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Manuel Doblaré - One of the best experts on this subject based on the ideXlab platform.
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Mechanical Stress Redistribution in the First Metatarsal Bone After Autologous Bone Harvesting.
Journal of the American Podiatric Medical Association, 2017Co-Authors: Javier Bayod López, Ricardo Becerro De Bengoa Vallejo, Marta Elena Losa Iglesias, Manuel DoblaréAbstract:Background: The first metatarsal bone is a viable source for autologous bone grafting in foot and ankle surgery and may serve as another convenient graft site to correct a flail Toe Deformity. We a...
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stress at the second metatarsal bone after correction of hammerToe and claw Toe Deformity a finite element analysis using an anatomical model
Journal of the American Podiatric Medical Association, 2013Co-Authors: Javier Bayod, Ricardo Becerro De Bengoa Vallejo, Marta Elena Losa Iglesias, Manuel DoblaréAbstract:Background: We used finite element analysis to evaluate three techniques for the correction of hammerToe and claw Toe deformities: flexor digitorum longus tendon transfer (FDLT), flexor digitorum brevis tendon transfer (FDBT), and proximal interphalangeal joint arthrodesis (PIPJA). Methods: We performed a finite element analysis of FDLT and FDBT compared with PIPJA of the second Toe using multislice computed tomography and 93 tomographic images of the foot obtained in a healthy 36-year-old man. Results: The PIPJA showed a significantly higher increase in traction and compressive stresses and strain at the medial aspect of the shaft of the second metatarsal bone compared with FDLT or FDBT (P < .01). Mean ± SD compressive stresses increased to −4.35 ± 7.05 MPa compared with the nonsurgical foot (−3.10 ± 4.90 MPa). It can, therefore, be hypothesized that if PIPJA is used to correct the hammerToe and claw Toe deformities, it could also increase traction and compressive stresses and strain in the metatarsals d...
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advantages and drawbacks of proximal interphalangeal joint fusion versus flexor tendon transfer in the correction of hammer and claw Toe Deformity a finite element study
Journal of Biomechanical Engineering-transactions of The Asme, 2010Co-Authors: Javier Bayod, Kevin T Jules, Ricardo Becerro De Bengoavallejo, Juan Carlos Pradosfrutos, Marta Elena Losaiglesias, Manuel DoblaréAbstract:Correction of claw or hammer Toe Deformity can be achieved using various techniques, including proximal interphalangeal joint arthrodesis (PIPJA), flexor digitorum longus tendon transfer (FDLT), and flexor digitorum brevis transfer. PIPJA is the oldest technique, but is associated with significant complications (infection, fracture, delayed union, and nonunion). FDLT eliminates the Deformity, but leads to loss of stability during gait. Flexor digitorum brevis tendon transfer (FDBT) seems to be the best surgical alternative, but it is a recent technique with still limited results. In this work, these three techniques have been analyzed by means of the finite-element method and a comparative analysis was done with the aim of extracting advantages and drawbacks. The results show that the best technique for reducing dorsal displacement of the proximal phalanx is PIPJA (2.28 mm versus 2.73 mm for FDLT, and 3.31 mm for FDBT). However, the best technique for reducing stresses on phalanges is FDLT or FDBT (a reduction of approximately 35% regarding the pathologic case versus the increase of 7% for the PIPJA in tensile stresses, and a reduction of approximately 40% versus 25% for the PIPJA in compression stresses). Moreover, the distribution of stresses in the entire phalanx is different for the PIPJA case. These facts could cause problems for patients, in particular, those with pain in the surgical Toe.
