Gelber Judith R, Sinacore David R, Strube Michael J, Mueller Michael J, Johnson Jeffrey E, Prior Fred W, Hastings Mary K
Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.
Foot Ankle Int. 2014 Aug;35(8):816-824. doi: 10.1177/1071100714538416. Epub 2014 Jun 10.
The windlass mechanism, acting through the plantar fascia, stabilizes the arches of the foot during stance phase of gait. The purpose of this study was to compare changes in radiographic measurements of the medial longitudinal arch (MLA) between toe-flat and -extended positions in participants with and without diabetes mellitus (DM), peripheral neuropathy (PN), and a low MLA.
Twelve participants with DMPN and low MLA and 12 controls received weightbearing radiographs in a toe-flat and toe-extended position. DMPN participants were subcategorized from radiographs into DMPN severe, evidence of severe joint changes, and DMPN low, absence of joint changes. Primary measurements of MLA were determined in each position and included Meary's angle, talar declination angle, first metatarsal declination angle, and navicular height.
The DMPN severe group had no difference between toe-flat and -extended positions for Meary's, talar declination, and first metatarsal declination angles (P > .35) while navicular height elevated (P < .05). The DMPN low group had no difference between toe-flat and -extended positions for talar declination angle (P = .38), while Meary's angle, first metatarsal declination angle, and navicular height elevated (P < .05). All measurements in the control group changed, consistent with arch height elevation, when toes were extended (P < .05).
The DMPN severe and low groups showed impaired ability to raise the arch from the toe-flat to -extended position. Further research is needed to examine the contribution of specific windlass mechanism components (ie, plantar fascia, ligament, foot joint integrity, and mobility) as they relate to progressive foot deformity in adults with DMPN.
Level III, comparative series.
绞盘机制通过足底筋膜起作用，在步态站立期稳定足弓。本研究的目的是比较患有和未患有糖尿病（DM）、周围神经病变（PN）以及低内侧纵弓（MLA）的参与者在足趾放平与伸展位置之间内侧纵弓（MLA）的影像学测量变化。
12名患有糖尿病性周围神经病变和低MLA的参与者以及12名对照组人员在足趾放平及伸展位置接受负重X线片检查。根据X线片将糖尿病性周围神经病变参与者分为重度糖尿病性周围神经病变组（有严重关节改变的证据）和轻度糖尿病性周围神经病变组（无关节改变）。在每个位置测定MLA的主要测量指标，包括梅里角、距骨倾斜角、第一跖骨倾斜角和舟骨高度。
重度糖尿病性周围神经病变组在足趾放平与伸展位置之间，梅里角、距骨倾斜角和第一跖骨倾斜角无差异（P>.35），而舟骨高度升高（P<.05）。轻度糖尿病性周围神经病变组在足趾放平与伸展位置之间距骨倾斜角无差异（P=.38），而梅里角、第一跖骨倾斜角和舟骨高度升高（P<.05）。对照组在足趾伸展时所有测量指标均发生变化，与足弓高度升高一致（P<.05）。
重度和轻度糖尿病性周围神经病变组从足趾放平到伸展位置时足弓升高能力受损。需要进一步研究以检查特定绞盘机制组成部分（即足底筋膜、韧带、足部关节完整性和活动度）与成年糖尿病性周围神经病变患者足部进行性畸形的关系。
III级，比较系列研究。
