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Bruening DA, Petersen SR, Ridge ST. New Perspectives on Foot Segment Forces and Joint Kinetics-Integrating Plantar Shear Stresses and Pressures with Multi-segment Foot Modeling. Ann Biomed Eng 2024; 52:1719-1731. [PMID: 38494465 DOI: 10.1007/s10439-024-03484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/24/2024] [Indexed: 03/19/2024]
Abstract
The role of the many small foot articulations and plantar tissues in gait is not well understood. While kinematic multi-segment foot models have increased our knowledge of foot segmental motions, the integration of kinetics with these models could further advance our understanding of foot mechanics and energetics. However, capturing and effectively utilizing segmental ground reaction forces remains challenging. The purposes of this study were to (1) develop methodology to integrate plantar pressures and shear stresses with a multi-segment foot model, and (2) generate and concisely display key normative data from this combined system. Twenty-six young healthy adults walked barefoot (1.3 m/s) across a pressure/shear sensor with markers matching a published 4-segment foot model. A novel anatomical/geometric template-based masking method was developed that successfully separated regions aligned with model segmentation. Directional shear force plots were created to summarize complex plantar shear distributions, showing opposing shear forces both between and within segments. Segment centers of pressure (CoPs) were shown to be primarily stationary within each segment, suggesting that forward progression in healthy gait arises primarily from redistributing weight across relatively fixed contact points as opposed to CoP movement within a segment. Inverse dynamics-based normative foot joint moments and power were presented in the context of these CoPs to aid in interpretation of tissue stresses. Overall, this work represents a successful integration of motion capture with direct plantar pressure and shear measurements for multi-segment foot kinetics. The presented tools are versatile enough to be used with other models and contexts, while the presented normative database may be useful as a baseline comparison for clinical work in gait energetics and efficiency, balance, and motor control. We hope that this work will aid in the advancement and availability of kinetic MSF modeling, increase our knowledge of foot mechanics, and eventually lead to improved clinical diagnosis, rehabilitation, and treatment.
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Affiliation(s)
- Dustin A Bruening
- Department of Exercise Sciences, Brigham Young University, 120F RB, Provo, UT, 84602, USA.
| | - Spencer R Petersen
- Department of Exercise Sciences, Brigham Young University, 120F RB, Provo, UT, 84602, USA
| | - Sarah T Ridge
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, 06117, USA
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Park GY, Kyung MG, Yoon YS, Kim DY, Lee DO, Lee DY. Change of Segmental Motion Following Total Ankle Arthroplasty Using a 3-Dimensional Multi-segment Foot Model. Clin Orthop Surg 2024; 16:455-460. [PMID: 38827760 PMCID: PMC11130636 DOI: 10.4055/cios23331] [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: 10/23/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 06/04/2024] Open
Abstract
Background Total ankle arthroplasty (TAA) enhances patients' subjective outcomes with respect to pain and function. The aim of this study was to analyze the biomechanical changes of the affected limb following TAA using gait analysis with a 3-dimensional multi-segment foot model (3D MFM). Methods We reviewed medical records, simple radiographs, and gait analyses using a 3D MFM of patients who underwent TAA for severe varus ankle arthritis. Preoperative and postoperative gait data of 24 patients were compared. Postoperative gait analyses were done at least 1 year after surgery. Results TAA significantly increased stride length (p = 0.024). The total range of motion of all planes in the hindfoot and forefoot showed no significant changes between preoperative and postoperative states. Hindfoot was significantly plantarflexed and pronated after TAA, while forefoot was significantly supinated in all phases. After appropriate calculations, the genuine coronal motion of the hindfoot showed no changes after TAA in all phases. Conclusions TAA did not result in biomechanical improvements of segmental motions in the forefoot and hindfoot, except for changes to the bony structures. Therefore, it is important to point out to patients that TAA will not result in significant improvement of ankle function and range of motion. Clinicians can consider this information during preoperative counseling.
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Affiliation(s)
- Gil Young Park
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Korea
| | - Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Sik Yoon
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Böhm H, Stebbins J, Kothari A, Dussa CU. Dynamic Gait Analysis in Paediatric Flatfeet: Unveiling Biomechanical Insights for Diagnosis and Treatment. CHILDREN (BASEL, SWITZERLAND) 2024; 11:604. [PMID: 38790599 PMCID: PMC11119624 DOI: 10.3390/children11050604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized assessment. This review examined 3D assessments in paediatric idiopathic flexible flat feet (FFF). METHODS Searches focused on paediatric idiopathic FFF in PubMed, Web of Science, and SCOPUS. Inclusion criteria required 3D kinematic and/or kinetic analysis during posture or locomotion, excluding non-idiopathic cases, adult feet, and studies solely on pedobarography or radiographs. RESULTS Twenty-four studies met the criteria. Kinematic and kinetic differences between FFF and typical feet during gait were outlined, with frontal plane deviations like hindfoot eversion and forefoot supination, alongside decreased second peak vertical GRF. Dynamic foot classification surpassed static assessments, revealing varied movement patterns within FFF. Associations between gait characteristics and clinical measures like pain symptoms and quality of life were explored. Interventions varied, with orthoses reducing ankle eversion and knee and hip abductor moments during gait, while arthroereisis normalized calcaneal alignment and hindfoot eversion. CONCLUSIONS This review synthesises research on 3D kinematics and kinetics in paediatric idiopathic FFF, offering insights for intervention strategies and further research.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, Treatment Center Aschau im Chiemgau, 83229 Aschau im Chiemgau, Germany
- Faculty of Engineering and Health Göttingen, University of Applied Sciences and Arts, 37077 Göttingen, Germany
| | - Julie Stebbins
- Oxford University Hospitals NHSFT, Oxford OX3 9DU, UK; (J.S.); (A.K.)
| | - Alpesh Kothari
- Oxford University Hospitals NHSFT, Oxford OX3 9DU, UK; (J.S.); (A.K.)
| | - Chakravarthy Ughandar Dussa
- Department of Orthopaedic Trauma and Surgery, Friedrich-Alexander University Erlangen, 91054 Erlangen, Germany;
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Nicolescu J, Gaudette L, Vogel O, Davis IS, Tenforde AS, Troy KL. How many segments are enough to biomechanically model the feet? A comparison of inverse kinematics and dynamics in multisegmented foot models. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.13.593935. [PMID: 38798588 PMCID: PMC11118526 DOI: 10.1101/2024.05.13.593935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Multisegmented foot models (MSFMs) capture kinematic and kinetic data of specific regions of the foot instead of representing the foot as a single, rigid segment. Models differ by the number of segments and segment definitions, so there is no consensus for best practice. It is unknown whether MSFMs yield the same joint kinematic and kinetic data and what level of detail is necessary to accurately measure such values. We compared the angle, moment, and power measurements at the tibiotalar, midtarsal, and metatarsophalangeal joints of four MSFMs using motion capture data of young adult runners during stance phase of barefoot walking and jogging. Of these models, three were validated: Oxford Foot Model, Milwaukee Foot Model, and Ghent Foot Model. One model was developed based upon literature review of existing models: the "Vogel" model. We performed statistical parametric mapping comparing joint measurements from each model to the corresponding results from the Oxford Model, the most heavily studied MSFM. We found that the Oxford Foot Model, Milwaukee Foot Model, Vogel Foot Model, and Ghent Foot Model do not provide the same results. The changes in model segment definitions impact the degrees of freedom in ways that alter the measured kinematic function of the foot, which in turn impacts the kinetic results. We also found that dynamic function of the midfoot/arch may be better captured by MSFMs with a separate midfoot segment. The results of this study capture the variability in performance of MSFMs and indicate a need to standardize the design of MSFMs.
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Affiliation(s)
- Julia Nicolescu
- Dept. of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA
| | - Logan Gaudette
- Dept. of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Olivia Vogel
- Dept. of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA
| | - Irene S. Davis
- Dept. of Physical Therapy, University of South Florida, Tempe, FL
| | - Adam S. Tenforde
- Dept. of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Karen L. Troy
- Dept. of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA
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Schallig W, Piening M, Quirijnen L, Witbreuk MM, Buizer AI, van der Krogt MM. Multi-segment foot kinematics during gait in children with spastic cerebral palsy. Gait Posture 2024; 110:144-149. [PMID: 38608379 DOI: 10.1016/j.gaitpost.2024.03.014] [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: 10/24/2023] [Revised: 02/10/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Foot deformities (e.g. planovalgus and cavovarus) are very common in children with spastic cerebral palsy (CP), with the midfoot often being involved. Dynamic foot function can be assessed with 3D gait analysis including a multi-segment foot model. Incorporating a midfoot segment in such a model, allows quantification of separate Chopart and Lisfranc joint kinematics. Yet, midfoot kinematics have not previously been reported in CP. RESEARCH QUESTIONS What is the difference in multi-segment kinematics including midfoot joints between common foot deformities in CP and typically-developing feet? METHODS 103 feet of 57 children with spastic CP and related conditions were retrospectively included and compared with 15 typically-developing children. All children underwent clinical gait analysis with the Amsterdam Foot Model marker set. Multi-segment foot kinematics were calculated for three strides per foot and averaged. A k-means cluster analysis was performed to identify foot deformity groups that were present within CP data. The deformity type represented by each cluster was based on the foot posture index. Kinematic output of the clusters was compared to typically-developing data for a static standing trial and for the range of motion and kinematic waveforms during walking, using regular and SPM independent t-tests respectively. RESULTS A neutral, planovalgus and varus cluster were identified. Neutral feet showed mostly similar kinematics as typically-developing data. Planovalgus feet showed increased ankle valgus and Chopart dorsiflexion, eversion and abduction. Varus feet showed increased ankle varus and Chopart inversion and adduction. SIGNIFICANCE This study is the first to describe Chopart and Lisfranc joint kinematics in different foot deformities of children with CP. It shows that adding a midfoot segment can provide additional clinical and kinematic information. It highlights joint angles that are more distinctive between deformities, which could be helpful to optimize the use of multi-segment foot kinematics in the clinical decision making process.