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finite element simulation of flexor digitorum longus or flexor digitorum brevis tendon transfer for the treatment of claw Toe Deformity
Journal of Biomechanics, 2009Co-Authors: Alberto Garciagonzalez, Kevin T Jules, Ricardo Becerro De Bengoavallejo, Juan Carlos Pradosfrutos, Marta Elena Losaiglesias, Javier Bayod, Manuel DoblaréAbstract:Claw Toe Deformity sometimes leads to dorsiflexion of the metatarsophalangeal joint (MPJ) and plantar flexion of the proximal (PIPJ) and distal interphalangeal (DIPJ) joints. Flexor digitorum longus tendon transfer (FDL) is currently the gold standard for the correction of this problem. Transfer of the flexor digitorum brevis (FDB) has been recently proposed as an alternative method to treat such Deformity. The aim of this work is to compare the biomechanical outcome of these two methods by means of finite-element simulation. The results show that the reduction in the dorsal displacement of the proximal phalanx (PP) for the second and third Toes were very similar (about 4.3 mm for each intervention), both achieving a significant reduction in MPJ dorsiflexion when compared to no intervention (displacements are reduced by approximately 51%). In the fourth and fifth Toes, only a small correction in the Deformity was achieved with both the techniques (10% and 7%, respectively). FDB and FDL tendon transfer reduced the stress level when compared with the non-operated pathologic foot (the reduction of stresses for the second and third PP ranged between 20% and 40%). FDB transfer resulted in a more uniform distribution of stress along the entire Toe, although differences were small in all cases. These results confirm that both the tendon-transfer techniques are effective in the treatment of claw Toe Deformity. Therefore, the choice of technique is at the discretion of the surgeon.
Marcel Levi - One of the best experts on this subject based on the ideXlab platform.
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Plantar Fat-Pad Displacement in Neuropathic Diabetic Patients With Toe Deformity A magnetic
2016Co-Authors: Sicco A Bus, Robert P J Michels, Mario Maas, Peter R Cavanagh, Marcel LeviAbstract:OBJECTIVE — The aim of this study was to quantify the association between claw/hammer Toe Deformity and changes in submetatarsal head (sub-MTH) fat-pad geometry in diabetic neuropathic feet. RESEARCH DESIGN AND METHODS — Thirteen neuropathic diabetic subjects (mean age 56.2 years) with Toe Deformity, 13 age- and sex-matched neuropathic diabetic control subjects without Deformity, and 13 age- and sex-matched healthy control subjects without Deformity were examined. From high-resolution sagittal plane magnetic resonance images of the second and third ray of the foot, Toe angle (a measure of Deformity), sub-MTH fat-pad thickness, and subphalangeal fat-pad thickness were measured. The ratio of these thicknesses was used to indicate fat-pad displacement. RESULTS — Sub-MTH fat pads were significantly thinner (2.5 1.3 vs. 6.0 1.4 mm, P 0.001) and subphalangeal fat pads significantly thicker (9.1 1.9 vs. 7.6 1.2 mm, P 0.005) in the neuropathic group with Deformity compared with neuropathic control subjects. As a result, thickness ratio was substantially smaller in the Deformity group: 0.28 0.14 vs. 0.79 0.14 in neuropathic control subjects (P 0.001). A significant correlation of 0.85 was presen
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Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed
2016Co-Authors: Sicco A Bus, Robert P J Michels, Mario Maas, Marcel LeviAbstract:OBJECTIVE — Clawing of the Toes in the diabetic neuropathic foot is believed to be caused by muscle imbalance resulting from intrinsic muscle atrophy. However, experimental data that support this mechanism are lacking. The aim of this study was to evaluate this hypothesis using magnetic resonance imaging (MRI). RESEARCHDESIGNANDMETHODS — In 20 neuropathic diabetic patients, 10 with claw Toe Deformity and 10 with normally aligned Toes, multiple plane images of the foot and lower leg were acquired using T1-weighted spin-echo MRI. Atrophy of the intrinsic and extrinsic muscles controlling the Toes was assessed using a semiquantitative 5-point atrophy scale. An intrinsic-to-extrinsic foot muscle imbalance score was derived from these atrophy scores, and correlation coefficients were established. RESULTS — The mean SD intrinsic muscle atrophy score was 3.1 1.1 for the Toe Deformity group and 2.6 1.2 for the nonDeformity group (not significantly different). The intrinsic muscle atrophy score was not significantly correlated with degree of Toe Deformity (r 0.18). The muscle imbalance score was not significantly different between study groups and was not significantly correlated with degree of Toe Deformity (r 0.14)
