Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Ave, St. Louis, MO 63108, USA.
Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 4525 Scott Ave, St. Louis, MO 63110, USA.
Clin Biomech (Bristol). 2021 May;85:105371. doi: 10.1016/j.clinbiomech.2021.105371. Epub 2021 May 3.
A toe-extension movement pattern may contribute to metatarsophalangeal joint deformity and ulceration in people with diabetes. We sought to quantify the relationship between toe extension magnitude and variability during three functional tasks (ankle range of motion, sit to stand, walking) with metatarsophalangeal joint deformity, and identify potential mechanisms associated with a toe-extension movement pattern.
Individuals with diabetes and peripheral neuropathy were included (n = 60). Metatarsophalangeal joint deformity was assessed using computed tomography (CT). Toe-extension movement was quantified using 3-dimensional motion capture. Linear regression was used to investigate the role of toe-extension movement pattern on metatarsophalangeal joint deformity. Regression analysis was used to identify mechanisms (neuropathy severity, foot intrinsic muscle deterioration ratio, ankle dorsiflexion range of motion) contributing to toe-extension movement pattern.
Toe extension with each functional task as well as the mean and coefficient of variation across all tasks were significantly related to metatarsophalangeal joint deformity (range of correlation coefficients = (-0.386, 0.692), p ≤ 0.001). Ankle dorsiflexion range of motion was associated with mean toe extension across all tasks (r = -0.282, p = 0.029). Neuropathy severity and foot intrinsic muscle deterioration ratio were associated with toe extension variability (r = -0.373, p = 0.003 and r = -0.266, p = 0.043; respectively).
Greater magnitude and lower variability of a toe-extension movement pattern was found to be associated with metatarsophalangeal joint deformity. These findings may support clinical assessment and treatment of movement across more than one task.
脚趾伸展运动模式可能导致糖尿病患者的跖趾关节畸形和溃疡。我们旨在定量分析在踝关节活动范围、坐站和行走三种功能任务中，跖趾关节畸形与脚趾伸展幅度和可变性之间的关系，并确定与脚趾伸展运动模式相关的潜在机制。
纳入患有糖尿病和周围神经病变的个体（n=60）。使用计算机断层扫描（CT）评估跖趾关节畸形。使用三维运动捕捉技术定量评估脚趾伸展运动。线性回归用于研究脚趾伸展运动模式对跖趾关节畸形的影响。回归分析用于确定导致脚趾伸展运动模式的机制（神经病变严重程度、足部内在肌肉恶化比例、踝关节背屈活动范围）。
每个功能任务的脚趾伸展以及所有任务的平均值和变异系数与跖趾关节畸形均具有显著相关性（相关系数范围为-0.386 至 0.692，p≤0.001）。踝关节背屈活动范围与所有任务的平均脚趾伸展相关（r=-0.282，p=0.029）。神经病变严重程度和足部内在肌肉恶化比例与脚趾伸展可变性相关（r=-0.373，p=0.003 和 r=-0.266，p=0.043；分别）。
发现脚趾伸展运动模式的幅度较大且可变性较低与跖趾关节畸形相关。这些发现可能支持对超过一项任务的运动进行临床评估和治疗。
