Bus Sicco A, Yang Qing X, Wang Jinghua H, Smith Michael B, Wunderlich Roshna, Cavanagh Peter R
Center for Locomotion Studies, Penn State University, University Park, Pennsylvania, USA.
Diabetes Care. 2002 Aug;25(8):1444-50. doi: 10.2337/diacare.25.8.1444.
The objectives of this study were to compare intrinsic foot muscle cross-sectional area (CSA) in patients with diabetic polyneuropathy and nondiabetic control subjects and to examine the association between intrinsic muscle CSA and clawing/hammering of the toes in neuropathic feet.
High-resolution T2-weighted fast spin-echo images and parametric T2 multiple spin-echo images were acquired using multiple spin-echo magnetic resonance imaging (MRI) of frontal plane sections of the metatarsal region of the foot in a sample of eight individuals with diabetic polyneuropathy and eight age- and sex-matched nonneuropathic nondiabetic control subjects. The configuration of joints of the second toe was obtained using a three-dimensional contact digitizer.
Remarkable atrophy was found in all the intrinsic muscles of neuropathic subjects as compared with nondiabetic control subjects. Quantitative T2 analysis showed a 73% decrease in muscle tissue CSA distally in the neuropathic subjects. Muscle comprised only 8.3 +/- 2.9% (means +/- SD) of total foot CSA compared with 30.8 +/- 3.9% in control subjects. No significant differences were found between the groups in the metatarso-phalangeal and proximal and distal interphalangeal joint angles of the second ray. Moreover, clawing/hammering of the toes was found in only two of eight neuropathic subjects.
Although sensory neuropathy is often emphasized in considerations of diabetic foot pathology, our results show that the consequences of motor neuropathy in the feet are profound in people with diabetes. This has implications for foot function and may play a significant role in postural instability. However, intrinsic muscle atrophy does not necessarily appear to imply toe deformity.
本研究的目的是比较糖尿病性多发性神经病患者与非糖尿病对照受试者的足部固有肌横截面积（CSA），并研究固有肌CSA与神经病变足部爪形趾/锤状趾之间的关联。
对8例糖尿病性多发性神经病患者和8例年龄及性别匹配的非神经病变非糖尿病对照受试者的足部样本，使用跖骨区域额面切片的多回波磁共振成像（MRI）获取高分辨率T2加权快速自旋回波图像和参数化T2多回波图像。使用三维接触式数字转换器获取第二趾关节的构型。
与非糖尿病对照受试者相比，神经病变受试者的所有足部固有肌均出现明显萎缩。定量T2分析显示，神经病变受试者远端肌肉组织CSA减少了73%。肌肉仅占足部总CSA的8.3±2.9%（平均值±标准差），而对照受试者为30.8±3.9%。两组在第二跖趾关节、近端和远端趾间关节角度方面无显著差异。此外，8例神经病变受试者中仅有2例出现爪形趾/锤状趾。
尽管在糖尿病足病理研究中常强调感觉神经病变，但我们的结果表明，糖尿病患者足部运动神经病变的后果严重。这对足部功能有影响，可能在姿势不稳中起重要作用。然而，固有肌萎缩不一定意味着趾畸形。
