Abstract
BackgroundNeuropathic 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.MethodsSixty 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.ResultsTalar 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.ConclusionsAn 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.
Highlights
Neuropathic deformities impair foot and ankle joint mobility, often leading to abnormal stresses and impact forces
The sequelae of impaired foot or ankle joint motion coupled with excessive plantar stresses in individuals with diabetes mellitus (DM) and peripheral neuropathy (PN) are ulceration
Schon and colleagues have reported that neuropathic individuals with acquired mid tarsus deformities and accompanying plantar ulcerations occur when hind foot alignment exceed the values encountered in asymptomatic, non-neuropathic adults without midfoot deformities [5]
Summary
Neuropathic deformities impair foot and ankle joint mobility, often leading to abnormal stresses and impact forces. Neuropathic midfoot deformities impair foot and ankle joint mobility, often leading to abnormal stresses and impact forces during walking [1]. Neuropathic midfoot deformities have been commonly demonstrated by radiographic measures that exceed bone and joint alignment values for individuals without deformities [5,6,7]. Schon and colleagues have reported that neuropathic individuals with acquired mid tarsus deformities and accompanying plantar ulcerations occur when hind foot alignment exceed the values encountered in asymptomatic, non-neuropathic adults without midfoot deformities [5]. Limited ankle joint and subtalar joint mobility can impair foot function and contribute to excessive vertical plantar pressures leading to neuropathic ulceration [1]. The impact of LJM in the ankle and subtalar joints to the onset and progression of acquired mid tarsus deformities is unknown
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
