A comparison of multi-segment foot kinematics during level overground and treadmill walking

Is treadmill walking biomechanically comparable to overground walking? A systematic review

BACKGROUND

The equivalency of treadmill and overground walking has been investigated in a large number of studies. However, no systematic review has been performed on this topic.

RESEARCH QUESTION

The aim of this study was to compare the biomechanical, electromyographical and energy consumption outcomes of motorized treadmill and overground walking.

METHODS

Five databases, ScienceDirect, SpringerLink, Web of Science, PubMed, and Scopus, were searched until January 13, 2021. Studies written in English comparing lower limb biomechanics, electromyography and energy consumption during treadmill and overground walking in healthy young adults (20-40 years) were included.

RESULTS

Twenty-two studies (n = 409 participants) were included and evaluated via the Cochrane Collaboration's tool. These 22 studies showed that some kinematic (reduced pelvic ROM, maximum hip flexion angle for females, maximum knee flexion angle for males and cautious gait pattern), kinetic (sagittal plane joint moments: dorsiflexor moments, knee extensor moments and hip extensor moments and sagittal plane joint powers at the knee and hip joints, peak backwards, lateral and medial COP velocities and propulsive forces during late stance) and electromyographic (lower limbs muscles activities) outcome measures were significantly different for motorized treadmill and overground walking.

SIGNIFICANCE

Spatiotemporal, kinematic, kinetic, electromyographic and energy consumption outcome measures were largely comparable for motorized treadmill and overground walking. However, the differences in kinematic, kinetic and electromyographic parameters should be taken into consideration by clinicians, trainers, and researchers when working on new protocols related to patient rehabilitation, fitness rooms or research as to be as close as possible to the outcome measures of overground walking. The protocol registration number is CRD42021236335 (PROSPERO International Prospective Register of Systematic Reviews).

Comparison of EMG signal of the flexor hallucis longus recorded using surface and intramuscular electrodes during walking

The purpose of this study was to compare the use of intramuscular (iEMG) and surface (sEMG) electromyography electrodes to record flexor hallucis longus (FHL) muscle activity during walking, and describe the role of the FHL. Muscle activity was recorded in 12 participants using sEMG and iEMG during treadmill and overground walking. Inter-tester reliability for visual detection of onset and offset of muscle activity was high (ICC = 1.00). During the loading period, the number of bursts of muscle activity was statistically significantly greater using iEMG compared to sEMG when treadmill walking (p = 0.016), and the duration of muscle activity was significantly greater for iEMG (p = 0.01) on both walking surfaces. There were no differences for peak and mean root mean squared (p ≥ 0.07). The FHL activity observed during the loading period (heel strike to forefoot strike) supports the function of the FHL to act as a dynamic ankle stabiliser of the rearfoot, as well as contributing to propulsion during the latter part of stance. The choice of electrodes to detect FHL activity should be dependent on whether the loading and propulsive periods are of interest, and whether treadmill or overground walking will be examined.

Efficacy of physical activities on children with juvenile idiopathic arthritis: a randomized controlled trial

Background

Juvenile idiopathic arthritis (JIA) is one of the serious chronic rheumatic disorders in children and adolescents which results in less physical activities and restlessness hours than their peer. The study aims to assess the efficacy of physical fitness training exercises on aerobic capacity and muscular strength of children with JIA. Sixty-five children with JIA were included in the study, out of a total of 70 children who were screened for eligibility. Children were randomized to a control group (n = 32) who received hot packs, transcutaneous electrical nerve stimulation (TENS), and strengthening exercises, or a study group (n = 33) who received a physical fitness training program (hydrotherapy pool exercises, bicycle ergometer, and treadmill apparatus) in addition to what had been given to the control group. Both groups were engaged in a training program for 12 consecutive weeks for three times per week. Evaluation was done pre- and post-interventions included: peak oxygen uptake (Vo2 peak) during an incremental treadmill test and muscle strength assessed by isokinetic dynamometer.

