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Liu W, Bai J. Meta-analysis of the quantitative assessment of lower extremity motor function in elderly individuals based on objective detection. J Neuroeng Rehabil 2024; 21:111. [PMID: 38926890 PMCID: PMC11202321 DOI: 10.1186/s12984-024-01409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To avoid deviation caused by the traditional scale method, the present study explored the accuracy, advantages, and disadvantages of different objective detection methods in evaluating lower extremity motor function in elderly individuals. METHODS Studies on lower extremity motor function assessment in elderly individuals published in the PubMed, Web of Science, Cochrane Library and EMBASE databases in the past five years were searched. The methodological quality of the included trials was assessed using RevMan 5.4.1 and Stata, followed by statistical analyses. RESULTS In total, 19 randomized controlled trials with a total of 2626 participants, were included. The results of the meta-analysis showed that inertial measurement units (IMUs), motion sensors, 3D motion capture systems, and observational gait analysis had statistical significance in evaluating the changes in step velocity and step length of lower extremity movement in elderly individuals (P < 0.00001), which can be used as a standardized basis for the assessment of motor function in elderly individuals. Subgroup analysis showed that there was significant heterogeneity in the assessment of step velocity [SMD=-0.98, 95%CI(-1.23, -0.72), I2 = 91.3%, P < 0.00001] and step length [SMD=-1.40, 95%CI(-1.77, -1.02), I2 = 86.4%, P < 0.00001] in elderly individuals. However, the sensors (I2 = 9%, I2 = 0%) and 3D motion capture systems (I2 = 0%) showed low heterogeneity in terms of step velocity and step length. The sensitivity analysis and publication bias test demonstrated that the results were stable and reliable. CONCLUSION observational gait analysis, motion sensors, 3D motion capture systems, and IMUs, as evaluation means, play a certain role in evaluating the characteristic parameters of step velocity and step length in lower extremity motor function of elderly individuals, which has good accuracy and clinical value in preventing motor injury. However, the high heterogeneity of observational gait analysis and IMUs suggested that different evaluation methods use different calculation formulas and indicators, resulting in the failure to obtain standardized indicators in clinical applications. Thus, multimodal quantitative evaluation should be integrated.
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Affiliation(s)
- Wen Liu
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Centre, Beijing, China
| | - Jinzhu Bai
- Rehabilitation Medicine Center, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.
- Department of Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Centre, Beijing, China.
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China.
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Dami A, Chicoine D, Payen E, Bouchard M, Belzile EL, Corbeil P, Moisan G. Lower limbs biomechanical deficits associated with stage 1 and 2 posterior tibialis tendon dysfunction during walking. Gait Posture 2024; 110:10-16. [PMID: 38460464 DOI: 10.1016/j.gaitpost.2024.03.004] [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: 09/29/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Posterior tibialis tendon dysfunction (PTTD) is a chronic degenerative musculoskeletal disorder causing a progressive ankle complex and arch collapse altering lower limb biomechanics. However, biomechanical changes associated with stage 1 and 2 PTTD need to be better characterized during walking to guide clinical recommendations and improve non-operative treatments. RESEARCH QUESTION What are the lower limb kinematic and kinetic differences between individuals with stage 1 (PTTD1), individuals with stage 2 PTTD (PTTD2) and healthy counterparts during gait? METHODS Sixteen PTTD1, 11 PTTD2 and 20 healthy controls were included in this multicentric case-control study to compare their lower limb gait biomechanics. Kinematic and kinetic data were recorded using a three-dimensional motion capture system and a force plate. One-dimensional statistical parametric mapping was used to compare lower limb joint motion and moments between groups during the stance phase. RESULTS PTTD1 had minimal biomechanical differences compared with the control group. In contrast, PTTD2 presented significant differences compared with controls and PTTD1. At the ankle, PTTD2 exhibited greater plantarflexion and eversion angles and midfoot dorsiflexion and inversion angles throughout stance compared with controls and PTTD1. PTTD2 presented lower midfoot abduction moments compared with controls. These changes led PTTD2 to exhibit knee and hip adaptative biomechanical mechanisms in the frontal and transverse planes in late stance. PTTD2 had greater knee internal rotation angles and smaller knee external rotation moments compared to controls. PTTD2 had smaller hip internal rotation angles compared with PTTD1 and smaller hip adduction moments compared with controls. SIGNIFICANCE PTTD1 showed minimal biomechanical differences compared to controls and important differences compared to PTTD2. The lower limb biomechanical deficits accentuate as the pathology advances from stage 1 to stage 2. PTTD is a progressive condition needing early clinical management at stage 1 to avoid successive biomechanical changes associated with stage 2.
