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Saraswat P, Shull ER, Westberry DE. Hindfoot flexibility assessment of cavovarus and planovalgus feet by modified Shriners Hospitals for Children - Greenville (mSHCG) foot model. Gait Posture 2024; 113:26-31. [PMID: 38823334 DOI: 10.1016/j.gaitpost.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Multi-segment foot models have been used to quantify foot kinematics during walking. However, walking kinematics is not sufficient to assess hindfoot flexibility (available range of hindfoot varus-valgus motion). The modified Shriners Hospitals for Children - Greenville (mSHCG) foot model has been used to quantify hindfoot flexibility with Coleman block test (peak hindfoot valgus) and Root test (peak hindfoot varus). Sensitivity of mSHCG foot model to detect clinically relevant difference in hindfoot flexibility measures for planovalgus (PV) and cavovarus (CV) feet has not been demonstrated. RESEARCH QUESTION Can mSHCG foot model detect statistically significant difference in hindfoot flexibility measures between PV, CV and typically developing (TD) feet? METHODS Hindfoot flexibility assessment was completed for 32 PV (37 feet), 27 CV (37 feet) and 20 TD (40 feet) individuals. Hindfoot position relative to tibia in coronal plane was measured in three postures: standing, heel raise and Coleman block test. Radiographic measures in standing position were also completed for PV and CV individuals and their correlation with hindfoot flexibility measures were evaluated. RESULTS Statistically significant (p<0.001) differences were observed between three groups (TD, PV, CV) in all three hindfoot flexibility measures- (i) Hindfoot varus in standing position (ii) Peak hindfoot varus in heel raise and (iii) Peak hindfoot valgus in Coleman block test. There was relatively stronger correlation (R2=0.407-0.854) between three radiographic measures and hindfoot varus in standing position. Correlation between hindfoot range of motion towards valgus from standing to Coleman block test and the three radiographic measures was weaker (R2=0.2329-0.3042). SIGNIFICANCE Hindfoot flexibility assessment can detect statistically significant difference between PV, CV and TD feet and provides additional information about available dynamic range of motion of hindfoot in the coronal plane that cannot be predicted from radiographic measures. Therefore, hindfoot flexibility assessment may assist in treatment planning of foot deformities.
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Affiliation(s)
- Prabhav Saraswat
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA.
| | - Emily R Shull
- Shriners Children's, Motion Analysis Center, Greenville, SC, USA
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Stone A, Stender CJ, Whittaker EC, Hahn ME, Rohr E, Cowley MS, Sangeorzan BJ, Ledoux WR. Ability of a multi-segment foot model to measure kinematic differences in cavus, neutrally aligned, asymptomatic planus, and symptomatic planus foot types. Gait Posture 2024; 113:452-461. [PMID: 39116735 DOI: 10.1016/j.gaitpost.2024.07.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Multi-segment foot models (MFMs) provide a better understanding of the intricate biomechanics of the foot, yet it is unclear if they accurately differentiate foot type function during locomotion. RESEARCH QUESTION We employed an MFM to detect subtle kinematic differences between foot types, including: pes cavus, neutrally aligned, and asymptomatic and symptomatic pes planus. The study investigates how variable the results of this MFM are and if it can detect kinematic differences between pathologic and non-pathologic foot types during the stance phase of gait. METHODS Independently, three raters instrumented three subjects on three days to assess variability. In a separate cohort, each foot type was statically quantified for ten subjects per group. Each subject walked while instrumented with a four-segment foot model to assess static alignment and foot motion during the stance phase of gait. Statistical analysis performed with a linear mixed effects regression. RESULTS Model variability was highest for between-day and lowest for between-rater, with all variability measures being within the true sample variance. Almost all static measures (radiographic, digital scan, and kinematic markers) differed significantly by foot type. Sagittal hindfoot to leg and forefoot to leg kinematics differed between foot types during late stance, as well as coronal hallux to forefoot range of motion. The MFM had low between-rater variability and may be suitable for multiple raters to apply to a single study sample without introducing significant error. The model, however, only detected a few dynamic differences, with the most dramatic being the hallux to forefoot coronal plane range of motion. SIGNIFICANCE Results only somewhat aligned with previous work. It remains unclear if the MFM is sensitive enough to accurately detect different motion between foot types (pathologic and non-pathologic). A more accurate method of tracking foot bone motion (e.g., biplane fluoroscopy) may be needed to address this question.
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Affiliation(s)
- Amanda Stone
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States.
| | - Christina J Stender
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, United States.
| | - Eric C Whittaker
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, United States.
| | - Michael E Hahn
- Department of Human Physiology, University of Oregon, Eugene, OR, United States.
| | - Eric Rohr
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, United States.
| | - Matthew S Cowley
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, United States.
| | - Bruce J Sangeorzan
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, United States; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, United States.
| | - William R Ledoux
- VA RR&D Center for Limb Loss and MoBility (CLiMB), Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, United States.
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3
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Liu T, Dimitrov A, Jomha N, Adeeb S, El-Rich M, Westover L. Development and validation of a novel ankle joint musculoskeletal model. Med Biol Eng Comput 2024; 62:1395-1407. [PMID: 38194185 DOI: 10.1007/s11517-023-03010-x] [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: 05/17/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
An improved understanding of contact mechanics in the ankle joint is paramount for implant design and ankle disorder treatment. However, existing models generally simplify the ankle joint as a revolute joint that cannot predict contact characteristics. The current study aimed to develop a novel musculoskeletal ankle joint model that can predict contact in the ankle joint, together with muscle and joint reaction forces. We modelled the ankle joint as a multi-axial joint and simulated contact mechanics between the tibia, fibula and talus bones in OpenSim. The developed model was validated with results from experimental studies through passive stiffness and contact. Through this, we found a similar ankle moment-rotation relationship and contact pattern between our study and experimental studies. Next, the musculoskeletal ankle joint model was incorporated into a lower body model to simulate gait. The ankle joint contact characteristics, kinematics, and muscle forces were predicted and compared to the literature. Our results revealed a comparable peak contact force and the same muscle activation patterns in four major muscles. Good agreement was also found in ankle dorsi/plantar-flexion and inversion/eversion. Thus, the developed model was able to accurately model the ankle joint and can be used to predict contact characteristics in gait.
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Affiliation(s)
- Tao Liu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Andrea Dimitrov
- School of Medicine, Nursing & Health Sciences, University of Galway, Galway, Ireland
| | - Nadr Jomha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Samer Adeeb
- Faculty of Civil and Environmental Engineering, University of Alberta, Edmonton, AB, Canada
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
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Hulshof CM, Schallig W, van den Noort JC, Streekstra GJ, Kleipool RP, Gg Dobbe J, Maas M, Harlaar J, van der Krogt MM. Skin marker-based versus bone morphology-based coordinate systems of the hindfoot and forefoot. J Biomech 2024; 166:112001. [PMID: 38527409 DOI: 10.1016/j.jbiomech.2024.112001] [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: 10/11/2023] [Revised: 01/31/2024] [Accepted: 02/14/2024] [Indexed: 03/27/2024]
Abstract
Segment coordinate systems (CSs) of marker-based multi-segment foot models are used to measure foot kinematics, however their relationship to the underlying bony anatomy is barely studied. The aim of this study was to compare marker-based CSs (MCSs) with bone morphology-based CSs (BCSs) for the hindfoot and forefoot. Markers were placed on the right foot of fifteen healthy adults according to the Oxford, Rizzoli and Amsterdam Foot Model (OFM, RFM and AFM, respectively). A CT scan was made while the foot was loaded in a simulated weight-bearing device. BCSs were based on axes of inertia. The orientation difference between BCSs and MCSs was quantified in helical and 3D Euler angles. To determine whether the marker models were able to capture inter-subject variability in bone poses, linear regressions were performed. Compared to the hindfoot BCS, all MCSs were more toward plantar flexion and internal rotation, and RFM was also oriented toward more inversion. Compared to the forefoot BCS, OFM and RFM were oriented more toward dorsal and plantar flexion, respectively, and internal rotation, while AFM was not statistically different in the sagittal and transverse plane. In the frontal plane, OFM was more toward eversion and RFM and AFM more toward inversion compared to BCS. Inter-subject bone pose variability was captured with RFM and AFM in most planes of the hindfoot and forefoot, while this variability was not captured by OFM. When interpreting multi-segment foot model data it is important to realize that MCSs and BCSs do not always align.