Results

The current study showed that there were significant differences between pre- and post-interventions in both groups (P < 0.05). Comparing the two groups, there were statistically significant differences between children in both groups in favor of the study group (P < 0.05).

Conclusions

Physical fitness exercise training resulted in improved aerobic capacity and muscle strength of children with JIA. The obtained results suggested that children with arthritis could participate in formal exercise testing and structural physical fitness program.

Trial registration

PACTR, PACTR201907504136763. Registered on May 21, 2019. Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID = 8150.

A combined method for binning coupling angles to define coordination patterns

The vector coding technique has been used to quantify coordination of two joints, segments, and/or planes during cyclic activities, such as walking. Coordination patterns can be identified by categorizing the tangent lines of an angle-angle plot by their direction, termed "coupling angle binning" or "phase binning". In the literature the ranges of directions, or "bins", originally divided by Chang et al. and more recently by Needham et al. have different strengths. Chang's method identifies general patterns with large bins while Needham's method identifies a dominant joint or segment in the pattern. This study created a novel method that incorporates bin categories from both methods, and therefore recognizes both general patterns and a dominant contributor when appropriate. This new method, the SRC method, as well as the two existing methods, were used to quantify knee-ankle coordination in the sagittal plane for healthy individuals and an individual with clubfoot during gait. Similarities and differences in classification between methods were compared and further investigated by interpreting the uncoupled angular data. Each method was then used to evaluate sagittal-coronal coordination of the forefoot in an individual with clubfoot during gait. This was done to demonstrate across-plane coordination analysis, to confirm that the advantages of the combined method extend to coupling pairs with like ranges of motion, and to present a clinical application. It was found that the TSRH binning methods provides a more complete description of coordination by including coordination categories defined by both the Chang and Needham method.

Gait Characteristics Based on Shoe-Type Inertial Measurement Units in Healthy Young Adults during Treadmill Walking

This study investigated the gait characteristics of healthy young adults using shoe-type inertial measurement units (IMU) during treadmill walking. A total of 1478 participants were tested. Principal component analyses (PCA) were conducted to determine which principal components (PC_s) best defined the characteristics of healthy young adults. A non-hierarchical cluster analysis was conducted to evaluate the essential gait ability, according to the results of the PC₁ score. One-way repeated analysis of variance with the Bonferroni correction was used to compare gait performances in the cluster groups. PCA outcomes indicated 76.9% variance for PC₁–PC₆, where PC₁ (gait variability (GV): 18.5%), PC₂ (pace: 17.8%), PC₃ (rhythm and phase: 13.9%), and PC₄ (bilateral coordination: 11.2%) were the gait-related factors. All of the pace, rhythm, GV, and variables for bilateral coordination classified the gait ability in the cluster groups. We suggest that the treadmill walking task may be reliable to evaluate the gait performances, which may provide insight into understanding the decline of gait ability. The presented results are considered meaningful for understanding the gait patterns of healthy adults and may prove useful as reference outcomes for future gait analyses.

Multisegment Foot Models and Clinical Application After Foot and Ankle Trauma: A Review

Since the end of the 1990s, several multisegment foot models (MSFMs) have been developed. Several models were used to describe foot and ankle kinematics in patients with foot and ankle pathologies; however, the diagnostic value for clinical practice of these models is not known. This review searched in the literature for studies describing kinematics in patients after foot and ankle trauma using an MSFM. The diagnostic value of the MSFMs in patients after foot and ankle trauma was also investigated. A search was performed on the databases PubMed/MEDLINE, Embase, and Cochrane Library. To investigate the diagnostic value of MSFMs in patients after foot and ankle trauma, studies were classified and analyzed following the diagnostic research questions formulated by Knottnerus and Buntinx. This review was based on 7 articles. All studies were published between 2010 and 2015. Five studies were retrospective studies, and 2 used an intervention. Three studies described foot and ankle kinematics in patients after fractures. Four studies described foot and ankle kinematics in patients after ankle sprain. In all included studies, altered foot and ankle kinematics were found compared with healthy subjects. No results on patient outcome using MSFMs and costs were found. Seven studies were found reporting foot and ankle kinematics in patients after foot and ankle trauma using an MSFM. Results show altered kinematics compared with healthy subjects, which cannot be seen by other diagnostic tests and add valuable data to the present literature; therefore, MSFMs seem to be promising diagnostic tools for evaluating foot and ankle kinematics. More research is needed to find the additional value for MSFMs regarding patient outcome and costs.

Multi-segment foot models and their use in clinical populations

BACKGROUND

Many multi-segment foot models based on skin-markers have been proposed for in-vivo kinematic analysis of foot joints. It remains unclear whether these models have developed far enough to be useful in clinical populations. The present paper aims at reviewing these models, by discussing major methodological issues, and analyzing relevant clinical applications.

RESEARCH QUESTION

Can multi-segment foot models be used in clinical populations?

METHODS

Pubmed and Google Scholar were used as the main search engines to perform an extensive literature search of papers reporting definition, validation or application studies of multi-segment foot models. The search keywords were the following: 'multisegment'; 'foot'; 'model'; 'kinematics', 'joints' and 'gait'.

RESULTS

More than 100 papers published between 1991 and 2018 were identified and included in the review. These studies either described a technique or reported a clinical application of one of nearly 40 models which differed according to the number of segments, bony landmarks, marker set, definition of anatomical frames, and convention for calculation of joint rotations. Only a few of these models have undergone robust validation studies. Clinical application papers divided by type of assessment revealed that the large majority of studies were a cross-sectional comparison of a pathological group to a control population.

SIGNIFICANCE

This review suggests that there is sufficient evidence that multi-segment foot models may be successfully applied in clinical populations. Analysis of the currently available models allows users to better identify the most suitable protocol for specific clinical applications. However new models require thorough validation and assessment before being used to support clinical decisions.

Using stiffness to assess injury risk: comparison of methods for quantifying stiffness and their reliability in triathletes

Background

A review of the literature has indicated that lower body stiffness, defined as the extent to which the lower extremity joints resists deformation upon contact with the ground, may be a useful measure for assessing Achilles injury risk in triathletes. The nature of overuse injuries suggests that a variety of different movement patterns could conceivably contribute to the final injury outcome, any number and combination of which might be observed in a single individual. Measurements which incorporate both kinetics and kinematics (such as stiffness) of a movement may be better able to shed light on individuals at risk of injury, with further analysis then providing the exact mechanism of injury for the individual. Stiffness can be measured as vertical, leg or joint stiffness to model how the individual interacts with the environment upon landing. However, several issues with stiffness assessments limit the effectiveness of these measures to monitor athletes’ performance and/or injury risk. This may reflect the variety of common biomechanical stiffness calculations (dynamic, time, true leg and joint) that have been used to examine these three stiffness levels (vertical, leg and joint) across a variety of human movements (i.e. running or hopping) as well as potential issues with the reliability of these measures, especially joint stiffness. Therefore, the aims of this study were to provide a comparison of the various methods for measuring stiffness during two forms of human bouncing locomotion (running and hopping) along with the measurement reliability to determine the best methods to assess links with injury risk in triathletes.

Methods

Vertical, leg and joint stiffness were estimated in 12 healthy male competitive triathletes on two occasions, 7 days apart, using both running at 5.0 ms⁻¹ and hopping (2.2 Hz) tasks.

Results

Inter-day reliability was good for vertical (ICC = 0.85) and leg (ICC = 0.98) stiffness using the time method. Joint stiffness reliability was poor when assessed individually. Reliability was improved when taken as the sum of the hip, knee and ankle (ICC = 0.86). The knee and ankle combination provided the best correlation with leg stiffness during running (Pearson’s Correlation = 0.82).

Discussion

The dynamic and time methods of calculating leg stiffness had better reliability than the “true” method. The time and dynamic methods had the best correlation with the different combinations of joint stiffness, which suggests that they should be considered for biomechanical screening of triathletes. The knee and ankle combination had the best correlation with leg stiffness and is therefore proposed to provide the most information regarding lower limb mechanics during gait in triathletes.