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role of intrinsic muscle atrophy in the etiology of claw Toe Deformity in diabetic neuropathy may not be as straightforward as widely believed
Diabetes Care, 2009Co-Authors: Mario Maas, Robert P J Michels, Marcel LeviAbstract:Abstract Objective: Clawing of the Toes in the diabetic neuropathic foot is believed to be caused by muscle imbalance resulting from intrinsic muscle atrophy. However, experimental data that supports this mechanism is lacking. The aim of this study was to evaluate this hypothesis using magnetic resonance imaging (MRI). Research Design and Methods: In twenty neuropathic diabetic patients, ten with claw Toe Deformity and ten with normally aligned Toes, multiple plane images of the foot and lower leg were acquired using T1-weighted spin-echo MRI. Atrophy of the intrinsic and extrinsic muscles controlling the Toes were assessed using a semi-quantitative 5-point atrophy scale. An intrinsic-to-extrinsic foot muscle imbalance score was derived from these atrophy scores and correlation coefficients were established. Results: Mean (SD) intrinsic muscle atrophy score was 3.1 (1.1) for the Toe Deformity group and 2.6 (1.2) for the non-Deformity group (not significantly different). Intrinsic muscle atrophy score was not correlated with degree of Toe Deformity (r = −0.18). Muscle imbalance score was not significantly different between study groups and not correlated with degree of Toe Deformity (r = −0.14). Conclusions: Neither intrinsic muscle atrophy nor muscle imbalance discriminated between neuropathic patients with or without claw Toe Deformity. This suggests that the role of these muscle factors in claw Toe development may not be primary or as straightforward as previously believed. These findings shed new light on the etiology of foot Deformity in diabetes and suggest a more complex nature of development, potentially involving anatomical and physiological predisposing factors.
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elevated plantar pressures in neuropathic diabetic patients with claw hammer Toe Deformity
Journal of Biomechanics, 2005Co-Authors: Mario Maas, Antony De Lange, Robert P J Michels, Marcel LeviAbstract:Abstract Elevated plantar foot pressures during gait in diabetic patients with neuropathy have been suggested to result, among other factors, from the distal displacement of sub-metatarsal head (MTH) fat-pad cushions caused by to claw/hammer Toe Deformity. The purpose of this study was to quantitatively assess these associations. Thirteen neuropathic diabetic subjects with claw/hammer Toe Deformity, and 13 age- and gender-matched neuropathic diabetic controls without Deformity, were examined. Dynamic barefoot plantar pressures were measured with an EMED pressure platform. Peak pressure and force–time integral for each of 11 foot regions were calculated. Degree of Toe Deformity and the ratio of sub-MTH to sub-phalangeal fat-pad thickness (indicating fat-pad displacement) were measured from sagittal plane magnetic resonance images of the foot. Peak pressures at the MTHs were significantly higher in the patients with Toe Deformity (mean 626 (SD 260) kPa) when compared with controls (mean 363 (SD 115) kPa, P r =−0.74) and with fat-pad displacement ( r =−0.71) ( P
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elevated plantar pressures in neuropathic diabetic patients with claw hammer Toe Deformity
Journal of Biomechanics, 2005Co-Authors: Mario Maas, Antony De Lange, Robert P J Michels, Marcel LeviAbstract:Abstract Elevated plantar foot pressures during gait in diabetic patients with neuropathy have been suggested to result, among other factors, from the distal displacement of sub-metatarsal head (MTH) fat-pad cushions caused by to claw/hammer Toe Deformity. The purpose of this study was to quantitatively assess these associations. Thirteen neuropathic diabetic subjects with claw/hammer Toe Deformity, and 13 age- and gender-matched neuropathic diabetic controls without Deformity, were examined. Dynamic barefoot plantar pressures were measured with an EMED pressure platform. Peak pressure and force–time integral for each of 11 foot regions were calculated. Degree of Toe Deformity and the ratio of sub-MTH to sub-phalangeal fat-pad thickness (indicating fat-pad displacement) were measured from sagittal plane magnetic resonance images of the foot. Peak pressures at the MTHs were significantly higher in the patients with Toe Deformity (mean 626 (SD 260) kPa) when compared with controls (mean 363 (SD 115) kPa, P r =−0.74) and with fat-pad displacement ( r =−0.71) ( P
Jan Willem K Louwerens - One of the best experts on this subject based on the ideXlab platform.
