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Nazir SNB, Ansari B. Determinants of Achilles tendon thickness and their influence on knee function and foot alignment in knee osteoarthritis. Sci Rep 2024; 14:16965. [PMID: 39043881 PMCID: PMC11266408 DOI: 10.1038/s41598-024-67932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/17/2024] [Indexed: 07/25/2024] Open
Abstract
Knee osteoarthritis (OA) significantly impacts the quality of life of individuals globally. However, the interconnections between Achilles tendon thickness, knee symptoms/functions, and foot alignment remain understudied in knee OA patients. This study determines the relationships between Achilles tendon thickness (ATT), knee symptoms/functions, and foot alignment in knee OA patients, considering their interconnected biomechanical nature. In a cross-sectional analysis involving 122 knee OA patients, Knee injury and Osteoarthritis Outcome Score (KOOS) assessed knee function and symptoms. Forefoot, midfoot, and rearfoot alignment were measured using hallux valgus angle, navicular/foot ratio, and rearfoot angle. The navicular/foot ratio represented the ratio of navicular height to total foot length. ATT was measured using a digital calliper. Pearson correlations and stepwise multiple linear regression models were employed to explore relationships and determinants. Out of 122 participants, 88 (72.1%) were females. ATT correlated significantly with ankle range of motion, forefoot alignment, and midfoot alignment. In stepwise multivariable regression, ankle range of motion, navicular/foot ratio, and age were significantly associated with ATT (adjusted R2 = 0.44). Similarly, KOOS-Symptoms scores were linked to the OA severity, navicular/foot ratio, ankle range of motion, gastrocnemius strength, and age (adjusted R2 = 0.22). KOOS-Function scores were significantly associated with knee OA severity, gastrocnemius strength, ankle range of motion, and age (adjusted R2 = 0.19). Midfoot alignment was significantly associated with ATT and knee symptoms in patients with Knee OA. This suggests potential benefits of interventions targeting both Achilles tendon properties and foot alignment for improved knee OA outcomes.
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Affiliation(s)
- Shaikh Nabi Bukhsh Nazir
- Department of Health, Physical Education, and Sports Sciences, University of Karachi, Karachi, Pakistan.
| | - Basit Ansari
- Department of Health, Physical Education, and Sports Sciences, University of Karachi, Karachi, Pakistan
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Shen X, Wang S, Chen J, Li J, Li C, Xiang R, Zhao C, Xu X. Inter-rater reliability and test-retest reliability of the foot posture index (FPI-6) for assessing static foot posture in elderly female patients with knee osteoarthritis and its association with quadriceps muscle tone and stiffness. Front Bioeng Biotechnol 2024; 12:1385986. [PMID: 38983600 PMCID: PMC11232489 DOI: 10.3389/fbioe.2024.1385986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024] Open
Abstract
Objective 1. To assess the Inter-rater reliability and test-retest reliability of FPI-6 total score and individual scores in static foot posture evaluation among elderly female patients with knee osteoarthritis (KOA), aiming to establish the reliability of the FPI-6 scale. 2. To investigate the disparity between dominant and non-dominant quadriceps characteristics in elderly female KOA patients, as well as explore the correlation between quadriceps characteristics and abnormal foot posture, thereby offering novel insights for the prevention and treatment of KOA. Methods The study enrolled a total of 80 lower legs of 40 participants (all female) with unilateral or bilateral KOA, who were assessed by two raters at three different time points. The inter-rater and test-retest reliability of the FPI-6 was evaluated using the intra-class correlation coefficient (ICC), while the absolute reliability of FPI-6 was examined using the standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The internal consistency of FPI-6 was assessed using Spearman's correlation coefficient. Additionally, MyotonPRO was employed to assess quadriceps muscle tone and stiffness in all participants, and the association between quadriceps muscle tone/stiffness and the total score of FPI-6 was analyzed. Result Our study found excellent inter-rater and test-retest reliability (ICC values of 0.923 and 0.931, respectively) for the FPI-6 total score, as well as good to excellent reliability (ICC values ranging from 0.680 to 0.863 and 0.739-0.883) for individual items. The SEM and MDC values for the total score of FPI-6 among our study inter-rater were 0.78 and 2.15, respectively. and the SEM and MDC values for the test-retest total score of FPI-6 were found to be 0.76 and 2.11, respectively. Furthermore, the SEM and MDC values between inter-rater and test-retest across six individual items ranged from 0.30 to 0.56 and from 0.84 to 1.56. The Bland-Altman plots and respective 95% LOA showed no evidence of systematic bias. In terms of the mechanical properties of the quadriceps on both sides, the muscle tone and stiffness of rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were significantly higher in the non-dominant leg compared to the dominant leg. Additionally, in the non-dominant leg, there was a significant positive correlation between the muscle tone and stiffness of VM, VL, RF and the total score of FPI-6. However, in the dominant leg, only VM's muscle tone and stiffness showed a significant positive correlation with the total score of FPI-6. Conclusion The reliability of the FPI-6 total score and its six individual items was good to excellent. Our findings offer a straightforward and dependable approach for researchers to assess foot posture in elderly female patients with KOA. Furthermore, we observed significantly greater quadriceps tension and stiffness in the non-dominant leg compared to the dominant leg. The FPI-6 total score exhibited a significant correlation with changes in quadriceps muscle performance among KOA patients. These observations regarding the relationship between changes in quadriceps muscle performance and foot posture in elderly female KOA patients may provide novel insights for disease prevention, treatment, and rehabilitation.
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Affiliation(s)
- XingXing Shen
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuai Wang
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahao Chen
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junyi Li
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Congcong Li
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruian Xiang
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanxi Zhao
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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Effects of Custom-made Insoles on Plantar Biomechanics and Upper Extremity Muscle Performance. Curr Med Sci 2021; 42:159-168. [PMID: 34846699 DOI: 10.1007/s11596-021-2471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/19/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the effectiveness of molding custom-made insoles for female patients with foot pain. METHODS The study included 20 patients whose insoles were prescribed according to biomechanical evaluations and molded by repositioning the subtalar joint in its neutral position using a simple set of tools. Plantar biomechanics were measured under the following conditions: static stand, walking at self-comfortable walking speed (CWS) barefoot, walking in patient owned running shoes, and walking in running shoes plus insoles. Each patient's upper arm isometric muscle strength and subjective feelings before and after the insole intervention were assessed. RESULTS The molded insoles increased plantar contact area both during static standing and walking at CWS compared to the barefoot condition. The insoles also had more evenly distributed plantar contact area and loading rate, with the changes in the medial arch area being most significant. Moreover, the custom-made insole intervention immediately increased maximum resistance and duration of bilateral upper arms, as well as improved foot comfort, especially at the medial arch area during single leg squat tests. CONCLUSION Molding custom-made insoles by repositioning the subtalar joint in its neutral position can be accomplished with a simple set of tools, making this method highly applicable for a majority of less developed regions. Insoles molded using this method are effective in immediately improving plantar biomechanics disorders and enhancing isometric upper muscle performance in female patients with foot pain.
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Chen Z, Ye X, Shen Z, Wang Y, Wu Z, Chen G, Guan Y, Wu J, Jiang T, Wu H, Liu W, Xu X. Comparison of the Asymmetries in Foot Posture and Properties of Gastrocnemius Muscle and Achilles Tendon Between Patients With Unilateral and Bilateral Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 9:636571. [PMID: 34738007 PMCID: PMC8561212 DOI: 10.3389/fbioe.2021.636571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/23/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Asymmetrical foot posture and properties alterations of the gastrocnemius muscle (GM) and Achilles tendon (AT) were observed in knee osteoarthritis (KOA). We aimed to investigate the inter-limbs asymmetries in foot posture and the properties of GM and AT and explore the association between them. Methods: A total of 62 subjects with unilateral or bilateral KOA were included in this study: 30 patients with unilateral pain and 32 patients with bilateral pain were assigned to the bilateral group (BG) and unilateral group (UG), respectively. The relatively serious leg (RSL) and relatively moderate leg (RML) were judged according to the severity of symptoms assessed by using visual analogue scale (VAS) motion. Foot posture and asymmetrical foot posture scores were assessed based on Foot Posture index (FPI-6). Subsequently, all the participants received an assessment for properties of GM and AT, including tone/tension (Hz), stiffness (N/m), and elasticity. We calculated the asymmetry index of AT (Asy-AT) in both legs and the difference of muscle properties between medial and lateral gastrocnemius (D-MLG) in the ipsilateral limb. Results: Asymmetry of foot posture was categorized into three types including normal, asymmetry, and severe asymmetry. The percentage of subjects classified as normal was higher in the BG (62.5%) than in the UG (36.67%), p < 0.05. Tension of AT and tone of lateral gastrocnemius (LG) in RSL were higher than those in RML (15.71 ± 0.91 vs. 15.23 ± 1.01; 25.31 ± 2.09 vs. 23.96 ± 2.08, p < 0.01 and p < 0.01, respectively), and stiffness of AT in the RSL was higher than that in RML (676.58 ± 111.45 vs. 625.66 ± 111.19, p < 0.01). Meanwhile, a positive relationship was found between ipsilateral FPI and tone of MG and LG in the left leg (0.246 per degree, 95% CI: −0.001, 0.129; p = 0.054 and 0.293 per degree, 95% CI: −0.014, 0.157; p = 0.021, respectively) and right leg (0.363 per degree, 95% CI: 0.033, 0.146; p = 0.004 and 0.272 per degree, 95% CI: 0.007, −0.144; p = 0.032, respectively). Moreover, a positive link was observed between asymmetrical FPI scores and K/L grade (0.291 per degree, 95% CI: 0.018, 0.216; p = 0.022). Furthermore, a significantly greater Asy-AT(tension) was detected in the UG than that in the BG (UG vs. UG: 8.20 ± 5.09% vs. 5.11 ± 4.72%, p < 0.01). Additionally, an increased asymmetrical FPI score (i.e., more severe asymmetry) was significantly associated with increases in Asy-AT(tension) and Asy-AT(stiffness) (0.42 per degree, 95% CI: 0.533, 1.881; p = 0.001 and 0.369 per degree, 95% CI: 0.596, 2.82; p = 0.003, respectively). Conclusions: The stiffness and tension of AT and the tone of LG in RSL were higher than those in RML in KOA patients, and inter-limbs foot posture and tension of AT were more asymmetrical in unilateral KOA patients compared to patients with bilateral KOA. Notably, foot posture, as an important biomechanical factor, was significantly associated with properties of GM, AT, and K/L grade in KOA patients.
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Affiliation(s)
- Zehua Chen
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangling Ye
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen Shen
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Yi Wang
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zugui Wu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoqian Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Yingxin Guan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Zhuhai Hospital of Guangdong Province Traditional Chinese Medical Hospital, Zhuhai, China
| | - Jiatao Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Zhuhai Hospital of Guangdong Province Traditional Chinese Medical Hospital, Zhuhai, China
| | - Tao Jiang
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Huai Wu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Wengang Liu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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Iseki T, Onishi S, Kanto M, Kanto R, Kambara S, Yoshiya S, Tachibana T, Nakayama H. Double-level osteotomy for severe varus osteoarthritic knees can prevent change in leg length and restore physiological joint geometry. Knee 2021; 31:136-143. [PMID: 34144326 DOI: 10.1016/j.knee.2021.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/01/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is unclear whether double-level osteotomy (DLO) combining closed-wedge osteotomy in the distal femur and open-wedge osteotomy in the proximal tibia deformity can prevent change in leg length and excessive coronal inclination of the tibial articular surface in surgical correction of the severe varus knee. The purpose of this study was to examine the postoperative change in leg length as well as radiological and clinical outcomes following DLO compared with the results obtained from knees undergoing isolated open-wedge high tibial osteotomy (OW-HTO). METHODS In cases of severe varus knee deformity (hip-knee-ankle angle (HKA) > 10°) 29 patients undergoing DLO and 35 patients undergoing OW-HTO were included. If the predicted mechanical medial proximal tibial angle (mMPTA) was 95° or greater or the wedge size was 15 mm or greater in the surgical simulation, then DLO was considered as the surgical of option. In cases where these criteria were not met, OW-HTO was selected. All patients were followed up for a minimum of 2 years. RESULTS The changes in the length of the whole leg in the DLO and OW-HTO groups averaged 2.3 ± 4.8 mm and 9.3 ± 7.2 mm, respectively (P < 0.001). mMPTA of more than 95° was found in no knee in the DLO group. CONCLUSIONS This study showed that DLO could avoid leg length change and non-physiologic joint lines when performed in patients with varus HKA > 10°, and the predicted mMPTA was 95° or greater or the wedge size was 15 mm or greater in the surgical simulation.