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Affiliation(s)
- Chantal M Hulshof
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118 1081 HZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Wouter Schallig
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118 1081 HZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Geert J Streekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Roeland P Kleipool
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Johannes Gg Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118 1081 HZ, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2 2628 CD, Delft, the Netherlands; Department of Orthopedics & Sports Medicine, Erasmus MC, Doctor Molewaterplein 40 3015 GD, Rotterdam, the Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118 1081 HZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
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Wang Y, Qi Y, Ma B, Wu H, Wang Y, Wei B, Wei X, Xu Y. Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases. Front Bioeng Biotechnol 2024; 12:1303035. [PMID: 38456008 PMCID: PMC10919227 DOI: 10.3389/fbioe.2024.1303035] [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: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Yongsheng Xu
- Orthopedic Center (Sports Medicine Center), Inner Mongolia People’s Hospital, Hohhot, China
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Salami F, Götze M, Campos S, Leboucher J, Hagmann S, Wolf SI. Estimation of a midfoot joint center in typically developed adults using functional calibration methods. Gait Posture 2022; 97:203-209. [PMID: 35988436 DOI: 10.1016/j.gaitpost.2022.08.013] [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: 03/31/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND There are detailed findings on hip and knee joint parameters determined via functional calibration methods for use in instrumented 3D-gait analysis but these methods have not yet been addressed to the foot. RESEARCH QUESTION Are functional calibration methods feasible for determining foot joint parameters and may they help for clinical interpretation of foot deformities? METHODS Rigid segments were formed by markers on forefoot and hindfoot via a least square method. The position of the midfoot joint articulating both foot segments was then determined via a functional calibration motion. This two-stage procedure was applied on a cohort of 17 typically developed adults and one subject with severe planovalgus foot deformity for determining the location of the midfoot joint and kinematics of hindfoot and forefoot. RESULTS The position of the midfoot joint center could be estimated in the typically developed cohort and also in the demonstration case with planovalgus foot deformity. Depending on the choice of marker set for hindfoot and forefoot, the position of the joint center varied in the anatomic midfoot region with most robust results when addressing the marker on the navicular to the hindfoot. CONCLUSION The presented method for joint center determination within the foot and the characteristic results of the foot joint angles appear promising for typically developed feet. However, further validation of the method is needed for application in clinical context.
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Affiliation(s)
- Firooz Salami
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Götze
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sarah Campos
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Julien Leboucher
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastién Hagmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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Schallig W, van den Noort JC, Piening M, Streekstra GJ, Maas M, van der Krogt MM, Harlaar J. The Amsterdam Foot Model: a clinically informed multi-segment foot model developed to minimize measurement errors in foot kinematics. J Foot Ankle Res 2022; 15:46. [PMID: 35668453 PMCID: PMC9172122 DOI: 10.1186/s13047-022-00543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Foot and ankle joint kinematics are measured during clinical gait analyses with marker-based multi-segment foot models. To improve on existing models, measurement errors due to soft tissue artifacts (STAs) and marker misplacements should be reduced. Therefore, the aim of this study is to define a clinically informed, universally applicable multi-segment foot model, which is developed to minimize these measurement errors. METHODS The Amsterdam foot model (AFM) is a follow-up of existing multi-segment foot models. It was developed by consulting a clinical expert panel and optimizing marker locations and segment definitions to minimize measurement errors. Evaluation of the model was performed in three steps. First, kinematic errors due to STAs were evaluated and compared to two frequently used foot models, i.e. the Oxford and Rizzoli foot models (OFM, RFM). Previously collected computed tomography data was used of 15 asymptomatic feet with markers attached, to determine the joint angles with and without STAs taken into account. Second, the sensitivity to marker misplacements was determined for AFM and compared to OFM and RFM using static standing trials of 19 asymptomatic subjects in which each marker was virtually replaced in multiple directions. Third, a preliminary inter- and intra-tester repeatability analysis was performed by acquiring 3D gait analysis data of 15 healthy subjects, who were equipped by two testers for two sessions. Repeatability of all kinematic parameters was assessed through analysis of the standard deviation (σ) and standard error of measurement (SEM). RESULTS The AFM was defined and all calculation methods were provided. Errors in joint angles due to STAs were in general similar or smaller in AFM (≤2.9°) compared to OFM (≤4.0°) and RFM (≤6.7°). AFM was also more robust to marker misplacement than OFM and RFM, as a large sensitivity of kinematic parameters to marker misplacement (i.e. > 1.0°/mm) was found only two times for AFM as opposed to six times for OFM and five times for RFM. The average intra-tester repeatability of AFM angles was σ:2.2[0.9°], SEM:3.3 ± 0.9° and the inter-tester repeatability was σ:3.1[2.1°], SEM:5.2 ± 2.3°. CONCLUSIONS Measurement errors of AFM are smaller compared to two widely-used multi-segment foot models. This qualifies AFM as a follow-up to existing foot models, which should be evaluated further in a range of clinical application areas.
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Affiliation(s)
- Wouter Schallig
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
- Amsterdam UMC location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Marjolein Piening
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Amsterdam UMC location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mario Maas
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
- Department of Orthopedics & Sports Medicine , ErasmusMC, Rotterdam, the Netherlands
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Mahaffey R, Le Warne M, Blandford L, Morrison SC. Age-related changes in three-dimensional foot motion during barefoot walking in children aged between 7 and 11 years old. Gait Posture 2022; 95:38-43. [PMID: 35421684 DOI: 10.1016/j.gaitpost.2022.04.001] [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: 07/01/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The biomechanical complexity of children's feet changes throughout childhood, yet kinematic development of the feet is poorly understood. Further work exploring the kinematic profile of children's feet would be beneficial to help inform our understanding of the typical development of children's feet. RESEARCH QUESTION Do three-dimensional segmental kinematics of the feet during gait relate to age in a sample of children age 7-11 years? METHODS This study was a secondary analysis of an existing database representing one hundred and twenty-one children age 7 - 11 years (90 male, 31 female; mean ± SD: age 9.57 ± , 1.17 years, height 1.37 ± 0.08 m, body mass 35.61 ± 9.33 kg). Fifteen, 9 mm retroreflective markers were attached to the right shank and foot of each participant in, line with the 3DFoot model. Multi-segmental joint kinematics were collected during barefoot walking. Sagittal, frontal, and transverse planar motion was described for the shank-calcaneus, calcaneus-midfoot, and midfoot-metatarsals segment of the right foot. Principal component analysis (PCA) was used to reduce the major modes of variation in the data to fully explore foot segment motion over the entire gait cycle. Correlations and multiple regression between PCA outputs with age, and potential confounding factors are presented. RESULTS Significant positive correlations were found between age and greater calcaneus, dorsiflexion, midfoot inversion and adduction, and metatarsal dorsiflexion, plantarflexion and abduction. There were no significant confounding effects of height, body mass, walking speed or gender on the relationships between age and PCA outputs. SIGNIFICANCE The findings from this study demonstrated a relationship between foot kinematics and age suggesting that the development of foot kinematics is ongoing until at least the age of 11 years. This work offers a comprehensive data set of inter-segmental kinematics which helps to advance understanding of the development of the pediatric foot.
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Affiliation(s)
- Ryan Mahaffey
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK.
| | - Megan Le Warne
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK.
| | - Lincoln Blandford
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK.
| | - Stewart C Morrison
- School of Life Course and Population Sciences, King's College London, UK.
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9
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Yoo HJ, Park HS, Lee DO, Kim SH, Park GY, Cho TJ, Lee DY. Comparison of the kinematics, repeatability, and reproducibility of five different multi-segment foot models. J Foot Ankle Res 2022; 15:1. [PMID: 34991669 PMCID: PMC8734222 DOI: 10.1186/s13047-021-00508-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-segment foot models (MFMs) for assessing three-dimensional segmental foot motions are calculated via various analytical methods. Although validation studies have already been conducted, we cannot compare their results because the experimental environments in previous studies were different from each other. This study aims to compare the kinematics, repeatability, and reproducibility of five MFMs in the same experimental conditions. METHODS Eleven healthy males with a mean age of 26.5 years participated in this study. We created a merged 29-marker set including five MFMs: Oxford (OFM), modified Rizzoli (mRFM), DuPont (DFM), Milwaukee (MiFM), and modified Shriners Hospital for Children Greenville (mSHCG). Two operators applied the merged model to participants twice, and then we analysed two relative angles of three segments: shank-hindfoot (HF) and hindfoot-forefoot (FF). Coefficients of multiple correlation (CMC) and mean standard errors were used to assess repeatability and reproducibility, and statistical parametric mapping (SPM) of the t-value was employed to compare kinematics. RESULTS HF varus/valgus of the MiFM and mSHCG models, which rotated the segment according to radiographic or goniometric measurements during the reference frame construction, were significantly more repeatable and reproducible, compared to other models. They showed significantly more dorsiflexed HF and plantarflexed FF due to their static offset angles. DFM and mSHCG showed a greater range of motion (ROM), and some models had significantly different FF points of peak angle. CONCLUSIONS Under the same conditions, rotating the segment according to the appropriate offset angle obtained from radiographic or goniometric measurement increased reliability, but all MFMs had clinically acceptable reliability compared to previous studies. Moreover, in some models, especially HF varus/valgus, there were differences in ROM and points of peak angle even with no statistical difference in SPM curves. Therefore, based on the results of this study, clinicians and researchers involved in the evaluation of foot and ankle dysfunction need an understanding of the specific features of each MFM to make accurate decisions.
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Affiliation(s)
- Hyo Jeong Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul, South Korea
| | - Hye Sun Park
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul, South Korea
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, South Korea
| | - Seong Hyun Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul, South Korea
| | - Gil Young Park
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul, South Korea
| | - Tae-Joon Cho
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul, South Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, South Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul, South Korea. .,Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, South Korea.
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Abstract
BACKGROUND Treatment of equinus contractures in children with cerebral palsy (CP) varies across centers. Existing literature utilizes mixed study populations with a variety of procedures. As such, there is limited knowledge regarding recurrence rates and efficacy of a single procedure performed on a homogenous cohort. Here we retrospectively evaluate outcomes from gastroc soleus fascial lengthenings (GSFL) performed at 2 centers with consistent approaches in both patient selection and operative technique. METHODS Subjects meeting inclusion criteria including CP diagnosis, ambulation status, and minimum follow-up criteria were identified. Revision rate was reported based on need for additional calf lengthening procedures. Functional outcomes were evaluated using physical exam measures and selected variables from computational gait analysis. Outcomes factors were identified by comparing revised subjects to unrevised. Longitudinal outcomes of index surgeries were assessed by comparing preoperative functional data to short-term, mid-term, and long-term data. RESULTS A total of 64 subjects with 87 limbs met inclusion criteria. In all, 25% of subjects and 21% of limbs went on to revision. Factors influencing revision were age at index surgery and gross motor function classification system (GMFCS) level. More than half of revised limbs had index surgery before age 7. Revision rates for subjects less than 7 were 44% compared with a 17% revision rate for ages 7 to 12, and a 4% revision rate on children older than 12. GMFCSIII subjects had significantly higher revision rates (43%) compared with GMFCSII (18%) and GMFCSI (11%) subjects. Ankle range of motion measures improved significantly with GSFL and most maintained improvements at all time periods. GSFL did not lead to significant calcaneal gait or crouch. CONCLUSIONS This study evaluates long term efficacy of GSFL to address equinus in ambulatory children with CP. Overall revision rates are similar to previous reports for GSFL and other calf lengthening procedures. This information may be useful in setting expectations and counselling families. Younger subjects and those with more severe involvement are more likely to need revision surgery, with these factors compounding the likelihood in the younger GMFCSIII child. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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11
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Schallig W, van den Noort JC, Maas M, Harlaar J, van der Krogt MM. Marker placement sensitivity of the Oxford and Rizzoli foot models in adults and children. J Biomech 2021; 126:110629. [PMID: 34320419 DOI: 10.1016/j.jbiomech.2021.110629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
Understanding the effect of individual marker misplacements is important to improve the repeatability and aid to the interpretation of multi-segment foot models like the Oxford and Rizzoli Foot Models (OFM, RFM). Therefore, this study aimed to quantify the effect of controlled anatomical marker misplacement on multi-segment foot kinematics (i.e. marker placement sensitivity) as calculated by OFM and RFM in a range of foot sizes. Ten healthy adults and nine children were included. A combined OFM and RFM marker set was placed on their right foot and a static standing trial was collected. Each marker was replaced ± 10 mm in steps of 1 mm over the three axes of a foot coordinate system. For each replacement the change in segment orientation (tibia, hindfoot, midfoot, forefoot) was calculated with respect to the reference pose in which no markers were replaced. A linear fit was made to calculate the sensitivity of segment orientation to marker misplacement in °/mm. Additionally, the effect of foot size on the sensitivity was determined using linear regressions. For every foot segment of both models, at least one marker had a sensitivity ≥ 1.0°/mm. Highest values were found for the markers at the posterior aspect of the calcaneus in OFM (1.5°/mm) and the basis of the second metatarsal in RFM (1.4°/mm). Foot size had a small effect on 40% of the sensitivity values. This study identified markers of which consistent placement is critical to prevent clinically relevant errors (>5°). For more repeatable multi-segment models, the role of these markers within the models' definitions needs to be reconsidered.
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Affiliation(s)
- Wouter Schallig
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mario Maas
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Orthopedics and Sports Medicine, ErasmusMC, Rotterdam, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
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12
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Leardini A, Stebbins J, Hillstrom H, Caravaggi P, Deschamps K, Arndt A. ISB recommendations for skin-marker-based multi-segment foot kinematics. J Biomech 2021; 125:110581. [PMID: 34217032 DOI: 10.1016/j.jbiomech.2021.110581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
The foot is anatomically and functionally complex, and thus an accurate description of intrinsic kinematics for clinical or sports applications requires multiple segments. This has led to the development of many multi-segment foot models for both kinematic and kinetic analyses. These models differ in the number of segments analyzed, bony landmarks identified, required marker set, defined anatomical axes and frames, the convention used to calculate joint rotations and the determination of neutral positions or other offsets from neutral. Many of these models lack validation. The terminology used is inconsistent and frequently confusing. Biomechanical and clinical studies using these models should use established references and describe how results are obtained and reported. The International Society of Biomechanics has previously published proposals for standards regarding kinematic and kinetic measurements in biomechanical research, and in this paper also addresses multi-segment foot kinematics modeling. The scope of this work is not to prescribe a particular set of standard definitions to be used in all applications, but rather to recommend a set of standards for collecting, calculating and reporting relevant data. The present paper includes recommendations for the overall modeling and grouping of the foot bones, for defining landmarks and other anatomical references, for addressing the many experimental issues in motion data collection, for analysing and reporting relevant results and finally for designing clinical and biomechanical studies in large populations by selecting the most suitable protocol for the specific application. These recommendations should also be applied when writing manuscripts and abstracts.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Julie Stebbins
- Oxford Gait Laboratory, Oxford University Hospitals NHS Foundation Trust, UK
| | - Howard Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, NY, USA
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kevin Deschamps
- Faculty of Movement & Rehabilitation Sciences, KULeuven, Bruges, Belgium
| | - Anton Arndt
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden
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13
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Roach KE, Foreman KB, MacWilliams BA, Karpos K, Nichols J, Anderson AE. The modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model provides clinically acceptable measurements of ankle and midfoot angles: A dual fluoroscopy study. Gait Posture 2021; 85:258-265. [PMID: 33626450 PMCID: PMC8085108 DOI: 10.1016/j.gaitpost.2021.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 09/28/2020] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several multi-segment foot models have been developed to evaluate foot and ankle motion using skin-marker motion analysis. However, few multi-segment models have been evaluated against a reference standard to establish kinematic accuracy. RESEARCH QUESTION How accurately do skin-markers estimate foot and ankle motion for the modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model when compared against the reference standard, dual fluoroscopy (DF), during gait, in asymptomatic participants? METHODS Five participants walked overground as full-body skin-marker trajectory data and DF images of the foot and shank were simultaneously acquired. Using the mSHCG model, ankle and midfoot angles were calculated throughout stance for both motion analysis techniques. Statistical parametric mapping assessed differences in joint angles and marker positions between skin-marker and DF motion analysis techniques. Paired t tests, and linear regression models were used to compare joint angles and range of motion (ROM) calculated from the two techniques. RESULTS In the coronal plane, the skin-marker model significantly overestimated ROM (p = 0.028). Further, the DF model midfoot ROM was significantly positively related to differences between DF and skin-marker midfoot angles (p = 0.035, adjusted R2 = 0.76). In the sagittal plane, skin-markers underestimated ankle angles by as much as 7.26°, while midfoot angles were overestimated by as much as 9.01°. However, DF and skin-marker joint angles were not significantly different over stance. Skin-markers on the tibia, calcaneus, and fifth metatarsal had significantly different positions than the DF markers along the direction of walking for isolated portions that were less than 10 % of stance. Euclidean distances between DF and skin-markers positions were less than 9.36 mm. SIGNIFICANCE As the accuracy of the mSHCG model was formerly unknown, the results of this study provide ranges of confidence for key angles calculated by this model.
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Affiliation(s)
- Koren E. Roach
- Department of Radiology and Biomedical Imaging, 185 Berry St., Suite 350, San Francisco, CA 94107,Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Biomedical Engineering, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108
| | - Bruce A. MacWilliams
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Motion Analysis Center, Shriners Hospitals for Children, 1275 Fairfax Rd., Salt Lake City, UT 84103, USA
| | - Kostantino Karpos
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Physics, Arizona State University, 550 E Tyler Drive Tempe, AZ 85287
| | - Jennifer Nichols
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108,Department of Biomedical Engineering, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112,Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108,Scientific Computing and Imaging Institute, University of Utah, 72 Central Campus Dr, Salt Lake City, UT 84112
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14
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Nahm NJ, Sohrweide SS, Wervey RA, Schwartz MH, Novacheck TF. Surgical treatment of pes planovalgus in ambulatory children with cerebral palsy: Static and dynamic changes as characterized by multi-segment foot modeling, physical examination and radiographs. Gait Posture 2020; 76:168-174. [PMID: 31862665 DOI: 10.1016/j.gaitpost.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/02/2019] [Accepted: 12/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study employs multi-segment foot modeling (MSFM) to examine flatfoot reconstruction among ambulatory children with cerebral palsy (CP). RESEARCH QUESTION Does flatfoot reconstruction improve MSFM measures, physical examination and radiographic variables for forefoot varus and midfoot collapse and associated multi-planar compensatory features? METHODS MSFM was performed preoperatively and postoperatively in a cohort of ambulatory CP patients undergoing flatfoot reconstruction (surgical group, n = 24). A comparison group of non-surgical group of ambulatory CP patients with pes planovalgus (flatfoot) who did not undergo flatfoot reconstruction was also identified (n = 17). All patients in this comparison group underwent MSFM at two separate time points. Physical examination was performed and standing AP and lateral foot radiographs were obtained during each gait analysis session. RESULTS Patients in the surgical group had improvement in their forefoot varus deformity, as documented on physical examination and kinematics in the STJN position of the foot and ankle, as well as in the compensatory hindfoot eversion and midfoot abduction during stance phase of gait. Furthermore, patients in the surgical group had improvement in midfoot collapse as identified kinematically by midfoot dorsiflexion, physical examination descriptors of midfoot position, and radiographic measures of calcaneal pitch and AP and lateral talar-first metatarsal angle. Patients in the non-surgical comparison group did not demonstrate these changes. SIGNIFICANCE Improvements in foot motion after flatfoot reconstruction in ambulatory CP patients were identified by MSFM, physical examination measures, and radiographs. Patients in the surgical and non-surgical groups had similar pre-operative radiographic findings, suggesting that physical examination and MSFM data were important in the surgical decision making process. Finally, surgical intervention did not fully restore normal foot kinematic, physical examination, and radiographic parameters, which suggests that a different, perhaps more aggressive, surgical approach for flatfoot reconstruction is needed.
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Affiliation(s)
- Nickolas J Nahm
- Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W Grand Blvd Detroit, MI, 48202, USA.
| | - Sue S Sohrweide
- Gillete Children's Specialty Healthcare, 200 University Ave East St. Paul, MN, 55101, USA.
| | - Roy A Wervey
- Gillete Children's Specialty Healthcare, 200 University Ave East St. Paul, MN, 55101, USA.
| | - Michael H Schwartz
- Gillete Children's Specialty Healthcare, 200 University Ave East St. Paul, MN, 55101, USA.
| | - Tom F Novacheck
- Gillete Children's Specialty Healthcare, 200 University Ave East St. Paul, MN, 55101, USA.
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15
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MacWilliams BA, McMulkin ML, Saraswat P, Davis RB. Center of pressure metrics derived from spatially registered typically developing data. Gait Posture 2020; 76:22-27. [PMID: 31715430 DOI: 10.1016/j.gaitpost.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/25/2019] [Accepted: 11/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pedobarography is a commonly used testing procedure in clinical gait analysis, yet has limited roles in quantification for treatment planning, outcome assessment, and classification. Spatial registration between plantar pressure and motion capture data allows for accurate quantitative assessment and metric development based on a typically developing cohort. RESEARCH QUESTION This study assesses the validity of new center of pressure based metrics of anatomically registered pedobarography data by evaluating kinematic relationships over a broad spectrum of feet and by evaluating the sensitivity of these metrics to pathologies, interventions, and outcomes in two common clinical foot pathologies. METHODS 3D trajectories from retroreflective markers were recorded to establish a single foot axis simultaneous with plantar pressure mat data spatially calibrated to a global coordinate system. Indices for clinical populations were determined as mediolateral (MLI, |MLI|, MFI) and anteroposterior (API, |API|) deviations of center of pressure excursions from typically developing feet. 198 feet were retrospectively identified to evaluate relationships between mediolateral (ML) indices and foot kinematics over a spectrum of foot pathologies. Additional feet from two broad pathologic foot types, planovalgus (PV) and cavovarus (CV), were assessed pre and post-surgery to determine sensitivity to pathology, surgical intervention, and outcomes. RESULTS ML indices and supination were highly correlated (r2 > 0.5). Two mediolateral indices (MLI, MFI) and one anteroposterior index (|API|) demonstrated significant differences between typical and PV feet, with the MFI index also exhibiting significant improvement with surgery. All three mediolateral indices and |API| demonstrated differences between typical and cavovarus feet, with |API| significantly improving with surgery. Changes in API also correlated with patient goals. SIGNIFICANCE Spatial registration between plantar pressure center of pressure and motion capture data allows calculation of indices that reflect foot function and are sensitive to foot pathologies and treatment outcomes.
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Affiliation(s)
- B A MacWilliams
- Shriners Hospitals for Children, Salt Lake City, UT, USA; University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA.
| | - M L McMulkin
- Shriners Hospitals for Children, Spokane, WA, USA
| | - P Saraswat
- Shriners Hospitals for Children, Greenville, SC, USA
| | - R B Davis
- Shriners Hospitals for Children, Greenville, SC, USA
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16
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Mahieu C, Salvia P, Beyer B, Rooze M, Feipel V, Van Sint Jan S. Metatarsal arch deformation and forefoot kinematics during gait in asymptomatic subjects. Int Biomech 2019; 6:75-84. [PMID: 34042007 PMCID: PMC7857307 DOI: 10.1080/23335432.2019.1642142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study aimed to investigate both foot arch-shaped architecture and forefoot kinematics during gait. Using a dedicated three-compartment forefoot subdivision, we studied asymptomatic subjects and quantified disorders related to the metatarsal arch. Foot motion and arch shape were measured in 30 healthy subjects with a motion-capture system and force plates. Kinematic results were expressed using a novel model, which anatomically divides the forefoot into three parts. This model integrated the medial longitudinal arch angle and the metatarsal arch height and width. During the first part of stance phase, the medial longitudinal arch flattens and all foot segments move toward dorsiflexion. During terminal stance and preswing phase, medial longitudinal and metatarsal arch restoration was noted with plantarflexion of all segments, an eversion and abduction of the medial forefoot, and an inversion and adduction of the lateral forefoot. Kinematics obtained with the proposed forefoot model corroborates metatarsal arch restoration in late stance. This observation supports the fact that foot architecture is supple until midstance and subsequently creates a rigid lever arm with restored arches to support propulsion. This study’s results and methods highlight the potential of the three-compartment model for use in clinical decision-making.
