Energy neutral: the human foot and ankle subsections combine to produce near zero net mechanical work during walking

The effect of including a mobile arch, toe joint, and joint coupling on predictive neuromuscular simulations of human walking

Predictive neuromuscular simulations are a powerful tool for studying the biomechanics of human walking, and deriving design criteria for technical devices like prostheses or biorobots. Good agreement between simulation and human data is essential for transferability to the real world. The human foot is often modeled with a single rigid element, but knowledge of how the foot model affects gait prediction is limited. Standardized procedures for selecting appropriate foot models are lacking. We performed 2D predictive neuromuscular simulations with six different foot models of increasing complexity to answer two questions: What is the effect of a mobile arch, a toe joint, and the coupling of toe and arch motion through the plantar fascia on gait prediction? and How much of the foot's anatomy do we need to model to predict sagittal plane walking kinematics and kinetics in good agreement with human data? We found that the foot model had a significant impact on ankle kinematics during terminal stance, push-off, and toe and arch kinematics. When focusing only on hip and knee kinematics, rigid foot models are sufficient. We hope our findings will help guide the community in modeling the human foot according to specific research goals and improve neuromuscular simulation accuracy.

Role of midsole hollow structure in energy storage and return in running shoes

Understanding the relationship between footwear features and their potential influence on running performance can inform the ongoing innovation of running footwear, aimed at pushing the limits of humans. A notable shoe feature is hollow structures, where an empty space is created in the midsole. Presently, the potential biomechanical effect of the hollow structures on running performance remains unknown. We investigated the role of hollow structures through quantifying the magnitude and timing of foot and footwear work. Sixteen male rearfoot runners participated in an overground running study in three shoe conditions: (a) a shoe with a hollow structure in the forefoot midsole (FFHS), (b) the same shoe without any hollow structure (Filled-FFHS) and (c) a shoe with a hollow structure in the midfoot midsole (MFHS). Distal rearfoot power was used to quantify the net power generated by foot and footwear together. The magnitude and timing of distal rearfoot work and ankle joint work were compared across shoe conditions. The results indicated that MFHS can significantly (p = 0.024) delay distal rearfoot energy return (3.4 % of stance) when compared to Filled-FFHS. Additionally, FFHS had the greatest positive (0.425 J/kg) and negative (-0.383 J/kg) distal rearfoot work, and the smallest positive (0.503 J/kg) and negative (-0.477 J/kg) ankle joint work among the three conditions. This showed that the size and location of the midsole hollow structure can affect timing and magnitude of energy storage and return. The forefoot hollow shoe feature can effectively increase distal rearfoot work and reduce ankle joint work during running.

A dynamic foot model for predictive simulations of human gait reveals causal relations between foot structure and whole-body mechanics

The unique structure of the human foot is seen as a crucial adaptation for bipedalism. The foot's arched shape enables stiffening the foot to withstand high loads when pushing off, without compromising foot flexibility. Experimental studies demonstrated that manipulating foot stiffness has considerable effects on gait. In clinical practice, altered foot structure is associated with pathological gait. Yet, experimentally manipulating individual foot properties (e.g. arch height or tendon and ligament stiffness) is hard and therefore our understanding of how foot structure influences gait mechanics is still limited. Predictive simulations are a powerful tool to explore causal relationships between musculoskeletal properties and whole-body gait. However, musculoskeletal models used in three-dimensional predictive simulations assume a rigid foot arch, limiting their use for studying how foot structure influences three-dimensional gait mechanics. Here, we developed a four-segment foot model with a longitudinal arch for use in predictive simulations. We identified three properties of the ankle-foot complex that are important to capture ankle and knee kinematics, soleus activation, and ankle power of healthy adults: (1) compliant Achilles tendon, (2) stiff heel pad, (3) the ability to stiffen the foot. The latter requires sufficient arch height and contributions of plantar fascia, and intrinsic and extrinsic foot muscles. A reduced ability to stiffen the foot results in walking patterns with reduced push-off power. Simulations based on our model also captured the effects of walking with anaesthetised intrinsic foot muscles or an insole limiting arch compression. The ability to reproduce these different experiments indicates that our foot model captures the main mechanical properties of the foot. The presented four-segment foot model is a potentially powerful tool to study the relationship between foot properties and gait mechanics and energetics in health and disease.

Effects of different step lengths at a preferred walking speed on forefoot, midfoot, and hindfoot motion in healthy young adults

Hindfoot, midfoot, and forefoot motion during the stance phase of walking provide insights into the forward progression of the body over the feet via the rocker mechanisms. These segmental motions are affected by walking speed. Increases in walking speed are accomplished by increasing step length and cadence. It is unknown if taking short, medium, and long steps at the same speed would increase hindfoot, midfoot, and forefoot motion similarly to walking speed. We examined effects of different step lengths at the same preferred walking speed on peak forefoot, midfoot, and hindfoot motions related to the foot rockers. Twelve young healthy adults completed five walking trials under three step length conditions in a random order as feet and lower extremity motion were measured via marker positions for the combined Oxford foot and conventional gait models. Peak hindfoot, midfoot, and forefoot joint angles indicating heel, ankle, and forefoot rockers were identified. When walking at the same preferred speed with increase in step length, there were increases in peak hindfoot-tibia plantarflexion angle (p < 0.001; ηp2 = 0.76) in early stance associated with the heel rocker and peak hindfoot-tibia dorsiflexion angle (p = 0.016; ηp2 = 0.39) in midstance associated with ankle rocker. In late stance, the peak hindfoot-tibia plantarflexion angle, forefoot-hindfoot angle, and forefoot-hallux dorsiflexion angle indicating forefoot rocker motion also increased with step length (p < 0.01). When foot kinematics are compared across different individuals or the same individual across different sessions, researchers and clinicians should consider the influence of step length as a contributor to differences in foot kinematics observed.