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Affiliation(s)
- Ahmed Dami
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada.
| | - Dominic Chicoine
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - Eléna Payen
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - Marc Bouchard
- CHU de Québec-Université Laval, 11, côte du Palais, Québec, QC G1R 2J6, Canada
| | - Etienne L Belzile
- CHU de Québec-Université Laval, 11, côte du Palais, Québec, QC G1R 2J6, Canada
| | - Phillipe Corbeil
- Department of Kinesiology, University Laval, 2325, rue de l'Université, Québec, QC G1V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, Boul. Wilfrid-Hamel, Québec, QC G1M 2S8, Canada
| | - Gabriel Moisan
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Department of Kinesiology, University Laval, 2325, rue de l'Université, Québec, QC G1V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, Boul. Wilfrid-Hamel, Québec, QC G1M 2S8, Canada
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Wuite S, Deschamps K, Eerdekens M, Scheys L, Loomans L, A Matricali G. Posterior tibial tendon dysfunction alters the midfoot mechanics and energetics during gait. J Orthop Res 2022; 40:2196-2208. [PMID: 34910323 DOI: 10.1002/jor.25241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/19/2021] [Accepted: 12/11/2021] [Indexed: 02/04/2023]
Abstract
A comprehensive insight into the in vivo foot kinetics of patients with posterior tibial tendon dysfunction (PTTD) is lacking to support clinical decision making. Our goal was to study how PTTD alters the kinetic and kinematic characteristics of the foot and ankle with a special focus on the midfoot joints. Multisegment foot joint kinetics and kinematics were compared based on the Rizzoli Foot Model and inversed dynamics between a control group (n = 25), patients with PTTD Stage II (n = 21) and PTTD Stage III (n = 4) over the entire stance phase. Compared to controls, a mean decrease in power generation of 1.3 W/kg was found in the Ankle joint in PTTD II patients (p < 0.001) and PTTD III patients of 1.5 W/kg (p < 0.001). In the Chopart joint, there was a mean increase in power absorption of 0.4 W/kg in the PTTD III patients (p = 0.014) and a mean decrease in power generation of 0.6 W/kg (p < 0.001) in the PTTD II patients. The distribution of total negative work showed a shift from the Ankle and first metatarsal phalangeal joint towards the Chopart joint in both PTTD compared with the control subjects. A significant reduction in range of motion was observed among both PTTD groups. The outcome of this study will enable the possibility to customize the conservative and surgical treatment of each patient with PTTD, to improve or even restore the kinetic features. This will prevent the natural deterioration of function seen in this pathology.
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Affiliation(s)
- Sander Wuite
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven and Division of Orthopaedics, Institute for Orthopaedic Research and Training, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kevin Deschamps
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Campus Brugge, Belgium.,Institut D'Enseignement Supérieur Parnasse Deux-Alice, Brussel, Belgium.,Department of Podiatry, Artevelde University College, Gent, Belgium
| | - Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, KU Leuven and Division of Orthopaedics, Institute for Orthopaedic Research and Training, University Hospitals Leuven, Leuven, Belgium
| | - Laura Loomans
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni A Matricali
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven and Division of Orthopaedics, Institute for Orthopaedic Research and Training, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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A 3-Dimensional Gait Analysis of the Effects of Fatigue-Induced Reduced Foot Adductor Muscle Strength on the Walking of Healthy Subjects. J Appl Biomech 2022; 38:271-279. [PMID: 35894908 DOI: 10.1123/jab.2022-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/11/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
Dysfunction of the tibialis posterior muscle is the most common cause of adult acquired flat foot. Tibialis posterior muscle weakness has been observed in several patient populations, including those in the early stages of rheumatoid arthritis. However, the influence of tibialis posterior weakness on gait mechanics is not fully understood, although gait instability has been reported. In 24 healthy participants, 3-dimension lower limb kinematics and kinetics during walking were evaluated bilaterally, before and after, a muscle fatigue protocol aiming to decrease the right foot adductor muscles strength, including the tibialis posterior muscle. The 3-dimension gait kinematics and kinetics were analyzed with statistical parametric mapping. The stance phase duration was increased for the right side. The right ankle external rotation moment decreased, and the left hip extension moment increased with reduced muscle strength compared with normal strength conditions. These changes are similar in patients with dysfunction in the tibialis posterior muscle, indicating that compensatory strategies observed in these patients might be related to the loss of tibialis posterior muscle strength. Such strategies may involve the unaffected side.