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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, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Marjolein Piening
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, de Boelelaan 1117, Amsterdam the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Loes Quirijnen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, de Boelelaan 1117, Amsterdam the Netherlands
| | - Melinda M Witbreuk
- Amsterdam UMC location University of Amsterdam, Orthopedic surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- 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, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Emma Children's Hospital, Amsterdam UMC, 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; Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands
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Kang HW, Kim DY, Kim JM, Park GY, Lee DO, Lee DY. Hindfoot motion according to subtalar compensation and ankle osteoarthritis stage analyzed by a multi-segment foot model. J Orthop Surg Res 2024; 19:202. [PMID: 38532518 DOI: 10.1186/s13018-024-04615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/03/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The biomechanics of the hindfoot in ankle osteoarthritis (OA) are not yet fully understood. Here, we aimed to identify hindfoot motion in a gait analysis using a multi-segment foot model (MFM) according to ankle OA stage and the presence of subtalar compensation defined by hindfoot alignment. METHODS We retrospectively reviewed the medical records, plain radiographs, and gait MFM data of 54 ankles admitted to our hospital for the treatment of advanced ankle OA. Spatiotemporal gait parameters and three-dimensional motions of the hindfoot segment were analyzed according to sex, age, body mass index, Takakura classification, and the presence of subtalar compensation. Twenty ankles were categorized as compensated group, and 34 ankles as decompensated group. RESULTS No spatiotemporal gait parameters differed significantly according to the presence of subtalar compensation or ankle OA stage. Only normalized step width differed significantly (P = 0.028). Average hindfoot motion (decompensation vs. compensation) did not differ significantly between the sagittal and transverse planes. Graphing of the coronal movement of the hindfoot revealed collapsed curves in both groups that differed significantly. Compared with Takakura stages 3a, 3b, and 4, cases of more advanced stage 3b had a smaller sagittal range of motion than those of stage 3a (P = 0.028). Coronal movement of the hindfoot in cases of Takakura stage 3a/3b/4 showed a relatively flat pattern. CONCLUSIONS The spatiotemporal parameters were not affected by the hindfoot alignment resulting from subtalar compensation. The sagittal range of hindfoot motion decreased in patients with advanced ankle OA. Once disrupted, the coronal movement of the subtalar joint in ankle OA did not change regardless of ankle OA stage or hindfoot compensation state.
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Affiliation(s)
- Ho Won Kang
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jung Min Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gil Young Park
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea.
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 03080, Republic of Korea.
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Rethlefsen SA, Hanson A, Ciccodicola E, Hara R, Kay RM, Chambers H, Wren TAL. Update on the reliability of gait analysis interpretation in cerebral palsy: Inter-institution agreement. Gait Posture 2024; 109:109-114. [PMID: 38295485 DOI: 10.1016/j.gaitpost.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/26/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Studies have shown good reliability for gait analysis interpretation among surgeons from the same institution. However, reliability among surgeons from different institutions remains to be determined. RESEARCH QUESTION Is gait analysis interpretation by surgeons from different institutions as reliable as it is for surgeons from the same institution? METHODS Gait analysis data for 67 patients with cerebral palsy (CP) were reviewed prospectively by two orthopedic surgeons from different institutions in the same state, each with > 10 years' experience interpreting gait analysis data. The surgeons identified gait problems and made treatment recommendations for each patient using a rating form. Percent agreement between raters was calculated for each problem and treatment, and compared to expected agreement based on chance using Cohen's kappa. RESULTS For problem identification, the greatest agreement was seen for equinus (85% agreement), calcaneus (88%), in-toeing (89%), and out-toeing (90%). Agreement for the remaining problems ranged between 66-78%. Percent agreement was significantly higher than expected due to chance for all issues (p ≤ 0.01) with modest kappa values ranging from 0.12 to 0.51. Agreement between surgeons for treatment recommendations was highest for triceps surae lengthening (89% agreement), tibial derotation osteotomy (90%), and foot osteotomy (87%). Agreement for the remaining treatments ranged between 72-78%. Percent agreement for all treatments was significantly higher than the expected values (p ≤ 0.002) with modest kappa values ranging from 0.22 to 0.52. SIGNIFICANCE Previous research established that computerized gait analysis data interpretation is reliable for surgeons within a single institution. The current study demonstrates that gait analysis interpretation can also be reliable among surgeons from different institutions. Future research should examine reliability among physicians from more institutions to confirm these results.
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Affiliation(s)
- Susan A Rethlefsen
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
| | - Alison Hanson
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Eva Ciccodicola
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Reiko Hara
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Robert M Kay
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Hank Chambers
- Rady Children's Hospital, 3030 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Tishya A L Wren
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
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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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Sato T, Iida K, Ohkawa T, Fukui T. Relationship between ankle-foot-complex mobility during static loading and frontal moment impulses of knee and hip joints during the stance phase. Gait Posture 2024; 108:301-306. [PMID: 38181482 DOI: 10.1016/j.gaitpost.2023.12.017] [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: 06/13/2023] [Revised: 11/08/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Ankle-foot-complex mobility impairments, which can be assessed by the difference between the sitting and standing positions, are related to an increase in the load on the knee and hip joints during the stance phase of the gait. RESEARCH QUESTION What is the relationship between the ankle-foot-complex mobility during static weight bearing and the mechanical stresses on the knee and hip joints throughout the stance phase? METHODS Ankle-foot-complex mobility and gait data were collected from 26 healthy adults. The complex mobility was established by comparing the foot indices, measured using a three-dimensional foot scanner, in sitting and standing positions. The gait data were acquired using eight cameras (recording at 100 Hz) and three force plates (recording at 1000 Hz). Stance phase data were collected via ground reaction forces. The stance phase was dissected into shock absorption and propulsion phases, during which the external knee and hip adduction moment impulses (KAMi, HAMi) were recorded. The correlation between the ankle-foot-complex mobility during static weight bearing and KAMi and HAMi during the stance phase was examined using Pearson's product-moment correlation coefficients. RESULTS This study revealed that KAMi correlated with medial malleolus mobility (r = -0.44) throughout the stance phase. Furthermore, in the propulsive phase, KAMi correlated with calcaneus (r = 0.51) and navicular (r = -0.50) mobilities, whereas HAMi correlated with calcaneus mobility (r = -0.40). SIGNIFICANCE The study provides insights into the relationship between the static mobility of the ankle-foot complex in healthy individuals and mechanical stress during the stance phase. Calcaneus and navicular mobilities were related to efficient push-off in the propulsive phase. Medial malleolus mobility was related to the control of the lateral tilt of the lower limb and ankle dorsiflexion motion throughout the stance phase.
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Affiliation(s)
- Toshihiko Sato
- Department of Physical Therapy, Faculty of Health Science Technology, Bunkyo Gakuin University, 1196 Kamekubo, Fujimino-shi, Saitama 356-8533, Japan.
| | - Kai Iida
- Department of Physical Therapy, Faculty of Health Science Technology, Bunkyo Gakuin University, 1196 Kamekubo, Fujimino-shi, Saitama 356-8533, Japan
| | - Takahiro Ohkawa
- Department of Physical Therapy, Faculty of Health Science Technology, Bunkyo Gakuin University, 1196 Kamekubo, Fujimino-shi, Saitama 356-8533, Japan
| | - Tsutomu Fukui
- Department of Physical Therapy, Faculty of Health Science Technology, Bunkyo Gakuin University, 1196 Kamekubo, Fujimino-shi, Saitama 356-8533, Japan; Health Care Science, Graduate School, Bunkyo Gakuin University, 1-19-1 Mukogaoka, Bunkyo-ku, Tokyo 113-8668, Japan
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Lenhart RL, Goodbody CM. Symptomatic flatfoot in cerebral palsy. Curr Opin Pediatr 2024; 36:98-104. [PMID: 37872808 DOI: 10.1097/mop.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the current literature and best practices in the evaluation and treatment of symptomatic flatfoot in cerebral palsy. RECENT FINDINGS While techniques to reconstruct the neuromuscular flatfoot and reestablish bony levers have remained similar over time, the concept of surgical dosing has helped guide appropriate interventions based on the magnitude of disease and functional level of the child. Moreover, the utilization of multisegment foot modeling in motion analysis has allowed quantitative description of such deformities and their impact on gait. SUMMARY Future research should focus on refining operative indications and interventions with larger, multicenter, prospective cohorts to provide more robust evidence in surgical decision making. Long-term data are needed to confirm and compare efficacy of procedures. Radiographic data alone are not sufficient for describing functional foot position. Gait analysis with foot modeling and pedobarography along with patient-centered subjective outcomes will be needed in such investigations to make conclusive recommendations.
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Conconi M, Pompili A, Sancisi N, Durante S, Leardini A, Belvedere C. Foot kinematics as a function of ground orientation and weightbearing. J Orthop Res 2024; 42:148-163. [PMID: 37442638 DOI: 10.1002/jor.25661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
The foot is responsible for the bodyweight transfer to the ground, while adapting to different terrains and activities. Despite this fundamental role, the knowledge about the foot bone intrinsic kinematics is still limited. The aim of the study is to provide a quantitative and systematic description of the kinematics of all bones in the foot, considering the full range of dorsi/plantar flexion and pronation/supination of the foot, both in weightbearing and nonweightbearing conditions. Bone kinematics was accurately reconstructed for three specimens from a series of computed tomography scans taken in weightbearing configuration. The ground inclination was imposed through a set of wedges, varying the foot orientation both in the sagittal and coronal planes; the donor body-weight was applied or removed by a cable-rig. A total of 32 scans for each foot were acquired and segmented. Bone kinematics was expressed in terms of anatomical reference systems optimized for the foot kinematic description. Results agree with previous literature where available. However, our analysis reveals that bones such as calcaneus, navicular, intermediate cuneiform, fourth and fifth metatarsal move more during foot pronation than flexion. Weightbearing significantly increase the range of motion of almost all the bone. Cuneiform and metatarsal move more due to weightbearing than in response to ground inclination, showing their role in the load-acceptance phase. The data here reported represent a step toward a deeper understanding of the foot behavior, that may help in the definition of better treatment and medical devices, as well as new biomechanical model of the foot.
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Affiliation(s)
- Michele Conconi
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Alessandro Pompili
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Stefano Durante
- Area Tecnico Diagnostica Radiologica, IRCCS S. Orsola Malpighi Hospital, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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12
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Zhu S, Jenkyn T. Development of a clinically useful multi-segment kinetic foot model. J Foot Ankle Res 2023; 16:86. [PMID: 38017489 PMCID: PMC10685473 DOI: 10.1186/s13047-023-00686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Traditionally, gait analysis studies record the foot as a single rigid segment, leaving movements and loads within the foot undetected. In addition, very few data of multi-segment foot kinetics have been represented in the literature due to measurement and equipment limitations. As a result, this study aims to develop a novel multi-segment kinetic foot model that is clinically feasible and enables both kinematic and kinetic analysis of large patient groups. RESULTS Outcome measurements include rotation angles of intersegmental dorsi/plantar flexion, inversion/eversion, and internal/external rotation, joint moments, joint powers and the medial longitudinal arch (MLA) height/length ratio. Repeatability of joint motions was calculated using coefficients of multiple correlation. Most joint motions measured by this foot model showed strong within-subject reliability (R > 0.7) in healthy adults. Outcome measures were in agreement with other multi-segment foot models found in the biomechanics literature. CONCLUSIONS This novel multi-segment foot model is able to quantify intersegmental foot kinematics and kinetics and can be a useful tool for research and assessments on clinical populations.