Mechanics of the foot and ankle joints during running using a multi-segment foot model compared with a single-segment model

The primary purpose of this study was to compare the ankle joint mechanics, during the stance phase of running, computed with a multi-segment foot model (MULTI; three segments) with a traditional single segment foot model (SINGLE). Traditional ankle joint models define all bones between the ankle and metatarsophalangeal joints as a single rigid segment (SINGLE). However, this contrasts with the more complex structure and mobility of the human foot, recent studies of walking using more multiple-segment models of the human foot have highlighted the errors arising in ankle kinematics and kinetics by using an oversimplified model of the foot. This study sought to compare whether ankle joint kinematics and kinetics during running are similar when using a single segment foot model (SINGLE) and a multi-segment foot model (MULTI). Seven participants ran at 3.1 m/s while the positions of markers on the shank and foot were tracked and ground reaction forces were measured. Ankle joint kinematics, resultant joint moments, joint work, and instantaneous joint power were determined using both the SINGLE and MULTI models. Differences between the two models across the entire stance phase were tested using statistical parametric mapping. During the stance phase, MULTI produced ankle joint angles that were typically closer to neutral and angular velocities that were reduced compared with SINGLE. Instantaneous joint power (p<0.001) and joint work (p<0.001) during late stance were also reduced in MULTI compared with SINGLE demonstrating the importance of foot model topology in analyses of the ankle joint during running. This study has highlighted that considering the foot as a rigid segment from ankle to MTP joint produces poor estimates of the ankle joint kinematics and kinetics, which has important implications for understanding the role of the ankle joint in running.

Greater foot and footwear mechanical work associated with less ankle joint work during running

Footwear energy storage and return is often suggested as one explanation for metabolic energy savings when running in Advanced Athletic Footwear. However, there is no common understanding of how footwear energy storage and return facilitates changes in muscle and joint kinetics. The purpose of this study was to evaluate the magnitude and timing of foot, footwear and lower limb joint powers and work while running in Advanced and Traditional Athletic Footwear. Fifteen runners participated in an overground motion analysis study. Since footwear kinetics are methodologically challenging to quantify, we leveraged distal rearfoot power analyses ('foot + footwear' power) and evaluated changes in the magnitude and timing of foot + footwear power and lower limb joint powers. Running in Advanced Footwear resulted in greater foot + footwear work, compared to Traditional Shoes, and lower positive ankle work, potentially reducing the muscular demand on the runner. The timing of foot + footwear power varied only slightly across footwear. There are exciting innovation opportunities to manipulate the timing of footwear energy and return. This study demonstrates the research value of quantifying time-series foot + footwear power, and points industry developers towards footwear innovation opportunities.

Quantification of push-off and collision work during step-to-step transition in amputees walking at self-selected speed: Effect of amputation level

Maintaining forward walking during human locomotion requires mechanical joint work, mainly provided by the ankle-foot in non-amputees. In lower-limb amputees, their metabolic overconsumption is generally attributed to reduced propulsion. However, it remains unclear how altered walking patterns resulting from amputation affect energy exchange. The purpose of this retrospective study was to investigate the impact of self-selected walking speed (SSWS) on mechanical works generated by the ankle-foot and by the entire lower limbs depending on the level of amputation. 155 participants, including 47 non-amputees (NAs), 40 unilateral transtibial amputees (TTs) and 68 unilateral transfemoral amputees (TFs), walked at their SSWS. Positive push-off work done by the trailing limb (WStS+) and its associated ankle-foot (Wankle-foot+), as well as negative collision work done by the leading limb (WStS-) were analysed during the transition from prosthetic limb to contralateral limb. An ANCOVA was performed to assess the effect of amputation level on mechanical works, while controlling for SSWS effect. After adjusting for SSWS, NAs produce more push-off work with both their biological ankle-foot and trailing limb than amputees do on prosthetic side. Using the same type of prosthetic feet, TTs and TFs can generate the same amount of prosthetic Wankle-foot+, while prosthetic WStS+ is significantly higher for TTs and remains constant with SSWS for TFs. Surprisingly and contrary to theoretical expectations, the lack of propulsion at TFs' prosthetic limb did not affect their contralateral WStS-, for which a difference is significant only between NAs and TTs. Further studies should investigate the relationship between the TFs' inability to increase prosthetic limb push-off work and metabolic expenditure.

Impact of pronated foot on energetic behavior and efficiency during walking

BACKGROUND

The longitudinal arch of the foot acts like a spring during stance and contributes to walking efficiency. Pronated foot characterized by a collapsed medial longitudinal arch may have the impaired spring-like function and poor walking efficiency. However, the differences in the energetic behavior during walking between individuals with pronated foot and neutral foot have not been considered.

RESEARCH QUESTION

How does the energetic behavior within the foot and proximal lower limb joints in pronated foot affect walking efficiency?

METHODS

Twenty-one healthy young adults were classified into neutral foot and pronated foot based on the Foot Posture Index score. All subjects walked across the floor and attempted to have the rearfoot and forefoot segments contact separate force plates to analyze the forces acting on isolated regions within the foot. Kinematic and kinetic data were recorded by a three-dimensional motion capture system. The hip, knee, ankle, and mid-tarsal joint power was quantified using a 6-degree-of-freedom joint power method. To qualify total power within all structures of the foot and forefoot, we used a unified deformable segment analysis. Additionally, we calculated the center of mass power to quantify the total power of the whole body RESULTS: There is no difference in the mid-tarsal joint work between the pronated foot and neutral foot. On the other hand, pronated foot exhibited greater net negative work at structures distal to the forefoot during walking. Additionally, pronated foot exhibited less net positive work at the ankle and center of mass during walking compared to neutral foot.

SIGNIFICANCE

Individuals with pronated foot generate the mid-tarsal joint work by increasing the work absorbed at structures distal to the forefoot, which results in reduced energy efficiency during walking. That energy inefficiency may reduce positive work at the ankle and affect the walking efficiency in individuals with pronated foot.

