Article

Metatarsophalangeal joint (MTPJ) hyperextension deformity is common
in people with diabetic neuropathy and a known risk factor for ulceration and
amputation. An MTPJ hyperextension movement pattern may contribute to the
development of this acquired deformity. OBJECTIVE:
The purpose of this study was
to determine, in people with diabetes mellitus and peripheral neuropathy (DM+PN),
the ankle and MTPJ ranges of motion that characterize an MTPJ hyperextension
movement pattern and its relationship to MTPJ deformity severity. It was
hypothesized that severity of MTPJ deformity would be related to limitations in
maximum ankle dorsiflexion and increased MTPJ extension during active ankle
dorsiflexion movement tasks. DESIGN: A cross-sectional study design was used that
included 34 people with DM+PN (mean age=59 years, SD=9). METHODS: Computed
tomography and 3-dimensional motion capture analysis were used to measure resting
MTPJ angle and intersegmental foot motion during the tasks of ankle dorsiflexion
and plantar flexion with the knee extended and flexed to 90 degrees, walking, and
sit-to/from-stand. RESULTS: The MTPJ extension movement pattern during all tasks
was directly correlated with severity of MTPJ deformity: maximum ankle
dorsiflexion with knee extended (r=.35; 95% confidence interval [CI]=.02, .62),
with knee flexed (r=.35; 95% CI=0.01, 0.61), during the swing phase of gait
(r=.47; 95% CI=0.16, 0.70), during standing up (r=.48; 95% CI=0.17, 0.71), and
during sitting down (r=.38; 95% CI=0.05, 0.64). All correlations were
statistically significant. LIMITATIONS: This study was cross-sectional, and
causal relationships cannot be made. CONCLUSIONS: A hyperextension MTPJ movement
pattern associated with limited ankle dorsiflexion has been characterized in
people with diabetic neuropathy. Increased MTPJ extension during movement and
functional tasks was correlated with severity of resting MTPJ alignment.
Repetition of this movement pattern could be an important factor in the etiology
of MTPJ deformity and future risk of ulceration.
CI - (c) 2016 American Physical Therapy Association.

Langue : ANGLAIS