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Affiliation(s)
- Songlin Zhu
- Wolf Orthopaedic Biomechanics Laboratory, School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, N6A 5B9, Canada.
| | - Thomas Jenkyn
- Wolf Orthopaedic Biomechanics Laboratory, Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, N6A 5B9, Canada
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13
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Akuzawa H, Imai A, Iizuka S, Matsunaga N, Kaneoka K. Contribution of the tibialis posterior and peroneus longus to inter-segment coordination of the foot during single-leg drop jump. Sports Biomech 2023; 22:1430-1443. [PMID: 32865130 DOI: 10.1080/14763141.2020.1806347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
Abnormal foot motion is considered to be related to sports related injuries. This study aimed to identify the relationship between calf muscle activity and inter-segment coordination of the foot during single-leg drop jumps. Eleven healthy men participated and performed single-leg drop jumps from a 30-cm box. Muscle activity of the tibialis posterior (TP), flexor digitorum longus, peroneus longus (PL) and gastrocnemius were measured. The rearfoot and midfoot segment angle from landing to leaping were calculated according to the Rizzoli Foot Model and time scaled to 100%. A modified vector coding technique was employed to classify inter-segment coordination of every 1% into four patterns (in-phase, anti-phase, rearfoot phase,and midfoot phase). The relationship between percentage of each pattern and muscle activity levels were statistically analysed with correlation coefficient. The TP showed a significant positive correlation with percentage of in-phase in coronal plane (r = 0.61, p = 0.045). The PL also showed a trend of positive correlation to in-phase in coronal plane (r = 0.59, p = 0.058). TP and PL muscle activities may modulate the inter-segment coordination between the rearfoot and midfoot in coronal plane. Clinically, these muscles should be assessed for abnormal inter-segment foot motion.
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Affiliation(s)
- Hiroshi Akuzawa
- Department of Sports Science, Japan Institute of Sport Sciences, Tokya, Saitama, Japan
| | - Atsushi Imai
- Faculty of Health and Medical Sciences, Aichi Shukutoku University, Nagakute, Aichi, Japan
| | - Satoshi Iizuka
- Department of Sports Science, Japan Institute of Sport Sciences, Tokya, Saitama, Japan
| | - Naoto Matsunaga
- General Education Core Curriculum Division, Seigakuin University, Ageo, Saitama, Japan
- Waseda Institute for Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Koji Kaneoka
- Department of Sports Science, Japan Institute of Sport Sciences, Tokya, Saitama, Japan
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14
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Bassett KE, Charles SK, Bruening DA. The signed helical angle: A technique for characterizing midfoot motion during gait. J Biomech 2023; 159:111791. [PMID: 37734183 DOI: 10.1016/j.jbiomech.2023.111791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
Quantifying motion in the midfoot during gait and other movements is important for a variety of applications, but challenging due to the complexity of the multiple small articulations involved. The most common motion capture based techniques are limited in their ability to characterize the non-planar nature of the midfoot joint axes. In this study we developed a novel Signed Helical Angle (SHA) to quantify midfoot angular displacement. Motion capture data from 40 healthy subjects walking at a controlled speed were used to calculate finite helical axes and angles from a two-segment foot model. Axes were classified as either pronation or supination based on their orientation, and given a sign, thus either adding to or subtracting from the angular displacement. Analysis focused on insights from axis orientation and comparisons to other techniques. Results showed that when transitions were excluded, pronation and supination axes were fairly well clustered in the transverse plane. The resulting SHA midfoot angle waveform was comparable to sagittal plane Euler and helical component waveforms, but with 39% (approximately 3°) greater range of motion in pronation and 25% (approximately 4°) greater in supination, due to the direct measurement of the motion path and the influence of the other planes. The proposed SHA method may provide an intuitive and useful method to analyze midfoot motion for a variety of applications, particularly when interventions cause subtle changes that may be diluted in planar analyses.
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Affiliation(s)
- Kirk E Bassett
- Brigham Young University, Mechanical Engineering Department, USA
| | - Steven K Charles
- Brigham Young University, Mechanical Engineering Department, USA
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15
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Phillips T, Brierty A, Goodchild D, Patritti BL, Murphy A, Boocock M, Dwan L, Passmore E, McGrath M, Edwards J. Australia and New Zealand Clinical Motion Analysis Group (ANZ-CMAG) clinical practice recommendations. Gait Posture 2023; 106:1-10. [PMID: 37607445 DOI: 10.1016/j.gaitpost.2023.07.001] [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] [Indexed: 08/24/2023]
Abstract
Clinical motion analysis involves quantitative measurement of gait patterns to identify gait anomalies that currently or have the potential to impact function, activities of daily living and participation. Clinical motion analysis services are equipped with motion capture technology and comprise specialised staff who deliver 3-dimensional motion analysis services to children and adults who present with varying levels of gait impairment. Data is then used to inform intervention recommendations to clinicians with a view to maintaining independent, functional and pain free walking (or appropriate mobility). The ANZ-CMAG (established in 2013) identified a need to establish recommendations to assist in standardising practice guidelines for both current and new clinical motion analysis services within the region. The group serves to promote collaboration between services in quality assurance processes, clinical practices, data sets and research activities. The clinical practice recommendations described in this paper cover: i) requirements for a motion analysis service (including staffing, facilities and equipment), ii) patient assessments (requirements, clinical information and data gathered, reporting and interpretation of patient data), iii) quality assurance processes (including motion capture system / biomechanical models & limitations, marker placement, data storage / record keeping, creation of normative dataset); iv) helpful resources. Better outcomes for children and adults with gait deviations is dependent upon accurate measurement and evaluation of walking and requires input from multidisciplinary clinical teams with specialist knowledge and skills. The ANZ-CMAG hopes these clinical practice recommendations are beneficial to motion analysis services with an aim to improve clinical practices, patient outcomes, and support research collaboration.
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Affiliation(s)
- Teresa Phillips
- Queensland Children's Motion Analysis Service, Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, 4101, Australia.
| | - Alexis Brierty
- Queensland Children's Motion Analysis Service, Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, 4101, Australia
| | - Denni Goodchild
- Queensland Children's Motion Analysis Service, Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, 4101, Australia
| | - Benjamin L Patritti
- South Australian Movement Analysis Centre, Division of Rehabilitation, Aged and Palliative Care, Flinders Medical Centre, Adelaide, 5042, Australia; College of Medicine and Public Health, Flinders University, Adelaide, 5042, Australia
| | - Anna Murphy
- Clinical Gait Analysis Service, Monash Health, Victoria, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, Victoria, 3800, Australia
| | - Mark Boocock
- Health and Rehabilitation Research Institute, Auckland University of Technology, Northcote, 0627, New Zealand
| | - Leanne Dwan
- The Children's Hospital at Westmead, Sydney, 2145, Australia; School of Health Sciences, The University of Sydney, Sydney, 2006, Australia
| | - Elyse Passmore
- Royal Children's Hospital, Gait Analysis Laboratory, Parkville, 3052, Australia; Murdoch Children's Research Institute, Developmental Imaging, Parkville, 3052, Australia; University of Melbourne, Engineering and Information Technology, Parkville, 3052, Australia; University of Melbourne, Medicine, Dentistry & Health Sciences, Parkville, 3052, Australia
| | - Michelle McGrath
- Queensland Motion Analysis Centre, Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, 4006, Australia
| | - Julie Edwards
- Queensland Children's Motion Analysis Service, Department of Orthopaedics, Children's Health Queensland Hospital and Health Service, South Brisbane, 4101, Australia
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16
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Sancho-Bru JL, Sanchis-Sales E, Rodríguez-Cervantes PJ, Vergés-Salas C. Foot Sole Contact Forces vs. Ground Contact Forces to Obtain Foot Joint Moments for In-Shoe Gait-A Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6744. [PMID: 37571530 PMCID: PMC10422389 DOI: 10.3390/s23156744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
In-shoe models are required to extend the clinical application of current multisegment kinetic models of the bare foot to study the effect of foot orthoses. Work to date has only addressed marker placement for reliable kinematic analyses. The purpose of this study is to address the difficulties of recording contact forces with available sensors. Ten participants walked 5 times wearing two different types of footwear by stepping on a pressure platform (ground contact forces) while wearing in-shoe pressure sensors (foot sole contact forces). Pressure data were segmented by considering contact cells' anteroposterior location, and were used to compute 3D moments at foot joints. The mean values and 95% confidence intervals were plotted for each device per shoe condition. The peak values and times of forces and moments were computed per participant and trial under each condition, and were compared using mixed-effect tests. Test-retest reliability was analyzed by means of intraclass correlation coefficients. The curve profiles from both devices were similar, with higher joint moments for the instrumented insoles at the metatarsophalangeal joint (~26%), which were lower at the ankle (~8%) and midtarsal (~15%) joints, although the differences were nonsignificant. Not considering frictional forces resulted in ~20% lower peaks at the ankle moments compared to previous studies, which employed force plates. The device affected both shoe conditions in the same way, which suggests the interchangeability of measuring joint moments with one or the other device. This hypothesis was reinforced by the intraclass correlation coefficients, which were higher for the peak values, although only moderate-to-good. In short, both considered alternatives have drawbacks. Only the instrumented in-soles provided direct information about foot contact forces, but it was incomplete (evidenced by the difference in ankle moments between devices). However, recording ground reaction forces offers the advantage of enabling the consideration of contact friction forces (using force plates in series, or combining a pressure platform and a force plate to estimate friction forces and torque), which are less invasive than instrumented insoles (which may affect subjects' gait).
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Affiliation(s)
- Joaquín L. Sancho-Bru
- Department of Mechanical Engineering and Construction, Universitat Jaume I, 12071 Castellón de la Plana, Spain;
| | - Enrique Sanchis-Sales
- Departmental Section of Podiatry, Nursing Department, Universitat de València, 46010 Valencia, Spain;
| | | | - Carles Vergés-Salas
- Departmental Section of Podiatry, Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain;
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17
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Wren TAL, Isakov P, Rethlefsen SA. Comparison of kinematics between Theia markerless and conventional marker-based gait analysis in clinical patients. Gait Posture 2023; 104:9-14. [PMID: 37285635 DOI: 10.1016/j.gaitpost.2023.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Markerless motion capture systems have the potential to make clinical gait analysis more efficient and convenient. Theia3D is a commercially available markerless system that may serve as an alternative to traditional gait analysis for clinical gait laboratories. RESEARCH QUESTION What is the concurrent validity of markerless gait analysis using Theia3D compared to traditional marker-based gait analysis in pediatric clinical gait patients? METHODS Thirty-six patients (20 male, age 2-25 years) with a range of diagnoses underwent clinical gait analysis with data being captured concurrently by a traditional marker-based motion capture system (Vicon Nexus) and a commercial markerless system (Theia3D). Multiple left strides were averaged for each subject, and the difference in kinematics (Theia - Vicon) was calculated over the gait cycle and evaluated using root mean square difference (RMSD), mean difference, and RMSD after subtracting the mean value across the gait cycle (RMSDoffset). Sub-analysis was performed for 25 patients with foot deformities, 9 wearing ankle-foot orthoses, and 6 walking with assistance (cane, crutches, walker, or handheld). RESULTS Kinematics showed similar patterns between the marker-based and markerless systems. RMSD was < 6° except for pelvic tilt, hip flexion, ankle inversion, foot progression, and transverse plane rotation of the hip, knee, and ankle. These measures mainly differed due to an offset between the curves. After adjusting for offsets, all RMSDoffset were < 6°. RMSD was larger for patients with foot deformities, wearing orthoses, or using assistive devices, but all RMSDoffset were still < 8°. In some cases, however, the markerless system had greater trial-to-trial variability, showed a larger knee varus "bump" in swing, or failed to track the subject. SIGNIFICANCE This study provides preliminary evidence of concurrent validity of Theia3D for pediatric patients with abnormal gait. However, some questions remain regarding identification of the knee axis and for patients with foot deformity or assistive devices.
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Affiliation(s)
- Tishya A L Wren
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, USA; Departments of Orthopaedic Surgery, Radiology, and Biomedical Engineering, University of Southern California, Los Angeles, USA.
| | - Pavel Isakov
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, USA
| | - Susan A Rethlefsen
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, USA
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18
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Papachatzis N, Ray SF, Takahashi KZ. Does human foot anthropometry relate to plantar flexor fascicle mechanics and metabolic energy cost across various walking speeds? J Exp Biol 2023; 226:jeb245113. [PMID: 37092255 PMCID: PMC10226764 DOI: 10.1242/jeb.245113] [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: 09/27/2022] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
Foot structures define the leverage in which the ankle muscles push off against the ground during locomotion. While prior studies have indicated that inter-individual variation in anthropometry (e.g. heel and hallux lengths) can directly affect force production of ankle plantar flexor muscles, its effect on the metabolic energy cost of locomotion has been inconclusive. Here, we tested the hypotheses that shorter heels and longer halluces are associated with slower plantar flexor (soleus) shortening velocity and greater ankle plantar flexion moment, indicating enhanced force potential as a result of the force-velocity relationship. We also hypothesized that such anthropometry profiles would reduce the metabolic energy cost of walking at faster walking speeds. Healthy young adults (N=15) walked at three speeds (1.25, 1.75 and 2.00 m s-1), and we collected in vivo muscle mechanics (via ultrasound), activation (via electromyography) and whole-body metabolic energy cost of transport (via indirect calorimetry). Contrary to our hypotheses, shorter heels and longer halluces were not associated with slower soleus shortening velocity or greater plantar flexion moment. Additionally, longer heels were associated with reduced metabolic cost of transport, but only at the fastest speed (2.00 m s-1, R2=0.305, P=0.033). We also found that individuals with longer heels required less increase in plantar flexor (soleus and gastrocnemius) muscle activation to walk at faster speeds, potentially explaining the reduced metabolic cost.
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Affiliation(s)
- Nikolaos Papachatzis
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Department of Mechanical Engineering & Materials Science, Yale University, New Haven, CT 06520, USA
| | - Samuel F. Ray
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Kota Z. Takahashi
- Department of Health & Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
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19
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Sacco ICN, Trombini-Souza F, Suda EY. Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective. J Biomech 2023; 154:111604. [PMID: 37159980 DOI: 10.1016/j.jbiomech.2023.111604] [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: 01/26/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.
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Affiliation(s)
- Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Francis Trombini-Souza
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil; Master's and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Eneida Yuri Suda
- Postgraduate Program in Physiotherapy, Universidade Ibirapuera, São Paulo, Brazil
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20
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Uhan J, Kothari A, Zavatsky A, Stebbins J. Using surface markers to describe the kinematics of the medial longitudinal arch. Gait Posture 2023; 102:118-124. [PMID: 37003196 DOI: 10.1016/j.gaitpost.2023.03.016] [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: 12/05/2022] [Revised: 02/16/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Static and dynamic assessment of the medial longitudinal arch (MLA) is an essential aspect for measuring foot function in both clinical and research fields. Despite this, most multi-segment foot models lack the ability to directly track the MLA. This study aimed to assess various methods of MLA assessment, through motion capture of surface markers on the foot during various activities. METHODS Thirty general population participants (mean age 20 years) without morphological alterations to their feet underwent gait analysis. Eight measures, each representing a unique definition of the MLA angle using either real only, or both real and floor-projected markers, were created. Participants performed tasks including standing, sitting, heel lift, Jack's test and walking, and had their Arch Height Index (AHI) measured using callipers. Multiple-criteria decision analysis (MCDA) with 10 criteria was utilised for selecting the optimal measure for dynamic and static MLA assessment. RESULTS In static tasks, the standing MLA angle was significantly greater in all measures but one when compared to sitting, Jack's test and heel lift. The MLA angle in Jack's test was significantly greater than in heel lift in all measures. Across the compared dynamic tasks, significant differences were noted in all measures except one for foot strike in comparison to 50% gait cycle. All MLA measures held significant inverse correlations with MLA measured from static and dynamic tasks. Based on MCDA criteria, a measure comprising the first metatarsal head, fifth metatarsal base, navicular and heel markers was deemed the best for MLA assessment. SIGNIFICANCE This study aligns with the current literature recommendations for the use of a navicular marker for characterising the MLA. It contrasts with previous recommendations and advocates against the use of projected markers in most situations.
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Affiliation(s)
- Jerneja Uhan
- Department of NDORMS, University of Oxford, Oxford, UK.
| | - Alpesh Kothari
- Department of NDORMS, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amy Zavatsky
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Julie Stebbins
- Department of NDORMS, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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21
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Ankle Kinematics Characterization in Children with Idiopathic Toe Walking: Does the Foot Model Change the Clinical Evaluation? Healthcare (Basel) 2023; 11:healthcare11060873. [PMID: 36981531 PMCID: PMC10047957 DOI: 10.3390/healthcare11060873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Idiopathic toe walking (ITW) is a gait deviation characterized by forefoot contact with the ground, sometimes observed in children, that alters ankle kinematics, possibly leading to health-related issues. When studying foot and ankle gait deviations, the adoption of a single-segment foot model entails a significant simplification of foot and ankle movement, and thus may potentially mask some important foot dynamics. Differences in ankle kinematics between single- (conventional gait model, PiG, or Davis) and multi-segment (Oxford foot model, OFM) foot models were investigated in children with ITW. Fourteen participants were enrolled in the study and underwent instrumented gait analysis. Children were asked to walk barefoot and while wearing a foot orthosis that modified the ankle movement pattern toward a more physiological one without blocking foot intrinsic motion. ITW gait abnormalities, e.g., the absence of heel rocker and the presence of anticipated forefoot rocker, were found/not found according to the foot model. Walking conditions significantly interacted with the foot model effect. Finally, the different characterization of gait abnormalities led to a different classification of ITW, with a possible impact on the clinical evaluation. Due to its closer adhesion to ankle anatomy and to its sensitivity to ITW peculiarities, OFM may be preferable for instrumented gait analysis in this population.
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22
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Hébert-Losier K, Dai B, Nunome H, Kong PW, Hobara H, Hsu WC, Bradshaw EJ, Fong DTP, Vanwanseele B. Reporting guidelines for running biomechanics and footwear studies using three-dimensional motion capture. Sports Biomech 2023; 22:473-484. [PMID: 36097884 DOI: 10.1080/14763141.2022.2110149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, Tauranga, New Zealand
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Hiroyuki Nunome
- Faculty of Sports and Health Science, Fukuoka University, Jonan-ku, Fukuoka, Japan
| | - Pui Wah Kong
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore
| | - Hiroaki Hobara
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Wei-Chun Hsu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Elizabeth J Bradshaw
- Centre for Sport Research, School of Exercise and Nutrition Science, Deakin University, Melbourne, Australia.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Benedicte Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU, Leuven, Belgium
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23
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Biomechanical Implications of Congenital Conditions of the Foot/Ankle. Foot Ankle Clin 2023; 28:27-43. [PMID: 36822687 DOI: 10.1016/j.fcl.2022.10.003] [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] [Indexed: 01/03/2023]
Abstract
Segmental foot and ankle models are often used as part of instrumented gait analysis when planning interventions for complex congenital foot conditions. More than 40 models have been used for clinical analysis, and it is important to understand the technical differences among models. These models have been used to improve clinical planning of pediatric foot conditions including clubfoot, planovalgus, and equinovarus. They have also been used to identify clinically relevant subgroups among pediatric populations, quantify postoperative outcomes, and explain variability in healthy populations.
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24
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Fast tool to evaluate 3D movements of the foot-ankle complex using multi-view depth sensors. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2023. [DOI: 10.1016/j.medntd.2023.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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25
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Brasiliano P, Mascia G, Di Feo P, Di Stanislao E, Alvini M, Vannozzi G, Camomilla V. Impact of Gait Events Identification through Wearable Inertial Sensors on Clinical Gait Analysis of Children with Idiopathic Toe Walking. MICROMACHINES 2023; 14:277. [PMID: 36837977 PMCID: PMC9962364 DOI: 10.3390/mi14020277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Idiopathic toe walking (ITW) is a gait deviation characterized by forefoot contact with the ground and excessive ankle plantarflexion over the entire gait cycle observed in otherwise-typical developing children. The clinical evaluation of ITW is usually performed using optoelectronic systems analyzing the sagittal component of ankle kinematics and kinetics. However, in standardized laboratory contexts, these children can adopt a typical walking pattern instead of a toe walk, thus hindering the laboratory-based clinical evaluation. With these premises, measuring gait in a more ecological environment may be crucial in this population. As a first step towards adopting wearable clinical protocols embedding magneto-inertial sensors and pressure insoles, this study analyzed the performance of three algorithms for gait events identification based on shank and/or foot sensors. Foot strike and foot off were estimated from gait measurements taken from children with ITW walking barefoot and while wearing a foot orthosis. Although no single algorithm stands out as best from all perspectives, preferable algorithms were devised for event identification, temporal parameters estimate and heel and forefoot rocker identification, depending on the barefoot/shoed condition. Errors more often led to an erroneous characterization of the heel rocker, especially in shoed condition. The ITW gait specificity may cause errors in the identification of the foot strike which, in turn, influences the characterization of the heel rocker and, therefore, of the pathologic ITW behavior.
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Affiliation(s)
- Paolo Brasiliano
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Guido Mascia
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Paolo Di Feo
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Eugenio Di Stanislao
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
- “ITOP SpA Officine Ortopediche”, Via Prenestina Nuova 307/A, 00036 Palestrina, Italy
| | - Martina Alvini
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
- “ITOP SpA Officine Ortopediche”, Via Prenestina Nuova 307/A, 00036 Palestrina, Italy
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Valentina Camomilla
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
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26
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Li M, Wang J, Yang S, Xie J, Xu G, Luo S. A CNN-LSTM model for six human ankle movements classification on different loads. Front Hum Neurosci 2023; 17:1101938. [PMID: 36968785 PMCID: PMC10030731 DOI: 10.3389/fnhum.2023.1101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
This study aims to address three problems in current studies in decoding the ankle movement intention for robot-assisted bilateral rehabilitation using surface electromyogram (sEMG) signals: (1) only up to four ankle movements could be identified while six ankle movements should be classified to provide better training; (2) feeding the raw sEMG signals directly into the neural network leads to high computational cost; and (3) load variation has large influence on classification accuracy. To achieve this, a convolutional neural network (CNN)-long short-term memory (LSTM) model, a time-domain feature selection method of the sEMG, and a two-step method are proposed. For the first time, the Boruta algorithm is used to select time-domain features of sEMG. The selected features, rather than raw sEMG signals are fed into the CNN-LSTM model. Hence, the number of model's parameters is reduced from 331,938 to 155,042, by half. Experiments are conducted to validate the proposed method. The results show that our method could classify six ankle movements with relatively good accuracy (95.73%). The accuracy of CNN-LSTM, CNN, and LSTM models with sEMG features as input are all higher than that of corresponding models with raw sEMG as input. The overall accuracy is improved from 73.23% to 93.50% using our two-step method for identifying the ankle movements with different loads. Our proposed CNN-LSTM model have the highest accuracy for ankle movements classification compared with CNN, LSTM, and Support Vector Machine (SVM).
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Affiliation(s)
- Min Li
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Min Li
| | - Jiale Wang
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Shiqi Yang
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Jun Xie
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Guanghua Xu
- Department of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Shan Luo
- Department of Engineering, King’s College London, London, United Kingdom
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27
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Klein T, Chapman GJ, Lastovicka O, Janura M, Richards J. Do different multi-segment foot models detect the same changes in kinematics when wearing foot orthoses? J Foot Ankle Res 2022; 15:68. [PMID: 36071489 PMCID: PMC9454165 DOI: 10.1186/s13047-022-00574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background Different multi-segment foot models have been used to explore the effect of foot orthoses. Previous studies have compared the kinematic output of different multi-segment foot models, however, no study has explored if different multi-segment foot models detect similar kinematic changes when wearing a foot orthoses. The aim of this study was to compare the ability of two different multi-segment foot models to detect kinematic changes at the hindfoot and forefoot during the single and double support phases of gait when wearing a foot orthosis. Methods Foot kinematics were collected during walking from a sample of 32 individuals with and without a foot orthosis with a medial heel bar using an eight-camera motion capture system. The Oxford Foot Model (OFM) and a multi-segment foot model using the Calibrated Anatomical System Technique (CAST) were applied simultaneously. Vector field statistical analysis was used to explore the kinematic effects of a medial heel bar using the two models, and the ability of the models to detect any changes in kinematics was compared. Results For the hindfoot, both models showed very good agreement of the effect of the foot orthosis across all three anatomical planes during the single and double support phases. However, for the forefoot, the level of agreement between the models varied with both models showing good agreement of the effect in the coronal plane but poorer agreement in the transverse and sagittal planes. Conclusions This study showed that while consistency exists across both models for the hindfoot and forefoot in the coronal plane, the forefoot in the transverse and sagittal planes showed inconsistent responses to the foot orthoses. This should be considered when interpreting the efficacy of different interventions which aim to change foot biomechanics.
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Affiliation(s)
- Tomas Klein
- Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, Olomouc, 77147, Czech Republic.
| | - Graham J Chapman
- Allied Health Research Unit, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Ondrej Lastovicka
- Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, Olomouc, 77147, Czech Republic
| | - Miroslav Janura
- Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, Olomouc, 77147, Czech Republic
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, PR1 2HE, UK
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28
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A step towards dynamic foot classification: Functional grouping using ankle joint frontal plane motion in running. Gait Posture 2022; 97:35-39. [PMID: 35868095 DOI: 10.1016/j.gaitpost.2022.07.005] [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: 03/09/2022] [Revised: 06/10/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The premise behind static foot classification suggests structure dictate's function. However, the validity of this has been challenged, as weak association between static foot type and dynamic motion exists. This has led to calls for dynamic assessments and classification of feet based on functional motion, yet methods to do this have been seldom explored. RESEARCH QUESTION Within a group of runners do homogenous sub-groups of ankle joint complex (AJC) frontal plane motion exist? METHODS A k means clustering analysis was conducted on the frontal plane AJC motion patterns of a group of healthy adults running barefoot (n = 42) to identify functional movement groups. Once identified, statistical parametric mapping was employed to determine the differences between clusters across stance. The identified clusters were used to determine dynamic foot type; an agreement analysis was conducted between the newly defined foot types and the Foot Posture Index (FPI-6). RESULTS Two distinct clusters were identified. Waveform analysis identified that cluster 1 displayed significantly (p < 0.001) less AJC eversion between 0% and 97% of the stance phase compared to cluster 2, with the differences between clusters associated with large effect sizes (g > 1). Based on the displayed kinematic profiles, cluster 1 was defined as a Neutral Dynamic Foot Type (NeutralDFT), and cluster 2 a Pronated Dynamic Foot Type (Pronated DynamicDFT). The newly defined foot type measure had only a slight agreement (κ = 0.08) with the FPI-6. SIGNIFICANCE We demonstrated a protocol to classify a runner's foot type derived directly from AJC motion during running. Poor agreement between the dynamic and static classification measures further evidence that these assessments are not analogous. Our results question the validity of static classification when looking to characterise the foot during running, suggesting dynamic assessments are more appropriate to reflect the foots functional response.
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29
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Mascia G, Brasiliano P, Di Feo P, Cereatti A, Camomilla V. A functional calibration protocol for ankle plantar-dorsiflexion estimate using magnetic and inertial measurement units: Repeatability and reliability assessment. J Biomech 2022; 141:111202. [PMID: 35751925 DOI: 10.1016/j.jbiomech.2022.111202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
The ankle joint complex presents a tangled functional anatomy, which understanding is fundamental to effectively estimate its kinematics on the sagittal plane. Protocols based on the use of magnetic and inertial measurement units (MIMUs) currently do not take in due account this factor. To this aim, a joint coordinate system for the ankle joint complex is proposed, along with a protocol to perform its anatomical calibration using MIMUs, consisting in a combination of anatomical functional calibrations of the tibiotalar axis and static acquisitions. Protocol repeatability and reliability were tested according to the metrics proposed in Schwartz et al. (2004) involving three different operators performing the protocol three times on ten participants, undergoing instrumented gait analysis through both stereophotogrammetry and MIMUs. Instrumental reliability was evaluated comparing the MIMU-derived kinematic traces with the stereophotogrammetric ones, obtained with the same protocol, through the linear fit method. A total of 270 gait cycles were considered. Results showed that the protocol was repeatable and reliable for what concerned the operators (0.4 ± 0.4 deg and 0.8 ± 0.5 deg, respectively). Instrumental reliability analysis showed a mean RMSD of 3.0 ± 1.3 deg, a mean offset of 9.4 ± 8.4 deg and a mean linear relationship strength of R2 = 0.88 ± 0.08. With due caution, the protocol can be considered both repeatable and reliable. Further studies should pay attention to the other ankle degrees of freedom as well as on the angular convention to compute them.
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Affiliation(s)
- Guido Mascia
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Roma, Italy; Department of Human, Sports, and Health Science, University of Rome "Foro Italico", Roma, Italy
| | - Paolo Brasiliano
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Roma, Italy; Department of Human, Sports, and Health Science, University of Rome "Foro Italico", Roma, Italy
| | - Paolo Di Feo
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Roma, Italy; Department of Human, Sports, and Health Science, University of Rome "Foro Italico", Roma, Italy
| | - Andrea Cereatti
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Roma, Italy; Department of Electronics and Telecommunications, Polytechnic of Turin, Torino, Italy
| | - Valentina Camomilla
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome "Foro Italico", Roma, Italy; Department of Human, Sports, and Health Science, University of Rome "Foro Italico", Roma, Italy.
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30
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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] [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. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00543-6.
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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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31
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Moisan G, Robb K, Mainville C, Blanchette V. Effects of foot orthoses on the biomechanics of the lower extremities in adults with and without musculoskeletal disorders during functional tasks: A systematic review. Clin Biomech (Bristol, Avon) 2022; 95:105641. [PMID: 35429692 DOI: 10.1016/j.clinbiomech.2022.105641] [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: 12/14/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Foot orthoses are among the most commonly used external supports to treat musculoskeletal disorders. It remains unclear how they change the biomechanics of the lower extremities during functional tasks. This systematic review aimed to determine the effects of foot orthoses on primary outcomes (i.e., kinematics, kinetics and electromyography of the lower extremities) in adults with and without musculoskeletal disorders during functional tasks. METHODS A literature search was conducted for articles published from inception to June 2021 in Medline, CINAHL, SPORTDiscus, Cochrane libraries and PEDro electronic databases. Two investigators independently assessed the titles and abstracts of retrieved articles based on the inclusion criteria. Of the 5578 citations, 24 studies were included in the qualitative synthesis as they reported the effects of foot orthoses on the primary outcomes. Risk of bias of included studies was determined using the modified Downs and Black Quality Index. FINDINGS During low impact tasks, foot orthoses decrease ankle inversion and increase midfoot plantar forces and pressure. During higher impact tasks, foot orthoses had little effects on electromyography and kinematics of the lower extremities but decreased ankle inversion moments. INTERPRETATION Even though the effects of foot orthoses on the biomechanics of the lower extremities seem task-dependent, foot orthoses mainly affected the biomechanics of the distal segments during most tasks. However, few studies determined their effects on the biomechanics of the foot. It remains unclear to what extent foot orthoses features induce different biomechanical effects and if foot orthoses effects change for different populations.
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Affiliation(s)
- Gabriel Moisan
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Canada 3351 Boul des Forges, Trois-Rivières, PQ G9A 5H7, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières, PQ, Canada.
| | - Kelly Robb
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Canada 75 University Ave., West Waterloo, ON N2L 3C5, Canada.
| | - Camille Mainville
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Canada 3351 Boul des Forges, Trois-Rivières, PQ G9A 5H7, Canada.
| | - Virginie Blanchette
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Canada 3351 Boul des Forges, Trois-Rivières, PQ G9A 5H7, Canada; Groupe Interdisciplinaire de Recherche Appliquée en Santé (GIRAS), Université du Québec à Trois-Rivières, Trois-Rivières, PQ, Canada.
