Foot landing position during gait influences ground reaction forces

How to walk to reduce footstep noise in multi-story residential buildings

Loud footsteps from upstairs cause disturbance to downstairs neighbours in multi-story residential buildings. In this experiment, we examined how participants walk when asked to walk quietly and evaluated the efficiency of their quiet walking patterns. Changes in vertical impact loading rates during the early stance phase, walking speed, and lower limb muscle activity when asked to walk quietly were evaluated from twenty-six young participants. Study data show that participants who struck the ground with the rearfoot reduced the impact loading rate by 44.6% with 29.3% slower walking speed than normal walking. Those who struck with the fore- or mid-foot reduced the impact loading by 69.2% with a 23.4% decrease in speed. Quiet walking with the non-rearfoot strike pattern reduced the impact loading by 48.7%, even when asked to walk as fast as normal walking. The results support the non-rearfoot strike pattern as an efficient walking strategy for lowering footstep impact.Practitioner summary: Data of this study show that voluntary gait alteration, such as adopting a non-rearfoot strike pattern, can reduce footstep impact. The study results propose that implementing such changes could be beneficial in addressing floor noise issues of multi-story residential buildings.Abbreviations: RFS: Rearfoot strike; NRFS: non-rearfoot strike; COP: Center of pressure; NW: Normal walking; QWs: Quiet walking at a preferred slower speed; QWn: Quiet walking at the speed of normal walking; EMG: Electromyography; BW: Body weight; iNEMG: integrated normalized EMG.

Effects of initial foot position on postural responses to lateral standing surface perturbations in younger and older adults

BACKGROUND

An age-related decline in standing balance control in the medio-lateral direction is associated with increased risk of falls. A potential approach to improve postural stability is to change initial foot position (IFP).

RESEARCH QUESTIONS

In response to a lateral surface perturbation, how are lower extremity muscle activation levels different and what are the effects of different IFPs on muscle activation patterns and postural stability in younger versus older adults?

METHODS

Ten younger and ten older healthy adults participated in this study. Three IFPs were tested [Reference (REF): feet were placed parallel, shoulder-width apart; Toes-out with heels together (TOHT): heels together with toes pointing outward; Modified Semi-Tandem (M-ST): the heel of the anterior foot was placed by the big toe of the posterior foot]. Unexpected lateral translations of the standing surface were applied. Electromyographic (EMG) activity of the lower extremity muscles, standard deviation (SD) of the body's CoM acceleration (SD of CoMAccel), and center of pressure (CoP) sway area were compared across IFPs and age.

RESULTS

Activation levels of the muscles serving the ankle and gluteus medius were greater than for the knee joint muscles and gluteus maximus in the loaded leg across all IFPs in both groups. TOHT showed greater EMG peak amplitude of the soleus and fibularis longus compared to REF, and had smaller SD of CoMAccel and CoP sway area than M-ST. Compared to younger adults, older adults demonstrated lower EMG peak amplitude and delayed peak timing of the fibularis longus and greater SD of CoMAccel and CoP sway area in all IFPs during balance recovery.

SIGNIFICANCE

During standing balance recovery, ankle muscles and gluteus medius are important active responders to unexpected lateral surface perturbations and a toes-out IFP could be a viable option to enhance ankle muscle activation that diminishes with age to improve postural stability.

Differences in lower-extremity kinematics between the male military personnel with and without plantar fasciitis

OBJECTIVE

To evaluate the factors that influence gait by comparing lower extremity kinematics during the stance phase of the gait cycle between individuals with and without plantar fasciitis.

DESIGN

A cross-sectional study.

SETTING

Motion analysis research laboratory.

PARTICIPANTS

Thirty subjects with plantar fasciitis and 30 aged-matched controls.

MAIN OUTCOME MEASURE(S)

Range of motion of the lower extremity and multi-segment foot during gait using a three-dimensional motion analysis system.

RESULTS

The plantar fasciitis group showed significant differences in motion in the multi-segment foot, ankle, knee, and hip from the control group during various subphases of the stance phase. Specifically, relative to the control group, the plantar fasciitis group had more rearfoot adduction, forefoot eversion, ankle abduction, and hip abduction. They also had less midfoot dorsiflexion, forefoot dorsiflexion, knee extension, knee external rotation, and hip extension (all Ps < 0.05).