Chasing footprints in time - reframing our understanding of human foot function in the context of current evidence and emerging insights

In this narrative review we evaluate foundational biomechanical theories of human foot function in light of new data acquired with technology that was not available to early researchers. The formulation and perpetuation of early theories about foot function largely involved scientists who were medically trained with an interest in palaeoanthropology, driven by a desire to understand human foot pathologies. Early observations of people with flat feet and foot pain were analogized to those of our primate ancestors, with the concept of flat feet being a primitive trait, which was a driving influence in early foot biomechanics research. We describe the early emergence of the mobile adaptor-rigid lever theory, which was central to most biomechanical theories of human foot function. Many of these theories attempt to explain how a presumed stiffening behaviour of the foot enables forward propulsion. Interestingly, none of the subsequent theories have been able to explain how the foot stiffens for propulsion. Within this review we highlight the key omission that the mobile adaptor-rigid lever paradigm was never experimentally tested. We show based on current evidence that foot (quasi-)stiffness does not actually increase prior to, nor during propulsion. Based on current evidence, it is clear that the mechanical function of the foot is highly versatile. This function is adaptively controlled by the central nervous system to allow the foot to meet the wide variety of demands necessary for human locomotion. Importantly, it seems that substantial joint mobility is essential for this function. We suggest refraining from using simple, mechanical analogies to explain holistic foot function. We urge the scientific community to abandon the long-held mobile adaptor-rigid lever paradigm, and instead to acknowledge the versatile and non-linear mechanical behaviour of a foot that is adapted to meet constantly varying locomotory demands.

Changes in Relative Work of the Lower Extremity and Distal Foot Joints After Total Ankle Replacement: An Exploratory Study

Ankle osteoarthritis does not only led to lower ankle power generation, but also results in compensatory gait mechanics at the hip and Chopart joints. Much of previous work explored the relative work distribution after total ankle replacement (TAR) either across the lower extremity joints where the foot was modelled as a single rigid unit or across the intrinsic foot joints without considering the more proximal lower limb joints. Therefore, this study aims, for the first time, to combine 3D kinetic lower limb and foot models together to assess changes in the relative joint work distribution across the foot and lower limb joints during level walking before and after patients undergo TAR. We included both patients and healthy control subjects. All patients underwent a three-dimensional gait analysis before and after surgery. Kinetic lower limb and multi-segment foot models were used to quantify all inter-segmental joint works and their relative contributions to the total lower limb work. Patients demonstrated a significant increase in the relative ankle positive joint work contribution and a significant decrease in the relative Chopart positive joint work contribution after TAR. Furthermore, there exists a large effect toward decreases in the relative contribution of the hip negative joint work after TAR. In conclusion, this study seems to corroborate the theoretical rationale that TAR reduces the compensatory strategy in the Chopart and hip joints in patients suffering from end-stage ankle osteoarthritis.

Mechanics of the human foot during walking on different slopes

When humans walk on slopes, the ankle, knee, and hip joints modulate their mechanical work to accommodate the mechanical demands. Yet, it is unclear if the foot modulates its work output during uphill and downhill walking. Therefore, we quantified the mechanical work performed by the foot and its subsections of twelve adults walked on five randomized slopes (-10°, -5°, 0°, +5°, +10°). We estimated the work of distal-to-hindfoot and distal-to-forefoot structures using unified deformable segment analysis and the work of the midtarsal, ankle, knee, and hip joints using a six-degree-of-freedom model. Further, using a geometric model, we estimated the length of the plantar structures crossing the longitudinal arch while accounting for the first metatarsophalangeal wrapping length. We hypothesized that compared to level walking, downhill walking would increase negative and net-negative work magnitude, particularly at the early stance phase, and uphill walking would increase the positive work, particularly at the mid-to-late stance phase. We found that downhill walking increased the magnitude of the foot's negative and net-negative work, especially during early stance, highlighting its capacity to absorb impacts when locomotion demands excessive energy dissipation. Notably, the foot maintained its net dissipative behavior between slopes; however, the ankle, knee, and hip shifted from net energy dissipation to net energy generation when changing from downhill to uphill. Such results indicate that humans rely more on joints proximal to the foot to modulate the body's total mechanical energy. Uphill walking increased midtarsal's positive and distal-to-forefoot negative work in near-equal amounts. That coincided with the prolonged lengthening and delayed shortening of the plantar structures, resembling a spring-like function that possibly assists the energetic demands of locomotion during mid-to-late stance. These results broaden our understanding of the foot's mechanical function relative to the leg's joints and could inspire the design of wearable assistive devices that improve walking capacity.

Concomitant Triceps Surae Lengthening in Total Ankle Arthroplasty Affects the Mechanical Work at the Ankle Joint

BACKGROUND

Previous studies have examined the effect of concomitant triceps surae lengthening on ankle dorsiflexion motion at the time of total ankle arthroplasty (TAA). As plantarflexor muscle-tendon structures are important for producing positive ankle work during the propulsive phase of gait, caution should be exercised when lengthening triceps surae, as it may decrease plantarflexion strength. In order to develop an understanding of the work of the anatomical structures crossing the ankle during propulsion, joint work must be measured. The aim of this explorative study was to assess the effect of concomitant triceps surae lengthening with TAA on the resultant ankle joint work.

METHODS

Thirty-three patients were recruited to the study and divided into 3 groups of 11. The first group underwent both triceps surae lengthening (Strayer and TendoAchilles) and TAA (Achilles group), the second group underwent only TAA (Non-Achilles group), and the third group underwent only TAA, but had a greater radiographic prosthesis range of motion (Control group) compared to the first 2 groups. The 3 groups were matched in terms of demographic variables and walking speed. All patients underwent a 3D gait analysis 1 year after surgery to measure intersegmental joint work using a 4-segmented kinetic foot model. An analysis of variance (ANOVA) or Kruskal-Wallis test was used to compare the 3 groups.

