title: Neuropathic midfoot deformity: associations with ankle and subtalar joint motion.
abstract: BACKGROUND
  Neuropathic deformities impair foot and ankle joint mobility, often leading to abnormal stresses and impact forces. The purpose of our study was to determine differences in radiographic measures of hind foot alignment and ankle joint and subtalar joint motion in participants with and without neuropathic midfoot deformities and to determine the relationships between radiographic measures of hind foot alignment to ankle and subtalar joint motion in participants with and without neuropathic midfoot deformities.
  
  
  METHODS
  Sixty participants were studied in three groups. Forty participants had diabetes mellitus (DM) and peripheral neuropathy (PN) with 20 participants having neuropathic midfoot deformity due to Charcot neuroarthropathy (CN), while 20 participants did not have deformity. Participants with diabetes and neuropathy with and without deformity were compared to 20 young control participants without DM, PN or deformity. Talar declination and calcaneal inclination angles were assessed on lateral view weight bearing radiograph. Ankle dorsiflexion, plantar flexion and subtalar inversion and eversion were assessed by goniometry.
  
  
  RESULTS
  Talar declination angle averaged 34±9, 26±4 and 23±3 degrees in participants with deformity, without deformity and young control participants, respectively (p< 0.010). Calcaneal inclination angle averaged 11±10, 18±9 and 21±4 degrees, respectively (p< 0.010). Ankle plantar flexion motion averaged 23±11, 38±10 and 47±7 degrees (p<0.010). The association between talar declination and calcaneal inclination angles with ankle plantar flexion range of motion is strongest in participants with neuropathic midfoot deformity. Participants with talonavicular and calcaneocuboid dislocations result in the most severe restrictions in ankle joint plantar flexion and subtalar joint inversion motions.
  
  
  CONCLUSIONS
  An increasing talar declination angle and decreasing calcaneal inclination angle is associated with decreases in ankle joint plantar flexion motion in individuals with neuropathic midfoot deformity due to CN that may contribute to excessive stresses and ultimately plantar ulceration of the midfoot.
authors.affiliation: Applied Kinesiology Laboratory, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, Saint Louis, MO 63108, USA. sinacored@wustl.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
authors.forename: David J
authors.initials: DJ
authors.lastname: Gutekunst
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hastings
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Strube
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Bohnert
authors.forename: Fred W
authors.initials: FW
authors.lastname: Prior
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson