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Gao T, Ma Z, Yang N, Zhang S, Shi H, Zhang H, Ren S, Huang H. The relationship of peak ankle dorsiflexion angle with lower extremity biomechanics during walking. J Foot Ankle Res 2024; 17:e12027. [PMID: 38812103 DOI: 10.1002/jfa2.12027] [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: 03/08/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Abnormal lower limb movement patterns have been observed during walking in individuals with limited ankle dorsiflexion. The purpose of this study was to investigate the relationships of peak ankle dorsiflexion angle during the stance phase of walking with the lower extremity biomechanics at the corresponding moment and to determine a cutoff value of functional limited ankle dorsiflexion during walking. METHODS Kinematic and kinetic data of 70 healthy participants were measured during walking. Spearman's correlation coefficients were calculated to establish the association between peak ankle dorsiflexion and angle and moment of ankle, knee, and hip, ground reaction force, and pelvic movement at peak ankle dorsiflexion. All variables significantly related to peak ankle dorsiflexion were extracted as a common factor by factor analysis. Maximally selected Wilcoxon statistic was used to perform a cutoff value analysis. RESULTS Peak ankle dorsiflexion positively correlated with ankle plantar flexion moment (r = 0.432; p = 0.001), ankle external rotation moment (r = 0.251; p = 0.036), hip extension angle (r = 0.281; p = 0.018), hip flexion moment (r = 0.341; p = 0.004), pelvic ipsilateral rotation angle (r = 0.284; p = 0.017), and medial, anterior, and vertical ground reaction force (r = 0.324; p = 0.006, r = 0.543; p = 0.001, r = 0.322; p = 0.007), negatively correlated with knee external rotation angle (r = -0.394; p = 0.001) and hip adduction angle (r = -0.256; p = 0.032). The cutoff baseline value for all 70 participants was 9.03°. CONCLUSIONS There is a correlation between the peak ankle dorsiflexion angle and the lower extremity biomechanics during walking. If the peak ankle dorsiflexion angle is less than 9.03°, the lower limb movement pattern will change significantly.
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Affiliation(s)
- Tianyu Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
| | - Zhengye Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Nan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
| | - Si Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Haitao Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Hongshi Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
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Aquino MRC, Resende RA, Van Emmerik R, Souza TR, Fonseca ST, Kirkwood RN, Ocarino JM. Influence of reduced passive ankle dorsiflexion range of motion on lower limb kinetics and stiffness during gait. Gait Posture 2024; 109:147-152. [PMID: 38309125 DOI: 10.1016/j.gaitpost.2024.01.020] [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: 03/09/2023] [Revised: 11/24/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The ankle dorsiflexion range of motion (ADF-ROM) during single support phase allows elastic energy storage in the calcaneal tendon, contributing to advance the body forward. Reduced ADF-ROM may influence lower limb kinetics and stiffness. RESEARCH QUESTION What is the influence of reduced passive ADF-ROM on lower limb internal moments and stiffness during gait? METHODS Thirty-two participants, classified into two groups according to passive ADF-ROM (smaller than 10° and greater than 15°), were submitted to gait assessment at self-selected speed with a force platform and a three-dimensional motion analysis system. Statistical parametrical mapping (SPM) analyses were used to compare the lower limbs' internal moments between groups. Independent t-tests analyzed the differences between groups on lower limb stiffness during gait. RESULTS The lower ADF-ROM group had greater knee flexor moment (terminal stance and push-off), greater ankle abductor (i.e., shank internal rotator) moment in terminal stance and greater knee internal rotator moment in mid to terminal stance. The lower ADF-ROM group also had higher lower limb stiffness during gait. SIGNIFICANCE Individuals with reduced passive ADF-ROM had greater lower limb stiffness and adopted a gait pattern with increased knee and ankle moments, suggesting increased loading at these joints.
