Bus Sicco A, Maas Mario, de Lange Antony, Michels Robert P J, Levi Marcel
Department of Internal Medicine, Academic Medical Center, University of Amsterdam, P.O.Box 22700, 1100DE, Amsterdam, The Netherlands.
J Biomech. 2005 Sep;38(9):1918-25. doi: 10.1016/j.jbiomech.2004.07.034.
Elevated plantar foot pressures during gait in diabetic patients with neuropathy have been suggested to result, among other factors, from the distal displacement of sub-metatarsal head (MTH) fat-pad cushions caused by to claw/hammer toe deformity. The purpose of this study was to quantitatively assess these associations. Thirteen neuropathic diabetic subjects with claw/hammer toe deformity, and 13 age- and gender-matched neuropathic diabetic controls without deformity, were examined. Dynamic barefoot plantar pressures were measured with an EMED pressure platform. Peak pressure and force-time integral for each of 11 foot regions were calculated. Degree of toe deformity and the ratio of sub-MTH to sub-phalangeal fat-pad thickness (indicating fat-pad displacement) were measured from sagittal plane magnetic resonance images of the foot. Peak pressures at the MTHs were significantly higher in the patients with toe deformity (mean 626 (SD 260)kPa) when compared with controls (mean 363 (SD 115) kPa, P<0.005). MTH peak pressure was significantly correlated with degree of toe deformity (r=-0.74) and with fat-pad displacement (r=-0.71) (P<0.001). The ratio of force-time integral in the toes and the MTHs (toe-loading index) was significantly lower in the group with deformity. These results show that claw/hammer toe deformity is associated with a distal-to-proximal transfer of load in the forefoot and elevated plantar pressures at the MTHs in neuropathic diabetic patients. Distal displacement of the plantar fat pad is suggested to be the underlying mechanism in this association. These conditions increase the risk for plantar ulceration in these patients.
有研究表明，在患有神经病变的糖尿病患者中，步态期间足底压力升高，除其他因素外，还源于爪形趾/槌状趾畸形导致的跖骨头（MTH）脂肪垫缓冲垫向远端移位。本研究的目的是定量评估这些关联。对13名患有爪形趾/槌状趾畸形的神经病变糖尿病受试者以及13名年龄和性别匹配、无畸形的神经病变糖尿病对照者进行了检查。使用EMED压力平台测量动态赤足足底压力。计算11个足部区域中每个区域的峰值压力和力-时间积分。从足部矢状面磁共振图像测量趾畸形程度以及MTH与趾骨下脂肪垫厚度之比（表明脂肪垫移位）。与对照组（平均363（标准差115）kPa，P<0.005）相比，趾畸形患者的MTH处峰值压力显著更高（平均626（标准差260）kPa）。MTH峰值压力与趾畸形程度（r=-0.74）和脂肪垫移位（r=-0.71）显著相关（P<0.001）。畸形组中趾部和MTH处的力-时间积分比值（趾负荷指数）显著更低。这些结果表明，爪形趾/槌状趾畸形与神经病变糖尿病患者前足负荷从远端向近端转移以及MTH处足底压力升高有关。足底脂肪垫向远端移位被认为是这种关联的潜在机制。这些情况增加了这些患者发生足底溃疡的风险。
