Foot problems are widespread in the elderly and have an important influence on mobility. In persons with diabetes, foot deformities are of particular significance because they are widely believed to contribute to plantar ulceration which significantly increases the risk of lower extremity amputation. The proposed research is designed to examine the putative role of intrinsic muscle atrophy in the progression of foot deformity. We will first examine the status of symmetrical distal sensory motor neuropathy, foot deformity, and the ability to develop toe flexor torque in a carefully chosen group of subjects with diabetes. MRI's of the feet will then be quantified to assess cross sectional areas of important intrinsic muscles and plantar pressure during gait will be measured. We hypothesize that sensory and motor neuropathy will proceed broadly in parallel, and that motor neuropathy is associated with intrinsic muscle atrophy, elevated plantar pressure, and clawing of the toes. There are three components to the significance of this research. First, it will enhance our basic understanding of an important disease process that leads to loss of limbs in the elderly. Second, it will contribute to a better understanding of diabetic peripheral neuropathy and its sequelae. Third, it should ultimately lead to an improvement in early recognition of feet that are at risk for ulceration.
| Bus, Sicco A; Yang, Qing X; Wang, Jinghua H et al. (2002) Intrinsic muscle atrophy and toe deformity in the diabetic neuropathic foot: a magnetic resonance imaging study. Diabetes Care 25:1444-50 |