Subject-Specific Axes of Rotation Based on Talar Morphology Do Not Improve Predictions of Tibiotalar and Subtalar Joint Kinematics

Use of subject-specific axes of rotation may improve predictions generated by kinematic models, especially for joints with complex anatomy, such as the tibiotalar and subtalar joints of the ankle. The objective of this study was twofold. First, we compared the axes of rotation between generic and subject-specific ankle models for ten control subjects. Second, we quantified the accuracy of generic and subject-specific models for predicting tibiotalar and subtalar joint motion during level walking using inverse kinematics. Here, tibiotalar and subtalar joint kinematics measured in vivo by dual-fluoroscopy served as the reference standard. The generic model was based on a cadaver study, while the subject-specific models were derived from each subject's talus reconstructed from computed tomography images. The subject-specific and generic axes of rotation were significantly different. The average angle between the modeled axes was 12.9° ± 4.3° and 24.4° ± 5.9° at the tibiotalar and subtalar joints, respectively. However, predictions from both models did not agree well with dynamic dual-fluoroscopy data, where errors ranged from 1.0° to 8.9° and 0.6° to 7.6° for the generic and subject-specific models, respectively. Our results suggest that methods that rely on talar morphology to define subject-specific axes may be inadequate for accurately predicting tibiotalar and subtalar joint kinematics.

The effect of foot orthoses with forefoot cushioning or metatarsal pad on forefoot peak plantar pressure in running

Background

Foot orthoses are frequently used in sports for the treatment of overuse complaints with sufficient evidence available for certain foot-related overuse pathologies like plantar fasciitis, rheumatoid arthritis and foot pain (e.g., metatarsalgia). One important aim is to reduce plantar pressure under prominent areas like metatarsal heads. For the forefoot region, mainly two common strategies exist: metatarsal pad (MP) and forefoot cushioning (FC). The aim of this study was to evaluate which of these orthosis concepts is superior in reducing plantar pressure in the forefoot during running.

Methods

Twenty-three (13 female, 10 male) asymptomatic runners participated in this cross-sectional experimental trial. Participants ran in a randomised order under the two experimental (MP, FC) conditions and a control (C) condition on a treadmill (2.78 ms⁻¹) for 2 min, respectively. Plantar pressure was measured with the in-shoe plantar pressure measurement device pedar-x®-System and mean peak pressure averaged from ten steps in the forefoot (primary outcome) and total foot was analysed. Insole comfort was measured with the Insole Comfort Index (ICI, sum score 0–100) after each running trial. The primary outcome was tested using the Friedman test (α = 0.05). Secondary outcomes were analysed descriptively (mean ± SD, lower & upper 95%-CI, median and interquartile-range (IQR)).

Results

Peak pressure [kPa] in the forefoot was significantly lower wearing FC (281 ± 80, 95%-CI: 246–315) compared to both C (313 ± 69, 95%-CI: 283–343; p = .003) and MP (315 ± 80, 95%-CI: 280–350; p = .001). No significant difference was found between C and MP (p = .858). Peak pressures under the total foot were: C: 364 ± 82, 95%-CI: 328–399; MP: 357 ± 80, 95%-CI: 326–387; FC: 333 ± 81 95%-CI: 298–368. Median ICI sum scores were: C 50, MP 49, FC 64.

Conclusions

In contrast to the metatarsal pad orthosis, the forefoot cushioning orthosis achieved a significant reduction of peak pressure in the forefoot of recreational runners. Consequently, the use of a prefabricated forefoot cushioning orthosis should be favoured over a prefabricated orthosis with an incorporated metatarsal pad in recreational runners with normal height arches.

Electronic supplementary material

The online version of this article (doi:10.1186/s13047-016-0176-z) contains supplementary material, which is available to authorized users.