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Affiliation(s)
- Céline Mahieu
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Salvia
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Center for Functional Evaluation, Université Libre de Bruxelles, Brussels, Belgium
| | - Benoît Beyer
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Marcel Rooze
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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17
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Zavatsky AB, Paik AM, Leitch J, Kothari A, Stebbins J. Comparison of the hindfoot axes of a multi-segment foot model to the underlying bony anatomy. J Biomech 2019; 93:34-41. [DOI: 10.1016/j.jbiomech.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022]
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18
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van Hoeve S, Poeze M. Multisegment Foot Models and Clinical Application After Foot and Ankle Trauma: A Review. J Foot Ankle Surg 2019; 58:748-754. [PMID: 31010768 DOI: 10.1053/j.jfas.2018.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Sander van Hoeve
- Professor, Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Martijn Poeze
- Professor, Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Professor, School for Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht, The Netherlands
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Precision of determining bone pose and marker position in the foot and lower leg from computed tomography scans: How low can we go in radiation dose? Med Eng Phys 2019; 69:147-152. [DOI: 10.1016/j.medengphy.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/29/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
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20
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McMulkin ML, Mader S, Elizondo T, Baird GO. Quantitative coronal plane motion of hindfoot during clinical flexibility assessments. Gait Posture 2019; 71:116-119. [PMID: 31051373 DOI: 10.1016/j.gaitpost.2019.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/07/2019] [Accepted: 04/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Common pediatric pathologic foot presentations include cavovarus and planovalgus feet. Flexibility of the hindfoot is established for these two clinical presentations through the Coleman block (eversion) and tiptoe tests (inversion). RESEARCH QUESTION The purposes of this study are to establish typical quantitative eversion and inversion motion of the hindfoot during Coleman block and tiptoe tests using 3-D motion capture and demonstrate feasibility of using this data to assist in making treatment decisions. METHODS Segmented foot model kinematics were collected for this prospective descriptive study with a focus on coronal plane inversion and eversion of the hindfoot relative to the tibia. Typical standing hindfoot position, with the feet plantigrade, was determined prior to performing the tiptoe test. Maximum hindfoot inversion was extracted from the tiptoe test. Maximum hindfoot eversion was extracted from the Coleman block tests. RESULTS 32 typically developing subjects (age range 5-21 years) completed this study. Hindfoot motion data showed a mean standing foot position of 1 ° eversion, 10 degrees inversion during tiptoe test and 6 degrees eversion during the Coleman block test. SIGNIFICANCE Establishing control values for hindfoot flexibility can assist with making clinical treatment decisions for disorders of the foot. At our center, clients who present to the Motion Analysis Center with foot concerns receive segmented foot model quantitative assessment of hindfoot flexibility with Coleman block and tiptoe tests as appropriate.
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Affiliation(s)
- Mark L McMulkin
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Hospitals for Children® - Spokane, 911 W. 5th, Spokane, WA 99204, USA.
| | - Shelley Mader
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Hospitals for Children® - Spokane, 911 W. 5th, Spokane, WA 99204, USA
| | - Tayler Elizondo
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Hospitals for Children® - Spokane, 911 W. 5th, Spokane, WA 99204, USA
| | - Glen O Baird
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Hospitals for Children® - Spokane, 911 W. 5th, Spokane, WA 99204, USA
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Leardini A, Caravaggi P, Theologis T, Stebbins J. Multi-segment foot models and their use in clinical populations. Gait Posture 2019; 69:50-59. [PMID: 30665039 DOI: 10.1016/j.gaitpost.2019.01.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Tim Theologis
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK.
| | - Julie Stebbins
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, UK.
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22
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Mueske NM, Õunpuu S, Ryan DD, Healy BS, Thomson J, Choi P, Wren TAL. Impact of gait analysis on pathology identification and surgical recommendations in children with spina bifida. Gait Posture 2019; 67:128-132. [PMID: 30321794 DOI: 10.1016/j.gaitpost.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/16/2018] [Accepted: 10/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait analysis provides quantitative data that can be used to supplement standard clinical evaluation in identifying and understanding gait problems. It has been established that gait analysis changes treatment decision making for children with cerebral palsy, but this has not yet been studied in other diagnoses such as spina bifida. RESEARCH QUESTION To determine the effects of gait analysis data on pathology identification and surgical recommendations in children with spina bifida. METHODS Two pediatric orthopaedic surgeons and two therapists with >10 years of experience in gait analysis reviewed clinical, video, and gait analysis data from 43 ambulatory children with spina bifida (25 male; mean age 11.7 years, SD 3.8; 25 sacral, 18 lumbar). Primary gait pathologies were identified by each assessor both before and after consideration of the gait analysis data. Surgical recommendations were also recorded by the surgeons before and after consideration of the gait analysis data. Frequencies of pathology and surgery identification with and without gait analysis were compared using Fisher's exact test, and percent change in pathology and surgery identification was calculated. RESULTS Pathology identification often changed for common gait problems including crouch (28% of cases), tibial rotation (35%), pes valgus (18%), excessive hip flexion (70%), and abnormal femur rotation (75%). Recognition of excessive hip flexion and abnormal femur rotation increased significantly after consideration of gait analysis data (p < 0.05). Surgical recommendations also frequently changed for the most common surgeries including tibial derotation osteotomy (30%), antero-lateral release (22%), plantar fascia release (33%), knee capsulotomy (25%), 1st metatarsal osteotomy (60%), and femoral derotation osteotomy (89%). At the patient level, consideration of gait analysis data altered surgical recommendations for 44% of patients. SIGNIFICANCE Since gait analysis data often changes pathology identification and surgical recommendations, treatment decision making may be improved by including gait analysis in the patient care process.
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Affiliation(s)
| | - Sylvia Õunpuu
- Connecticut Children's Medical Center, Hartford, CT, USA
| | | | - Bitte S Healy
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Paul Choi
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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Kim EJ, Shin HS, Lee JH, Kyung MG, Yoo HJ, Yoo WJ, Lee DY. Repeatability of a Multi-segment Foot Model with a 15-Marker Set in Normal Children. Clin Orthop Surg 2018; 10:484-490. [PMID: 30505418 PMCID: PMC6250958 DOI: 10.4055/cios.2018.10.4.484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022] Open
Abstract
Background The use of three-dimensional multi-segment foot models (3D MFMs) is increasing since they have superior ability to illustrate the effect of foot and ankle pathologies on intersegmental motion of the foot compared to single-segment foot model gait analysis. However, validation of the repeatability of the 3D MFMs is important for their clinical use. Although many MFMs have been validated in normal adults, research on MFM repeatability in children is lacking. The purpose of this study is to validate the intrasession, intersession, and interrater repeatability of an MFM with a 15-marker set (DuPont foot model) in healthy children. Methods The study included 20 feet of 20 healthy children (10 boys and 10 girls). We divided the participants into two groups of 10 each. One group was tested by the same operator in each test (intersession analysis), while the other group was tested by a different operator in each test (interrater analysis). The multiple correlation coefficient (CMC) and intraclass correlation coefficient (ICC) were calculated to assess repeatability. The difference between the two sessions of each group was assessed at each time point of gait cycle. Results The intrasession CMC and ICC values of all parameters showed excellent or very good repeatability. The intersession CMC of many parameters showed good or better repeatability. Interrater CMC and ICC values were generally lower for all parameters than intrasession and intersession. The mean gaps of all parameters were generally similar to those of the previous study. Conclusions We demonstrated that 3D MFM using a 15-marker set had high intrasession, intersession, and interrater repeatability in the assessment of foot motion in healthy children but recommend some caution in interpreting the hindfoot parameters.
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Affiliation(s)
- Eo Jin Kim
- Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea
| | - Hyuk Soo Shin
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Hee Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyo Jeong Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Won Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Comparison of three-dimensional multi-segmental foot models used in clinical gait laboratories. Gait Posture 2018; 63:236-241. [PMID: 29778063 DOI: 10.1016/j.gaitpost.2018.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many skin-mounted three-dimensional multi-segmented foot models are currently in use for gait analysis. Evidence regarding the repeatability of models, including between trial and between assessors, is mixed, and there are no between model comparisons of kinematic results. RESEARCH QUESTION This study explores differences in kinematics and repeatability between five three-dimensional multi-segmented foot models. The five models include duPont, Heidelberg, Oxford Child, Leardini, and Utah. METHODS Hind foot, forefoot, and hallux angles were calculated with each model for ten individuals. Two physical therapists applied markers three times to each individual to assess within and between therapist variability. Standard deviations were used to evaluate marker placement variability. Locally weighted regression smoothing with alpha-adjusted serial T tests analysis was used to assess kinematic similarities. RESULTS All five models had similar variability, however, the Leardini model showed high standard deviations in plantarflexion/dorsiflexion angles. P-value curves for the gait cycle were used to assess kinematic similarities. The duPont and Oxford models had the most similar kinematics. CONCLUSIONS All models demonstrated similar marker placement variability. Lower variability was noted in the sagittal and coronal planes compared to rotation in the transverse plane, suggesting a higher minimal detectable change when clinically considering rotation and a need for additional research. Between the five models, the duPont and Oxford shared the most kinematic similarities. While patterns of movement were very similar between all models, offsets were often present and need to be considered when evaluating published data.