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32
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Jasiewicz B, Klimiec E, Guzdek P, Kołaszczyński G, Piekarski J, Zaraska K, Potaczek T. Investigation of Impact of Walking Speed on Forces Acting on a Foot-Ground Unit. SENSORS 2022; 22:s22083098. [PMID: 35459082 PMCID: PMC9028688 DOI: 10.3390/s22083098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 12/04/2022]
Abstract
Static and dynamic methods can be used to assess the way a foot is loaded. The research question is how the pressure on the feet would vary depending on walking/running speed. This study involved 20 healthy volunteers. Dynamic measurement of foot pressure was performed using the Ortopiezometr at normal, slow, and fast paces of walking. Obtained data underwent analysis in a “Steps” program. Based on the median, the power generated by the sensors during the entire stride period is the highest during a fast walk, whereas based on the average; a walk or slow walk prevails. During a fast walk, the difference between the mean and the median of the stride period is the smallest. Regardless of the pace of gait, the energy released per unit time does not depend on the paces of the volunteers’ gaits. Conclusions: Ortopiezometr is a feasible tool for the dynamic measurement of foot pressure. For investigations on walking motions, the plantar pressure analysis system, which uses the power generated on sensors installed in the insoles of shoes, is an alternative to force or energy measurements. Regardless of the pace of the walk, the amounts of pressure applied to the foot during step are similar among healthy volunteers.
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Affiliation(s)
- Barbara Jasiewicz
- Department of Orthopedics and Rehabilitation, Medical College, Jagiellonian University, Balzera 15, 34-500 Zakopane, Poland;
- Correspondence:
| | - Ewa Klimiec
- Łukasiewicz Research Network—Institute of Microelectronics and Photonics, Kraków Division, Zablocie 39, 30-701 Krakow, Poland; (E.K.); (P.G.); (G.K.); (J.P.); (K.Z.)
| | - Piotr Guzdek
- Łukasiewicz Research Network—Institute of Microelectronics and Photonics, Kraków Division, Zablocie 39, 30-701 Krakow, Poland; (E.K.); (P.G.); (G.K.); (J.P.); (K.Z.)
| | - Grzegorz Kołaszczyński
- Łukasiewicz Research Network—Institute of Microelectronics and Photonics, Kraków Division, Zablocie 39, 30-701 Krakow, Poland; (E.K.); (P.G.); (G.K.); (J.P.); (K.Z.)
| | - Jacek Piekarski
- Łukasiewicz Research Network—Institute of Microelectronics and Photonics, Kraków Division, Zablocie 39, 30-701 Krakow, Poland; (E.K.); (P.G.); (G.K.); (J.P.); (K.Z.)
| | - Krzysztof Zaraska
- Łukasiewicz Research Network—Institute of Microelectronics and Photonics, Kraków Division, Zablocie 39, 30-701 Krakow, Poland; (E.K.); (P.G.); (G.K.); (J.P.); (K.Z.)
| | - Tomasz Potaczek
- Department of Orthopedics and Rehabilitation, Medical College, Jagiellonian University, Balzera 15, 34-500 Zakopane, Poland;
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33
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Fritz JM, Canseco K, Konop KA, Kruger KM, Tarima S, Long JT, Law BC, Kraus JC, King DM, Harris GF. Multi-segment foot kinematics during gait following ankle arthroplasty. J Orthop Res 2022; 40:685-694. [PMID: 33913547 DOI: 10.1002/jor.25062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/13/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
Ankle arthritis is a debilitating disease marked by pain and limited function. Total ankle arthroplasty improves pain while preserving motion and offers an alternative to the traditional treatment of ankle fusion. Gait analysis and functional outcomes tools can provide an objective balanced analysis of ankle replacement for the treatment of ankle arthritis. Twenty-nine patients with end-stage ankle arthritis were evaluated before and after ankle arthroplasty. Multi-segment foot and ankle kinematics were assessed annually following surgery (average 3.5 years, range 1-6 years) using the Milwaukee Foot Model and a Vicon video motion analysis system. Functional outcomes (American Orthopedic Foot and Ankle Society [AOFAS] ankle/hindfoot scale, short form 36 [SF-36] questionnaire) and temporal-spatial parameters were also assessed. Kinematic results were compared to findings from a previously collected group of healthy ambulators. AOFAS and SF-36 mean scores improved postoperatively. Walking speed and stride length increased after surgery. There were significant improvements in tibial sagittal range of motion in terminal stance and hindfoot sagittal range of motion in preswing. Decreased external rotation of the tibia and increased external rotation of the hindfoot were noted throughout the gait cycle. Pain and function improved after ankle replacement as supported by better outcomes scores, increased temporal-spatial parameters, and significant improvement in tibial sagittal range of motion during terminal stance and hindfoot sagittal range of motion during preswing. While multi-segment foot kinematics were improved, they were not restored to control values. Statement of clinical significance: Total ankle arthroplasty does not fully normalize mutli-segment gait kinematics despite improved patient-reported outcomes and gait mechanics.
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Affiliation(s)
- Jessica M Fritz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karl Canseco
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine A Konop
- Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Karen M Kruger
- Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Motion Analysis Center, Shriners Hospitals for Children-Chicago, Chicago, Illinois, USA
| | - Sergey Tarima
- Department of Biostatistics, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason T Long
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian C Law
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan C Kraus
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David M King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gerald F Harris
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, WI, USA.,Orthopedic and Rehabilitation Engineering Center, Marquette University/Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Motion Analysis Center, Shriners Hospitals for Children-Chicago, Chicago, Illinois, USA
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Williams LR, Ridge ST, Johnson AW, Arch ES, Bruening DA. The influence of the windlass mechanism on kinematic and kinetic foot joint coupling. J Foot Ankle Res 2022; 15:16. [PMID: 35172865 PMCID: PMC8848977 DOI: 10.1186/s13047-022-00520-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Previous research shows kinematic and kinetic coupling between the metatarsophalangeal (MTP) and midtarsal joints during gait. Studying the effects of MTP position as well as foot structure on this coupling may help determine to what extent foot coupling during dynamic and active movement is due to the windlass mechanism. This study’s purpose was to investigate the kinematic and kinetic foot coupling during controlled passive, active, and dynamic movements. Methods After arch height and flexibility were measured, participants performed four conditions: Seated Passive MTP Extension, Seated Active MTP Extension, Standing Passive MTP Extension, and Standing Active MTP Extension. Next, participants performed three heel raise conditions that manipulated the starting position of the MTP joint: Neutral, Toe Extension, and Toe Flexion. A multisegment foot model was created in Visual 3D and used to calculate ankle, midtarsal, and MTP joint kinematics and kinetics. Results Kinematic coupling (ratio of midtarsal to MTP angular displacement) was approximately six times greater in Neutral heel raises compared to Seated Passive MTP Extension, suggesting that the windlass only plays a small kinematic role in dynamic tasks. As the starting position of the MTP joint became increasingly extended during heel raises, the amount of negative work at the MTP joint and positive work at the midtarsal joint increased proportionally, while distal-to-hindfoot work remained unchanged. Correlations suggest that there is not a strong relationship between static arch height/flexibility and kinematic foot coupling. Conclusions Our results show that there is kinematic and kinetic coupling within the distal foot, but this coupling is attributed only in small measure to the windlass mechanism. Additional sources of coupling include foot muscles and elastic energy storage and return within ligaments and tendons. Furthermore, our results suggest that the plantar aponeurosis does not function as a rigid cable but likely has extensibility that affects the effectiveness of the windlass mechanism. Arch structure did not affect foot coupling, suggesting that static arch height or arch flexibility alone may not be adequate predictors of dynamic foot function. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00520-z.
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Repeatability of the Oxford Foot Model: Comparison of a team of assessors with different backgrounds and no prior experience of the Oxford Foot Model. Gait Posture 2022; 92:191-198. [PMID: 34864484 DOI: 10.1016/j.gaitpost.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 02/02/2023]
Abstract
RESEARCH QUESTION What is the intra- and inter-assessor error of the Oxford Foot Model (OFM) during healthy adult walking when applied by three assessors with different professional backgrounds and lower limb marker placement experience, not native to the originators of the model and with no prior clinical experience of the model? BACKGROUND No previous OFM studies have examined the repeatability of more than two assessors with different backgrounds, and many of the studies have been conducted by the model originators METHODS: The OFM was applied to ten healthy adults on three separate occasions by three different assessors with varied professional experience and no prior involvement with the OFM (other than local training). Participants walked at self-selected speeds and intra/inter assessor error was calculated using the SEM + 95% upper confidence limit. RESULTS Inter-assessor errors ranged from 2.2° to 5.5° whereas intra-assessor errors fell between 1.8° and 5.5°. The error difference between assessors over the same joint angle varied from 0.4° (hindfoot/tibia dorsiflexion) to 1.5° (hindfoot/tibia inversion). The percentage of error to total range of motion varied from 11% (hindfoot/tibia dorsiflexion) to 126% (forefoot/hindfoot adduction). SIGNIFICANCE Based on commonly used recommendations, the OFM is a largely repeatable tool for measuring foot kinematics during healthy adult walking when applied by assessors with no prior OFM experience, varied experience and not native to the model originators. Intra-assessor error was lower for assessors with prior anatomical knowledge and significant lower limb marker placement experience. The proportion of inter-assessor error to movement exceeded 50% of the total range of motion for four movements, notably forefoot/hindfoot adduction (126%). As such, this movement cannot be recommended as an outcome measure. Inter- and intra-assessor error, specific to each laboratory, should be considered, along with the proportion of error to range of motion when interpreting patient data.
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Ito K, Nakamura T, Suzuki R, Negishi T, Oishi M, Nagura T, Jinzaki M, Ogihara N. Comparative Functional Morphology of Human and Chimpanzee Feet Based on Three-Dimensional Finite Element Analysis. Front Bioeng Biotechnol 2022; 9:760486. [PMID: 35096789 PMCID: PMC8793834 DOI: 10.3389/fbioe.2021.760486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022] Open
Abstract
To comparatively investigate the morphological adaptation of the human foot for achieving robust and efficient bipedal locomotion, we develop three-dimensional finite element models of the human and chimpanzee feet. Foot bones and the outer surface of the foot are extracted from computer tomography images and meshed with tetrahedral elements. The ligaments and plantar fascia are represented by tension-only spring elements. The contacts between the bones and between the foot and ground are solved using frictionless and Coulomb friction contact algorithms, respectively. Physiologically realistic loading conditions of the feet during quiet bipedal standing are simulated. Our results indicate that the center of pressure (COP) is located more anteriorly in the human foot than in the chimpanzee foot, indicating a larger stability margin in bipedal posture in humans. Furthermore, the vertical free moment generated by the coupling motion of the calcaneus and tibia during axial loading is larger in the human foot, which can facilitate the compensation of the net yaw moment of the body around the COP during bipedal locomotion. Furthermore, the human foot can store elastic energy more effectively during axial loading for the effective generation of propulsive force in the late stance phase. This computational framework for a comparative investigation of the causal relationship among the morphology, kinematics, and kinetics of the foot may provide a better understanding regarding the functional significance of the morphological features of the human foot.