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treatment of metatarsalgia based on claw Toe Deformity through soft tissue release of the metatarsophalangeal joint and resection of the proximal interphalangeal joint evaluation based on foot kinematics and plantar pressure distribution
Foot and Ankle Surgery, 2019Co-Authors: Niki M Stolwijk, Noel L W Keijsers, Jantsje H Pasma, Wandana Nanhoemahabier, Jacques Duysens, Jan Willem K LouwerensAbstract:Abstract Introduction This study investigated the effect of operative claw Toe correction with release of the metatarsophalangeal (MTP) joint, repositioning of the plantar fat pad and resection of the proximal interphalangeal joint on foot kinematics, plantar pressure distribution and Foot Function Index (FFI). Methods Prospective experimental study with pretest-posttest design. The plantar pressure, 3D foot kinematics and the FFI of 15 patients with symptomatic claw Toes were measured three months before and 12 months after surgery. Mean pressure, peak pressure and pressure time integral per sensor and various foot angles were calculated for the pre- and posttest and compared to a control group (N = 15). Results Claw Toe patients have increased pressure under the distal part of the metatarsal head and less pressure under the proximal part of the metatarsal heads compared to healthy controls. After surgery, there was a redistribution of pressure, resulting in a significant decrease of pressure under the distal part and an increase under the proximal part of the metatarsal head, providing a more equal plantar pressure distribution. Except for some small areas under the forefoot, heel and Toes, there were no significant differences in pressure distribution between the operated feet and controls. Small, but significant differences between the pre- and postoperative condition were found for the lateral arch angle, calcaneus/malleolus supination and tibio-talar flexion. The score on the FFI improved statistically significant. Discussion These findings imply that the present operative procedure results in a more equal distribution of the plantar pressure under the forefoot and decrease of pain and offers successful treatment of metatarsalgia based on claw Toe Deformity.
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treatment of metatarsalgia based on claw Toe Deformity through soft tissue release of the metatarsophalangeal joint and resection of the proximal interphalangeal joint evaluation based on foot kinematics and plantar pressure distribution
Foot and Ankle Surgery, 2019Co-Authors: Niki M Stolwijk, Noel L W Keijsers, Jantsje H Pasma, Wandana Nanhoemahabier, Jacques Duysens, Jan Willem K LouwerensAbstract:Abstract Introduction This study investigated the effect of operative claw Toe correction with release of the metatarsophalangeal (MTP) joint, repositioning of the plantar fat pad and resection of the proximal interphalangeal joint on foot kinematics, plantar pressure distribution and Foot Function Index (FFI). Methods Prospective experimental study with pretest-posttest design. The plantar pressure, 3D foot kinematics and the FFI of 15 patients with symptomatic claw Toes were measured three months before and 12 months after surgery. Mean pressure, peak pressure and pressure time integral per sensor and various foot angles were calculated for the pre- and posttest and compared to a control group (N = 15). Results Claw Toe patients have increased pressure under the distal part of the metatarsal head and less pressure under the proximal part of the metatarsal heads compared to healthy controls. After surgery, there was a redistribution of pressure, resulting in a significant decrease of pressure under the distal part and an increase under the proximal part of the metatarsal head, providing a more equal plantar pressure distribution. Except for some small areas under the forefoot, heel and Toes, there were no significant differences in pressure distribution between the operated feet and controls. Small, but significant differences between the pre- and postoperative condition were found for the lateral arch angle, calcaneus/malleolus supination and tibio-talar flexion. The score on the FFI improved statistically significant. Discussion These findings imply that the present operative procedure results in a more equal distribution of the plantar pressure under the forefoot and decrease of pain and offers successful treatment of metatarsalgia based on claw Toe Deformity.