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Affiliation(s)
- Mariana R C Aquino
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Avenida Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil
| | - Renan A Resende
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Avenida Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil
| | - Richard Van Emmerik
- University of Massachusetts Amherst, Department of Kinesiology, 30 Eastman Lane, 01003 Amherst, MA, USA
| | - Thales R Souza
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Avenida Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil
| | - Sergio T Fonseca
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Avenida Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil
| | - Renata N Kirkwood
- McMaster University, Hamilton School of Rehabilitation Science, 1280 Main Street West, L8S 4L8 ON, Canada
| | - Juliana M Ocarino
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Avenida Antônio Carlos, 6627, Pampulha, 31270-901 Belo Horizonte, MG, Brazil.
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Rao Y, Yang N, Gao T, Zhang S, Shi H, Lu Y, Ren S, Huang H. Effects of peak ankle dorsiflexion angle on lower extremity biomechanics and pelvic motion during walking and jogging. Front Neurol 2024; 14:1269061. [PMID: 38362013 PMCID: PMC10867967 DOI: 10.3389/fneur.2023.1269061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/17/2023] [Indexed: 02/17/2024] Open
Abstract
Objective Ankle dorsiflexion during walking causes the tibia to roll forward relative to the foot to achieve body forward. Individuals with ankle dorsiflexion restriction may present altered movement patterns and cause a series of dysfunction. Therefore, the aim of this research was to clearly determine the effects of peak ankle dorsiflexion angle on lower extremity biomechanics and pelvic motion during walking and jogging. Method This study involved 51 subjects tested for both walking and jogging. The motion capture system and force measuring platforms were used to synchronously collect kinematics and kinetics parameters during these activities. Based on the peak ankle dorsiflexion angle during walking, the 51 subjects were divided into a restricted group (RADF group, angle <10°) and an ankle dorsiflexion-unrestricted group (un-RADF group, angle >10°). Independent-Sample T-tests were performed to compare the pelvic and lower limb biomechanics parameters between the groups during walking and jogging test on this cross-sectional study. Results The parameters that were significantly smaller in the RADF group than in the un-RADF group at the moment of peak ankle dorsiflexion in the walking test were: ankle plantar flexion moment (p < 0.05), hip extension angle (p < 0.05), internal ground reaction force (p < 0.05), anterior ground reaction force (p < 0.01), pelvic ipsilateral tilt angle (p < 0.05). In contrast, the external knee rotation angle was significantly greater in the RADF group than in the un-RADF group (p < 0.05). The parameters that were significantly smaller in the RADF group than in the un-RADF group at the moment of peak ankle dorsiflexion in the jogging test were: peak ankle dorsiflexion angle (p < 0.01); the anterior ground reaction force (p < 0.01), the angle of pelvic ipsilateral rotation (p < 0.05). Conclusion This study shows that individuals with limited ankle dorsiflexion experience varying degrees of altered kinematics and dynamics in the pelvis, hip, knee, and foot during walking and jogging. Limited ankle dorsiflexion alters the movement pattern of the lower extremity during walking and jogging, diminishing the body's ability to propel forward, which may lead to higher injury risks.
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Affiliation(s)
- Yi Rao
- Department of Rehabilitation, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Nan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Tianyu Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Si Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Haitao Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Yiqun Lu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Hongshi Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China
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Molina-García C, López-Del-Amo-Lorente A, Ramos-Petersen L, Martínez-Sebastián C, Jiménez-García JD, Álvarez-Salvago F, Velázquez-Díaz D. Childhood obesity and its impact on the characteristics of gait stance phases: a cross-sectional study. Eur J Pediatr 2024; 183:123-134. [PMID: 37843611 DOI: 10.1007/s00431-023-05268-7] [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: 05/23/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
This study aimed to investigate the variations in foot type, laxity, dynamic characteristics of gait, and the characteristics of the stance phase of gait, in relation to body mass index (BMI) and groups of children of different ages. Additionally, it aimed to explore the correlations between BMI and these variables across children groups of different ages. A cross-sectional study was conducted involving 196 infants aged between 5 and 10 years old. The variables assessed included BMI, foot type, laxity, dynamic variables, and characteristics of the stance phase of gait. Significant variations were observed in foot type, laxity, certain dynamic variables, and characteristics of the stance phase of gait between normoweight (NW) and overweight/obese (OW/OB) groups among children aged between 5 and 10 years old (p ranged between 0.019 and 0.050). Moreover, BMI was also positively associated with the initial forefoot contact, heel off, total duration of the step, and forefoot contact phase of children 7 to 10 years of age (p ranged between < 0.010 and 0.040). Conclusion: Children who are OW/OB had alterations at different stages of gait. Being OW/OB is related to alterations of the phases of gait mainly from 7 to 10 years of age, and spending more time in each of the phases of walking. This could indicate that children who are OW/OB, in addition to walking slower, overload the musculoskeletal system, subjecting their joints and muscles to greater stress. What is Known: • Children who are overweight (OW) and obese (OB) can experience changes in their musculoskeletal systems, posture, and gait due to increased body mass index. • OW and OB children experience additional stress on their musculoskeletal systems, impacting posture, biomechanics, mobility, physical activity, and daily tasks. Excessive plantar loading is linked to foot pain in adults. What is New: • Body mass index was positively associated with initial forefoot contact, heel off, total duration of the step, and forefoot contact phase in children aged 7 to 10 years old. OW/OB children aged 5-6 exhibited less ankle dorsiflexion and smaller relaxed calcaneal stance position (RCSP) as compared to normal-weight children. • Obese children aged 5-6 showed less pronation excursion, suggesting altered frontal plane movement due to RCSP differences. Children aged 7-8 who are OW/OB spent more time in certain gait phases, particularly in the forefoot contact phase. Being OW/OB is linked to altered gait parameters such as initial forefoot, heel off, total step duration, and forefoot contact phase. Being OW/OB was associated with a longer forefoot contact phase, particularly in the right foot.
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Affiliation(s)
- Cristina Molina-García
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos nº135, Guadalupe , 30107, Murcia, Spain
| | - Andrés López-Del-Amo-Lorente
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos nº135, Guadalupe , 30107, Murcia, Spain
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, University of Malaga, 29071, Málaga, Andalucía, Spain
| | | | | | - Francisco Álvarez-Salvago
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071, Jaén, Spain.
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, 46010, Valencia, Spain.
| | - Daniel Velázquez-Díaz
- ExPhy Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
- AdventHealth Research Institute, Neuroscience Institute, Orlando, FL, 32803, USA
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Zhai M, Huang Y, Zhou S, Jin Y, Feng J, Pei C, Wen L, Wen's L. Effects of age-related changes in trunk and lower limb range of motion on gait. BMC Musculoskelet Disord 2023; 24:234. [PMID: 36978129 PMCID: PMC10044394 DOI: 10.1186/s12891-023-06301-4] [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: 10/25/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The ability to walk is crucial for maintaining independence and a high quality of life among older adults. Although gait characteristics have been extensively studied in older adults, most studies have investigated muscle activity in the joints of the trunk or the lower limbs without assessing their interactions. Thus, the causes of altered trunk and lower limb movement patterns in older adults remain to explore. Therefore, this study compared the joint kinematic parameters of both trunk and lower limbs between young and older adults to identify kinematic factors associated with changes in gait among older adults. METHODS In total, 64 older (32 males, aged 68.34 ± 7.38 years; 32 females, aged 67.16 ± 6.66 years) and 64 young (32 males, aged 19.44 ± 0.84 years; 32 females, aged 19.69 ± 0.86 years) healthy adults participated in this study. The range of motion (ROM) of the thorax, pelvis, and trunk in the horizontal plane and of the hip, knee, and ankle joints of the lower limbs in the sagittal plane were measured using a motion capture system with wearable sensors. Two-way analysis of variance assessed differences in ROM by group, sex, and spatio-temporal gait parameters; Pearson correlation analysis assessed the correlation of the trunk and lower limbs. RESULTS Step length, gait speed, and stride length were greater in young adults (p < 0.001) than in older adults, but older women displayed the fastest gait speed (p < 0.05). ROM values for the pelvis, thorax, trunk, knee joint, and ankle joint of young adults were greater (p < 0.05) than those in older adults. However, hip ROM in older adults was significantly greater than that in young adults (p < 0.05). CONCLUSION With increasing age, ROM of the lower limbs, especially the ankle joint, decreased significantly, resulting in a significant decrease in gait speed. As ROM of the pelvis decreased, stride length decreased significantly in older adults, who compensate through thoracic rotation. Thus, older adults should enhance muscle strength and increase ROM to improve gait patterns.
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Affiliation(s)
- Meiling Zhai
- School of Sports and Health, Nanjing Sport Institute, Nanjing, Jiangsu, China
| | - Yongchao Huang
- School of Sports and Health, Nanjing Sport Institute, Nanjing, Jiangsu, China
| | - Shi Zhou
- Physical Activity, Sport and Exercise Research Theme, Faculty of Health, Southern Cross University, 2480, Lismore, NSW, Australia
| | - Yahong Jin
- School of Physical Education and Humanities, Nanjing Sport Institute, Nanjing, Jiangsu, China.
| | - Jiayun Feng
- Institute of Sports Training, Tianjin University of Sport, Tianjin, China
| | - Chaolei Pei
- Institute of Physical Education, Shanxi Normal University, Taiyuan, China
| | - Li Wen
- School of Sports and Health, Nanjing Sport Institute, Nanjing, Jiangsu, China.
| | - Li Wen's
- School of Sports and Health, Nanjing Sport Institute, Nanjing, Jiangsu, China
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Klaewkasikum K, Patathong T, Angsanuntsukh C, Woratanarat T, Sanguantrakul J, Woratanarat P. The ankle kinematic reference of normal gait pattern in Thai adults. Front Surg 2022; 9:915090. [PMID: 36034375 PMCID: PMC9403080 DOI: 10.3389/fsurg.2022.915090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study was aimed to establish the reference values of ankle kinematics and factors associated with ankle kinematics of healthy Thai adults.MethodsA prospective cohort was conducted among healthy volunteers aged between 18 and 40 years and evaluated gait analysis between 2016 and 2020. After applying the modified Halen Hayes marker set, participants were assigned to walk 8–10 rounds with their preferred speed. Demographic data i.e., age, gender and body mass index (BMI) and ankle kinematics (varus-valgus, dorsiflexion-plantar flexion, foot progression, and ankle rotation) using motion analysis software were recorded and analyzed.Results98 volunteers (60 females and 38 males) aged 28.6 ± 5.4 years with body mass index 21.2 ± 2.0 kg/m2 were included. The average ranges of ankle kinematics entire gait cycle were varus-valgus −1.62 to 3.17 degrees, dorsiflexion-plantar flexion 0.67 to 14.52 degrees, foot progression −21.73 to −8.47 degrees, and ankle rotation 5.22 to 9.74 degrees. The ankle kinematic data in this study population was significantly different from the normal values supplied by OrthoTrak software of the motion analysis program, especially more ankle internal rotation at mid-stance (5.22 vs. −12.10 degrees) and terminal stance (5.48 vs. −10.74 degrees) with P < 0.001. Foot progression significantly exhibited more external rotation for 1.5 degrees on the right compared to the left side, and for 5 degrees more in males than females. One increment in age was significantly correlated with ankle internal rotation at mid-swing (coefficient 0.21 degrees, P = 0.039). BMI had no statistical association with ankle kinematics. Statistical parametric mapping for full-time series of angle assessments showed significantly different foot progression at initial contact and terminal stance between sides, and our ankle kinematics significantly differed from the reference values of the motion analysis program in all planes (P < 0.05).ConclusionThe reference of ankle kinematics of Thai adults was established and differences between sides and the normal values of the motion analysis program were identified. Advanced age was associated with ankle internal rotation, and male gender was related to external foot progression. Further studies are needed to define all-age group reference values.
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Affiliation(s)
- Krongkaew Klaewkasikum
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyaporn Patathong
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chanika Angsanuntsukh
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thira Woratanarat
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, BangkokThailand
| | - Jongsook Sanguantrakul
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Pathumthani, Thailand
| | - Patarawan Woratanarat
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Patarawan Woratanarat
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