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Davies K, Black A, Hunt M, Holsti L. Long-term gait outcomes following conservative management of idiopathic toe walking. Gait Posture 2018; 62:214-219. [PMID: 29571089 DOI: 10.1016/j.gaitpost.2018.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/03/2018] [Accepted: 02/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Idiopathic toe walking is a diagnosis of exclusion characterized by a persistent toe-toe gait pattern after three years of age. Treatment for toe walking includes physical therapy, orthotics, casting, Botulinum Toxin A injection into gastrocnemius/soleus muscles, and/or surgery; yet, little evidence exists regarding long-term treatment effects. RESEARCH QUESTION The objective of this study was to explore the differences in longer-term gait outcomes and severity of idiopathic toe walking between children treated actively with casting or inactively following recommendations for stretching. METHODS Forty-three adolescents and young adults (14.3-28.8 years; 21 females, 22 males) who had participated in an idiopathic toe walking classification study as children, returned for repeat physical examination and three-dimensional computerized gait analysis (13.4 years follow-up, range 9.4-17.8 years); 23 participants had received active treatment with casting and ankle foot orthotics ± Botulinum Toxin A injection as children and 20 participants had received inactive treatment with recommended stretching exercises. Gait analysis data were compared retrospectively from baseline to follow-up using analysis of variance; toe walking severity was compared using a Wilcoxin Signed-Rank Sums test. RESULTS Ankle angle at initial contact, peak dorsiflexion in stance, and toe walking severity improved significantly in the active treatment group only at follow-up. Significant improvement in peak ankle power and timing of ankle kinematics and kinetics in the gait cycle were found in both groups; however, greater changes occurred in the active treatment group. Both groups showed significantly improved internal plantar flexor moments, whereas knee extension increased in stance and passive ankle dorsiflexion decreased in both groups at follow-up (p = 0.001). Intermittent toe walking was reported in 49% (21/43) of participants at follow-up. SIGNIFICANCE The results of this study suggest that improvement in ankle kinematic timing and ankle kinetic gait analysis variables is sustainable, independent of conservative treatment for idiopathic toe walking in childhood.
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Affiliation(s)
- Karen Davies
- Shriners Gait Lab, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, British Columbia V5M 3E8, Canada.
| | - Alec Black
- Shriners Gait Lab, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, British Columbia V5M 3E8, Canada.
| | - Michael Hunt
- Department of Physical Therapy, The University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Liisa Holsti
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada; British Columbia Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, British Columbia V5Z 4H4, Canada.
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Two-Segment Foot Model for the Biomechanical Analysis of Squat. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9652948. [PMID: 29065674 PMCID: PMC5563415 DOI: 10.1155/2017/9652948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/05/2017] [Indexed: 12/26/2022]
Abstract
Squat exercise is acquiring interest in many fields, due to its benefits in improving health and its biomechanical similarities to a wide range of sport motions and the recruitment of many body segments in a single maneuver. Several researches had examined considerable biomechanical aspects of lower limbs during squat, but not without limitations. The main goal of this study focuses on the analysis of the foot contribution during a partial body weight squat, using a two-segment foot model that considers separately the forefoot and the hindfoot. The forefoot and hindfoot are articulated by the midtarsal joint. Five subjects performed a series of three trials, and results were averaged. Joint kinematics and dynamics were obtained using motion capture system, two force plates closed together, and inverse dynamics techniques. The midtarsal joint reached a dorsiflexion peak of 4°. Different strategies between subjects revealed 4° supination and 2.5° pronation of the forefoot. Vertical GRF showed 20% of body weight concentrated on the forefoot and 30% on the hindfoot. The percentages varied during motion, with a peak of 40% on the hindfoot and correspondently 10% on the forefoot, while the traditional model depicted the unique constant 50% value. Ankle peak of plantarflexion moment, power absorption, and power generation was consistent with values estimated by the one-segment model, without statistical significance.
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Estimation of foot joint kinetics in three and four segment foot models using an existing proportionality scheme: Application in paediatric barefoot walking. J Biomech 2017; 61:168-175. [DOI: 10.1016/j.jbiomech.2017.07.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/11/2017] [Accepted: 07/16/2017] [Indexed: 11/22/2022]
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Oosterwaal M, Carbes S, Telfer S, Woodburn J, Tørholm S, Al-Munajjed AA, van Rhijn L, Meijer K. The Glasgow-Maastricht foot model, evaluation of a 26 segment kinematic model of the foot. J Foot Ankle Res 2016; 9:19. [PMID: 27398096 PMCID: PMC4938906 DOI: 10.1186/s13047-016-0152-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/16/2016] [Indexed: 12/03/2022] Open
Abstract
Background Accurately measuring of intrinsic foot kinematics using skin mounted markers is difficult, limited in part by the physical dimensions of the foot. Existing kinematic foot models solve this problem by combining multiple bones into idealized rigid segments. This study presents a novel foot model that allows the motion of the 26 bones to be individually estimated via a combination of partial joint constraints and coupling the motion of separate joints using kinematic rhythms. Methods Segmented CT data from one healthy subject was used to create a template Glasgow-Maastricht foot model (GM-model). Following this, the template was scaled to produce subject-specific models for five additional healthy participants using a surface scan of the foot and ankle. Forty-three skin mounted markers, mainly positioned around the foot and ankle, were used to capture the stance phase of the right foot of the six healthy participants during walking. The GM-model was then applied to calculate the intrinsic foot kinematics. Results Distinct motion patterns where found for all joints. The variability in outcome depended on the location of the joint, with reasonable results for sagittal plane motions and poor results for transverse plane motions. Conclusions The results of the GM-model were comparable with existing literature, including bone pin studies, with respect to the range of motion, motion pattern and timing of the motion in the studied joints. This novel model is the most complete kinematic model to date. Further evaluation of the model is warranted.
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Affiliation(s)
- Michiel Oosterwaal
- NUTRIM, Department of Human Movement Sciences, Maastricht University Medical Centre +, PO 5800, 6202 AZ Maastricht, The Netherlands ; CAPHRI, Department of Orthopaedic Surgery, Maastricht University Medical Centre +, PO 5800, 6202 AZ Maastricht, The Netherlands
| | - Sylvain Carbes
- AnyBody Technology A/S, Niels Jernes Vej 10, DK-9220 Aalborg East, Denmark
| | - Scott Telfer
- The Institute for Applied Health Research, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - James Woodburn
- The Institute for Applied Health Research, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Søren Tørholm
- AnyBody Technology A/S, Niels Jernes Vej 10, DK-9220 Aalborg East, Denmark
| | - Amir A Al-Munajjed
- AnyBody Technology A/S, Niels Jernes Vej 10, DK-9220 Aalborg East, Denmark
| | - Lodewijk van Rhijn
- CAPHRI, Department of Orthopaedic Surgery, Maastricht University Medical Centre +, PO 5800, 6202 AZ Maastricht, The Netherlands
| | - Kenneth Meijer
- NUTRIM, Department of Human Movement Sciences, Maastricht University Medical Centre +, PO 5800, 6202 AZ Maastricht, The Netherlands
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A marker placement laser device for improving repeatability in 3D-foot motion analysis. Gait Posture 2016; 44:227-30. [PMID: 27004663 DOI: 10.1016/j.gaitpost.2015.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/11/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND In 3D gait analysis, the repeated positioning of markers is associated with a high error rate, particularly when using a complex foot model with many markers. Therefore, a marker placement laser device was developed that ensures a reliable repositioning of markers. We report the development and reliability of this device for the foot at different tape conditions. METHODS In 38 subjects, markers were placed at the foot according to the Heidelberg foot measurement method. Subjects were tested barefoot and barefoot with three different tape conditions. For all conditions, a static standing trial was captured. We analyzed differences in distances between markers and the intra-class correlation coefficients (ICC). RESULTS Small differences between the conditions (0.03-3.28 mm) and excellent ICCs (0.91-0.97 mm) were found for all parameters. CONCLUSION The laser marker placement device appeared to be a reliable method to place markers on a tape at previously palpated positions and ensures an exact position. The device could find a wide application in different clinical research fields.
