but the causes of deformity are not well understood. The purposes of this study were to determine the effects of intrinsic foot muscle deterioration and limited ankle joint mobility on the severity of metatarsophalangeal joint (MTPJ) deformity, and determine the relationships between these potential contributing factors and indicators of diabetic complications (peripheral neuropathy and advanced glycation end products). Methods A total of 34 participants with diabetic neuropathy (average age, 59 years; range 41-73) were studied. MTPJ angle and intrinsic foot muscle deterioration were measured with computed tomography and magnetic resonance imaging, respectively. Maximum ankle dorsiflexion was measured using kinematics. Skin intrinsic fluorescence served as a proxy measure for advanced glycation end product accumulation. Results Total forefoot lean muscle volume (r = −0.52, P < .01) and maximum ankle dorsiflexion (r = −0.42, P < .05) were correlated with severity of MTPJ deformity. Together they explained 35% of the variance of MTPJ angle. Neuropathy was correlated with forefoot muscle deterioration (ρ = 0.53, P < .01). Skin intrinsic fluorescence was correlated to severity of neuropathy (r = 0.50, P < .01) but not maximum ankle dorsiflexion, or forefoot deterioration when controlling for neuropathy. Conclusion These results suggest that the interplay of intrinsic foot muscle deterioration and limited ankle mobility may be the primary contributor to the development of MTPJ deformity. Identifying these muscle and ankle motion impairments as risk factors for MTPJ deformity supports the need for targeted interventions early in the disease process to slow, or possibly stop the progression of deformity over time and reduce the risk of amputation. Level of Evidence Level IV, case series.

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“…Changes in DMPN multi-segment kinematics are also present during higher-level tasks. Hastings et al 56 . demonstrated decreased forefoot relative to rearfoot plantarflexion (lower medial longitudinal arch) during a heel raise task in people with DMPN and medial column deformity, in comparison to controls.…”

Section: Advancing Clinical Guidelinesmentioning

confidence: 99%

The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

DiLiberto

Baumhauer

Nawoczenski

2016

Braz. J. Phys. Ther.

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BackgroundImplementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload). Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines.ObjectivesThe first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration.DiscussionResearch demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes.ConclusionContinued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus.

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

Cited by 18 publications

References 28 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

Muscle and Joint Factors Associated With Forefoot Deformity in the Diabetic Neuropathic Foot

The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

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