{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T06:41:07Z","timestamp":1780382467303,"version":"3.54.1"},"reference-count":24,"publisher":"American Diabetes Association","issue":"6","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":4553,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2009,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The mean \u00b1 SD intrinsic muscle atrophy score was 3.1 \u00b1 1.1 for the toe deformity group and 2.6 \u00b1 1.2 for the nondeformity group (not significantly different). The intrinsic muscle atrophy score was not significantly correlated with degree of toe deformity (r = \u22120.18). The muscle imbalance score was not significantly different between study groups and was not significantly correlated with degree of toe deformity (r = \u22120.14).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc08-2174","type":"journal-article","created":{"date-parts":[[2009,3,12]],"date-time":"2009-03-12T02:24:53Z","timestamp":1236824693000},"page":"1063-1067","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":77,"title":["Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed"],"prefix":"10.2337","volume":"32","author":[{"given":"Sicco A.","family":"Bus","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Maas","sequence":"additional","affiliation":[{"name":"Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert P.J.","family":"Michels","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Levi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2009,3,11]]},"reference":[{"key":"2022031218280365500_B1","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1177\/107110079701800606","article-title":"Prevalence of radiographic foot abnormalities in patients with diabetes","volume":"18","author":"Smith","year":"1997","journal-title":"Foot Ankle Int"},{"key":"2022031218280365500_B2","first-page":"35","article-title":"Prevalence of foot pathology and lower extremity complications in a diabetic outpatient clinic","volume":"26","author":"Holewski","year":"1989","journal-title":"J Rehabil Res Dev"},{"key":"2022031218280365500_B3","doi-asserted-by":"crossref","first-page":"2376","DOI":"10.2337\/diacare.27.10.2376","article-title":"Plantar fat-pad displacement in neuropathic diabetic patients with toe deformity: a magnetic resonance imaging study","volume":"27","author":"Bus","year":"2004","journal-title":"Diabetes Care"},{"key":"2022031218280365500_B4","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1016\/j.jbiomech.2004.07.034","article-title":"Elevated plantar pressures in neuropathic diabetic patients with claw\/hammer toe deformity","volume":"38","author":"Bus","year":"2005","journal-title":"J Biomech"},{"key":"2022031218280365500_B5","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.2337\/diacare.22.7.1036","article-title":"A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study","volume":"22","author":"Boyko","year":"1999","journal-title":"Diabetes Care"},{"key":"2022031218280365500_B6","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1080\/00325481.1984.11698001","article-title":"Mallet toes, hammer toes, claw toes, and corns: causes and treatment of lesser-toe deformities","volume":"75","author":"Coughlin","year":"1984","journal-title":"Postgrad Med"},{"key":"2022031218280365500_B7","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2106\/00004623-198971010-00008","article-title":"The pathological anatomy of claw and hammer toes","volume":"71","author":"Myerson","year":"1989","journal-title":"J Bone Joint Surg Am"},{"key":"2022031218280365500_B8","first-page":"A277","article-title":"Rupture of the plantar fascia in the diabetic foot leads to toe dorsiflexion deformity","volume":"41","author":"Taylor","year":"1998","journal-title":"Diabetologia"},{"key":"2022031218280365500_B9","first-page":"585","article-title":"Diabetic neuropathic ulcer","volume":"35","author":"Ellenberg","year":"1968","journal-title":"J Mt Sinai Hosp NY"},{"key":"2022031218280365500_B10","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/dme.1996.13.s1.12","article-title":"The pathogenesis of diabetic foot problems: an overview","volume":"13","author":"Boulton","year":"1996","journal-title":"Diabet Med"},{"key":"2022031218280365500_B11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/bjs.1800720102","article-title":"The aetiology of diabetic neuropathic ulceration of the foot","volume":"72","author":"Delbridge","year":"1985","journal-title":"Br J Surg"},{"key":"2022031218280365500_B12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7547\/87507315-70-1-1","article-title":"Interossei and lumbricales muscles of the foot: an anatomical and functional study","volume":"70","author":"Jarrett","year":"1980","journal-title":"J Am Podiatry Assoc"},{"key":"2022031218280365500_B13","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.2337\/diacare.25.8.1444","article-title":"Intrinsic muscle atrophy and toe deformity in the diabetic neuropathic foot: a magnetic resonance imaging study","volume":"25","author":"Bus","year":"2002","journal-title":"Diabetes Care"},{"key":"2022031218280365500_B14","doi-asserted-by":"crossref","first-page":"2382","DOI":"10.2337\/diacare.27.10.2382","article-title":"Atrophy of foot muscles: a measure of diabetic neuropathy","volume":"27","author":"Andersen","year":"2004","journal-title":"Diabetes Care"},{"key":"2022031218280365500_B15","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.2337\/diacare.27.7.1668","article-title":"Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in Caucasian diabetic men","volume":"27","author":"van Schie","year":"2004","journal-title":"Diabetes Care"},{"key":"2022031218280365500_B16","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1136\/bmj.288.6433.1793","article-title":"Use of a biothesiometer to measure individual vibration thresholds and their variation in 519 non-diabetic subjects","volume":"288","author":"Bloom","year":"1984","journal-title":"Br Med J"},{"key":"2022031218280365500_B17","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1148\/radiology.210.1.r99ja35189","article-title":"Uniform fat suppression in hands and feet through the use of two-point Dixon chemical shift MR imaging","volume":"210","author":"Maas","year":"1999","journal-title":"Radiology"},{"key":"2022031218280365500_B18","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/jmri.20601","article-title":"Reproducibility of foot structure measurements in neuropathic diabetic patients using magnetic resonance imaging","volume":"24","author":"Bus","year":"2006","journal-title":"J Magn Reson Imaging"},{"key":"2022031218280365500_B19","first-page":"p. 132","article-title":"Lesser toe deformities","author":"Coughlin","year":"1986","journal-title":"DuVries' Surgery of the Foot"},{"key":"2022031218280365500_B20","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1177\/107110079501600610","article-title":"Volkmann's ischemic contracture of the foot and ankle: evaluation and treatment of established deformity","volume":"16","author":"Santi","year":"1995","journal-title":"Foot Ankle Int"},{"key":"2022031218280365500_B21","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1053\/crad.2000.0589","article-title":"Deltoid contracture: MR imaging features","volume":"56","author":"Ogawa","year":"2001","journal-title":"Clin Radiol"},{"key":"2022031218280365500_B22","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/S1064-9689(21)00543-2","article-title":"The plantar plate of the lesser metatarsophalangeal joints: potential for injury and role of MR imaging","volume":"9","author":"Umans","year":"2001","journal-title":"Magn Reson Imaging Clin N Am"},{"key":"2022031218280365500_B23","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s001250050025","article-title":"1H- and 31P-magnetic resonance spectroscopy and imaging as a new diagnostic tool to evaluate neuropathic foot ulcers in type II diabetic patients","volume":"43","author":"Suzuki","year":"2000","journal-title":"Diabetologia"},{"key":"2022031218280365500_B24","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.2337\/diacare.28.6.1425","article-title":"Foot small muscle atrophy is present before the detection of clinical neuropathy","volume":"28","author":"Greenman","year":"2005","journal-title":"Diabetes Care"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/32\/6\/1063\/602797\/zdc00609001063.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/32\/6\/1063\/602797\/zdc00609001063.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T19:29:13Z","timestamp":1647113353000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/32\/6\/1063\/28013\/Role-of-Intrinsic-Muscle-Atrophy-in-the-Etiology"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,3,11]]},"references-count":24,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2009,3,11]]},"published-print":{"date-parts":[[2009,6,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc08-2174","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,3,11]]}}}