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Affiliation(s)
- Kohta Ito
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan
- Graduate School of Human Sciences, Osaka University, Suita, Japan
| | - Tomoya Nakamura
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan
| | - Ryo Suzuki
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan
| | - Takuo Negishi
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan
- Department of Biological Science, Graduate School of Science, The University of Tokyo, Tokyo, Japan
| | - Motoharu Oishi
- Department of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Naomichi Ogihara
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan
- Department of Biological Science, Graduate School of Science, The University of Tokyo, Tokyo, Japan
- *Correspondence: Naomichi Ogihara,
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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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Comparison between the Rizzoli and Oxford foot models with independent and clustered tracking markers. Gait Posture 2022; 91:48-51. [PMID: 34649170 DOI: 10.1016/j.gaitpost.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Rizzoli Foot Model (RFM) and Oxford Foot Model (OFM) are used to analyze segmented foot kinematics with independent tracking markers. Alternatively, rigid marker clusters can be used to improve markers' visualization and facilitate analyzing shod gait. RESEARCH QUESTION Are there differences in angles from the RFM and OFM, obtained with independent and clustered tracking markers, during the stance phase of walking? METHODS Walking kinematics of 14 non-disabled participants (25.2 years (SD 2.8)) were measured at self-selected speed. Rearfoot-shank and forefoot-rearfoot angles were measured from two models with two tracking methods: RFM, OFM, RFM-cluster, and OFM-cluster. In RFM-cluster and OFM-cluster, the rearfoot and forefoot tracking markers were rigidly clustered, fixed on rods' tips attached to a metallic base. Statistical Parametric Mapping (SPM) One-Way Repeated Measures ANOVAs and SPM Paired t-tests were used to compare waveforms. Coefficients of Multiple Correlation (CMC) quantified the similarity between waveforms. One-way Repeated Measures ANOVAs were conducted to compare the ranges of motion (ROMs), and pre-planned contrasts investigated differences between the models and tracking methods. Intraclass Correlation Coefficients (ICC) were computed to verify the similarity between ROMs. RESULTS Differences occurred mostly in small parts of the stance phase for the cluster vs. non-cluster comparisons and the RFM vs. OFM comparisons. ROMs were slightly different between the models and tracking methods in most comparisons. The curves (CMC ≥ 0.71) were highly similar between the models and tracking methods. The ROMs (ICC ≥ 0.67) were moderatetly to highly similar in most comparisons. RFM vs. RFM-cluster (forefoot-rearfoot angle - transverse plane), OFM vs. OFM-cluster and RFM vs. OFM (forefoot-rearfoot angle - frontal plane) were not similar (non-significant). SIGNIFICANCE Rigid clusters are an alternative for tracking rearfoot-shank and forefoot-rearfoot angles during the stance phase of walking. However, specific differences should be considered to contrast results from different models and tracking methods.
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Chan PH, Stebbins J, Zavatsky AB. Efficacy of quantifying marker-cluster rigidity in a multi-segment foot model: a Monte-Carlo based global sensitivity analysis and regression model. Comput Methods Biomech Biomed Engin 2021; 25:308-319. [PMID: 34289759 DOI: 10.1080/10255842.2021.1954170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Marker-based clinical gait analysis and multi-segment foot models (MSFM) have been successfully used for the diagnosis and clinical management of various lower limb disorders. The accuracy and validity of the kinematics measured depend on the design of the model, as well as on the adherence to its inherent rigid body assumption. This study applies a Monte-Carlo based global sensitivity analysis to evaluate the efficacy of using 'rigid body error (σRBE)' in quantifying the rigidity of a MSFM marker-cluster. A regression model is proposed. It is concluded that σRBE is effective in quantifying rigidity.
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Affiliation(s)
- Po-Hsiang Chan
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Julie Stebbins
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre NHS Trust, Oxford, UK
| | - Amy B Zavatsky
- Department of Engineering Science, University of Oxford, Oxford, UK
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40
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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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41
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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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Quirino J, Santos TRT, Okai-Nóbrega LA, de Araújo PA, Carvalho R, Ocarino JDM, Souza TR, Fonseca ST. Runners with a history of injury have greater lower limb movement regularity than runners without a history of injury. Sports Biomech 2021:1-13. [PMID: 34121609 DOI: 10.1080/14763141.2021.1929435] [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: 09/05/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to investigate the regularity of the lower limb joint kinematics in runners with and without a history of running-related injuries. The second aim was to verify if the movement pattern regularities are different among the lower limb joints. Eighteen asymptomatic recreational runners with and without a history of running-related injury participated in this study. Lower limb kinematics in the sagittal plane were recorded during running on a treadmill at a self-selected speed. The regularities of the time series of hip, knee, and ankle were analysed using sample entropy (SampEn). A mixed analysis of variance was used to investigate differences between groups and among joints. Runners with a history of injury had lower SampEn values than runners without a history of injury. Ankle kinematics SampEn was higher than that of the knee and hip. Knee kinematics had higher values of SampEn than that of the hip. Runners with a history of running-related injury had greater joint kinematic's regularity. This result suggests that, even in asymptomatic runners, previous injuries could influence the movement pattern regularity. Also, the regularity was different among joints. The ankle demonstrated the lowest regularity, reinforcing the different functions that lower limb joints perform during running.
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Affiliation(s)
- Juliana Quirino
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Ribeiro Teles Santos
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Liria Akie Okai-Nóbrega
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Priscila Albuquerque de Araújo
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renatha Carvalho
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juliana de Melo Ocarino
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thales Rezende Souza
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sérgio Teixeira Fonseca
- School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Schallig W, Streekstra GJ, Hulshof CM, Kleipool RP, Dobbe JGG, Maas M, Harlaar J, van der Krogt MM, van den Noort JC. The influence of soft tissue artifacts on multi-segment foot kinematics. J Biomech 2021; 120:110359. [PMID: 33730563 DOI: 10.1016/j.jbiomech.2021.110359] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/11/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022]
Abstract
Movement of skin markers with respect to their underlying bone (i.e. soft tissue artifacts (STAs)) might corrupt the accuracy of marker-based movement analyses. This study aims to quantify STAs in 3D for foot markers and their effect on multi-segment foot kinematics as calculated by the Oxford and Rizzoli Foot Models (OFM, RFM). Fifteen subjects with asymptomatic feet were seated on a custom-made loading device on a computed tomography (CT) table, with a combined OFM and RFM marker set on their right foot. One unloaded reference CT-scan with neutral foot position was performed, followed by 9 loaded CT-scans at different foot positions. The 3D-displacement (i.e. STA) of each marker in the underlying bone coordinate system between the reference scan and other scans was calculated. Subsequently, segment orientations and joint angles were calculated from the marker positions according to OFM and RFM definitions with and without STAs. The differences in degrees were defined as the errors caused by the marker displacements. Markers on the lateral malleolus and proximally on the posterior aspect of the calcaneus showed the largest STAs. The hindfoot-shank joint angle was most affected by STAs in the most extreme foot position (40° plantar flexion) in the sagittal plane for RFM (mean: 6.7°, max: 11.8°) and the transverse plane for OFM (mean: 3.9°, max: 6.8°). This study showed that STAs introduce clinically relevant errors in multi-segment foot kinematics. Moreover, it identified marker locations that are most affected by STAs, suggesting that their use within multi-segment foot models should 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.
| | - Geert J Streekstra
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Chantal M Hulshof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Roeland P Kleipool
- Amsterdam UMC, University of Amsterdam, Medical Biology, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Johannes G G Dobbe
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, 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
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Josien C van den Noort
- 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
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Reliability testing of the heel marker in three-dimensional gait analysis. Gait Posture 2021; 85:84-87. [PMID: 33517041 DOI: 10.1016/j.gaitpost.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/23/2020] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In three-dimensional gait analysis, anatomical axes are defined by and therefore sensitive to marker placement. Previous analysis of the Oxford Foot Model (OFM) has suggested that the axes of the hindfoot are most sensitive to marker placement on the posterior aspect of the heel. Since other multi-segment foot models also use a similar marker, it is important to find methods to place this as accurately as possible. The aim of this pilot study was to test two different 'jigs' (anatomical alignment devices) against eyeball marker placement to improve reliability of heel marker placement and calculation of hindfoot angles using the OFM. METHODS Two jigs were designed using three-dimensional printing: a ratio caliper and heel mould. OFM kinematics were collected for ten healthy adults; intra-tester and inter-tester repeatability of hindfoot marker placement were assessed using both an experienced and inexperienced gait analyst for 5 clinically relevant variables. RESULTS For 3 out of 5 variables the intra-tester and inter-tester variability was below 2 degrees for all methods of marker placement. The ratio caliper had the lowest intra-tester variability for the experienced gait analyst in all 5 variables and for the inexperienced gait analyst in 4 out of 5 variables. However for inter-tester variability, the ratio caliper was only lower than the eyeball method in 2 out of the 5 variables. The mould produced the worst results for 3 of the 5 variables, and was particularly prone to variability when assessing average hindfoot rotation, making it the least reliable method overall. CONCLUSIONS The use of the ratio caliper may improve intra-tester variability, but does not seem superior to the eyeball method of marker placement for inter-tester variability. The use of a heel mould is discouraged.
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Takabayashi T, Edama M, Inai T, Kubo M. Differences in rearfoot, midfoot, and forefoot kinematics of normal foot and flatfoot during running. J Orthop Res 2021; 39:565-571. [PMID: 33038023 DOI: 10.1002/jor.24877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 02/04/2023]
Abstract
Flatfoot is a common foot deformity, which could contribute to running injuries such as medial tibial stress syndrome. Intrafoot kinematics of flatfoot during walking have often been documented using multisegment foot models. However, the intrafoot kinematics of flatfoot during running remains unclear, despite the possible relationship between flatfoot and running injuries. We aimed to clarify rearfoot, midfoot, and forefoot kinematics when running in participants with normal foot and flatfoot. Participants with the normal foot (n = 14) and flatfoot (n = 14) were asked to runover-ground at their preferred speed. Three-dimensional kinematics of the rearfoot, midfoot, and forefoot during running were calculated based on the Rizzoli foot model. A two-sample t-test of statistical parametric mapping was performed to determine differences between normal foot and flatfoot in time histories of intrafoot kinematics during running. No differences were found between groups in characteristics and spatiotemporal parameters. In the frontal rearfoot angle, a significantly increased eversion from 24% to 100% (p < .001) was observed in the flatfoot compared to the normal foot. At the midfoot angle, a significantly increased eversion from 0% to 4% (p < .049) and 21% to 100% (p < .001) was observed in the flatfoot compared to the normal foot. At the forefoot angle, a significantly increased inversion from 6% to 17% (p < .047) was observed in the flatfoot compared to the normal foot. These findings may be useful to explain why flatfoot could contribute to running injuries such as medial tibial stress syndrome.