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Affiliation(s)
- Tomoya Iseki
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan.
| | - Shintaro Onishi
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Makoto Kanto
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Ryo Kanto
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shunichiro Kambara
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Shinichi Yoshiya
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroshi Nakayama
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
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Custom-Made Foot Orthoses as Non-Specific Chronic Low Back Pain and Pronated Foot Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136816. [PMID: 34201981 PMCID: PMC8297241 DOI: 10.3390/ijerph18136816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
Excessive foot pronation has been reported as being related to chronic low back pain symptoms and risk factors in sports-specific pathologies. Compensating custom-made foot orthotics treatment has not been entirely explored as an effective therapy for chronic low back pain (CLBP). This study aims to observe the effects of custom-made foot orthoses, in subjects with foot pronation suffering from CLBP. A total of 101 patients with nonspecific CLBP and a pronated foot posture index (FPI) were studied. They were randomized in two groups: an experimental one (n = 53) used custom-made foot orthotics, and the control group (n = 48) were treated with non-biomechanical effect orthoses. The CLBP was measured using the Oswestry Disability Index (ODI) Questionnaire and a visual analogue scale (VAS), both for lower back pain. The symptoms were evaluated twice, at first when the subject was included in the study, and later, after 4 weeks of treatment. The analysis of outcomes showed a significant decrease in CLBP in the custom-made foot orthoses participants group (p < 0.001 ODI; p < 0.001 VAS). These findings suggest that controlling excessive foot pronation by using custom-made foot orthoses may significantly contribute to improving CLBP.
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Miyazaki T, Kawada M, Kiyama R, Yone K. Validity of two-dimensional analysis using a tablet computer for estimation of foot arch height during walking. J Phys Ther Sci 2021; 33:194-198. [PMID: 33814703 PMCID: PMC8012182 DOI: 10.1589/jpts.33.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/01/2020] [Indexed: 12/04/2022] Open
Abstract
[Purpose] To examine the validity of two-dimensional analysis using a tablet computer
for the estimation of arch height during walking by comparing it with a motion capture
system and static foot alignment screenings. [Participants and Methods] Fourteen healthy
males and 15 healthy females participated in this study. The arch height of the right foot
while walking was simultaneously measured using a tablet computer and motion capture
system. Dynamic foot alignment, including arch height, at the mid-stance and pre-swing
phases was calculated from the kinematic data measured using the tablet computer and
motion analysis system. Static foot alignment was also assessed by screening tests
including arch height index and foot posture index. [Results] Arch height measured using a
tablet computer showed a significant high correlation with that measured using the motion
capture system at the mid-stance and pre-swing phases. Arch height index showed a
significant moderate correlation with arch height measured using the motion capture system
at the mid-stance phase. Meanwhile, foot posture index showed no relationship with arch
height measured by the motion capture system. [Conclusion] These results demonstrate the
high validity of dynamic foot analysis using a tablet computer for the estimation of arch
height during walking. Such gait analysis can be effective for assessing dynamic foot
alignment in clinical practice.
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Affiliation(s)
- Takasuke Miyazaki
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University: 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima 890-8506, Japan.,Department of Rehabilitation, Tarumizu Municipal Medical Center, Tarumizu Central Hospital, Japan
| | - Masayuki Kawada
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University: 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima 890-8506, Japan
| | - Ryoji Kiyama
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University: 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima 890-8506, Japan
| | - Kazunori Yone
- Course of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University: 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima 890-8506, Japan
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Fajardo CDC, Cardoso TB, Gontijo BA, Magalhães FAD, Souza TRD, Fonseca STD, Ocarino JDM, Resende RA. Hip passive stiffness is associated with midfoot passive stiffness. Braz J Phys Ther 2021; 25:530-535. [PMID: 33658164 DOI: 10.1016/j.bjpt.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Hip motion in the transverse plane is coupled with foot motion in the frontal plane during closed kinematic activities, such as gait. Considering that movement patterns and bone alignment might influence passive mechanical properties of joints in the long term, it is possible that hip passive stiffness and foot complex stiffness and alignment are related to each other. OBJECTIVES To investigate whether hip passive stiffness, midfoot passive stiffness and shank-forefoot alignment are related to each other. METHOD Thirty healthy adult individuals with a mean age of 25.4 years participated (18 women and 12 men). The Foot Torsimeter was used to measure midfoot stiffness, and hip stiffness and foot alignment were measured using clinical measures. Pearson and Spearman correlation coefficients were calculated to test the associations between each pair of variables, with α = 0.05. RESULTS Hip stiffness was positively correlated with midfoot absolute stiffness (r = 0.41, p = 0.02), indicating that increased hip stiffness is associated with increased midfoot stiffness. There were no associations between shank-forefoot alignment and the other variables. CONCLUSIONS In clinical settings, individuals with reduced hip passive stiffness may also have reduced midfoot passive stiffness, and vice versa. Shank-forefoot alignment is not linearly associated with hip or midfoot passive stiffness.