Repeatability of a 3D multi-segment foot model during anterior and lateral step down tests

The aim of the present study was to analyse the reproducibility of the Oxford Foot Model (OFM) when used with healthy adults during two clinical tests, i.e., the Anterior Step Down Test (SDA) and the Lateral Step Down Test (SDL). Five healthy participants (one male and four females, 10 limbs in total) with a mean age of 22.2 (19-30) years were assessed in four sessions of tests conducted at intervals of one week. Two independent examiners performed two of the sessions of each of the tests. For each session (intra-day), nine repetitions of each clinical test (SDA and SDL) were performed. After an interval of three hours, the data were collected again. The tests were conducted again after an interval of one week using the same experimental conditions. The intra- and inter-session repeatabilities of the ranges of motion of the feet were determined according to the standard error of measurement (SEM) for each examiner and for the differences between the examiners. The repeatabilities of the results were high for both of the conducted tests. The SEM results were as follows: 0.47-1.94° for the intra-examiner assessment (SDA), 0.55-2.01° for the inter-examiner comparison (SDA), 0.44-2.43° for the intra-examiner assessment (SDL), and 0.54-1.89° for the inter-examiner comparison (SDL). The OFM model was shown to be reproducible in terms of assessing the range of motion of healthy adults during functional tests (SDA and SDL).

Achilles tendon loading patterns during barefoot walking and slow running on a treadmill: An ultrasonic propagation study

Measurement of tendon loading patterns during gait is important for understanding the pathogenesis of tendon "overuse" injury. Given that the speed of propagation of ultrasound in tendon is proportional to the applied load, this study used a noninvasive ultrasonic transmission technique to measure axial ultrasonic velocity in the right Achilles tendon of 27 healthy adults (11 females and 16 males; age, 26 ± 9 years; height, 1.73 ± 0.07 m; weight, 70.6 ± 21.2 kg), walking at self-selected speed (1.1 ± 0.1 m/s), and running at fixed slow speed (2 m/s) on a treadmill. Synchronous measures of ankle kinematics, spatiotemporal gait parameters, and vertical ground reaction forces were simultaneously measured. Slow running was associated with significantly higher cadence, shorter step length, but greater range of ankle movement, higher magnitude and rate of vertical ground reaction force, and higher ultrasonic velocity in the tendon than walking (P < 0.05). Ultrasonic velocity in the Achilles tendon was highly reproducible during walking and slow running (mean within-subject coefficient of variation < 2%). Ultrasonic maxima (P1, P2) and minima (M1, M2) were significantly higher and occurred earlier in the gait cycle (P1, M1, and M2) during running than walking (P < 0.05). Slow running was associated with higher and earlier peaks in loading of the Achilles tendon than walking.

Keep moving forward: a new energy returning prosthetic device with low installation height after Syme or Pirogoff amputation

BACKGROUND

The incidence of foot amputations increased in the Netherlands to 3.3/100,000 people up to 1994. Despite these numbers, only a few basic prosthetic and orthotic devices are available, and all lack functionality to restore ankle and foot mobility.

OBJECTIVES

The aim of this explorative study was to design and test a unique prosthesis for Syme or Pirogoff amputees with the necessary low installation height but restoring ankle and foot mobility.

STUDY DESIGN

A case study was performed.

METHODS

The new prosthesis was designed and numerically analyzed on aspects concerning strength and deformation. A prototype was tested in a case study to assess the biomechanical behavior of the new foot. As a reference, six Syme/Pirogoff amputees were measured. Additionally, all volunteers filled out a questionnaire to evaluate their prosthetic feet.

RESULTS

The self-selected and maximum walking speed of the case subject at 0° and 5° slopes was higher using the new foot (0.36 m/s and 0.53 m/s, respectively) comparing to the Low Rider (Otto Bock HealthCare) (0.31 m/s and 0.31 m/s, respectively). Using the new foot, a more symmetrical walking pattern was achieved.

CONCLUSION

The case study shows that this new prosthetic foot could be an improvement compared to existing prosthetic feet.

