Importance and challenges of measuring intrinsic foot muscle strength

Achini Soysa, Claire Hiller, Kathryn Refshauge, Joshua Burns, Achini Soysa, Claire Hiller, Kathryn Refshauge, Joshua Burns

Abstract

Background: Intrinsic foot muscle weakness has been implicated in a range of foot deformities and disorders. However, to establish a relationship between intrinsic muscle weakness and foot pathology, an objective measure of intrinsic muscle strength is needed. The aim of this review was to provide an overview of the anatomy and role of intrinsic foot muscles, implications of intrinsic weakness and evaluate the different methods used to measure intrinsic foot muscle strength.

Method: Literature was sourced from database searches of MEDLINE, PubMed, SCOPUS, Cochrane Library, PEDro and CINAHL up to June 2012.

Results: There is no widely accepted method of measuring intrinsic foot muscle strength. Methods to estimate toe flexor muscle strength include the paper grip test, plantar pressure, toe dynamometry, and the intrinsic positive test. Hand-held dynamometry has excellent interrater and intrarater reliability and limits toe curling, which is an action hypothesised to activate extrinsic toe flexor muscles. However, it is unclear whether any method can actually isolate intrinsic muscle strength. Also most methods measure only toe flexor strength and other actions such as toe extension and abduction have not been adequately assessed. Indirect methods to investigate intrinsic muscle structure and performance include CT, ultrasonography, MRI, EMG, and muscle biopsy. Indirect methods often discriminate between intrinsic and extrinsic muscles, but lack the ability to measure muscle force.

Conclusions: There are many challenges to accurately measure intrinsic muscle strength in isolation. Most studies have measured toe flexor strength as a surrogate measure of intrinsic muscle strength. Hand-held dynamometry appears to be a promising method of estimating intrinsic muscle strength. However, the contribution of extrinsic muscles cannot be excluded from toe flexor strength measurement. Future research should clarify the relative contribution of intrinsic and extrinsic muscles during intrinsic foot muscle strength testing.