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Affiliation(s)
- Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata, Japan
| | - Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata, Japan
| | - Masayoshi Kubo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Niigata, Japan
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Deleu PA, Naaim A, Leemrijse T, Dumas R, Devos Bevernage B, Besse JL, Crevoisier X, Chèze L. Impact of foot modeling on the quantification of the effect of total ankle replacement: A pilot study. Gait Posture 2021; 84:308-314. [PMID: 33429193 DOI: 10.1016/j.gaitpost.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/17/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kinematic and kinetic foot models showed that computing ankle joint angles, moments and power with a one-segment foot modeling approach alters kinematics and tends to overestimate ankle joint power. Nevertheless, gait studies continue to implement one-segment foot models to assess the effect of total ankle replacement. RESEARCH QUESTION The objective of this pilot study was to investigate the effect of the foot modeling approach (one-segment versus multi-segment) on how total ankle replacement is estimated to benefit or degrade the patient's biomechanical performance. METHODS Ten subjects with post-traumatic ankle osteoarthritis scheduled for total ankle replacement and 10 asymptomatic subjects were recruited. A one-segment and a multi-segment foot model were used to calculate intrinsic foot joints kinematics and kinetics during gait. A linear mixed model was used to investigate the effect of the foot model on ankle joint kinematic and kinetic analysis and the effect of total ankle replacement. RESULTS Differences in range of motion due to the foot model effect were significant for all the gait subphases of interest except for midstance. Peak power generation was significantly overestimated when computed with the one-segment foot model. Ankle and shank-calcaneus joint dorsi-/plantarflexion range of motion did not increase post-operatively except during the loading response phase. A significant 'group' effect was found for stance and pre-swing phase range of motion, with total ankle replacement patients showing lower range of motion values than controls for dorsi/plantarflexion. SIGNIFICANCE The outcome of this study showed that the 'foot model' had a significant effect on estimates of range of motion and power generation. The findings in our study therefore emphasize the clinical interest of multi-segment foot modeling when assessing the outcome of a therapeutic intervention.
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Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France; Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium.
| | - Alexandre Naaim
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
| | - Thibaut Leemrijse
- Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium; CHIREC Delta Hospital, 201 Boulevard Du Triomphe, 1160, Brussels, Belgium.
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
| | - Bernhard Devos Bevernage
- Foot & Ankle Institute, 5 Avenue Ariane, 1200 Brussels, Belgium; CHIREC Delta Hospital, 201 Boulevard Du Triomphe, 1160, Brussels, Belgium.
| | - Jean-Luc Besse
- Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud, Service De Chirurgie Orthopédique Et Traumatologique, 69495 Pierre-Bénite Cédex, France.
| | - Xavier Crevoisier
- Department of Orthopedics and Traumatology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Laurence Chèze
- Univ Lyon, Univ Gustave Eiffel, LBMC UMR_T9406, 43 Bd Du 11 Novembre 1918, F69622, Lyon, France.
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Wyers L, Di Marco R, Zambelli S, Masiero S, Hallemans A, Van de Walle P, Desloovere K, Del Felice A. Foot-floor contact pattern in children and adults with Dravet Syndrome. Gait Posture 2021; 84:315-320. [PMID: 33445140 DOI: 10.1016/j.gaitpost.2020.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dravet Syndrome (DS) is a developmental and epileptic encephalopathy characterized by severe drug-resistant seizures and associated with cognitive and motor impairments. Walking problems are frequently observed. As the foot plays a key role during walking, compromised foot function can be a feature of deviant gait. AIM To investigate foot function in DS by characterizing foot-floor contact patterns using pedobarography. METHODS A total of 31 children and adults were included in the DS group (aged 5.2-32.8 years, 17 female, 174 steps) and 30 in the control group (aged 6.0-32.9, 16 female, 180 steps). The foot-floor contact pattern was evaluated based on progression, length and smoothness (spectral arc length) of the center of pressure (CoP). Linear mixed models were used to identify differences between non-heel strikes and heel strikes and between the DS and control group. RESULTS Fifteen participants with DS showed inconsistency in the type of foot-floor contact (heel strikes and non-heel strikes). Heel strikes of participants with DS had significantly reduced time of CoP under the hindfoot and increased time under the midfoot region compared to the control group. Significant time and age effects were detected. CONCLUSIONS AND IMPLICATIONS Deviant foot-floor contact patterns were observed in DS. Possible gait immaturity and instability as well as implications for interventions are discussed.
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Affiliation(s)
- Lore Wyers
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Multidisciplinary Motor Centre Antwerp, University of Antwerp, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Roberto Di Marco
- Department of Neuroscience, Section of Rehabilitation, Laboratory of Clinical Analysis and Biomechanics of Movement and Posture NEUROMOVE-Rehab, University of Padova, Padova, Italy
| | - Stefano Zambelli
- Department of Neuroscience, Section of Rehabilitation, Laboratory of Clinical Analysis and Biomechanics of Movement and Posture NEUROMOVE-Rehab, University of Padova, Padova, Italy; Department of Information Engineering, University of Padova, Padova, Italy
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, Laboratory of Clinical Analysis and Biomechanics of Movement and Posture NEUROMOVE-Rehab, University of Padova, Padova, Italy; PNC, Padova Neuroscience Center, Padova, Italy
| | - Ann Hallemans
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Multidisciplinary Motor Centre Antwerp, University of Antwerp, Belgium.
| | - Patricia Van de Walle
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Multidisciplinary Motor Centre Antwerp, University of Antwerp, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospital Leuven, Pellenberg, Belgium
| | - Alessandra Del Felice
- Department of Neuroscience, Section of Rehabilitation, Laboratory of Clinical Analysis and Biomechanics of Movement and Posture NEUROMOVE-Rehab, University of Padova, Padova, Italy; PNC, Padova Neuroscience Center, Padova, Italy
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Akai M. CORR Insights®: Loss of Mechanical Ankle Function Is Not Compensated by the Distal Foot Joints in Patients with Ankle Osteoarthritis. Clin Orthop Relat Res 2021; 479:116-118. [PMID: 33079773 PMCID: PMC7899489 DOI: 10.1097/corr.0000000000001519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/09/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Masami Akai
- M. Akai, Graduate School, International University of Health and Welfare, Tokyo, Japan
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Deleu PA, Naaim A, Chèze L, Dumas R, Devos Bevernage B, Goubau L, Besse JL, Leemrijse T. The effect of ankle and hindfoot malalignment on foot mechanics in patients suffering from post-traumatic ankle osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 81:105239. [PMID: 33246795 DOI: 10.1016/j.clinbiomech.2020.105239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle and hindfoot malalignment is a common finding in patients suffering from post-traumatic ankle osteoarthritis. However, no studies have addressed the effect of concomitant foot deformities on intrinsic foot kinematics and kinetics. Therefore, the objective of this study was to investigate the effect of ankle and hindfoot malalignment on the kinematics and kinetics of multiple joints in the foot and ankle complex in patients suffering from post-traumatic ankle osteoarthritis. METHODS Twenty-nine subjects with post-traumatic ankle osteoarthritis participated in this study. Standardized weight-bearing radiographs were obtained preoperatively to categorize patients as having cavus, planus or neutral ankle and hindfoot alignment, based on 4 X-ray measurements. All patients underwent standard gait assessment. A 4-segment foot model was used to estimate intrinsic foot joint kinematics and kinetics during gait. Statistical parametric mapping was used to compare foot kinematics and kinetics between groups. FINDINGS There were 3 key findings regarding overall foot function in the 3 groups of post-traumatic ankle osteoarthritis: (i) altered frontal and transverse plane inter-segmental angles and moments of the Shank-Calcaneus and Calcaneus-Midfoot joints in the cavus compared to the planus group; (ii) in cavus OA group, Midfoot-Metatarsus joint abduction sought to compensate the varus inclination of the ankle joint; (iii) there were no significant differences in inter-segmental angles and moments between the planus and neutral OA groups. INTERPRETATION Future studies should integrate assessment of concomitant foot and ankle deformities in post-traumatic ankle osteoarthritis, to provide additional insight into associated mechanical deficits and compensation mechanisms during gait.
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Affiliation(s)
- P-A Deleu
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France; Foot & Ankle Institute, Brussels, Belgium.
| | - A Naaim
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | - L Chèze
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | - R Dumas
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMR_T9406, F69622 Lyon, France
| | | | - L Goubau
- Foot & Ankle Institute, Brussels, Belgium
| | - J-L Besse
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, France
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Kim EJ, Shin HS, Takatori N, Yoo HJ, Cho YJ, Yoo WJ, Lee DY. Inter-segmental foot kinematics during gait in elderly females according to the severity of hallux valgus. J Orthop Res 2020; 38:2409-2418. [PMID: 32162717 DOI: 10.1002/jor.24657] [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: 05/03/2019] [Revised: 01/11/2019] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study was to find the effect of hallux valgus (HV) deformity on the inter-segmental motion of the foot using an MFM with a 15-marker set (DuPont Foot Model, DuFM) in comparison with age and sex controlled healthy adults. Fifty-eight female symptomatic HV patients and 50 female asymptomatic older female volunteers were included in this study. According to the radiographic hallux valgus angle (HVA), the study population was divided into severe HV (SHV, HVA ≥ 40°, n = 25), moderate HV (MHV, 20° ≤ HVA < 40°, n = 47), and control (CON, n = 36). MHV group was divided into symptomatic MHV group (S-MHV, n = 33) and asymptomatic MHV group (A-MHV, n = 14) according to the symptoms associated with HV. For temporal parameters, gait speed and stride length were diminished according to the severity of HV deformity. Sagittal range of motion of hallux and hindfoot decreased significantly in SHV group. Loss of push-off during the preswing phase was observed and forefoot adduction motion during terminal stance was decreased in SHV group. In a subgroup analysis of MHV, asymptomatic HV minimally affects gait and inter-segmental motion during gait. HV deformity affects gait parameters and inter-segmental motion of the foot during gait in proportion to the severity of the deformity. However, the effect of MHV itself on foot kinematics might be limited while pain or arthritic change of the joint might cause changes in gait in patients with symptomatic HV.
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Affiliation(s)
- Eo Jin Kim
- Department of Orthopedic Surgery, CHA Bundang Medical Center, Seongnam, Korea
| | - Hyuck Soo Shin
- Department of Orthopedic Surgery, CM Hospital, Seoul, Korea
| | - Naoko Takatori
- Usami Orthopedic Clinic, Foot and Ankle Medical Center, Tokyo, Japan
| | - Hyo Jeong Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Yun Jae Cho
- 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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