RESULTS

The ANOVA showed significant differences between the 3 groups. Post hoc analyses suggested that (1) the Achilles group had less positive work at the ankle joint than the Non-Achilles and Control groups; (2) the Achilles group produced less positive work performed by all foot and ankle joints than the Control group; and (3) the Achilles and Non-Achilles groups absorbed less energy across all foot and ankle joints during the stance phase than the Control group.

CONCLUSION

Concomitant triceps surae lengthening in TAA may reduce the positive work at the ankle joint.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Kinetic coupling in distal foot joints during walking

BACKGROUND

Kinematic coupling between the first metatarsophalangeal (MTP) and midtarsal joints is evident during gait and other movement tasks, however kinetic foot coupling during walking has not been examined. Furthermore, contributing factors to foot coupling are still unclear. Therefore, the purpose of this study was to investigate kinematic and kinetic coupling within the foot by restricting MTP motion during overground walking. We hypothesized that when the MTP joint was prevented from fully extending, the midtarsal joint would achieve less peak motion and generate less positive work compared to walking with normal MTP motion.

METHODS

Twenty-six individuals participated in this randomized cross-over study. Using motion capture to track motion, participants walked at 1.3 m/s while wearing a brace that restricted MTP motion in a neutral (BR_NT) or extended (BR_EX) position. Additionally, participants walked while wearing the brace in a freely moveable setting (BR_UN) and with no brace (CON). A pressure/shear sensing device was used to capture forces under each foot segment. During stance, peak joint motion and work were calculated for the MTP and midtarsal joints using inverse dynamics. A series of ANOVAs and Holm post hoc tests were performed for all metrics (alpha = 0.05).

RESULTS

The brace successfully decreased peak MTP motion by 19% compared to BR_UN and CON. This was coupled with 9.8% less midtarsal motion. Kinetically, the work absorbed by the MTP joint (26-51%) and generated by the midtarsal joint (30-38%) were both less in BR_EX and BR_NT compared to BR_UN.

CONCLUSION

Implications and sources of coupling between the MTP and midtarsal joints are discussed within the context of center of pressure shifts and changes to segmental foot forces. Our results suggest that interventions aimed at modulating MTP negative work (such as footwear or assistive device design) should not ignore the midtarsal joint.

A Review of Piezoelectric Footwear Energy Harvesters: Principles, Methods, and Applications

Over the last couple of decades, numerous piezoelectric footwear energy harvesters (PFEHs) have been reported in the literature. This paper reviews the principles, methods, and applications of PFEH technologies. First, the popular piezoelectric materials used and their properties for PEEHs are summarized. Then, the force interaction with the ground and dynamic energy distribution on the footprint as well as accelerations are analyzed and summarized to provide the baseline, constraints, potential, and limitations for PFEH design. Furthermore, the energy flow from human walking to the usable energy by the PFEHs and the methods to improve the energy conversion efficiency are presented. The energy flow is divided into four processing steps: (i) how to capture mechanical energy into a deformed footwear, (ii) how to transfer the elastic energy from a deformed shoes into piezoelectric material, (iii) how to convert elastic deformation energy of piezoelectric materials to electrical energy in the piezoelectric structure, and (iv) how to deliver the generated electric energy in piezoelectric structure to external resistive loads or electrical circuits. Moreover, the major PFEH structures and working mechanisms on how the PFEHs capture mechanical energy and convert to electrical energy from human walking are summarized. Those piezoelectric structures for capturing mechanical energy from human walking are also reviewed and classified into four categories: flat plate, curved, cantilever, and flextensional structures. The fundamentals of piezoelectric energy harvesters, the configurations and mechanisms of the PFEHs, as well as the generated power, etc., are discussed and compared. The advantages and disadvantages of typical PFEHs are addressed. The power outputs of PFEHs vary in ranging from nanowatts to tens of milliwatts. Finally, applications and future perspectives are summarized and discussed.

Mechanics and energetics of human feet: a contemporary perspective for understanding mobility impairments in older adults

Much of our current understanding of age-related declines in mobility has been aided by decades of investigations on the role of muscle-tendon units spanning major lower extremity joints (e.g., hip, knee and ankle) for powering locomotion. Yet, mechanical contributions from foot structures are often neglected. This is despite the emerging evidence for their critical importance in youthful locomotion. With rapid growth in the field of human foot biomechanics over the last decade, our theoretical knowledge of young asymptomatic feet has transformed, from long-held views of a stiff lever and a shock-absorber to a versatile system that can modulate mechanical power and energy output to accommodate various locomotor task demands. In this perspective review, we predict that the next set of impactful discoveries related to locomotion in older adults will emerge by integrating the novel tools and approaches that are currently transforming the field of human foot biomechanics. By illuminating the functions of feet in older adults, we envision that future investigations will refine our mechanistic understanding of mobility deficits affecting our aging population, which may ultimately inspire targeted interventions to rejuvenate the mechanics and energetics of locomotion.

Novel testing system to determine shoe mechanical properties

BACKGROUND

Shoes play an important role in ankle foot orthosis (AFO) function and alignment. Despite this, shoe mechanical testing systems are rarely colocated with gait analysis systems, limiting their availability and use during AFO-related studies.

OBJECTIVE

The purpose of this study was to evaluate a novel mechanical testing system used to measure shoe heel stiffness and change in height with loading using equipment available in most gait analysis laboratories. The novel testing system will allow for shoe assessment during AFO studies at little additional cost.

STUDY DESIGN

Shoes were tested to determine initial stiffness, terminal stiffness, and total stiffness, and whether these measures changed with repeated compressions (early vs. late).

TECHNIQUE

The novel testing system consists of a baseplate for counterweights, uprights that support a low-friction hinge, and a lever arm with a heel-shaped indenter to apply force to the shoe. Minimal detectable change values were calculated using the standard error of measurement. Intraclass correlation coefficients were calculated in SPSS using a (2, k) model.

