title: Windlass Mechanism in Individuals With Diabetes Mellitus, Peripheral Neuropathy, and Low Medial Longitudinal Arch Height.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level III, comparative series.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA gelberj@wustl.edu.
authors.forename: Judith R
authors.initials: JR
authors.lastname: Gelber
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
authors.affiliation: Department of Psychology, Washington University, St. Louis, Missouri, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Strube
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mueller
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
authors.affiliation: Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA.
authors.forename: Fred W
authors.initials: FW
authors.lastname: Prior
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hastings
keywords: deformity; foot; radiograph