References

    1. Allen RH, Gross MT. Toe flexors strength and passive extension range of motion of the first metatarsophalangeal joint in individuals with plantar fasciitis. J Orthop Sports Phys Ther. 2003;33:468–478.
    1. Alanen AM, Falck B, Kalimo H, Komu ME, Sonninen VH. Ultrasound, computed tomography and magnetic resonance imaging in myopathies: correlations with electromyography and histopathology. Acta Neurol Scand. 1994;89:336–346.
    1. Mann R, Inman VT. Phasic activity of intrinsic muscles of the foot. J Bone Joint Surg Am. 1964;46:469–481.
    1. Basmajian JV, Stecko G. The role of muscles in arch support of the foot: electromyographic study. J Bone Joint Surg Am. 1963;45:1184–1190.
    1. Basmajian J, Bentzon J. An electromyographic study of certain muscles of the foot in the standing position. Surg Gynecol Obstet. 1954;98:662–666.
    1. Chung KW, Suh BC, Shy ME, Cho SY, Yoo JH, Park SW, Moon H, Park KD, Choi KG, Kim S. et al.Different clinical and magnetic resonance imaging features between Charcot-Marie-Tooth disease type 1A and 2A. Neuromuscul Disord. 2008;18:610–618. doi: 10.1016/j.nmd.2008.05.012.
    1. Gallardo E, García A, Combarros A, Berciano J. Charcot–Marie–Tooth disease type 1A duplication: spectrum of clinical and magnetic resonance imaging features in leg and foot muscles. Brain. 2006;129:426–437.
    1. Chang R, Kent-Braun J, Van Emmerik E, Hamill J. 2nd Congress of the International Foot and Ankle Biomechanics Community. Seattle, USA: Journal of Foot and Ankle Research; 2010. Distribution of Intrinsic Foot Muscles in Healthy and Plantar Fasciitis Feet.
    1. Headlee D, Leonardb J, Harta J, Ingersolla C, Hertela J. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008;18:420–425. doi: 10.1016/j.jelekin.2006.11.004.
    1. Myerson MS, Shereff MJ. The pathological anatomy of claw and hammer toes. J Bone Joint Surg Am. 1989;71:45–49.
    1. Kwon OY, Tuttle LJ, Johnson JE, Mueller MJ. Muscle imbalance and reduced ankle joint motion in people with hammer toe deformity. Clin Biomech (Bristol, Avon) 2009;24:670–675. doi: 10.1016/j.clinbiomech.2009.05.010.
    1. Arinci Incel N, Genc H, Erdem HR, Yorgancioglu ZR. Muscle imbalance in hallux valgus: an electromyographic study. Am J Phys Med Rehabil. 2003;82:345–349.
    1. Hoffmeyer P, Cox JN, Blanc Y, Meyer JM, Taillard W. Muscle in hallux valgus. Clin Orthop Relat Res. 1988;232:112–118.
    1. de Win MM, Theuvenet WJ, Roche PW, de Bie RA, van Mameren H. The paper grip test for screening on intrinsic muscle paralysis in the foot of leprosy patients. Int J Lepr Other Mycobact Dis. 2002;70:16–24.
    1. Menz HB, Zammit GV, Munteanu SE, Genevieve S. Plantarflexion strength of the toes: age and gender differences and evaluation of a clinical screening test. Foot Ankle Int. 2006;27:1103–1108.
    1. Mickle KJ, Chambers S, Steele JR, Munro BJ. A novel and reliable method to measure toe flexor strength[abstract] Clin Biomech (Bristol, Avon) 2008;23:683–683. doi: 10.1016/j.clinbiomech.2008.03.025.
    1. Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. ISB Clinical Biomechanics Award 2009: toe weakness and deformity increase the risk of falls in older people. Clin Biomech (Bristol, Avon) 2009;24:787–791. doi: 10.1016/j.clinbiomech.2009.08.011.
    1. Senda M, Takahara Y, Yagata Y, Yamamoto K, Nagashima H, Tukiyama H, Inoue H. Measurement of the muscle power of the toes in female marathon runners using a toe dynamometer. Acta Med Okayama. 1999;53:189–191.
    1. Unger CL, Wooden MJ. Effect of foot intrinsic muscle strength training on jump performance. [article] J Strength Cond Res. 2000;14:373–378.
    1. Bus S, Maas M, Michels P, Levi M. Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed. Diabetes Care. 2009;32:1063–1067. doi: 10.2337/dc08-2174.
    1. Bus SA, Maas M, Lindeboom R. Reproducibility of foot structure measurements in neuropathic diabetic patients using magnetic resonance imaging. J Magn Reson Imaging. 2006;24:25–32. doi: 10.1002/jmri.20601.
    1. Bus SA, Yang QX, Wang JH, Smith MB, Wunderlich R, Cavanagh PR. Intrinsic muscle atrophy and toe deformity in the diabetic neuropathic foot: a magnetic resonance imaging study. Diabetes Care. 2002;25:1444–1450. doi: 10.2337/diacare.25.8.1444.
    1. Robertson DD, Mueller MJ, Smith KE, Commean PK, Pilgram T, Johnson JE. Structural changes in the forefoot of individuals with diabetes and a prior plantar ulcer. J Bone Joint Surg Am. 2002;84:1395–1404.
    1. Mueller MJ, Smith KE, Commean PK, Robertson DD, Johnson JE. Use of computed tomography and plantar pressure measurement for management of neuropathic ulcers in patients with diabetes. Phys Ther. 1999;79:296–307.