RESULTS

No significant differences in mean values, or interactions, were observed between rounds of testing and early and late compressions (P > .05). Intraclass correlation coefficient values were greater than 0.98, and minimal detectable change values were less than 20% of the average for each measure.

CONCLUSIONS

The novel mechanical testing system, combined with pre-existing gait analysis equipment, can be used to reliably assess shoe stiffness and change in height.

Methods of Estimating Foot Power and Work in Standing Vertical Jump

Experimental motion capture studies have commonly considered the foot as a single rigid body even though the foot contains 26 bones and 30 joints. Various methods have been applied to study rigid body deviations of the foot. This study compared 3 methods: distal foot power (DFP), foot power imbalance (FPI), and a 2-segment foot model to study foot power and work in the takeoff phase of standing vertical jumps. Six physically active participants each performed 6 standing vertical jumps from a starting position spanning 2 adjacent force platforms to allow ground reaction forces acting on the foot to be divided at the metatarsophalangeal (MTP) joints. Shortly after movement initiation, DFP showed a power absorption phase followed by a power generation phase. FPI followed a similar pattern with smaller power absorption and a larger power generation compared to DFP. MTP joints primarily generated power in the 2-segment model. The net foot work was -4.0 (1.0) J using DFP, 1.8 (1.1) J using FPI, and 5.1 (0.5) J with MTP. The results suggest that MTP joints are only 1 source of foot power and that differences between DFP and FPI should be further explored in jumping and other movements.

Decreased Mechanical Work Demand in the Chopart Joint After Total Ankle Replacement

BACKGROUND

The success of total ankle replacement (TAR) must be based on restoring reasonable mechanical balance with anatomical structures that can produce mechanical joint work through elastic (eg, tendons, fascia) or viscoelastic (eg, heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution across the affected joint and the neighboring foot joints after TAR is lacking. Therefore, the objective of this study was to investigate if there is a change in the joint work distribution across the Ankle, Chopart, Lisfranc and Metatarsophalangeal joints during level walking before and after patients undergo TAR.

METHODS

Fifteen patients with end-stage ankle osteoarthritis scheduled for primary TAR for pain relief were recruited and peer-matched with a sample of 15 control subjects. All patients underwent a 3D gait analysis before and after surgery, during which a kinetic multisegment foot model was used to quantify intersegmental joint work.

RESULTS

The contribution of the Ankle joint (P = .007) to the total foot and ankle positive work increased significantly after TAR. In contrast, a significant decrease in the contribution to the total foot and ankle joint positive work (P < .001) were found at the Chopart joint after TAR. The foot joints combined produced a significant increase in a net mechanical work from +0.01 J/kg before surgery to +0.05 J/kg after TAR (P = .006).

CONCLUSION

The findings of this study corroborate the theoretical rationale that TAR reduces significantly the compensatory strategy in the Chopart joint in patients with end-stage ankle osteoarthritis after TAR. However, the findings also showed that the contribution of the ankle joint of patients after TAR to the total foot and ankle joint positive work remained impaired compared to the control group.

Modulating Energy Among Foot-Ankle Complex With an Unpowered Exoskeleton Improves Human Walking Economy

Over the course of both evolution and development, the human musculoskeletal system has been well shaped for the cushion function of the foot during foot-strike and the impulsive function of the ankle joint during push-off. Nevertheless, an efficient energy interaction between foot structure and ankle joint is still lacking in the human body itself, which may limit the further potential of economical walking. Here we showed the metabolic expenditure of walking can be lessened by an unpowered exoskeleton robot that modulates energy among the foot-ankle complex towards a more effective direction. The unpowered exoskeleton recycles negative mechanical energy of the foot that is normally dissipated in heel-strike, retains the stored energy before mid-stance, and then transfers the energy to the ankle joint to assist the push-off. The modulation process of the exoskeleton consumes no input energy, yet reduces the metabolic cost of walking by 8.19 ± 0.96 % (mean ± s.e.m) for healthy subjects. The electromyography measurements demonstrate the activities of target ankle plantarflexors decreased significantly without added effort for the antagonistic muscle, suggesting the exoskeleton enhanced the subjects' energy efficiency of the foot-ankle complex in a natural manner. Furthermore, the exoskeleton also provides cushion assistance for walking, which leads to significantly decreased activity of the quadriceps muscle during heel-strike. Rather than strengthening the functions of existing biological structures, developing the complementary energy loop that does not exist in the human body itself also shows its potential for gait assistance.

Does the Heel’s Dissipative Energetic Behavior Affect Its Thermodynamic Responses During Walking?

Most of the terrestrial legged locomotion gaits, like human walking, necessitate energy dissipation upon ground collision. In humans, the heel mostly performs net-negative work during collisions, and it is currently unclear how it dissipates that energy. Based on the laws of thermodynamics, one possibility is that the net-negative collision work may be dissipated as heat. If supported, such a finding would inform the thermoregulation capacity of human feet, which may have implications for understanding foot complications and tissue damage. Here, we examined the correlation between energy dissipation and thermal responses by experimentally increasing the heel’s collisional forces. Twenty healthy young adults walked overground on force plates and for 10 min on a treadmill (both at 1.25 ms−1) while wearing a vest with three different levels of added mass (+0%, +15%, &amp; +30% of their body mass). We estimated the heel’s work using a unified deformable segment analysis during overground walking. We measured the heel’s temperature immediately before and after each treadmill trial. We hypothesized that the heel’s temperature and net-negative work would increase when walking with added mass, and the temperature change is correlated with the increased net-negative work. We found that walking with +30% added mass significantly increased the heel’s temperature change by 0.72 ± 1.91 ℃ (p = 0.009) and the magnitude of net-negative work (extrapolated to 10 min of walking) by 326.94 ± 379.92 J (p = 0.005). However, we found no correlation between the heel’s net-negative work and temperature changes (p = 0.277). While this result refuted our second hypothesis, our findings likely demonstrate the heel’s dynamic thermoregulatory capacity. If all the negative work were dissipated as heat, we would expect excessive skin temperature elevation during prolonged walking, which may cause skin complications. Therefore, our results likely indicate that various heat dissipation mechanisms control the heel’s thermodynamic responses, which may protect the health and integrity of the surrounding tissue. Also, our results indicate that additional mechanical factors, besides energy dissipation, explain the heel’s temperature rise. Therefore, future experiments may explore alternative factors affecting thermodynamic responses, including mechanical (e.g., sound &amp; shear-stress) and physiological mechanisms (e.g., sweating, local metabolic rate, &amp; blood flow).