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Chicoine D, Bouchard M, Laurendeau S, Moisan G, Belzile EL, Corbeil P. Biomechanical effects of three types of foot orthoses in individuals with posterior tibial tendon dysfunction. Gait Posture 2021; 83:237-244. [PMID: 33190045 DOI: 10.1016/j.gaitpost.2020.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 10/13/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Posterior tibial tendon dysfunction (PTTD) is characterized by degeneration of this tendon leading to a flattening of the medial longitudinal arch of the foot. Foot orthoses (FOs) can be used as a treatment option, but their biomechanical effects on individuals with PTTD are not yet fully understood. RESEARCH QUESTION The aim of this study was to investigate the effects of three types of FOs on gait biomechanics in individuals with PTTD. METHODS Fourteen individuals were recruited with painful stage 1 or 2 PTTD based on Johnson and Strom's classification. Quantitative gait analysis of the affected limb was performed in four conditions: shoes only (Shoe), prefabricated FO (PFO), neutral custom FO (CFO) and custom varus FO (CVFO) with a 5° medial wedge and a 4 mm medial heel skive. A curve analysis, using 1D statistical parametric mapping, was undertaken to assess differences in lower limb joint motion, joint moments and muscle activity over the stance phase of gait across conditions. RESULTS Decreased hindfoot eversion angles, decreased ankle inversion moments and increased ankle eversion moments were observed with custom FOs compared to the Shoe and PFO conditions (p < 0.001). CFOs and CVFOs induced an increased knee abduction moment compared to Shoe (p < 0.001). No changes in hip kinematics and kinetics or in EMG activity of tested muscles were observed between conditions. SIGNIFICANCE Custom orthoses may be more suitable than PFOs to decrease the pathological biomechanical outcomes observed in PTTD. Decreased ankle inversion moments during the stance phase could explain why custom orthoses are effective at reducing pain in PTTD patients. However, clinicians should be careful when prescribing custom orthoses for PTTD since unwanted collateral biomechanical effects can be observed at the knee.
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Affiliation(s)
- Dominic Chicoine
- Department of Kinesiology, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boul. Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada.
| | - Marc Bouchard
- CHU de Québec-Université Laval, 11, côte du Palais, Québec, QC, G1R 2J6, Canada
| | - Simon Laurendeau
- Department of Kinesiology, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boul. Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
| | - Gabriel Moisan
- Department of Kinesiology, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boul. Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
| | - Etienne L Belzile
- CHU de Québec-Université Laval, 11, côte du Palais, Québec, QC, G1R 2J6, Canada
| | - Philippe Corbeil
- Department of Kinesiology, Université Laval, 2325, rue de l'Université, Québec, QC, G1V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boul. Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
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Tamura H, Tanaka R, Kawanishi H. Reliability of a markerless motion capture system to measure the trunk, hip and knee angle during walking on a flatland and a treadmill. J Biomech 2020; 109:109929. [DOI: 10.1016/j.jbiomech.2020.109929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
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Wang J, Mannen EM, Siddicky SF, Lee JM, Latt LD. Gait alterations in posterior tibial tendonitis: A systematic review and meta-analysis. Gait Posture 2020; 76:28-38. [PMID: 31715431 DOI: 10.1016/j.gaitpost.2019.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/14/2019] [Accepted: 11/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Posterior tibial tendon dysfunction (PTTD) is a common and debilitating tendinopathy that can lead to a profound decrease in gait function. While the clinical diagnosis and treatment of this disorder are well described, the pathomechanics have not been adequately characterized. The purpose of this systematic review and meta-analysis is to compare foot/ankle kinematics and kinetics in patients with PTTD with healthy controls during gait. METHODS Relevant articles were selected thought Medline (Pubmed), Scopus, CINAHL, and Web of Science. Studies focused on foot/ankle kinematics and kinetics in patients with PTTD were involved. Articles were included if they: 1) compared patients with PTTD to healthy controls, 2) utilized kinematics or kinetics as the primary outcome measure, 3) evaluated gait tasks, and 4) were written in English. RESULTS Eleven articles were included in this systematic review, and 8 studies were synthesized and analyzed. Our meta-analyses indicated increased dorsiflexion and abduction of the forefoot, as well as increased plantarflexion and eversion of hindfoot for patients with PTTD during stance of walking. CONCLUSION Our results from the meta-analysis showed more conclusive changes in the forefoot (increased dorsiflexion and abduction) and hindfoot (increased plantarflexion and eversion) kinematics during stance of walking, which may be associated with a pathological process of PTTD. This review provides an improved understanding of gait function in patients with PTTD and preliminary knowledge for future research.
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Affiliation(s)
- Junsig Wang
- Department of Orthopaedic Surgery, University of Arkansas for Medical Science, Little Rock, AR, USA.
| | - Erin M Mannen
- Department of Orthopaedic Surgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Safeer F Siddicky
- Department of Orthopaedic Surgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Jung-Min Lee
- Department of Physical Education, Kyung Hee University, Yong-in, Republic of Korea
| | - L Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
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