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Affiliation(s)
- Clara de Castro Fajardo
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Thais Brasil Cardoso
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bruna Antônia Gontijo
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Fabrício Anício de Magalhães
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Thales Rezende de Souza
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sérgio Teixeira da Fonseca
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Juliana de Melo Ocarino
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Renan Alves Resende
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Dodelin D, Tourny C, L'Hermette M. The biomechanical effects of pronated foot function on gait. An experimental study. Scand J Med Sci Sports 2020; 30:2167-2177. [PMID: 32735749 DOI: 10.1111/sms.13785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 02/05/2023]
Abstract
The relationship between foot kinematics and the development of lower extremity musculoskeletal disorders (MSD) has been the focus of recent attention. However, most studies evaluated static foot type and not dynamic foot function. The purpose was to compare lower limb and foot kinematics, and plantar pressures during gait in physically active individuals with pronated and non-pronated foot function. Foot function in 154 adult participants was documented as pronated (n = 63) or neutral (n = 91) using 2 established methods: The Foot Posture Index and the Center of Pressure Excursion Index. Difference between the groups in triplanar motion of the lower limb during barefoot gait was evaluated using a 3D motion capture system incorporating the Oxford Foot Model. Dynamic parameters of plantar pressure were recorded using a pressure platform. Anterior-posterior pelvic tilt range of motion (ROM), peak knee internal rotation, forefoot dorsiflexion ROM, peak forefoot abduction, and rearfoot eversion were all increased in those with pronated foot function. Hallux contact time and time to peak force under the medial forefoot were increased with pronated foot function, and maximal force under the lateral forefoot was reduced. Pronated foot function affected the whole lower limb kinematic chain during gait. These kinematic alterations could increase the risk of developing MSD. Further studies should elucidate the relationship between pronated foot function and MSD, and, if confirmed, foot function should be evaluated in clinical practice for patients with lower limb and low back pain.
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Affiliation(s)
- Damien Dodelin
- CETAPS, EA 3832, EDSH, UFR STAPS, Université de Rouen-Normandie, Mont Saint Aignan Cedex, France
| | - Claire Tourny
- CETAPS, EA 3832, EDSH, UFR STAPS, Université de Rouen-Normandie, Mont Saint Aignan Cedex, France
| | - Maxime L'Hermette
- CETAPS, EA 3832, EDSH, UFR STAPS, Université de Rouen-Normandie, Mont Saint Aignan Cedex, France
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Association between Foot Posture Asymmetry and Static Stability in Patients with Knee Osteoarthritis: A Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1890917. [PMID: 32596282 PMCID: PMC7294354 DOI: 10.1155/2020/1890917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/02/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
Background Interlimb asymmetries are considered to be closely related to knee osteoarthritis (KOA), but foot posture asymmetries in patients with KOA are scarcely reported. Objectives We aimed to explore the asymmetrical difference in foot posture between the healthy adults and KOA patients and the relationship between foot posture asymmetry and static stability. Methods 21 subjects suffering from KOA in the patient group (PG) and 21 healthy adults in the control group (CG) were included in this study. Foot postures on both feet were evaluated by using the foot posture index (FPI); subsequently, asymmetrical FPI scores between two feet were calculated for the two groups. Meanwhile, all the participants were tested with a standing on Dynamic and Static Balancing Instrument (Pro-kin 254P, TecnoBody Company, Italy) for bilateral stability assessment, and center of pressure (COP) parameters including sway length (SL, mm) and sway area (SA, mm2) were recorded. Results Compared to CG, a larger percentage of supinated feet was examined in relatively severe legs (5, 23.81%), relatively moderate legs (4, 19.05%), and merged results (9, 21.43%) of PG (P < 0.05), and the percentage of severe asymmetry (38.1%) was higher in the PG (P < 0.05). Moreover, these relationships between the absolute value of asymmetry score and SL or SA were significant in CG and PG, the P values below 0.01. Conclusions Foot posture asymmetry is significantly associated with static stability both in KOA patients and healthy adults, and more severe asymmetry in foot posture was observed in KOA patients, so it is critical to evaluate foot posture asymmetry for treatment and rehabilitation for patients with KOA.