Tun Hing Lui - One of the best experts on this subject based on the ideXlab platform.
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modified double plantar plate tenodesis
Foot and Ankle Surgery, 2017Co-Authors: Tun Hing Lui, L L LiyeungAbstract:Abstract Background Metatarsophalangeal joint instability of the lesser Toe can cause acquired Toe Deformity. Plantar plate deficiency is the major pathology. Plantar plate repair can stabilize the joint but may result in iatrogenic transverse plane Toe Deformity in correction of claw Toe Deformity. Limited Toe extension can be resulted after correction of crossover Toe Deformity by plantar plate tenodesis and extensor digitorum brevis transfer. A modification of the technique is proposed. Materials and methods The clinical outcomes of 10 patients with the modified procedure performed were assessed. Results The correction was full in all Toes with no recurrence. Conclusion The modified technique can stabilize the metatarsophalangeal joint and correct lesser Toe Deformity without the need of tendon transfer, osteotomy or sophisticated instrumentation.
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correction of crossover Toe Deformity by arthroscopically assisted plantar plate tenodesis
Arthroscopy techniques, 2016Co-Authors: Tun Hing LuiAbstract:Plantar plate deficiency is the major pathology causing metatarsophalangeal joint instability. As the joint subluxates dorsally, the lumbrical is tethered at the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover Toe Deformity. Plantar plate repair or reconstruction is a logical surgical treatment option. This can be performed through a dorsal or plantar approach. The purpose of this technical note is to report a minimally invasive technique of crossover Toe Deformity correction by suturing the plantar plate to the extensor tendon. It is indicated for symptomatic crossover Toe Deformity that is not responsive to nonsurgical treatment. It is contraindicated if the metatarsophalangeal joint is degenerated, destructed, or dislocated, or there is interdigital neuroma at the sides of the deformed Toe, or the Deformity is caused by bony deformities of the metatarsal head or the proximal phalanx.
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percutaneous dorsal closing wedge osteotomy of the metatarsal neck in management of metatarsalgia
The Foot, 2014Co-Authors: Tun Hing LuiAbstract:Abstract Introduction Metatarsalgia can be caused by plantarflexion of a central metatarsal or discrepancies in the metatarsals' length. Nonsurgical management is usually sufficient to achieve satisfactory results. For those recalcitrant cases, metatarsal osteotomy is needed to relieve the pain. We describe a technique of percutaneous dorsal closing wedge osteotomy of the metatarsal to manage the recalcitrant metatarsalgia. A case series was reviewed retrospectively. Materials and methods From March 2010 to March 2013, percutaneous dorsal closing wedge osteotomy of the metatarsal neck has been performed in 33 patients. Thirty six feet with 63 metatarsals were operated on. Thirty two second metatarsals, 22 third metatarsals, 5 fourth metatarsals and 4 fifth metatarsals were operated on. Results All the osteotomy sites healed up without any transverse plane Deformity. The painful callosities subsided except in one operated metatarsal. Recurrence of painful callosities occurred in 2 operated metatarsals. Transfer metatarsalgia occurred in 2 feet. Floating Toe Deformity occurred in 2 operated rays. There was no nerve injury noted. Two patients had delayed wound healing with serous discharge and the wounds were eventually healed up with wound dressing. Conclusion Percutaneous dorsal closing wedge osteotomy of the metatarsal neck is an effective and safe surgical treatment of recalcitrant metatarsalgia.
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correction of crossover Deformity of second Toe by combined plantar plate tenodesis and extensor digitorum brevis transfer a minimally invasive approach
Archives of Orthopaedic and Trauma Surgery, 2011Co-Authors: Tun Hing LuiAbstract:Purpose To study the efficacy and safety of the combined plantar plate tenodesis and extensor digitorum brevis transfer in correction of claw Toe Deformity.
