Foot & Ankle Injury & Recovery

The focus of our work is to examine the relationship between anatomical and biomechanical factors of the foot and ankle and mechanisms of injury, interventions, and treatment outcomes.

Our research combines multiple, non-invasive measures of muscle, tendon, and fascial function with kinematic analysis of movement. In collaboration with the Electronic Radiology Laboratory, we have developed the methodology necessary to measure muscle, fat, tendon, and fascial volumes as well as bony alignment. The use of imaging techniques in physical therapy related research has allowed us to explore the contribution of tissue level abnormalities to foot and ankle dysfunction.

The kinematic analysis of foot and ankle motion is captured using a multi-segmental foot model. Previous work modeled the foot as a single segment with motion occurring at the ankle. The multi-segmental foot model allows measurement of motion within the foot. The expanded model allows us to discover the role of motion at the midfoot and toes during functional activities and to explore the contribution of the motion to foot deformity and pain.

Faculty Investigators

Mary K. Hastings, PT, DPT, MSCI, OCS

Staff

Chris Sorensen PhD, MSCI
Kay Bohnert, MS
Darrah Snozek

Student Members

Whitney Korgan, DPT Student
Nick Schroeder, DPT Student
Rose Reida, DPT Student

Research Physical Therapists

Ellen Frye, PT
Suzanne Kuebler, PT

Current Research Studies

Muscle, joint, and movement deterioration contributing to neuropathic forefoot deformity
Funding Source: NIH/NIDDK R01 DK107809

Forefoot deformity in individuals with diabetes and neuropathy increases the risk of skin breakdown and possibility of lower extremity amputation. We will follow individuals with diabetes and neuropathy over 3 years and measure key factors we believe contribute to toe deformity (foot muscle and fat volumes, toe extension movement pattern, and advanced glycation end products). In addition we have included an intervention to assess the ability of a foot specific stretching and strengthening foot program to impact short term and long term deformity progression.

Microcirculatory function in diabetic foot muscles with MRI
Funding Support: NIH/NIDDK RO1 DK105322

Foot ulcers in those with and without diabetes have multiple components that make them difficult to heal and remain healed long term. Blood perfusion of the wound bed plays a critical role but we currently have limited methods available to measure microvascular perfusion of wound beds that extend past the dermis. This project employs a novel use of magnetic resonance imaging to measure perfusion and oxygen extraction of the muscles of the feet of individuals with and without diabetes, with and without ulcers, and those with and without peripheral vascular disease.

Characterization of microcirculatory function in diabetic leg and foot with MRI
Source: NIH/ NIAMS R21 AR065672

This project focused on honing the methods to evaluate the MRI technique (discussed above) to characterize the skeletal muscle microcirculation in groups of patients with diabetes mellitus, in comparison with healthy subjects and patients with peripheral vascular disease.

The role of intermuscular fat in diabetic muscle pathology
Source: Program in Physical Therapy, Washington University School of Medicine

The pilot project is investigating the role of intermuscular adipose tissue in the lower extremity muscle pathology of individuals with diabetes. We are obtaining muscle and fat samples from the calf and foot and will use gene chip technology to understand how changes in IMAT-sensitive pathways might regulate muscle function.

Past Research Studies

Biomechanical Contributions to Acquired Foot Deformity in Diabetes (Comprehensive Opportunities in Rehabilitation Research Training NIH/NICHD, NCMRR, NINDS K12 HD055931)

Botulinum Toxin’s Effects on Plantar Ulcer Recurrence (NIH/NICH/NCMRR R21 HD048972)

Biomarkers development for Diabetic Complications (NIH/ NIDDK R21 DK079457)

Outcomes of the Bridle procedure for the treatment of traumatic foot drop (Midwest Stone Institute)

Effects of Discomfort and Lower Extremity Fatigue on Gait and Activity Parameters (Dr. Scholl’s)