Adaptations for bipedal walking: Musculoskeletal structure and three-dimensional joint mechanics of humans and bipedal chimpanzees (Pan troglodytes)

Humans are unique among apes and other primates in the musculoskeletal design of their lower back, pelvis, and lower limbs. Here, we describe the three-dimensional ground reaction forces and lower/hindlimb joint mechanics of human and bipedal chimpanzees walking over a full stride and test whether: 1) the estimated limb joint work and power during the stance phase, especially the single-support period, is lower in humans than bipedal chimpanzees, 2) the limb joint work and power required for limb swing is lower in humans than in bipedal chimpanzees, and 3) the estimated total mechanical power during walking, accounting for the storage of passive elastic strain energy in humans, is lower in humans than in bipedal chimpanzees. Humans and bipedal chimpanzees were compared at matched dimensionless and dimensional velocities. Our results indicate that humans walk with significantly less work and power output in the first double-support period and the single-support period of stance, but markedly exceed chimpanzees in the second double-support period (i.e., push-off). Humans generate less work and power in limb swing, although the species difference in limb swing power was not statistically significant. We estimated that total mechanical positive 'muscle fiber' work and power were 46.9% and 35.8% lower, respectively, in humans than in bipedal chimpanzees at matched dimensionless speeds. This is due in part to mechanisms for the storage and release of elastic energy at the ankle and hip in humans. Furthermore, these results indicate distinct 'heel strike' and 'lateral balance' mechanics in humans and bipedal chimpanzees and suggest a greater dissipation of mechanical energy through soft tissue deformations in humans. Together, our results document important differences between human and bipedal chimpanzee walking mechanics over a full stride, permitting a more comprehensive understanding of the mechanics and energetics of chimpanzee bipedalism and the evolution of hominin walking.

Changes in ankle work, foot work, and tibialis anterior activation throughout a long run

BACKGROUND

The ankle and foot together contribute to over half of the positive and negative work performed by the lower limbs during running. Yet, little is known about how foot kinetics change throughout a run. The amount of negative foot work may decrease as tibialis anterior (TA) electromyography (EMG) changes throughout longer-duration runs. Therefore, we examined ankle and foot work as well as TA EMG changes throughout a changing-speed run.

METHODS

Fourteen heel-striking subjects ran on a treadmill for 58 min. We collected ground reaction forces, motion capture, and EMG. Subjects ran at 110%, 100%, and 90% of their 10-km running speed and 2.8 m/s multiple times throughout the run. Foot work was evaluated using the distal rearfoot work, which provides a net estimate of all work contributors within the foot.

RESULTS

Positive foot work increased and positive ankle work decreased throughout the run at all speeds. At the 110% 10-km running speed, negative foot work decreased and TA EMG frequency shifted lower throughout the run. The increase in positive foot work may be attributed to increased foot joint work performed by intrinsic foot muscles. Changes in negative foot work and TA EMG frequency may indicate that the TA plays a role in negative foot work in the early stance of a run.

CONCLUSION

This study is the first to examine how the kinetic contributions of the foot change throughout a run. Future studies should investigate how increases in foot work affect running performance.

Investigation of Impact of Walking Speed on Forces Acting on a Foot-Ground Unit

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.

The influence of the windlass mechanism on kinematic and kinetic foot joint coupling

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.

Deformable foot orthoses redistribute power from the ankle to the distal foot during walking

Recently, carbon fiber plates, or orthoses, have been incorporated into footwear to improve running performance, presumably through improved energy storage and return. However, few studies have explored the energetic effects these orthoses have on the distal foot, have utilized such orthoses in walking, and none have sought to specifically harness metatarsophalangeal joint deformation to store and return energy to the ankle-foot complex. To address these gaps, we developed and tested a deformable carbon fiber foot orthosis aiming to harness foot energetics and quantify the resulting effects on ankle energetics during walking in healthy adults. Eight subjects walked under three conditions: barefoot (BF), with minimalist shoes (SH), and with bilateral, deformable foot orthoses in the minimalist shoes (ORTH). Ankle and distal foot energetics, foot-to-floor and ankle angle, stance time, step length, and max center of pressure (COP) position were calculated. When walking with the orthoses, subjects showed 263.6% increase in positive distal foot work along with a 31.9% decrease in ankle work and little to no change in the overall ankle-foot complex work. Step length, stance time, and max anterior COP position significantly increased with orthosis use. No statistical or visual differences were found between BF and SH conditions indicating that our findings were due to the foot orthoses. These results suggest this foot orthosis redistributes power from the ankle to the distal foot for healthy adults, reducing the energetic demand on the ankle. These results lay the foundation for designing orthotics and footwear to improve ankle-foot energetics for clinical populations.

Effects of Longitudinal Bending Stiffness of forefoot rocker profile shoes on ankle kinematics and kinetics

INTRODUCTION

Rocker profile shoes with a proximally placed apex are currently one of the most prescribed shoe modifications for treatment and prevention of lower leg deficits. Three geometrical rocker design parameters apex position (AP), apex angle (AA) and rocker radius (RR) influence both plantar pressure redistribution and kinetic and kinematic alterations of the lower leg. In addition, longitudinal bending stiffness (LBS) of the outsole influences these parameters as well. This study aims to investigate the effects of the LBS in combination with different forefoot radii of rocker shoes on kinematics and kinetics of the lower limb.