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The effect of extra-osseous talotarsal stabilization (EOTTS) to reduce medial knee compartment forces - An in vivo study. PLoS One 2019; 14:e0224694. [PMID: 31830044 PMCID: PMC6907838 DOI: 10.1371/journal.pone.0224694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/18/2019] [Indexed: 11/19/2022] Open
Abstract
Background Excessive hindfoot pronation, talotarsal joint (TTJ) instability, has been attributed to an increase in medial knee compartment pathology. Advocacy for hindfoot realignment has been the subject of research. An internal solution for TTJ instability, extra-osseous talotarsal stabilization (EOTTS), exists but its effect on knee forces is unknown. This is the first study to measure the in vivo forces acting within the medial knee compartment before and after EOTTS. We hypothesized that following EOTTS there should be a reduction of force acting on the medial knee compartment. Methods 10 fresh frozen cadaver lower extremities exhibiting clinical and radiographic evidence of TTJ instability were evaluated. The proximal femur segment was mounted to a mechanical testing unit. Pressure sensors were placed within the medial knee compartment. A force of 1000 newtons was then applied, and the femur was internally rotated 10 degrees. Measurements were recorded before and after the insertion of a type II EOTTS stent. Results Pre-EOTTS resulted in an average of 842 ± 247N acting within the medial knee joint compartment. These forces then decreased to an average of 565 ± 260N (<0.05) following EOTTS, representing an average reduction of force by 32.8%. Conclusion EOTTS has been shown to decrease the in vivo forces action within the medial knee compartment. This helps to further illustrate the importance of realigning and stabilizing the hindfoot for the prevention and treatment of chronic knee pain.
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Braga UM, Mendonça LD, Mascarenhas RO, Alves COA, Filho RGT, Resende RA. Effects of medially wedged insoles on the biomechanics of the lower limbs of runners with excessive foot pronation and foot varus alignment. Gait Posture 2019; 74:242-249. [PMID: 31574408 DOI: 10.1016/j.gaitpost.2019.09.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 09/06/2019] [Accepted: 09/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Excessive foot pronation during running in individuals with foot varus alignment may be reduced by medially wedged insoles. RESEARCH QUESTION This study investigated the effects of a medially wedged insole at the forefoot and at the rearfoot on the lower limbs angles and internal moments of runners with excessive foot pronation and foot varus alignment. METHODS Kinematic and kinetic data of 19 runners (11 females and 8 males) were collected while they ran wearing flat (control condition) and medially wedged insoles (insole condition). Both insoles had arch support. We used principal component analysis for data reduction and dependent t-test to compare differences between conditions. RESULTS The insole condition reduced ankle eversion (p = 0.003; effect size = 0.63); reduced knee range of motion in the transverse plane (p = 0.012; effect size = 0.55); increased knee range of motion in the frontal plane in early stance and had earlier knee adduction peak (p = 0.018; effect size = 0.52); reduced hip range of motion in the transverse plane (p = 0.031; effect size = 0.48); reduced hip adduction (p = 0.024; effect size = 0.50); reduced ankle inversion moment (p = 0.012; effect size = 0.55); and increased the difference between the knee internal rotation moment in early stance and midstance (p = 0.012; effect size = 0.55). SIGNIFICANCE Insoles with 7˚ medial wedges at the forefoot and rearfoot are able to modify motion and moments patterns that are related to lower limb injuries in runners with increased foot pronation and foot varus alignment with some non-desired effects on the knee motion in the frontal plane.
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Affiliation(s)
- Uiara M Braga
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Department of Physical Therapy, Rodovia MGT 367 - KM 583/5000, Campus Diamantina, Alto do Jacuba, 39100 000, Diamantina, MG, Brazil.
| | - Luciana D Mendonça
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Department of Physical Therapy, Rodovia MGT 367 - KM 583/5000, Campus Diamantina, Alto do Jacuba, 39100 000, Diamantina, MG, Brazil.
| | - Rodrigo O Mascarenhas
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Department of Physical Therapy, Rodovia MGT 367 - KM 583/5000, Campus Diamantina, Alto do Jacuba, 39100 000, Diamantina, MG, Brazil.
| | - Carolina O A Alves
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Avenida Antônio Carlos 6627, Campus Pampulha, Pampulha, 31270-901, Belo Horizonte, MG, Brazil.
| | - Renato G T Filho
- Universidade Federal do Vale do Jequitinhonha e Mucuri, Department of Physical Therapy, Rodovia MGT 367 - KM 583/5000, Campus Diamantina, Alto do Jacuba, 39100 000, Diamantina, MG, Brazil.
| | - Renan A Resende
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Avenida Antônio Carlos 6627, Campus Pampulha, Pampulha, 31270-901, Belo Horizonte, MG, Brazil.
