12/31/2022 0 Comments Claw toes![]() ![]() When the intrinsic muscles are weakened, theoretically they are overpowered by the extrinsic muscles. Initially, it was hypothesized that this deformity is caused by an imbalance between the extrinsic and intrinsic foot muscles. The literature is equivocal regarding the relationship between claw toes and diabetes. For this study, we will refer to both as “claw toes” (Fig. A claw toe is defined as extended MTPJ, flexed proximal interphalangeal joint (PIPJ), and flexed distal interphalangeal joint (DIPJ), while a hammer toe is defined as extended MTPJ, flexed PIPJ, and extended DIPJ. Characteristically, this forefoot deformity is commonly called a “claw toe” or a “hammer toe”. The most common deformity is at the metatarsophalangeal joints (MTPJ), which has been shown to have a prevalence as high as 85% in persons with a history of ulcers and amputation. The development of diabetic foot ulcers is a multi-factorial process that has been associated with, among other factors, diabetic neuropathy, minor foot trauma, and foot deformities. ![]() However, there are still a significant number of diabetic amputations each year (108,000 in the United States in 2014 ) and it has been estimated that up to 80% of those are preceded by diabetic foot ulcers. The rate of non-traumatic amputation has trended downward and is likely a result of improved preventive care, increases in revascularization interventions, and evolving orthopedic management. Intrinsic muscle atrophy and plantar aponeurosis thickening may be related to the development of claw toes in the presence of neuropathy.ĭiabetes currently affects more than 425 million people worldwide and is expected to surpass 629 million individuals by 2045. Subjects with concurrent neuropathy and claw toe deformity were associated with the smallest intrinsic foot muscle volumes and the thickest plantar aponeuroses. A negative correlation was observed between plantar aponeurosis thickness and intrinsic muscle volume (R 2 = 0.323, p < 0.001). A similar pattern may exist for intrinsic muscle volume, but results were not as conclusive. The effects of neuropathy and claw toes on aponeurosis thickness were synergistic rather than additive. Subjects with concurrent neuropathy and claw toes had thicker mean plantar aponeurosis ( p < 0.006) and may have had less mean intrinsic muscle volume ( p = 0.083) than the other 3 groups. A linear mixed-effects analysis on the effects of peripheral neuropathy and claw toe deformity on plantar aponeurosis thickness and intrinsic muscle volume was performed. Five measurement sites in the medial-lateral direction were utilized to fully characterize the plantar aponeurosis thickness. Plantar aponeurosis thickness was measured in the reformatted sagittal plane at 20% of the distance from the most inferior point of the calcaneus to the most inferior point of the second metatarsal. The intrinsic muscles of the foot were segmented from processed CT images. Methodsįorty randomly-selected subjects with type 2 diabetes were selected for each of the following four groups ( n = 10 per group): 1) peripheral neuropathy with claw toes, 2) peripheral neuropathy without claw toes, 3) non-neuropathic with claw toes, and 4) non-neuropathic without claw toes. The objective of this study was to explore the relationships between claw toe deformity, peripheral neuropathy, intrinsic muscle volume, and plantar aponeurosis thickness using computed tomography (CT) images of diabetic feet in a cross-sectional analysis.
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