METHODS

10 participants walked in standard shoes and six experimental shoe conditions with high and low LBS and three different forefoot rocker radii with the same (proximal) AP and AA. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with a repeated measures ANOVA and Statistical Parametric Mapping (SPM) (α = .05; post hoc α = .05/6).

RESULTS

SPM analyses revealed no significant differences for LBS and interaction LBS*RR for most research variables in terminal stance (ankle angle, ankle moment, ankle power, foot-to-horizontal angle, shank-to-vertical angle, external ankle moment, ground reaction force angle). A significant LBS effect was found for anterior-posterior position of the centre of pressure during pre-swing and peak ankle dorsiflexion angle. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle between low and high LBS.

CONCLUSION

This study showed that longitudinal bending stiffness does not affect the biomechanical working mechanism of rocker profile shoes as long as toe plantarflexion is restricted. Providing that the forefoot rocker radius supports at least a normal foot-to-horizontal angle at toe-off, there is no reason to increase sole stiffness to change ankle kinematics and kinetics.

The transverse arch in the human feet: A narrative review of its evolution, anatomy, biomechanics and clinical implications

The dominant characteristics of the human foot are its shock-absorbing capability during walking or gait cycle and its adaptation to uneven surfaces. On the stance phase of the gait, the foot has to be flexible at first for shock absorption and adapt to the terrain; whereas, during the propulsive phase, it has to be dynamically rigid to function as a lever. Foot flexibility and rigidity are mainly controlled at the subtalar and midtarsal joints by tendons and ligaments. The subtalar joint is part of the longitudinal arch, but the midtarsal joint along with the tarsometatarsal joint are components of the transverse arch. However, the existence and functional role of transverse arch in human was challenged by some authors. But recent studies have revealed that the transverse arch has a predominant role in midfoot stiffness (Venkadeshan et al., 2020, & Holowoka et al., 2017). This midfoot stiffness allows the human foot to store elastic energy at the time of heel strike, which is utilized during the push-off mechanism for propulsion, thus making bipedalism more energy-efficient. Moreover, the transverse arch allows the longitudinal arch to be flexible like a lever and, at the same time, makes the arch of the foot rigid to behave like a stiff spring lever. Understanding the role of the transverse arch is obligatory to study the biomechanics of foot injuries and Charcot or diabetic foot. Studies on diabetic foot have shown that the modulation of transverse arch biomechanics and off-loading modalities would improve outcomes in the form of wound-healing and prevention of re-ulceration.

The effects of footplate stiffness on push-off power when walking with posterior leaf spring ankle-foot orthoses

BACKGROUND

Many studies on ankle-foot orthoses investigated the optimal stiffness around the ankle, while the effect of footplate stiffness has been largely ignored. This study investigated the effects of ankle-foot orthosis footplate stiffness on ankle-foot push-off power during walking in able-bodied persons.

METHODS

Twelve healthy participants walked at a fixed speed (1.25 m·s^-1) on an instrumented treadmill in four conditions: shod and with a posterior leaf-spring orthosis with a flexible, stiff or rigid footplate. For each trial, ankle kinematics and kinetics were averaged over one-minute walking. Separate contributions of the ankle joint complex and distal hindfoot to total ankle-foot power and work were calculated using a deformable foot model.

FINDINGS

Peak ankle joint power was significantly higher with the rigid footplate compared to the flexible and stiff footplate and not different from shod walking. The stiff footplate increased peak hindfoot power compared to the flexible and rigid footplate and shod walking. Total ankle-foot power showed a significant increase with increasing footplate stiffness, where walking with the rigid footplate was comparable to shod walking. Similar effects were found for positive mechanical work.

INTERPRETATION

A rigid footplate increases the lever of the foot, resulting in an increased ankle moment and energy storage and release of the orthosis' posterior leaf-spring as reflected in higher ankle joint power. This effect dominates the power generation of the foot, which was highest with the intermediate footplate stiffness. Future studies should focus on how tuning footplate stiffness could contribute to optimizing ankle-foot orthosis efficacy in clinical populations.

The energetic function of the human foot and its muscles during accelerations and decelerations

The human foot is known to aid propulsion by storing and returning elastic energy during steady-state locomotion. While its function during other tasks is less clear, recent evidence suggests the foot and its intrinsic muscles can also generate or dissipate energy based on the energetic requirements of the center of mass during non-steady-state locomotion. In order to examine contributions of the foot and its muscles to non-steady-state locomotion, we compared the energetics of the foot and ankle joint while jumping and landing before and after the application of a tibial nerve block. Under normal conditions, energetic contributions of the foot rose as work demands increased, while the relative contributions of the foot to center of mass work remained constant with increasing work demands. Under the nerve block, foot contributions to both jumping and landing decreased. Additionally, ankle contributions were also decreased under the influence of the block for both tasks. Our results reinforce findings that foot and ankle function mirror the energetic requirements of the center of mass and provide novel evidence that foot contributions remain relatively constant under increasing energetic demands. Also, while the intrinsic muscles can modulate the energetic capacity of the foot, their removal accounted for only a 3% decrement in total center of mass work. Therefore, the small size of intrinsic muscles appears to limit their capacity to contribute to center of mass work. However, their role in contributing to ankle work capacity is likely important for the energetics of movement.

