Orthopaedic and Rehabilitation Engineering Center, Marquette University, 1515 W. Wisconsin Ave., Milwaukee, WI 53233, USA; Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201, USA.
Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Ave., St. Louis, MO 63108, USA.
Foot (Edinb). 2022 May;51:101912. doi: 10.1016/j.foot.2022.101912. Epub 2022 Feb 11.
Midfoot movement dysfunction, as measured by heel rise performance, is associated with midfoot deformity in people with diabetes and peripheral neuropathy. Understanding contributors of midfoot movement dysfunction may help clinicians understand deformity progression. The purpose of this study was to determine the factors associated with midfoot angle at peak heel rise.
The outcomes of fifty-eight participants with type 2 diabetes mellitus and peripheral neuropathy were analyzed. Midfoot (forefoot on hindfoot) sagittal kinematics during unilateral heel rise task were measured using 3-dimensional motion analysis. A multivariate linear regression model was used to predict midfoot sagittal movements at peak heel rise. Independent variables that were entered in the model were (in order of entry): age, body mass index, intrinsic foot muscle volume, and maximum available midfoot plantarflexion range of motion. Intrinsic foot muscle volume was obtained from magnetic resonance imaging and maximum available midfoot motion was measured during non-weightbearing plantarflexion using 3-dimensional motion analysis.
Body mass index (R = 30.5%, p < 0.001) and maximum available midfoot plantarflexion range of motion (R = 10.9%, p = 0.001) were significant factors that accounted for 41.4% of variance of midfoot angle at peak heel rise, while age and intrinsic foot muscle volume were not significant predictors.
Greater body mass index and less available midfoot plantarflexion range of motion were associated with greater midfoot movement dysfunction. These two significant predictors are potentially modifiable, suggesting possible improvements in midfoot movements with reduction in body weight and increasing midfoot plantarflexion range of motion. Health care professionals should consider patient's weight and joint motion when prescribing foot exercise(s) to prevent excessive midfoot collapse during weightbearing tasks.
跟骨抬高试验中距下关节活动度的改变与糖尿病伴周围神经病变患者的中足畸形有关。了解距下关节活动度改变的相关因素可能有助于临床医生了解畸形的进展。本研究旨在确定与跟骨抬高峰值时距下关节角度相关的因素。
分析了 58 例 2 型糖尿病伴周围神经病变患者的结果。采用三维运动分析测量单侧跟骨抬高试验中距下关节矢状面运动。使用多元线性回归模型预测跟骨抬高峰值时的距下关节矢状面运动。纳入模型的独立变量（按进入顺序）为：年龄、体重指数、固有足部肌肉体积和最大可获得的距下关节跖屈活动度。固有足部肌肉体积通过磁共振成像获得，最大可获得的距下关节运动在非负重跖屈时通过三维运动分析测量。
体重指数（R=30.5%，p<0.001）和最大可获得的距下关节跖屈活动度（R=10.9%，p=0.001）是解释跟骨抬高峰值时距下关节角度变异性的 41.4%的显著因素，而年龄和固有足部肌肉体积不是显著的预测因素。
更大的体重指数和更小的距下关节跖屈活动度与更大的距下关节运动障碍相关。这两个显著的预测因素是潜在可改变的，这表明通过减轻体重和增加距下关节跖屈活动度，可能会改善距下关节运动。在为预防承重任务时过度的中足塌陷而开具足部运动（s）时，医疗保健专业人员应考虑患者的体重和关节运动。