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Jafarnezhadgero AA, Sorkhe E, Oliveira AS. Motion-control shoes help maintaining low loading rate levels during fatiguing running in pronated female runners. Gait Posture 2019; 73:65-70. [PMID: 31299505 DOI: 10.1016/j.gaitpost.2019.07.133] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/29/2019] [Accepted: 07/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of motion-control shoes may assist pronated runners to maintain their stability throughout a fatiguing running. However, there are no studies describing the effects of fatigue on running biomechanics of runners with pronated feet. RESEARCH QUESTION Whether motion-control shoes can assist pronated recreational female runners to maintain impact loading patterns following a fatiguing protocol? METHODS Twenty-two female rearfoot runners with foot pronation were asked to perform a fatiguing treadmill running protocol using a neutral shoe or a motion-control shoe in two separate occasions. Before (Pre-fatigue) and after the fatiguing protocol (Post-fatigue), participants were asked to run overground on a track that contained two force platforms to record ground reaction forces and moments. Running speed were 3.3 m s-1 (±2.5% variability). The effects of shoe type and fatigue were investigated on the peak vertical impact ground reaction force (pvIGRF), time to reach pvIGRF, vertical loading rate (LR) and peak negative foot free moments (FM). RESULTS Pronated runners presented lower LR with motion-control shoes compared to neutral shoes Pre- (p < 0.005; -18 ± 25%) and Post-fatigue (p < 0.001; -27 ± 15%). This change in LR was predominantly driven by a longer time to reach pvIGRF with motion-control shoes (p < 0.001, 39%). The pvIGRF and LR increased after fatiguing running with neutral shoes (pvIGRF: p < 0.05; 18 ± 28%; LR: p < 0.05; 15 ± 22%), but not with motion-control shoes. Furthermore, there were strong correlations between FM and LR for both Pre-fatigue (r=-0.61, p < 0.005) and Post-fatigue measurements (r=-0.66, p < 0.01), but only for the motion-control shoes. SIGNIFICANCE These results suggest that motion-control shoes prevent exacerbated fatigue-related increases in mechanical loading following initial contact in pronated female runners.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Physical Education and Sport Sciences, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Elham Sorkhe
- Department of Physical Education and Sport Sciences, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Anderson S Oliveira
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, Building 4, DK-9220 Aalborg E, Denmark
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Selistre LFA, Gonçalves GH, Nakagawa TH, Petrella M, Jones RK, Mattiello SM. The role of hip abductor strength on the frontal plane of gait in subjects with medial knee osteoarthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1779. [PMID: 31012216 DOI: 10.1002/pri.1779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/13/2019] [Accepted: 03/17/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship of hip abductor strength with external hip and knee adduction moments, pain and physical function, and trunk, pelvis, and hip kinematics in the frontal plane during walking in subjects with medial knee osteoarthritis. METHODS Twenty-five subjects with medial knee osteoarthritis were evaluated through an isokinetic strength test for hip abductor, three-dimensional gait analysis (kinetics and kinematics), and pain and physical function scores. Regression models were used to control the influence of other parameters such as pain, age, gender, severity, walking speed, mass, and height. RESULTS No relationship was found of hip abductor strength with peak of external knee adduction moment and knee adduction angular impulse. Hip abductor strength explained 17% of contralateral pelvic drop and 21% of hip adduction angle. In addition, hip abductor strength explained 4% and 1% of the variance in the WOMAC physical function score and 40-m fast paced walk test, respectively. CONCLUSION Considering the relationship of hip abductor strength with contralateral pelvic drop and hip adduction angle, specific exercises might improve physical function and lower limb dynamic alignment during gait.
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Affiliation(s)
| | | | | | - Marina Petrella
- Departamento de Fisioterapia, São Carlos, Universidade Federal de São Carlos, São Paulo, Brazil
| | - Richard Keith Jones
- School of Health Sciences, Brian Blatchford Building, University of Salford, Salford, UK
| | - Stela Márcia Mattiello
- Departamento de Fisioterapia, São Carlos, Universidade Federal de São Carlos, São Paulo, Brazil
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Steppacher R, North D, Künzle C, Lengnick H, Klima H, Mündermann A, Wegener R. Retrospective Evaluation of Changes in Gait Patterns in Children and Adolescents With Cerebral Palsy After Multilevel Surgery. J Child Neurol 2018; 33:453-462. [PMID: 29683017 DOI: 10.1177/0883073818766681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to retrospectively investigate changes in gait patterns after single-event multilevel surgery in children and adolescents with bilateral cerebral palsy. Three-dimensional instrumented pre- and postoperative gait data of 12 patients were compared to data of 12 healthy control subjects using principal component analysis to reduce the dimensionality of kinematic and kinetic gait data and detect gait differences. The differences between pre- and postoperative data and between postoperative data and data of control subjects were calculated using a linear mixed model. The results revealed 14 significant effects for pre- and postoperative waveforms and 11 significant effects for postoperative and control waveforms. Patients after single-event multilevel surgery walked with smaller internal foot progression angle throughout the gait cycle, lower knee flexion at initial swing, and earlier knee extension during terminal swing. Retained gait deviations included excessive pelvic tilt and internally rotated and flexed hips over the entire gait cycle. Contrary to our hypothesis, postoperative waveforms in the sagittal plane differed more from control waveforms than from preoperative waveforms. These results emphasize the importance of carefully planning further conservative therapy 2 years after single-event multilevel surgery.
