Cheuy Victor A, Hastings Mary K, Commean Paul K, Ward Samuel R, Mueller Michael J
Applied Biomechanics Laboratory, Movement Science Program, Washington University School of Medicine, St. Louis, MO, USA.
Clin Biomech (Bristol). 2013 Nov-Dec;28(9-10):1055-60. doi: 10.1016/j.clinbiomech.2013.10.006. Epub 2013 Oct 12.
Metatarsophalangeal joint deformity is associated with skin breakdown and amputation. The aims of this study were to compare intrinsic foot muscle deterioration ratios (ratio of adipose to muscle volume), and physical performance in subjects with diabetic neuropathy to controls, and determine their associations with 1) metatarsophalangeal joint angle and 2) history of foot ulcer.
23 diabetic, neuropathic subjects [59 (SD 10) years] and 12 age-matched controls [57 (SD 14) years] were studied. Radiographs and MRI were used to measure metatarsophalangeal joint angle and intrinsic foot muscle deterioration through tissue segmentation by image signal intensity. The Foot and Ankle Ability Measure evaluated physical performance.
The diabetic, neuropathic group had a higher muscle deterioration ratio [1.6 (SD 1.2) vs. 0.3 (SD 0.2), P<0.001], and lower Foot and Ankle Ability Measure scores [65.1 (SD 24.4) vs. 98.3 (SD 3.3) %, P<0.01]. The correlation between muscle deterioration ratio and metatarsophalangeal joint angle was r=-0.51 (P=0.01) for all diabetic, neuropathic subjects, but increased to r=-0.81 (P<0.01) when only subjects with muscle deterioration ratios >1.0 were included. Muscle deterioration ratios in individuals with diabetic neuropathy were higher for those with a history of ulcers.
Individuals with diabetic neuropathy had increased intrinsic foot muscle deterioration, which was associated with second metatarsophalangeal joint angle and history of ulceration. Additional research is required to understand how foot muscle deterioration interacts with other impairments leading to forefoot deformity and skin breakdown.
跖趾关节畸形与皮肤破损和截肢相关。本研究的目的是比较糖尿病性神经病变患者与对照组的足部内在肌退化率（脂肪与肌肉体积之比）及身体机能，并确定它们与1）跖趾关节角度和2）足部溃疡病史之间的关联。
对23例糖尿病性神经病变患者[年龄59（标准差10）岁]和12例年龄匹配的对照组[年龄57（标准差14）岁]进行了研究。通过X线片和磁共振成像，利用图像信号强度进行组织分割来测量跖趾关节角度和足部内在肌退化情况。采用足踝功能测量量表评估身体机能。
糖尿病性神经病变组的肌肉退化率更高[1.6（标准差1.2）vs. 0.3（标准差0.2），P<0.001]，足踝功能测量量表得分更低[65.1（标准差24.4）vs. 98.3（标准差3.3）%，P<0.01]。在所有糖尿病性神经病变患者中，肌肉退化率与跖趾关节角度之间的相关性为r=-0.51（P=0.01），但仅纳入肌肉退化率>1.0的患者时，相关性增加至r=-0.81（P<0.01）。有溃疡病史的糖尿病性神经病变患者的肌肉退化率更高。
糖尿病性神经病变患者的足部内在肌退化增加，这与第二跖趾关节角度和溃疡病史相关。需要进一步研究以了解足部肌肉退化如何与导致前足畸形和皮肤破损的其他损伤相互作用。