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arthroscopic assisted correction of claw Toe or overriding Toe Deformity plantar plate tenodesis
Archives of Orthopaedic and Trauma Surgery, 2007Co-Authors: Tun Hing LuiAbstract:Hyperextension of the metatarsophalangeal joint is the key component of claw Toe Deformity. We describe an arthroscopic technique to stabilize the plantar plate and reduce the metatarsophalangeal joint. Under arthroscopic guide, the dorsal capsule is released. The plantar plate is anchored and sutured to the extensor digiturum longus tendon. In case of overriding Toe Deformity, the medial capsule is also reduced and lateral capsule is plicated under arthroscopic guide
Mario Maas - One of the best experts on this subject based on the ideXlab platform.
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Plantar Fat-Pad Displacement in Neuropathic Diabetic Patients With Toe Deformity A magnetic
2016Co-Authors: Sicco A Bus, Robert P J Michels, Mario Maas, Peter R Cavanagh, Marcel LeviAbstract:OBJECTIVE — The aim of this study was to quantify the association between claw/hammer Toe Deformity and changes in submetatarsal head (sub-MTH) fat-pad geometry in diabetic neuropathic feet. RESEARCH DESIGN AND METHODS — Thirteen neuropathic diabetic subjects (mean age 56.2 years) with Toe Deformity, 13 age- and sex-matched neuropathic diabetic control subjects without Deformity, and 13 age- and sex-matched healthy control subjects without Deformity were examined. From high-resolution sagittal plane magnetic resonance images of the second and third ray of the foot, Toe angle (a measure of Deformity), sub-MTH fat-pad thickness, and subphalangeal fat-pad thickness were measured. The ratio of these thicknesses was used to indicate fat-pad displacement. RESULTS — Sub-MTH fat pads were significantly thinner (2.5 1.3 vs. 6.0 1.4 mm, P 0.001) and subphalangeal fat pads significantly thicker (9.1 1.9 vs. 7.6 1.2 mm, P 0.005) in the neuropathic group with Deformity compared with neuropathic control subjects. As a result, thickness ratio was substantially smaller in the Deformity group: 0.28 0.14 vs. 0.79 0.14 in neuropathic control subjects (P 0.001). A significant correlation of 0.85 was presen
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Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed
2016Co-Authors: Sicco A Bus, Robert P J Michels, Mario Maas, Marcel LeviAbstract:OBJECTIVE — Clawing of the Toes in the diabetic neuropathic foot is believed to be caused by muscle imbalance resulting from intrinsic muscle atrophy. However, experimental data that support this mechanism are lacking. The aim of this study was to evaluate this hypothesis using magnetic resonance imaging (MRI). RESEARCHDESIGNANDMETHODS — In 20 neuropathic diabetic patients, 10 with claw Toe Deformity and 10 with normally aligned Toes, multiple plane images of the foot and lower leg were acquired using T1-weighted spin-echo MRI. Atrophy of the intrinsic and extrinsic muscles controlling the Toes was assessed using a semiquantitative 5-point atrophy scale. An intrinsic-to-extrinsic foot muscle imbalance score was derived from these atrophy scores, and correlation coefficients were established. RESULTS — The mean SD intrinsic muscle atrophy score was 3.1 1.1 for the Toe Deformity group and 2.6 1.2 for the nonDeformity group (not significantly different). The intrinsic muscle atrophy score was not significantly correlated with degree of Toe Deformity (r 0.18). The muscle imbalance score was not significantly different between study groups and was not significantly correlated with degree of Toe Deformity (r 0.14)
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role of intrinsic muscle atrophy in the etiology of claw Toe Deformity in diabetic neuropathy may not be as straightforward as widely believed