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Affiliation(s)
- Ramona Steppacher
- 1 Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland.,2 Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - David North
- 2 Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Christoph Künzle
- 3 Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Harald Lengnick
- 3 Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Harry Klima
- 3 Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Annegret Mündermann
- 4 Clinic of Traumatology and Orthopaedics, University Hospital Basel, Basel, Switzerland.,5 Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Regina Wegener
- 2 Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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Shaw KE, Charlton JM, Perry CKL, de Vries CM, Redekopp MJ, White JA, Hunt MA. The effects of shoe-worn insoles on gait biomechanics in people with knee osteoarthritis: a systematic review and meta-analysis. Br J Sports Med 2017; 52:238-253. [PMID: 28684391 DOI: 10.1136/bjsports-2016-097108] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The effect of shoe-worn insoles on biomechanical variables in people with medial knee osteoarthritis has been studied extensively. The majority of research has focused specifically on the effect of lateral wedge insoles at the knee. The aim of this systematic review and meta-analysis was to summarise the known effects of different shoe-worn insoles on all biomechanical variables during level walking in this patient population to date. METHODS Four electronic databases were searched to identify studies containing biomechanical data using shoe-worn insole devices in the knee osteoarthritis population. Methodological quality was assessed and a random effects meta-analysis was performed on biomechanical variables reported in three or more studies for each insole. RESULTS Twenty-seven studies of moderate-to-high methodological quality were included in this review. The primary findings were consistent reductions in the knee adduction moment with lateral wedge insoles, although increases in ankle eversion with these insoles were also found. CONCLUSION Lateral wedge insoles produce small reductions in knee adduction angles and external moments, and moderate increases in ankle eversion. The addition of an arch support to a lateral wedge minimises ankle eversion change, and also minimises adduction moment reductions. The paucity of available data on other insole types and other biomechanical outcomes presents an opportunity for future research.
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Affiliation(s)
- Kathryn E Shaw
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Christina K L Perry
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Courtney M de Vries
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Matthew J Redekopp
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jordan A White
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Mild leg length discrepancy affects lower limbs, pelvis and trunk biomechanics of individuals with knee osteoarthritis during gait. Clin Biomech (Bristol, Avon) 2016; 38:1-7. [PMID: 27509479 DOI: 10.1016/j.clinbiomech.2016.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Leg length discrepancy greater than 1cm increases odds of progressive knee osteoarthritis in the shorter limb. METHODS Biomechanical data of 15 knee osteoarthritis participants were collected while they walked under two conditions: (1) control - wearing thick sandals; (2) short limb - wearing a thin sandal on the osteoarthritic limb and a thick sandal on the contralateral limb. The thick and thin sandals had 1.45cm of thickness difference. The knee osteoarthritis limb was analyzed for both conditions. Ankle, knee, hip, pelvis and trunk kinematics and moments were measured with a motion and force capture system. Principal component analysis and mean hypothesis' tests were used to compare the conditions. FINDINGS The short limb condition reduced rearfoot plantarflexion in loading response and increased plantarflexion in late stance (p<0.001), increased ankle dorsiflexion moment (p=0.003), increased knee flexion angle in loading response and delayed knee flexion in late stance (p=0.001), increased knee extension moment in loading response and increased knee flexion moment in terminal stance (p=0.023), reduced hip extension moment in early stance and reduced hip flexion moment in late stance (p<0.001), reduced knee adduction moment (p=0.015), reduced hip adduction angle (p=0.001) and moment (p=0.012) and increased pelvic (p=0.023) and trunk (p=0.001) external rotation. INTERPRETATION Mild leg length discrepancy affects the entire kinetic chain of individuals with knee osteoarthritis during gait, increasing knee sagittal plane loading, which helps to explain why mild leg length discrepancy accelerates knee osteoarthritis progression. Mild leg length discrepancy should not be overlooked in knee osteoarthritis individuals.
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