Intrinsic foot muscle deterioration is associated with metatarsophalangeal joint angle in people with diabetes and neuropathy

Abstract

Background: Metatarsophalangeal joint deformity is associated with skin breakdown and amputation. The aims of this study were to compare intrinsic foot muscle deterioration ratios (ratio of adipose to muscle volume), and physical performance in subjects with diabetic neuropathy to controls, and determine their associations with 1) metatarsophalangeal joint angle and 2) history of foot ulcer.

Methods: 23 diabetic, neuropathic subjects [59 (SD 10) years] and 12 age-matched controls [57 (SD 14) years] were studied. Radiographs and MRI were used to measure metatarsophalangeal joint angle and intrinsic foot muscle deterioration through tissue segmentation by image signal intensity. The Foot and Ankle Ability Measure evaluated physical performance.

Findings: The diabetic, neuropathic group had a higher muscle deterioration ratio [1.6 (SD 1.2) vs. 0.3 (SD 0.2), P<0.001], and lower Foot and Ankle Ability Measure scores [65.1 (SD 24.4) vs. 98.3 (SD 3.3) %, P<0.01]. The correlation between muscle deterioration ratio and metatarsophalangeal joint angle was r=-0.51 (P=0.01) for all diabetic, neuropathic subjects, but increased to r=-0.81 (P<0.01) when only subjects with muscle deterioration ratios >1.0 were included. Muscle deterioration ratios in individuals with diabetic neuropathy were higher for those with a history of ulcers.

Interpretation: Individuals with diabetic neuropathy had increased intrinsic foot muscle deterioration, which was associated with second metatarsophalangeal joint angle and history of ulceration. Additional research is required to understand how foot muscle deterioration interacts with other impairments leading to forefoot deformity and skin breakdown.

Keywords: Foot deformity; Intermuscular adipose tissue; Muscle.

Figure 1

A) Lateral radiograph measure of the second metatarsophalangeal joint angle. B) Example MR image with the intrinsic foot muscle group highlighted. C) Histogram of signal intensities with the multiple-Gaussian-functions fitting algorithm applied. D) Lean muscle tissue and E) adipose volumes calculated as determined by the threshold between tissue types.

Figure 2

A) Mean volume of lean muscle, adipose tissue, and total intrinsic foot muscle from the hindfoot to the midfoot (Black bars = control group, white bars = DMPN group. * P = 0.003, ^† P = 0.001 between groups). B) Scatter plot of the second metatarsophalangeal joint (MTPJ) angle versus the IFM ratio (IMAT / lean muscle volume) for the control (X) and DMPN (●) subjects, including regression line and R² of correlation for the DMPN group. C) Scatter plot of the MTPJ angle versus the IFM deterioration ratio for DMPN subjects with a ratio ≤ 1.0 (■) and with a ratio > 1.0 (▲), including regression line and R² of correlation in the > 1.0 subgroup.