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Portinaro N, Leardini A, Panou A, Monzani V, Caravaggi P. Modifying the Rizzoli foot model to improve the diagnosis of pes-planus: application to kinematics of feet in teenagers. J Foot Ankle Res 2014; 7:754. [PMID: 25558289 PMCID: PMC4282742 DOI: 10.1186/s13047-014-0057-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 12/12/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A number of multi-segment foot protocols have been proposed to obtain measurements of clinical value. In the clinical assessment of foot pathologies and deformities, such as in the pes-planus, the frontal-plane alignment of the calcaneus and the dynamic properties of the medial longitudinal arch are critical parameters though often neglected by the majority of foot protocols. The aim of the present work is to modify an established foot protocol to obtain static and kinematic measures more consistent with corresponding clinical observations. Moreover, while many papers have reported kinematic data from varying populations, few investigations have focussed on young participants from same-age cohorts. METHODS A 6-camera motion capture system was employed to track the shank, rear-, mid- and fore-foot segments in the left and right leg of 10 children (13.1 ± 0.8 years) during gait. Three markers were attached to each segment thus allowing for triplanar motion of five joints to be described according to the Rizzoli Foot Model. An additional marker was attached to the posterior bottom of the calcaneus to enhance measurement of frontal-plane orientation. Description of the medial longitudinal arch angle was redefined to be more consistent with rearfoot orientation and to common clinical assessments. A novel 3-marker description of the hallux segment was implemented to improve robustness in calculating 1(st) metatarso-phalangeal joint rotations. RESULTS Foot segments kinematics showed good inter- participant repeatability and overall consistency with previous similar reports. 15 out of 20 feet showed neutral or slightly valgus orientation of the calcaneus. Relatively large medial longitudinal arch angles (mean 186 ± 16 deg) were found in the present young population. Both measurements were reasonably in accordance with the relevant clinical observations of these feet. CONCLUSIONS Modifications to a widely used multisegmental foot kinematic model were implemented to improve robustness and consistency with relevant clinical observations. A detailed description of foot joints motion during barefoot walking in a population of 13-year old children with apparent flat feet has been presented, which may provide useful information to investigate the development of gait in children and the diagnosis of flexible flat foot.
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Affiliation(s)
- Nicola Portinaro
- />Department of Orthopaedic and Trauma, University of Milano, Milano, Italy
- />Pediatric Orthopaedic Unit, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Alberto Leardini
- />Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Artemisia Panou
- />Pediatric Orthopaedic Unit, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Valerio Monzani
- />Pediatric Orthopaedic Unit, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Paolo Caravaggi
- />Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
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Nester CJ, Jarvis HL, Jones RK, Bowden PD, Liu A. Movement of the human foot in 100 pain free individuals aged 18-45: implications for understanding normal foot function. J Foot Ankle Res 2014; 7:51. [PMID: 25493100 PMCID: PMC4260241 DOI: 10.1186/s13047-014-0051-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding motion in the normal healthy foot is a prerequisite for understanding the effects of pathology and thereafter setting targets for interventions. Quality foot kinematic data from healthy feet will also assist the development of high quality and research based clinical models of foot biomechanics. To address gaps in the current literature we aimed to describe 3D foot kinematics using a 5 segment foot model in a population of 100 pain free individuals. METHODS Kinematics of the leg, calcaneus, midfoot, medial and lateral forefoot and hallux were measured in 100 self reported healthy and pain free individuals during walking. Descriptive statistics were used to characterise foot movements. Contributions from different foot segments to the total motion in each plane were also derived to explore functional roles of different parts of the foot. RESULTS Foot segments demonstrated greatest motion in the sagittal plane, but large ranges of movement in all planes. All foot segments demonstrated movement throughout gait, though least motion was observed between the midfoot and calcaneus. There was inconsistent evidence of movement coupling between joints. There were clear differences in motion data compared to foot segment models reported in the literature. CONCLUSIONS The data reveal the foot is a multiarticular structure, movements are complex, show incomplete evidence of coupling, and vary person to person. The data provide a useful reference data set against which future experimental data can be compared and may provide the basis for conceptual models of foot function based on data rather than anecdotal observations.
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Affiliation(s)
- Christopher J Nester
- School of Health Sciences, University of Salford, PO 32 Brian Blatchford Building, Salford, M6 6PU UK
| | - Hannah L Jarvis
- School of Health Sciences, University of Salford, PO 32 Brian Blatchford Building, Salford, M6 6PU UK
| | - Richard K Jones
- School of Health Sciences, University of Salford, PO 32 Brian Blatchford Building, Salford, M6 6PU UK
| | - Peter D Bowden
- School of Health Sciences, University of Salford, PO 32 Brian Blatchford Building, Salford, M6 6PU UK
| | - Anmin Liu
- School of Health Sciences, University of Salford, PO 32 Brian Blatchford Building, Salford, M6 6PU UK
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Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity. Gait Posture 2014; 40:128-33. [PMID: 24703359 PMCID: PMC4038905 DOI: 10.1016/j.gaitpost.2014.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/03/2014] [Accepted: 03/05/2014] [Indexed: 02/02/2023]
Abstract
Diabetic foot deformity onset and progression maybe associated with abnormal foot and ankle motion. The modified Oxford multi-segmental foot model allows kinematic assessment of inter-segmental foot motion. However, there are insufficient anatomical landmarks to accurately representation the alignment of the hindfoot and forefoot segments during model construction. This is most notable for the sagittal plane which is referenced parallel to the floor, allowing comparison of inter-segmental excursion but not capturing important sagittal hind-to-forefoot deformity associated with diabetic foot disease and can potentially underestimate true kinematic differences. The purpose of the study was to compare walking kinematics using local coordinate systems derived from the modified Oxford model and the radiographic directed model which incorporated individual calcaneal and 1st metatarsal declination pitch angles for the hindfoot and forefoot. We studied twelve participants in each of the following groups: (1) diabetes mellitus, peripheral neuropathy and medial column foot deformity (DMPN+), (2) DMPN without medial column deformity (DMPN-) and (3) age- and weight-match controls. The modified Oxford model coordinate system did not identify differences between groups in the initial, peak, final, or excursion hindfoot relative to shank or forefoot relative to hindfoot dorsiflexion/plantarflexion during walking. The radiographic coordinate system identified the DMPN+ group to have an initial, peak and final position of the forefoot relative to hindfoot that was more dorsiflexed (lower arch phenotype) than the DMPN- group (p<.05). Use of radiographic alignment in kinematic modeling of those with foot deformity reveals segmental motion occurring upon alignment indicative of a lower arch.
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Seo SG, Lee DY, Moon HJ, Kim SJ, Kim J, Lee KM, Chung CY, Choi IH. Repeatability of a multi-segment foot model with a 15-marker set in healthy adults. J Foot Ankle Res 2014; 7:24. [PMID: 24782914 PMCID: PMC4004446 DOI: 10.1186/1757-1146-7-24] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/11/2014] [Indexed: 02/01/2023] Open
Abstract
Background Several 3D multi-segment foot models (MFMs) have been introduced for the in vivo analysis of dynamic foot kinematics. However, reproducibility of a model should be checked and ascertained before clinical utilization of a MFM. The purpose of this study was to determine the reliability of recently introduced MFM with a 15-marker set by assessing the participant’s stride-to-stride (intra-session) and visit-to-revisit (inter-session) repeatability. Methods Twenty healthy adults with a mean age of 28.9 years (10 males and 10 females) were tested. Three representative strides from five separate trials were used for analysis from each session. Kinematic data of foot segmental motion was collected and tracked using the Foot3D Multi-Segment Software (Motion Analysis Co., Santa Rosa. CA). A retest was performed in the same manner at an interval of 4 weeks. Coefficients of multiple correlation (CMC) and intra-class correlation coefficient (ICC) were calculated in order to assess the intra-session and inter-session repeatability. Results Inter-segment foot angles from healthy adults from a MFM with 15-marker set showed a narrow range of variability during the gait cycle. The mean intra-session ICC was 0.981 (±0.010), which was interpreted as excellent. The mean intra-session CMC was 0.948 (±0.027), which was interpreted as very good repeatability. The mean inter-session ICC was 0.886 (±0.047) and the mean inter-session CMC was 0.801 (±0.077), which were interpreted as excellent and good repeatability, respectively. Conclusion We demonstrated a MFM with a 15-marker set had high intra-session and inter-session repeatability, especially in sagittal plane motion. We thought this MFM would be applicable to evaluation of the segmental foot motion during gait.
