Article

Diabetic foot deformity onset and progression maybe associated with abnormal foot
and ankle motion. The modified Oxford multi-segmental foot model allows kinematic
assessment of inter-segmental foot motion. However, there are insufficient
anatomical landmarks to accurately representation the alignment of the hindfoot
and forefoot segments during model construction. This is most notable for the
sagittal plane which is referenced parallel to the floor, allowing comparison of
inter-segmental excursion but not capturing important sagittal hind-to-forefoot
deformity associated with diabetic foot disease and can potentially underestimate
true kinematic differences. The purpose of the study was to compare walking
kinematics using local coordinate systems derived from the modified Oxford model
and the radiographic directed model which incorporated individual calcaneal and
1st metatarsal declination pitch angles for the hindfoot and forefoot. We studied
twelve participants in each of the following groups: (1) diabetes mellitus,
peripheral neuropathy and medial column foot deformity (DMPN+), (2) DMPN without
medial column deformity (DMPN-) and (3) age- and weight-match controls. The
modified Oxford model coordinate system did not identify differences between
groups in the initial, peak, final, or excursion hindfoot relative to shank or
forefoot relative to hindfoot dorsiflexion/plantarflexion during walking. The
radiographic coordinate system identified the DMPN+ group to have an initial,
peak and final position of the forefoot relative to hindfoot that was more
dorsiflexed (lower arch phenotype) than the DMPN- group (p<.05). Use of
radiographic alignment in kinematic modeling of those with foot deformity reveals
segmental motion occurring upon alignment indicative of a lower arch.
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