CONCLUSIONS

Individuals with plantar fasciitis exhibited more flexibility in the ankle-foot complex and poorer quality of lower-extremity movement than the group that did not have plantar fasciitis. Thus, differences in structures in both the ankle-foot complex as well as those in the hip and knee joints appear to be associated with the presence of plantar fasciitis.

Ankle Joint and Rearfoot Biomechanics During Toe-In and Toe-Out Walking in People With Medial Compartment Knee Osteoarthritis

BACKGROUND

Toe-in and toe-out walking are 2 strategies that have been shown to be effective in reducing the knee adduction moment in people with knee osteoarthritis. However, despite a positive biomechanical impact on the knee, altering foot rotation may impart unintended forces or joint positions on the ankle that could impact joint health. The kinematic and kinetic changes at the ankle during toe-in or toe-out walking have yet to be examined.

OBJECTIVE

To examine ankle/rearfoot biomechanics during toe-in and toe-out walking in those with knee osteoarthritis.

DESIGN

Single-session repeated measures design to compare ankle biomechanics during walking with 4 different foot rotations.

SETTING

University motion analysis laboratory.

PARTICIPANTS

A convenience sample (N = 15) of males and females with a diagnosis of medial knee osteoarthritis confirmed by radiographs.

METHODS

Participants walked in 4 conditions guided by real-time biofeedback: (1) toe-in (+10°), (2) zero rotation (0°), (3) toe-out (-10°), and (4) toe-out (-20°). Ankle and rearfoot kinematics and kinetics were examined during barefoot over-ground walking.

MAIN OUTCOME MEASURES

Ankle joint angles, moments, moment impulses, and foot rotation.

RESULTS

Overall, toe-in compared to toe-out walking decreased (P = .03) peak rearfoot eversion (toe-in = -1.6°; 10° toe-out = -3.7°; 20° toe-out = -4.1°). Toe-in compared to toe-out walking also increased rearfoot inversion at initial contact (7.4° vs 3.1° at 10° toe-out and 1.9° at 20° toe-out; P < .001) and frontal plane rearfoot angle excursion (9.0° vs 6.8° at 10° toe-out and 6.0° at 20° toe-out; P < .006). Toe-in compared to all other conditions increased peak external ankle inversion moments (0.04 Nm/kg vs 0.02 Nm/kg at 0°, 0.02 Nm/kg at 10° toe-out, and 0.01 Nm/kg at 20° toe-out; P < .003).

CONCLUSIONS

Toe-in and toe-out walking require different ankle/rearfoot biomechanics, though no differences in discomfort were observed. Longer-term studies are required to properly assess these relationships in knee osteoarthritis populations.

LEVEL OF EVIDENCE

IV.

Prospective study of biomechanical risk factors for second and third metatarsal stress fractures in military recruits

OBJECTIVES

This prospective study investigated anatomical and biomechanical risk factors for second and third metatarsal stress fractures in military recruits during training.

DESIGN

Prospective cohort study.

METHODS

Anatomical and biomechanical measures were taken for 1065 Royal Marines recruits at the start of training when injury-free. Data included passive range of ankle dorsi-flexion, dynamic peak ankle dorsi-flexion and plantar pressures during barefoot running. Separate univariate regression models were developed to identify differences between recruits who developed second (n=7) or third (n=14) metatarsal stress fracture and a cohort of recruits completing training with no injury (n=150) (p<0.05). A multinomial logistic regression model was developed to predict the risk of injury for the two sites compared with the no-injury group. Multinomial logistic regression results were back transformed from log scale and presented in Relative Risk Ratios (RRR) with 95% confidence intervals (CI).

RESULTS

Lower dynamic arch index (high arch) (RRR: 0.75, CI: 0.63-0.89, p<0.01) and lower foot abduction (RRR: 0.87, CI: 0.80-0.96, p<0.01) were identified as increasing risk for second metatarsal stress fracture, while younger age (RRR: 0.78, CI: 0.61-0.99, p<0.05) and later peak pressure at the second metatarsal head area (RRR: 1.19, CI: 1.04-1.35, p<0.01) were identified as risk factors for third metatarsal stress fracture.

CONCLUSIONS

For second metatarsal stress fracture, aspects of foot type have been identified as influencing injury risk. For third metatarsal stress fracture, a delayed forefoot loading increases injury risk. Identification of these different injury mechanisms can inform development of interventions for treatment and prevention.

Gastrocnemius inflexibility on foot progression angle and ankle kinetics during walking

BACKGROUND

Gastrocnemius inflexibility is a major problem in many orthopedic and neurological patients. Clinically, inflexible gastrocnemius muscles interfere with the performance of functional abilities and associate with many overuse injuries of the lower extremity. The purpose of this study was to investigate the effects of the gastrocnemius inflexibility on the foot progression angle and ankle kinetics during walking.

METHODS

There were 50 subjects, 23 patients with the inflexible gastrocnemius and 27 normal subjects, included in this investigation. Participants were asked to walk at two preset cadences of 100 steps/min and 140 steps/min. Data were collected from a motion analysis system and force plates. Kinematic and kinetic variables of gait were computed and analyzed.

FINDINGS

Compared with the control group, greater toe-out foot progression angle (P=0.001, effect size=0.314) and knee external rotation (P=0.008, effect size=0.136) were found in the inflexible group during stance phase. Furthermore, significant greater plantarflexion moment (P=0.032, effect size=0.093) and medial ground reaction force (P=0.009, effect size=0.135) during midstance were discovered in the inflexible group.

INTERPRETATION

The present results indicate that gastrocnemius inflexibility might bring about the changes in the joint angles, ankle moments and ground reaction forces. The abnormal joint alignment in the lower extremities and greater force upon joint tissue might be significant for the clinical considerations on soft tissue injuries for the patients with inflexible gastrocnemius muscles.

Analysis of ground reaction force and electromyographic activity of the gastrocnemius muscle during double support

Mechanisms associated with energy expenditure during gait have been extensively researched and studied. According to the double-inverted pendulum model energy expenditure is higher during double support, as lower limbs need to work to redirect the centre of mass velocity. This study looks into how the ground reaction force of one limb affects the muscle activity required by the medial gastrocnemius of the contralateral limb during step-to-step transition. Thirty-five subjects were monitored as to the medial gastrocnemius electromyographic activity of one limb and the ground reaction force of the contralateral limb during double support. After determination of the Pearson correlation coefficient (r), a moderate correlation was observed between the medial gastrocnemius electromyographic activity of the dominant leg and the vertical (Fz) and anteroposterior (Fy) components of ground reaction force of the non-dominant leg (r = 0.797, p < 0.0001; r = –0.807, p < 0.0001). A weak and moderate correlation was observed between the medial gastrocnemius electromyographic activity of the non-dominant leg and the Fz and Fy of the dominant leg, respectively (r = 0.442, p = 0.018; r = –0.684 p < 0.0001). The results obtained suggest that during double support, ground reaction force is associated with the electromyographic activity of the contralateral medial gastrocnemius and that there is an increased dependence between the ground reaction force of the non-dominant leg and the electromyographic activity of the dominant medial gastrocnemius.

Foot pressure and center of pressure in athletes with ankle instability during lateral shuffling and running gait

This study evaluates foot pressure and center of pressure (COP) patterns in individuals with ankle instability during running and lateral shuffling. Eleven participants with ankle instability (AI) and 11 normal subjects (Normal) performed running and lateral shuffling tasks. The outcome measures were foot progression angle, peak pressure, and displacement of COP during stance phase. During running, the foot progression angle, that is, the angle of foot abduction, was lower in the AI group (Normal: 13.46° ± 4.45°; AI: 8.78° ± 3.91°), and the 1st metatarsal contact pressure (Normal: 0.76 ± 0.47 N/cm(2)·kg; AI: 1.05 ± 0.70 N/cm(2)·kg) and the 3rd metatarsal peak pressure were higher in the AI (Normal: 0.96 ± 0.60 N/cm(2)·kg; AI: 1.54 ± 0.68 N/cm(2)·kg). The medial-lateral (M-L) COP in the late-stance phase of running for the AI group transferred faster from lateral to medial foot than the Normal group. For lateral shuffling, the AI group had greater peak pressure at the 1st (Normal: 0.76 ± 0.67 N/cm(2)·kg; AI: 1.49 ± 1.04 N/cm(2)·kg), 2nd (Normal: 0.57 ± 0.39 N/cm(2)·kg; AI: 0.87 ± 0.68 N/cm(2)·kg), 3rd (Normal: 0.70 ± 0.54 N/cm(2)·kg; AI: 1.42 ± 0.87 N/cm(2)·kg), and 4th (Normal: 0.52 ± 0.38 N/cm(2)·kg; AI: 1.12 ± 0.78 N/cm(2)·kg) metatarsal areas than the Normal group. The M-L COP located more laterally from the early to mid-stance phase in the AI compared with the Normal group. The findings suggest that COP displacement during lateral shuffle may be a factor in ankle instability while the foot progression angle during running may be a compensatory strategy.

