Zellers JA, Mueller MJ, Commean PK, Chen L, Jeong HJ, Hastings MK, et al.
Journal of clinical medicine. Date of publication 2020 Apr 3;volume 9(4):.
1. J Clin Med. 2020 Apr 3;9(4). pii: E1012. doi: 10.3390/jcm9041012.
Multi-System Factors Associated with Metatarsophalangeal Joint Deformity in
Individuals with Type 2 Diabetes.
Zellers JA(1), Mueller MJ(1), Commean PK(2), Chen L(3), Jeong HJ(1), Hastings
MK(1).
Author information:
(1)Program in Physical Therapy, Washington University School of Medicine in St.
Louis, 4444 Forest Park Ave., St. Louis, MO 63108, USA.
(2)Mallinckrodt Institute of Radiology, Washington University School of Medicine
in St. Louis, 510 South Kingshighway Blvd., St. Louis, MO 63110, USA.
(3)Division of Biostatistics, Washington University School of Medicine in St.
Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
The underlying factors contributing to metatarsophalangeal joint deformity, a
known precursor to skin breakdown in individuals with diabetes mellitus (DM), is
likely to involve multiple body systems. The purpose of this cross-sectional
study was to identify multi-system factors associated with metatarsophalangeal
joint deformity in individuals with type 2 DM and peripheral neuropathy (n = 60).
Metatarsophalangeal joint deformity was quantified with a computed tomography
(CT) scan. System biomarkers included the musculoskeletal system (foot intrinsic
muscle deterioration, tarsal/metatarsal bone mineral density, ankle dorsiflexion,
metatarsophalangeal extension movement during a sit to stand task); the vascular
system (ankle-brachial index); and the endocrine/immune systems (high sensitivity
C-reactive protein, skin intrinsic fluorescence, and hemoglobin A1C). Muscle
deterioration (r = 0.27), bone density (r = -0.35), metatarsophalangeal extension
movement (r = 0.50), maximum dorsiflexion (r = -0.31), and ankle-brachial index
(r = 0.33) were related to metatarsophalangeal joint deformity (p < 0.05). Bone
mineral density and metatarsophalangeal extension movement were retained in a
regression model relating to deformity (R2 = 0.34). All musculoskeletal system
biomarkers and the ankle-brachial index demonstrated weak to moderate
relationships to metatarsophalangeal joint deformity. Bone mineral density of the
tarsal/metatarsal bones and extending the toes during a sit to stand task were
the two strongest factors associated with metatarsophalangeal joint deformity.
Evaluation and management of foot bone mineral density and toe extension movement
pattern could reduce metatarsophalangeal joint deformity and the risk of skin
breakdown and subsequent amputation.
DOI: 10.3390/jcm9041012
PMID: 32260124
