Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
J Neuroeng Rehabil. 2023 May 16;20(1):65. doi: 10.1186/s12984-023-01172-1.
Hereditary motor and sensory neuropathies (HMSN), also known as Charcot-Marie-Tooth disease, are characterized by affected peripheral nerves. This often results in foot deformities that can be classified into four categories: (1) plantar flexed first metatarsal, neutral hindfoot, (2) plantar flexed first metatarsal, correctable hindfoot varus, (3) plantar flexed first metatarsal, uncorrectable hindfoot varus, and (4) hindfoot valgus. To improve management and for the evaluation of surgical interventions, a quantitative evaluation of foot function is required. The first aim of this study was to provide insight into plantar pressure of people with HMSN in relation to foot deformities. The second aim was to propose a quantitative outcome measure for the evaluation of surgical interventions based on plantar pressure.
In this historic cohort study, plantar pressure measurements of 52 people with HMSN and 586 healthy controls were evaluated. In addition to the evaluation of complete plantar pressure patterns, root mean square deviations (RMSD) of plantar pressure patterns from the mean plantar pressure pattern of healthy controls were calculated as a measure of abnormality. Furthermore, center of pressure trajectories were calculated to investigate temporal characteristics. Additionally, plantar pressure ratios of the lateral foot, toes, first metatarsal head, second/third metatarsal heads, fifth metatarsal head, and midfoot were calculated to measure overloading of foot areas.
Larger RMSD values were found for all foot deformity categories compared to healthy controls (p < 0.001). Evaluation of the complete plantar pressure patterns revealed differences in plantar pressure between people with HMSN and healthy controls underneath the rearfoot, lateral foot, and second/third metatarsal heads. Center of pressure trajectories differed between people with HMSN and healthy controls in the medio-lateral and anterior-posterior direction. The plantar pressure ratios, and especially the fifth metatarsal head pressure ratio, differed between healthy controls and people with HMSN (p < 0.05) and between the four foot deformity categories (p < 0.05).
Spatially and temporally distinct plantar pressure patterns were found for the four foot deformity categories in people with HMSN. We suggest to consider the RMSD in combination with the fifth metatarsal head pressure ratio as outcome measures for the evaluation of surgical interventions in people with HMSN.
遗传性运动感觉神经病（HMSN），又称夏科-马里-图什病，其特征为外周神经受损。这通常导致足部畸形，可分为四类：（1）跖屈第一跖骨，中立后足；（2）跖屈第一跖骨，可矫正后足内翻；（3）跖屈第一跖骨，不可矫正后足内翻；（4）后足外翻。为了改善管理和评估手术干预效果，需要对足部功能进行定量评估。本研究的首要目标是深入了解 HMSN 患者的足底压力与足部畸形的关系。其次，旨在基于足底压力提出一种用于评估手术干预效果的定量测量方法。
在这项历史性队列研究中，评估了 52 名 HMSN 患者和 586 名健康对照者的足底压力测量值。除了评估完整的足底压力模式外，还计算了足底压力模式与健康对照组平均足底压力模式的均方根偏差（RMSD），作为异常程度的衡量标准。此外，还计算了中心压力轨迹，以研究时间特征。另外，还计算了外侧足部、脚趾、第一跖骨头、第二/第三跖骨头、第五跖骨头和中足部的足底压力比，以测量足部区域的过载情况。
与健康对照组相比，所有足部畸形类别中的 RMSD 值均较大（p<0.001）。评估完整的足底压力模式显示，HMSN 患者与健康对照组的后足、外侧足部和第二/第三跖骨头下的足底压力存在差异。在中-侧和前-后方向，中心压力轨迹在 HMSN 患者与健康对照组之间存在差异。足底压力比，特别是第五跖骨头压力比，在健康对照组与 HMSN 患者之间（p<0.05）以及在四个足部畸形类别之间（p<0.05）存在差异。
在 HMSN 患者的四种足部畸形类别中，发现了空间和时间上明显不同的足底压力模式。我们建议将 RMSD 与第五跖骨头压力比结合起来作为 HMSN 患者手术干预效果的评估指标。