The influence of foot geometry on the calcaneal osteotomy angle based on two-dimensional static force analyses

BACKGROUND

Malalignment of the hindfoot can be corrected with a calcaneal osteotomy (CO). A well-selected osteotomy angle in the sagittal plane will reduce the shear force in the osteotomy plane while walking. The purpose was to determine the presence of a relationship between the foot geometry and loading of the calcaneus, which influences the choice of the preferred CO angle.

METHODS

A static free body force analysis was made of the posterior calcaneal fragment in the second half of the stance phase to determine the main loads: the plantar apeunorosis (PA) and Achilles tendon (AT). The third load is on the osteotomy surface which should be oriented such that the shear component of the force is zero. The force direction of the PA and AT was measured on 58 MRIs of the foot, and the force ratio between both structures was taken from the literature. In addition the PA-to-AT force ratio was estimated for different foot geometries to identify the relationship.

RESULTS

Based on the wish to minimize the shear force during walking, a mean CO angle was determined to be 33° (SD8) relative to the foot sole. In pes planus foot geometry, the angle should be higher than the mean. In pes cavus foot geometry, the angle should be smaller.

CONCLUSION

Foot geometry, in particular the relative foot heights is a determinant for the individual angle in performing the sliding calcaneal osteotomy. It is recommended to take into account the foot geometry (arch) when deciding on the CO angle for hindfoot correction.

Reliability, smallest real difference and concurrent validity of indices computed from GRF components in gait of stroke patients

We analysed reliability, smallest real difference (SRD) and concurrent validity of indices computed from the ground reaction force (GRF) vertical and fore-aft components in a sample of 56 patients with hemiparesis secondary to stroke. These parameters have been recommended for the assessment of weight-bearing and propulsion. The sample size was calculated based on guidelines for reliability studies and patient levels of impairment ranged from mild to severe. Reliability was assessed by the intraclass correlation coefficient (ICC), SRD was computed as the 95% confidence interval (CI) of the standard error and concurrent validity was assessed using the Spearman correlation coefficient between each index and gait speed, with the latter being used as the criterion standard. Excellent reliability (ICC>0.90) for all indices was achieved by averaging values of three consecutive gait trials. SRD ranged between 5% and 10% of the sample grand mean for vertical GRF-based indices, and between 20% and 40% for fore-aft GRF-based indices. All indices but one showed concurrent validity with walking speed, with correlation coefficients ranging from 0.423 (p<0.01) to 0.834 (p<0.01). Amongst studied indices, the mean value of vertical GRF and the mean value of the propulsive part of the fore-aft component showed the best performance in terms of ICC, SRD and concurrent validity. These appear to be the most appropriate indices to assess weight-bearing and propulsive ability, respectively, in this group.

Ground reaction: intrinsic and extrinsic variability assessment and related method for artefact treatment

Ground reaction (GR) components measured by a dynamometric platform represent the dynamic interaction of the moving human body with the ground and depend on the subject-platform relative position and orientation. The observed variability among the GR measurements of the walking trials of an individual is either due to variability in the motor performance (intrinsic variability) or due to changes in the direction of walking and in the position and orientation of the striking foot relative to the platform (extrinsic variability). A method, based on the median operator, is presented here which lets us quantify the two components of variability. The application of the method to a large data set of normal subjects evidenced changes in progression direction/foot orientation (95th percentile value is 6.9 degrees ), which can dramatically change the patterns of GR components. This result warns about improper analysis of ground reaction measurement. An algorithm for restoring GR measurements affected by artefact was derived from the above method. This tool can be of valuable aid in clinical practice where patients' conditions suggest to not insist on repetition of trials even if the required number of correct foot placements has not been achieved. The artefact correction algorithm has been applied to a large data set artificially corrupted to evaluate its robustness.