title: Acquired midfoot deformity and function in individuals with diabetes and peripheral neuropathy.
abstract: BACKGROUND
  Diabetes mellitus related medial column foot deformity is a major contributor to ulceration and amputation. However, little is known about the relationship between medial column alignment and function and the integrity of the soft tissues that support and move the medial column. The purposes of this study were to determine the predictors of medial column alignment and function in people with diabetes and peripheral neuropathy.
  
  
  METHODS
  23 participants with diabetes and neuropathy had radiographs, heel rise kinematics, magnetic resonance imaging and isokinetic muscle testing to measure: 1) medial column alignment (Meary's angle--the angle between the 1st metatarsal longitudinal axis and the talar head and neck), 2) medial column function (forefoot relative to hindfoot plantarflexion during heel rise), 3) intrinsic foot muscle and fat volume, ratio of posterior tibialis to flexor digitorum tendon volume, 4) plantar fascia function (Meary's angle change from toes flat to extended) and 5) plantarflexor peak torque. Predictors of medial column alignment and function were determined using simultaneous entry multiple regression.
  
  
  RESULTS
  Posterior tibialis to flexor digitorum tendon volume ratio and intrinsic foot muscle volume were significant predictors of medial column alignment (P<.05), accounting for 44% of the variance. Intrinsic foot fat volume and plantarflexor peak torque were significant predictors of medial column function (P<.05), accounting for 37% of the variance.
  
  
  CONCLUSIONS
  Deterioration of medial column supporting structures predicted alignment and function. Prospective research is required to monitor alignment, structure, and function over time to inform early intervention strategies to prevent deformity, ulceration, and amputation.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA. Electronic address: hastingsmk@wustl.edu.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hastings
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mueller
authors.affiliation: Institute for Applied Health Research, Glasgow Caledonian University, Glasgow City, UK.
authors.forename: James
authors.initials: J
authors.lastname: Woodburn
authors.affiliation: Department of Psychology, Washington University in St. Louis, MO 63105, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Strube
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Commean
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Cheuy
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005530:Foot Deformities / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D013710:Tendons / Q000503:physiopathology
keywords: Intrinsic foot muscle; Muscle volume; Plantarflexor power; Posterior tibialis tendon