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Affiliation(s)
- Sang Gyo Seo
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul 110-744, South Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul 110-744, South Korea
| | - Hyuk Ju Moon
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul 110-744, South Korea
| | - Sung Ju Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul 110-744, South Korea
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul Metropolitan Government Seoul National, Korea University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Sungnam, Kyungki 463-707, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Sungnam, Kyungki 463-707, South Korea
| | - In Ho Choi
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul 110-744, South Korea
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Novak AC, Mayich DJ, Perry SD, Daniels TR, Brodsky JW. Gait analysis for foot and ankle surgeons-- topical review, part 2: approaches to multisegment modeling of the foot. Foot Ankle Int 2014; 35:178-91. [PMID: 24334310 DOI: 10.1177/1071100713511435] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Alison C Novak
- iDAPT Centre for Rehabilitation Research, Toronto Rehabilitation Institute-UHN, Toronto, Canada
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Mahaffey R, Morrison SC, Drechsler WI, Cramp MC. Evaluation of multi-segmental kinematic modelling in the paediatric foot using three concurrent foot models. J Foot Ankle Res 2013; 6:43. [PMID: 24176241 PMCID: PMC3832939 DOI: 10.1186/1757-1146-6-43] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Various foot models are used in the analysis of foot motion during gait and selection of the appropriate model can be difficult. The clinical utility of a model is dependent on the repeatability of the data as well as an understanding of the expected error in the process of data collection. Kinematic assessment of the paediatric foot is challenging and little is reported about multi-segment foot models in this population. The aim of this study was to examine three foot models and establish their concurrent test-retest repeatability in evaluation of paediatric foot motion during gait. Methods 3DFoot, Kinfoot and the Oxford Foot Model (OFM) were applied concurrently to the right foot and lower limb of 14 children on two testing sessions. Angular data for foot segments were extracted at gait cycle events and peaks and compared between sessions by intraclass correlation coefficient (ICC) with 95% confidence intervals (95%CI) and standard error of measurement (SEM). Results All foot models demonstrated moderate repeatability: OFM (ICC 0.55, 95% CI 0.16 to 0.77), 3DFoot (ICC 0.47, 95% CI 0.15 to 0.64) and Kinfoot (ICC 0.43, 95% CI -0.03 to 0.59). On the basis of a cut-off of 5°, acceptable mean error over repeated sessions was observed for OFM (SEM 4.61° ± 2.86°) and 3DFoot (SEM 3.88° ± 2.18°) but not for Kinfoot (SEM 5.08° ± 1.53°). Reliability of segmental kinematics varied, with low repeatability (ICC < 0.4) found for 14.3% of OFM angles, 22.7% of 3DFoot angles and 37.6% of Kinfoot angles. SEM greater than 5° was found in 26.2% of OFM, 15.2% of 3DFoot, and 43.8% of Kinfoot segmental angles. Conclusion Findings from this work have demonstrated that segmental foot kinematics are repeatable in the paediatric foot but the level of repeatability and error varies across the segments of the different models. Information on repeatability and test-retest errors of three-dimensional foot models can better inform clinical assessment and advance understanding of foot motion during gait.
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Affiliation(s)
- Ryan Mahaffey
- School of Health, Sport and Bioscience, University of East London, Stratford, London E15 4LZ, England.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e3182a6a18b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saraswat P, MacWilliams BA, Davis RB, D'Astous JL. Kinematics and kinetics of normal and planovalgus feet during walking. Gait Posture 2013; 39:339-45. [PMID: 24001868 DOI: 10.1016/j.gaitpost.2013.08.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 07/03/2013] [Accepted: 08/06/2013] [Indexed: 02/02/2023]
Abstract
Planovalgus deformity is prevalent in cerebral palsy patients, but very few studies have quantitatively reported differences between planovalgus and normal foot function. Intersegmental foot kinetics have not been reported in this population. In this study, a three segment (hindfoot, forefoot, hallux) kinematic and kinetic model was applied to typically developing (n=10 subjects, 20 feet) and planovalgus (n=10 subjects, 18 feet) pediatric subjects by two clinicians for each subject. Intra-clinician and inter-clinician repeatability of kinematic variables have been previously reported. Variability of kinetic outcomes (joint moments and power) is reported and found to be equally repeatable in typically developing and planovalgus groups. Kinematic differences in the planovalgus foot including excessive ankle eversion (valgus) and plantarflexion, reduced ankle flexion range of motion, and increased midfoot joint dorsiflexion and pronation reflected the reported pathology. Contrary to clinical expectations no significant difference was observed in midfoot flexion or ankle eversion ranges of motion. Kinetic differences in planovalgus feet compared to typically developing feet included reduced ankle plantarflexion moment, ankle power and midfoot joint power.
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A kinematic description of dynamic midfoot break in children using a multi-segment foot model. Gait Posture 2013; 38:287-92. [PMID: 23273965 DOI: 10.1016/j.gaitpost.2012.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/28/2012] [Accepted: 12/02/2012] [Indexed: 02/02/2023]
Abstract
Midfoot break (MFB) is a foot deformity that occurs most commonly in children with cerebral palsy (CP), but may also affect children with other developmental disorders. Dynamic MFB develops because the muscles that cross the ankle joint are hypertonic, resulting in a breakdown and dysfunction of the bones within the foot. In turn, this creates excessive motion at the midfoot. With the resulting inefficient lever arm, the foot is then unable to push off the ground effectively, resulting in an inadequate and painful gait pattern. Currently, there is no standard quantitative method for detecting early stages of MFB, which would allow early intervention before further breakdown occurs. The first step in developing an objective tool for early MFB diagnosis is to examine the difference in dynamic function between a foot with MFB and a typical foot. Therefore, the main purpose of this study was to compare the differences in foot motion between children with MFB and children with typical feet (Controls) using a multi-segment kinematic foot model. We found that children with MFB had a significant decrease in peak ankle dorsiflexion compared to Controls (1.3 ± 6.4° versus 8.6 ± 3.4°) and a significant increase in peak midfoot dorsiflexion compared to Controls (15.2 ± 4.9° versus 6.4 ± 1.9°). This study may help clinicians track the progression of MFB and help standardize treatment recommendations for children with this type of foot deformity.
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Bibliography—Editors’ selection of current world literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e31828aa74c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Saraswat P, MacWilliams BA, Davis RB, D'Astous JL. A multi-segment foot model based on anatomically registered technical coordinate systems: method repeatability and sensitivity in pediatric planovalgus feet. Gait Posture 2013; 37:121-5. [PMID: 22858244 DOI: 10.1016/j.gaitpost.2012.06.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/18/2012] [Accepted: 06/25/2012] [Indexed: 02/02/2023]
Abstract
Several multisegment foot models have been proposed and some have been used to study foot pathologies. These models have been tested and validated on typically developed populations; however application of such models to feet with significant deformities presents an additional set of challenges. For the first time, in this study, a multisegment foot model is tested for repeatability in a population of children with symptomatic abnormal feet. The results from this population are compared to the same metrics collected from an age matched (8-14 years) typically developing population. The modified Shriners Hospitals for Children, Greenville (mSHCG) foot model was applied to ten typically developing children and eleven children with planovalgus feet by two clinicians. Five subjects in each group were retested by both clinicians after 4-6 weeks. Both intra-clinician and inter-clinician repeatability were evaluated using static and dynamic measures. A plaster mold method was used to quantify variability arising from marker placement error. Dynamic variability was measured by examining trial differences from the same subjects when multiple clinicians carried out the data collection multiple times. For hindfoot and forefoot angles, static and dynamic variability in both groups was found to be less than 4° and 6° respectively. The mSHCG model strategy of minimal reliance on anatomical markers for dynamic measures and inherent flexibility enabled by separate anatomical and technical coordinate systems resulted in a model equally repeatable in typically developing and planovalgus populations.
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