    1. Jung D-Y, Koh E-K, Kwon O-Y. Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: A randomized controlled trial. J Back Musculoskelet Rehabil. 2011;24:225–231.
    1. Kura H, Luo ZP, Kitaoka HB, An KN. Quantitative analysis of the intrinsic muscles of the foot. Anat Rec. 1997;249:143–151. doi: 10.1002/(SICI)1097-0185(199709)249:1<143::AID-AR17>;2-P.
    1. Gray H. Gray’s anatomy. 37. Edinburgh: C. Livingstone; 1989.
    1. Basmajian J. DeLuca C: Muscles alive. Their functions revealed by electromyography. Baltimore: Williams and Wilkins; 1985.
    1. Cd C, König BJ, Vitti M. Electromyographic study of the muscles "extensor digitorum brevis" and "extensor hallucis brevis". Rev Hosp Clin Fac Med Sao Paulo. 1967;22:65–72.
    1. Baltensperger MM, Ganzoni N, Jirecek V, Meyer VE. The extensor digitorum brevis island flap: possible applications based on anatomy. Plast Reconstr Surg. 1998;101:107–113. doi: 10.1097/00006534-199801000-00018.
    1. Rolian C, Lieberman DE, Hamill J, Scott JW, Werbel W. Walking, running and the evolution of short toes in humans. J Exp Biol. 2009;212:713–721. doi: 10.1242/jeb.019885.
    1. Mann RA, Hagy JL. The function of the toes in walking, jogging and running. Clin Orthop Relat Res. 1979;142:24–29.
    1. Latimer BM, Lovejoy CO, Johanson DC, Coppens Y. Hominid tarsal, metatarsal, and phalangeal bones recovered from the Hadar formation: 1974–1977 collections. Am J Phys Anthropol. 1982;57:701–719. doi: 10.1002/ajpa.1330570412.
    1. Lewis OJ. The comparative morphology of M. flexor accessorius and the associated long flexor tendons. J Anat. 1962;96:321–333.
    1. Reeser L, Susman R, Stern J. Electromyographic studies of the human foot: experimental approaches to hominid evolution. Foot Ankle. 1983;3:391–407.
    1. Chang R, Larsen R, Kent-Braun J, Hamill J. 1st Congress of the International Foot & Ankle Biomechanics (i-FAB) community. Bologna: Journal of Foot and Ankle Research; 2008. Energetics of the intrinsic foot muscles in plantar fasciitis.
    1. Jacob HAC. Forces acting in the forefoot during normal gait - an estimate. Clin Biomech (Bristol, Avon) 2001;16:783–792. doi: 10.1016/S0268-0033(01)00070-5.
    1. Wong YS. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study. Foot Ankle Int. 2007;28:617–620. doi: 10.3113/FAI.2007.0617.
    1. Goldmann J-P, Brüggemann G-P. The potential of human toe flexor muscles to produce force. J Anat. 2012;221:187–194. doi: 10.1111/j.1469-7580.2012.01524.x.
    1. Nihal A, Goldstein J, Haas J, Hiebert R, Kummer FJ, Liederbach M, Trepman E. Toe flexor forces in dancers and non-dancers. Foot Ankle Int. 2002;23:1119–1123.
    1. Kelly LA, Kuitunen S, Racinais S, Cresswell AG. Recruitment of the plantar intrinsic foot muscles with increasing postural demand. Clin Biomech (Bristol, Avon) 2012;27:46–51. doi: 10.1016/j.clinbiomech.2011.07.013.
    1. Caravaggi P, Pataky T, Günther M, Savage R, Crompton R. Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis. J Anat. 2010;217:254–261. doi: 10.1111/j.1469-7580.2010.01261.x.
    1. Wu L. Nonlinear finite element analysis for musculoskeletal biomechanics of medial and lateral plantar longitudinal arch of Virtual Chinese Human after plantar ligamentous structure failures. Clin Biomech (Bristol, Avon) 2007;22:221–229. doi: 10.1016/j.clinbiomech.2006.09.009.
    1. Sabir M, Lyttle D. Pathogenesis of pes cavus in Charcot-Marie-Tooth disease. Clin Orthop Relat Res. 1983;175:173–178.
    1. Mann D, Hsu J. Triple arthrodesis in the treatment of fixed cavovarus deformity in adolescent patients with Charcot-Marie-Tooth disease. Foot Ankle. 1992;13(1):1–6.
    1. Coughlin M. Mallet toes, hammer toes, claw toes, and corns: causes and treatment of lesser-toe deformities. Postgrad Med. 1984;75:191–198.
    1. Smith D, Barnes B, Sands A, Boyko E, Ahroni J. Prevalence of radiographic foot abnormalities in patients with diabetes. Foot Ankle Int. 1997;18:342–346.
    1. Ledoux W, Schoen J, Lovell M, Huff E. Clawed toes in the diabetic foot: neuropathy, intrinsic muscle volume, and plantar aponeurosis thickness[abstract] J Foot Ankle Res. 2008;1:1–2. doi: 10.1186/1757-1146-1-1.
    1. Garth WP Jr. Miller ST: Evaluation of claw toe deformity, weakness of the foot intrinsics, and posteromedial shin pain. Am J Sports Med. 1989;17:821–827. doi: 10.1177/036354658901700617.
    1. Spink M, Fotoohabadia M, Menz H. Foot and Ankle Strength Assessment Using Hand-Held Dynamometry: Reliability and Age-Related Differences. Gerontology. 2010;56(6):525–532. doi: 10.1159/000264655.
    1. Fleiss JL. The design and analysis of clinical experiments. New York: Wiley; 1986. Reliability of Measurement.
