Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed
Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed
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DOI：
10.2337/dc08-2174
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发表时间：
2009-06-01
期刊：
影响因子：
16.2
通讯作者：
Levi, Marcel
中科院分区：
文献类型：
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作者：
Bus, Sicco A.;Maas, Mario;Levi, Marcel
目的：糖尿病性神经病足的脚趾抓挠被认为是由内在肌肉萎缩导致的肌肉失衡引起的。然而，缺乏支持这种机制的实验数据。本研究的目的是评估这一假设，使用磁共振成像（MRI）。研究设计和方法-在20名神经病性糖尿病患者，10爪趾畸形和10个正常对齐的脚趾，多个平面图像的脚和小腿采用T1加权自旋回波MRI采集。使用半定量5点萎缩量表评估控制脚趾的内在和外在肌肉的萎缩。一个内在的到外在的足部肌肉不平衡的分数来自这些萎缩scores，和相关系数established.RESULTS -平均+/- SD内在肌肉萎缩评分为3.1 +/- 1.1为脚趾畸形组和2.6 +/- 1.2为非畸形组（没有显着差异）。内在肌萎缩评分与足趾畸形程度无显著相关性（r = -0.18）。肌肉不平衡评分在研究组之间没有显著差异，并且与脚趾畸形程度没有显著相关性（r = -0.14）。结论-无论是内在的肌肉萎缩还是肌肉不平衡，都不能区分有或没有爪状趾畸形的神经病患者，这表明这些肌肉因素在爪状趾发育中的作用可能不是主要的，也不像以前认为的那样简单。这些发现为糖尿病足畸形的病因学提供了新的线索，并提示了更复杂的发展性质，可能涉及解剖学和生理学诱发因素。
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).RESEARCH DESIGN AND METHODS - 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).CONCLUSIONS - Neither intrinsic muscle atrophy nor muscle imbalance discriminated between neuropathic patients with or without claw toe deformity, suggesting 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.