Multi-System Factors Associated with Metatarsophalangeal Joint Deformity in Individuals with Type 2 Diabetes

Abstract

The underlying factors contributing to metatarsophalangeal joint deformity, a known precursor to skin breakdown in individuals with diabetes mellitus (DM), is likely to involve multiple body systems. The purpose of this cross-sectional study was to identify multi-system factors associated with metatarsophalangeal joint deformity in individuals with type 2 DM and peripheral neuropathy (n = 60). Metatarsophalangeal joint deformity was quantified with a computed tomography (CT) scan. System biomarkers included the musculoskeletal system (foot intrinsic muscle deterioration, tarsal/metatarsal bone mineral density, ankle dorsiflexion, metatarsophalangeal extension movement during a sit to stand task); the vascular system (ankle-brachial index); and the endocrine/immune systems (high sensitivity C-reactive protein, skin intrinsic fluorescence, and hemoglobin A1C). Muscle deterioration (r = 0.27), bone density (r = −0.35), metatarsophalangeal extension movement (r = 0.50), maximum dorsiflexion (r = −0.31), and ankle-brachial index (r = 0.33) were related to metatarsophalangeal joint deformity (p < 0.05). Bone mineral density and metatarsophalangeal extension movement were retained in a regression model relating to deformity (R2 = 0.34). All musculoskeletal system biomarkers and the ankle-brachial index demonstrated weak to moderate relationships to metatarsophalangeal joint deformity. Bone mineral density of the tarsal/metatarsal bones and extending the toes during a sit to stand task were the two strongest factors associated with metatarsophalangeal joint deformity. Evaluation and management of foot bone mineral density and toe extension movement pattern could reduce metatarsophalangeal joint deformity and the risk of skin breakdown and subsequent amputation.

Feasibility of a home-based foot–ankle exercise programme for musculoskeletal dysfunctions in people with diabetes: randomised controlled FOotCAre (FOCA) Trial II

“…A difference of 3.2 degrees was observed, suggesting an improved mobility at the propulsion phase. A greater metatarsophalangeal joint extension may be associated with metatarsophalangeal joint deformity 42 and may increase the risk of metatarsal heads exposure on the plantar surface repeatedly during gait, increasing plantar pressures at the forefoot 43 . However, our result can be considered positive because according to Deschamps et al 44 , individuals with DPN present significantly smaller sagittal ROM of the first metatarsophalangeal joint during the forefoot push-off phase.…”

Rate of tarsal and metatarsal bone mineral density change in adults with diabetes mellitus and peripheral neuropathy: a longitudinal study

“…BMD of each of the 12 tarsals and metatarsals was obtained using a previously published protocol [ 17 , 27 ]. Each tarsal and metatarsal was individually segmented, and Hounsfield Unit (HU) was converted to BMD (mg/cm 3 ) using the calibration phantom (Fig.…”

“…Foot fracture risk and deformity are associated DM complications [ 15 ] and have been linked to the loss of tarsal and metatarsal bone mineral density (BMD) [ 16 , 17 ]. Of particular interest, individuals with type 2 DM showed the most significant elevation of fracture risk in the foot, where the relative risk was 37% higher than that in the control population without type 2 DM, suggesting the involvement of PN in fracture predisposition [ 18 ].…”