    1. Lauer RT, Kilgore KL, Peckham PH, Bhadra N, Keith MW. The function of the finger intrinsic muscles in response to electrical stimulation. IEEE Trans Rehabil Eng. 1999;7:19–26. doi: 10.1109/86.750547.
    1. Zammit GV, Menz HB, Munteanu SE. Reliability of the TekScan MatScan® system for the measurement of plantar forces and pressures during barefoot level walking in healthy adults. J Foot Ankle Res. 2010;3:11. doi: 10.1186/1757-1146-3-11.
    1. Orlin M, McPoil T. Plantar pressure assessment. Phys Ther. 2000;80:399–409.
    1. Severinsen K, Obel A, Jakobsen J, Andersen H. Atrophy of Foot Muscles in Diabetic Patients Can Be Detected With Ultrasonography. Diabetes Care. 2007;30:3053–3057. doi: 10.2337/dc07-0108.
    1. Brash PD, Foster J, Vennart W, Anthony P, Tooke JE. Magnetic resonance imaging techniques demonstrate soft tissue damage in the diabetic foot. Diabet Med. 1999;16:55–61. doi: 10.1046/j.1464-5491.1999.00005.x.
    1. Severinsen K, Andersen H. Evaluation of atrophy of foot muscles in diabetic neuropathy - A comparative study of nerve conduction studies and ultrasonography. Clin Neurophysiol. 2007;118:2172–2175. doi: 10.1016/j.clinph.2007.06.019.
    1. Flemming DJ, Murphey MD, McCarthy K. Imaging of the foot and ankle: Summary and update. Curr Opin Orthop. 2005;16:54–59. doi: 10.1097/01.bco.0000154176.29585.8b.
    1. Kuo GP, Carrino JA. Skeletal muscle imaging and inflammatory myopathies. Curr Opin Rheumatol. 2007;19:530–535. doi: 10.1097/BOR.0b013e3282efdc66.
    1. Andersen H, Gjerstad MD, Jakobsen J. Atrophy of foot muscles: A measure of diabetic neuropathy. Diabetes Care. 2004;27:2382–2385. doi: 10.2337/diacare.27.10.2382.
    1. Hing W, Rome K, Cameron A. Reliability of measuring abductor hallucis muscle parameters using two different diagnostic ultrasound machines. J Foot Ankle Res. 2009;2:33. doi: 10.1186/1757-1146-2-33.
    1. Fukunaga T, Roy RR, Shellock FG, Hodgson JA, Day MK, Lee PL, Kwong-Fu H, Edgerton VR. Physiological cross-sectional area of human leg muscles based on magnetic resonance imaging. J Orthop Res. 1992;10:928–934.
    1. Lloyd DG, Besier TF. An EMG-driven musculoskeletal model to estimate muscle forces and knee joint moments in vivo. J Biomech. 2003;36:765–776. doi: 10.1016/S0021-9290(03)00010-1.
    1. Ledoux WR, Hirsch BE, Church T, Caunin M. Pennation angles of the intrinsic muscles of the foot. J Biomech. 2001;34:399–403. doi: 10.1016/S0021-9290(00)00194-9.
    1. de Oliveira LF, Luporini Menegaldo L. Individual-specific muscle maximum force estimation using ultrasound for ankle joint torque prediction using an EMG-driven Hill-type model. J Biomech. 2010;43:2816–2821. doi: 10.1016/j.jbiomech.2010.05.035.
    1. Ward S, Eng C, Smallwood L, Lieber R. Are current measurements of lower extremity muscle architecture accurate? Clin Orthop Relat Res. 2009;467:1074–1082. doi: 10.1007/s11999-008-0594-8.
    1. Sheehan F. The instantaneous helical axis of the subtalar and talocrural joints: a non-invasive in vivo dynamic study. J Foot Ankle Res. 2010;3:13. doi: 10.1186/1757-1146-3-13.
    1. Schedel H, Reimers CD, Witt TN, Pongratz DE, Vogl T. x00E. Imaging techniques in myotonic dystrophy. A comparative study of ultrasound, computed tomography and magnetic resonance imaging of skeletal muscles. Eur J Radiol. 1992;15:230–238. doi: 10.1016/0720-048X(92)90113-N.
    1. Mickle K, Nester C, Crofts G, Steele J. Reliability of ultrasound to measure morphology of the toe flexor muscles[abstract] J Foot Ankle Res. 2012;5:1–2. doi: 10.1186/1757-1146-5-1.
    1. Cameron A, Rome K, Hing W. Ultrasound evaluation of the abductor hallucis muscle: reliability study. J Foot Ankle Res. 2008;1:12. doi: 10.1186/1757-1146-1-12.
    1. Wallwork T, Hides J, Stanton W. Intrarater and interrater reliability of assessment of lumbar multifidus thickness using rehabilitative ultrasound imaging. J Orthop Sports Phys Ther. 2007;37:608–612.
    1. Reaz M, Hussain M, Mohd-Yasin F. Techniques of EMG signal analysis: detection, processing, classification and applications (Correction) Biol Proced Online. 2006;8:163–163. doi: 10.1251/bpo124.
    1. Daube JR, Rubin DI. Needle electromyography. Muscle Nerve. 2009;39:244–270. doi: 10.1002/mus.21180.
    1. Dubowitz V, Sewry C, editor. Muscle biopsy: a practical approach. 3. Philadelphia: Saunders/Elsevier; 2007.
    1. Gadeberg P, Andersen H, Jakobsen J. Volume of ankle dorsiflexors and plantar flexors determined with stereological techniques. J Appl Physiol. 1999;86:1670–1675. doi: 10.1063/1.370945.

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