CLINICAL RELEVANCE

Foot amputees with low available installation height still experience daily the inconvenience of missing ankle and foot mobility. Their low velocity and cosmetically poor walking pattern influence on their sound leg and overall walking functionality. A more functional prosthesis would have a great impact on their daily activities.

Comparison of gait after total ankle arthroplasty and ankle arthrodesis

BACKGROUND

Prior studies reported improved gait after total ankle arthroplasty and better parameters of gait than those reported in earlier studies of patients after ankle arthrodesis. However, there are very limited data prospectively evaluating the effects on gait after ankle arthroplasty compared with ankle arthrodesis. Controversy remains regarding the relative advantages and disadvantages of these 2 treatments and especially the differences in function between them.

METHODS

We performed a prospective study involving 28 patients with posttraumatic and primary ankle osteoarthritis and a control group of 14 normal volunteers. We compared gait in 14 patients who had undergone ankle arthrodesis with the gait of 14 patients who had ankle arthroplasty preoperatively and at 1 year postoperatively. Three-dimensional gait analysis was performed with a 12-camera digital-motion capture system. Temporospatial measurements included stride length and cadence. The kinematic parameters that were measured included the sagittal plane range of motion of the ankle and the coronal plane range of motion of the ankle. Double force plates were used to collect kinetic parameters such as ankle coronal and plantar flexion-dorsiflexion moments and sagittal plane ankle power. Center of pressure (CoP) and its progression in gait cycle were calculated.

RESULTS

Baseline parameters showed comparability among the treatment and control groups. Temporospatial analysis, using time as the main effect, showed that compared with ankle arthrodesis, patients with total ankle arthroplasty had higher walking velocity attributable to both increases in stride length and cadence as well as more normalized first and second rockers of the gait cycle. Kinematic analysis, using time and intervention as the main effects, showed that patients who had ankle arthroplasty had better sagittal dorsiflexion (P = .001), whereas those undergoing ankle arthrodesis had better coronal plane eversion (P = .01). Neither ankle arthrodesis nor arthroplasty altered the CoP progression during stance phase. Total ankle arthroplasty produced a more symmetrical vertical ground reaction force curve, which was closer to that of the controls than was the curve of the ankle arthrodesis group.

CONCLUSIONS

Patients in both the arthrodesis and arthroplasty groups had significant improvements in various parameters of gait when compared with their own preoperative function. Neither group functioned as well as the normal control subjects. Neither group was superior in every parameter of gait at 1 year postoperatively. However, the data suggest that the major parameters of gait after ankle arthrodesis in deformed ankle arthritis are comparable to gait function after total ankle arthroplasty in nondeformed ankle arthritis.

LEVEL OF EVIDENCE

Level II, prospective comparative study.

Agreement between temporal and spatial gait parameters from an instrumented walkway and treadmill system at matched walking speed

BACKGROUND

Commercially available instrumented treadmill systems that provide continuous measures of temporospatial gait parameters have recently become available for clinical gait analysis. This study evaluated the level of agreement between temporospatial gait parameters derived from a new instrumented treadmill, which incorporated a capacitance-based pressure array, with those measured by a conventional instrumented walkway (criterion standard).

METHODS

Temporospatial gait parameters were estimated from 39 healthy adults while walking over an instrumented walkway (GAITRite(®)) and instrumented treadmill system (Zebris) at matched speed. Differences in temporospatial parameters derived from the two systems were evaluated using repeated measures ANOVA models. Pearson-product-moment correlations were used to investigate relationships between variables measured by each system. Agreement was assessed by calculating the bias and 95% limits of agreement.

RESULTS

All temporospatial parameters measured via the instrumented walkway were significantly different from those obtained from the instrumented treadmill (P<.01). Temporospatial parameters derived from the two systems were highly correlated (r, 0.79-0.95). The 95% limits of agreement for temporal parameters were typically less than ±2% of gait cycle duration. However, 95% limits of agreement for spatial measures were as much as ±5cm.