Diabetes Care, 2009Co-Authors: Mario Maas, Robert P J Michels, Marcel LeviAbstract:Abstract Objective: Clawing of the Toes in the diabetic neuropathic foot is believed to be caused by muscle imbalance resulting from intrinsic muscle atrophy. However, experimental data that supports this mechanism is lacking. The aim of this study was to evaluate this hypothesis using magnetic resonance imaging (MRI). Research Design and Methods: In twenty neuropathic diabetic patients, ten with claw Toe Deformity and ten with normally aligned Toes, multiple plane images of the foot and lower leg were acquired using T1-weighted spin-echo MRI. Atrophy of the intrinsic and extrinsic muscles controlling the Toes were assessed using a semi-quantitative 5-point atrophy scale. An intrinsic-to-extrinsic foot muscle imbalance score was derived from these atrophy scores and correlation coefficients were established. Results: Mean (SD) intrinsic muscle atrophy score was 3.1 (1.1) for the Toe Deformity group and 2.6 (1.2) for the non-Deformity group (not significantly different). Intrinsic muscle atrophy score was not correlated with degree of Toe Deformity (r = −0.18). Muscle imbalance score was not significantly different between study groups and not correlated with degree of Toe Deformity (r = −0.14). Conclusions: Neither intrinsic muscle atrophy nor muscle imbalance discriminated between neuropathic patients with or without claw Toe Deformity. This suggests that the role of these muscle factors in claw Toe development may not be primary or as straightforward as previously believed. These findings shed new light on the etiology of foot Deformity in diabetes and suggest a more complex nature of development, potentially involving anatomical and physiological predisposing factors.
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elevated plantar pressures in neuropathic diabetic patients with claw hammer Toe Deformity
Journal of Biomechanics, 2005Co-Authors: Mario Maas, Antony De Lange, Robert P J Michels, Marcel LeviAbstract:Abstract Elevated plantar foot pressures during gait in diabetic patients with neuropathy have been suggested to result, among other factors, from the distal displacement of sub-metatarsal head (MTH) fat-pad cushions caused by to claw/hammer Toe Deformity. The purpose of this study was to quantitatively assess these associations. Thirteen neuropathic diabetic subjects with claw/hammer Toe Deformity, and 13 age- and gender-matched neuropathic diabetic controls without Deformity, were examined. Dynamic barefoot plantar pressures were measured with an EMED pressure platform. Peak pressure and force–time integral for each of 11 foot regions were calculated. Degree of Toe Deformity and the ratio of sub-MTH to sub-phalangeal fat-pad thickness (indicating fat-pad displacement) were measured from sagittal plane magnetic resonance images of the foot. Peak pressures at the MTHs were significantly higher in the patients with Toe Deformity (mean 626 (SD 260) kPa) when compared with controls (mean 363 (SD 115) kPa, P r =−0.74) and with fat-pad displacement ( r =−0.71) ( P
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elevated plantar pressures in neuropathic diabetic patients with claw hammer Toe Deformity
Journal of Biomechanics, 2005Co-Authors: Mario Maas, Antony De Lange, Robert P J Michels, Marcel LeviAbstract:Abstract Elevated plantar foot pressures during gait in diabetic patients with neuropathy have been suggested to result, among other factors, from the distal displacement of sub-metatarsal head (MTH) fat-pad cushions caused by to claw/hammer Toe Deformity. The purpose of this study was to quantitatively assess these associations. Thirteen neuropathic diabetic subjects with claw/hammer Toe Deformity, and 13 age- and gender-matched neuropathic diabetic controls without Deformity, were examined. Dynamic barefoot plantar pressures were measured with an EMED pressure platform. Peak pressure and force–time integral for each of 11 foot regions were calculated. Degree of Toe Deformity and the ratio of sub-MTH to sub-phalangeal fat-pad thickness (indicating fat-pad displacement) were measured from sagittal plane magnetic resonance images of the foot. Peak pressures at the MTHs were significantly higher in the patients with Toe Deformity (mean 626 (SD 260) kPa) when compared with controls (mean 363 (SD 115) kPa, P r =−0.74) and with fat-pad displacement ( r =−0.71) ( P