CONCLUSIONS

Differences in temporospatial parameters between systems were small but statistically significant and of similar magnitude to changes reported between shod and unshod gait in healthy young adults. Temporospatial parameters derived from an instrumented treadmill, therefore, are not representative of those obtained from an instrumented walkway and should not be interpreted with reference to literature on overground walking.

Multisegment foot kinematics during walking in younger and older adults

Background

Currently, age-related changes in foot mechanics are poorly understood. A greater understanding of the natural changes in foot motion is needed to improve our understanding of pathological foot conditions.

Methods

The purpose of this study was to compare multisegment foot kinematic data during gait in younger and older individuals. Eleven (N = 11) adult male participants between the ages of 18 - 30 years (younger group; mean ± SD: 24.6 ± 3.0 years) and eleven (N = 11) adults aged 55 years or older (older group; mean ± SD: 65.0 ± 4.2 years) were recruited for the study. The foot was modeled as a four-segment rigid body model. Three-dimensional kinematic and kinetic gait parameters were recorded using an 8-camera Vicon MCam motion capture system and two Kistler force plates. A MANOVA was used to test for significant differences in mean temporal-spatial data, mean ranges of motion, and mean peak joint angle data between age groups.

Results

No significant differences (P > 0.05) were found between the two age groups for any of the gait parameters. The results of the present study suggest that individuals aged 65.0 ± 4.2 years have foot mechanics that are comparable to younger walkers.

Conclusions

As such, any deviations in motion at this age may be indicative of an underlying disease or disorder.

Comparison of pelvic complex kinematics during treadmill and overground walking

OBJECTIVES

To determine if there are changes in temporal gait parameters with a focus on pelvis when comparing overground and treadmill ambulation, and to assess the effect of sex.

DESIGN

An observational study employing motion analysis techniques to evaluate pelvic movement during gait.

SETTING

University biomechanics laboratory.

PARTICIPANTS

Men (n=8; 22.5±3.0 y) and women (n=6; 23.8±4.1 y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Cadence, stride time, stance phase percent, and pelvic tilt, obliquity, and rotation parameters throughout the gait cycle were assessed during overground and treadmill walking. Kinematic data were recorded using a passive full body marker based motion analysis system. While an independent sample t test was used to determine if differences in walking speed were evident between sexes, a 2-way, repeated-measures analysis of variance was performed to examine the effect of walking mode and sex on each dependent variable.

RESULTS

Significant differences (P<.05) between overground and treadmill walking for the temporal parameters analyzed were evident for both sexes. A lower pelvic obliquity motion for treadmill walking when compared with overground walking was evident for both sexes, and the pelvic rotation movement pattern showed the greatest difference between walking modes. The majority of the significant differences between sexes were of a magnitude greater than the differences between overground and treadmill walking.

CONCLUSIONS

The differences in temporal and angular kinematics identified in the present study should be considered when treadmills are used in a rehabilitation program.

The effects of surface slope on multi-segment foot kinematics in healthy adults

Previous work evaluating the effects of surface slope on gait has focused on lower extremity kinematics and kinetics. However, an assessment of multi-segment foot kinematics during walking on inclined and declined ramps has not been previously reported. Sagittal ankle motion using a single rigid body foot model and three-dimensional hindfoot and forefoot kinematics for 24 healthy adults (16 females and 8 males, average age 25.5 ± 4.4 years) were compared during level surface, inclined surfaces of 3%, 6%, 9% and 12% grade and a declined surface of approximately 7.5% grade at a constant speed using a standard treadmill. Significant differences in peak hindfoot plantarflexion, sagittal plane range of motion and time of peak dorsiflexion, plantarflexion, varus and valgus were seen between surface slope conditions. Significant changes were also seen in forefoot plantarflexion and sagittal plane range of motion however the maximum difference between conditions was less than 3°. These results indicate that foot mechanics can be significantly altered when ambulating on ramps in healthy adults. Specifically, treadmill protocols which incorporate different surface slopes often encountered during ambulation of daily living, may provide an improved technique in evaluating a patient's ability to function in the community.