Effects of age and locomotor demand on foot mechanics during walking

Older adults exhibit reductions in push-off power that are often attributed to deficits in plantarflexor force-generating capacity. However, growing evidence suggests that the foot may also contribute to push-off power during walking. Thus, age-related changes in foot structure and function may contribute to altered foot mechanics and ultimately reduced push-off power. The purpose of this paper was to quantify age-related differences in foot mechanical work during walking across a range of speeds and at a single fixed speed with varied demands for push-off power. 9 young and 10 older adults walked at 1.0, 1.2, and 1.4 m/s, and at 1.2 m/s with an aiding or impeding horizontal pulling force equal to 5% BW. We calculated foot work in Visual3D using a unified deformable foot model, accounting for contributions of structures distal to the hindfoot's center-of-mass. Older adults walked while performing less positive foot work and more negative net foot work (p < 0.05). Further, we found that the effect of age on mechanical work performed by the foot and the ankle-foot complex increased with increased locomotor demand (p < 0.05). Our findings suggest that during walking, age-related differences in foot mechanics may contribute to reduced push-off intensity via greater energy loss from distal foot structures, particularly during walking tasks with a greater demand for foot power generation. These findings are the first step in understanding the role of the foot in push-off power deficits in older adults and may serve as a roadmap for developing future low-cost mobility interventions.

The rise of the longitudinal arch when sitting, standing, and walking: Contributions of the windlass mechanism

The original windlass mechanism describes a one-to-one coupling between metatarsal joint dorsiflexion and medial longitudinal arch rise. The description assumes a sufficiently stiff plantar aponeurosis and absence of foot muscle activity. However, recent research calls for a broader interpretation of the windlass mechanism that accounts for an extensible plantar aponeurosis and active foot muscles. In this study, we investigate the rise of the arch in response to toe dorsiflexion when sitting, standing, and walking to discuss the windlass mechanism’s contributions in static and dynamic load scenarios. 3D motion analysis allowed a kinematic investigation of the rise and drop of the arch relative to the extent of toe dorsiflexion. The results suggest that static windlass effects poorly predict the relationship between arch dynamics and metatarsophalangeal joint motion during dynamic load scenarios, such as walking. We were able to show that toe dorsiflexion resulted in an immediate rise of the longitudinal arch during sitting and standing. In contrast, a decrease in arch height was observed during walking, despite toe dorsiflexion at the beginning of the push-off phase. Further, the longitudinal arch rose almost linearly with toe dorsiflexion in the static loading scenarios, while the dynamic load scenario revealed an exponential rise of the arch. In addition to that, the rate of change in arch height relative to toe motion was significantly lower when sitting and standing compared to walking. Finally, and most surprisingly, arch rise was found to correlate with toe dorsiflexion only in the dynamic loading scenario. These results challenge the traditional perspective of the windlass mechanism as the dominating source of foot rigidity for push-off against the ground during bipedal walking. It seems plausible that other mechanisms besides the windlass act to raise the foot arch.

Neuromechanical adaptations of foot function to changes in surface stiffness during hopping

Humans choose work-minimizing movement strategies when interacting with compliant surfaces. Our ankles are credited with stiffening our lower limbs and maintaining the excursion of our body's center of mass on a range of surface stiffnesses. We may also be able to stiffen our feet through an active contribution from our plantar intrinsic muscles (PIMs) on such surfaces. However, traditional modeling of the ankle joint has masked this contribution. We compared foot and ankle mechanics and muscle activation on low, medium, and high stiffness surfaces during bilateral hopping using a traditional and anatomical ankle model. The traditional ankle model overestimated work and underestimated stiffness compared with the anatomical model. Hopping on a low stiffness surface resulted in less longitudinal arch compression with respect to the high stiffness surface. However, because midfoot torque was also reduced, midfoot stiffness remained unchanged. We observed lower activation of the PIMs, soleus, and tibialis anterior on the low and medium stiffness conditions, which paralleled the pattern we saw in the work performed by the foot and ankle. Rather than performing unnecessary work, participants altered their landing posture to harness the energy stored by the sprung surface in the low and medium conditions. These findings highlight our preference to minimize mechanical work when transitioning to compliant surfaces and highlight the importance of considering the foot as an active, multiarticular, part of the human leg.NEW & NOTEWORTHY When seeking to understand how humans adapt their movement to changes in substrate, the role of the human foot has been neglected. Using multi-segment foot modeling, we highlight the importance of adaptable foot mechanics in adjusting to surfaces of different compliance. We also show, via electromyography, that the adaptations are under active muscular control.

Association between foot thermal responses and shear forces during turning gait in young adults

BACKGROUND

The human foot typically changes temperature between pre and post-locomotion activities. However, the mechanisms responsible for temperature changes within the foot are currently unclear. Prior studies indicate that shear forces may increase foot temperature during locomotion. Here, we examined the shear-temperature relationship using turning gait with varying radii to manipulate magnitudes of shear onto the foot.

METHODS

Healthy adult participants (N = 18) walked barefoot on their toes for 5 minutes at a speed of 1.0 m s-1 at three different radii (1.0, 1.5, and 2.0 m). Toe-walking was utilized so that a standard force plate could measure shear localized to the forefoot. A thermal imaging camera was used to quantify the temperature changes from pre to post toe-walking (ΔT), including the entire foot and forefoot regions on the external limb (limb farther from the center of the curved path) and internal limb.

RESULTS

We found that shear impulse was positively associated with ΔT within the entire foot (P < 0.001) and forefoot (P < 0.001): specifically, for every unit increase in shear, the temperature of the entire foot and forefoot increased by 0.11 and 0.17 °C, respectively. While ΔT, on average, decreased following the toe-walking trials (i.e., became colder), a significant change in ΔT was observed between radii conditions and between external versus internal limbs. In particular, ΔT was greater (i.e., less negative) when walking at smaller radii (P < 0.01) and was greater on the external limb (P < 0.01) in both the entire foot and forefoot regions, which were likely explained by greater shear forces with smaller radii (P < 0.0001) and on the external limb (P < 0.0001). Altogether, our results support the relationship between shear and foot temperature responses. These findings may motivate studying turning gait in the future to quantify the relationship between shear and foot temperature in individuals who are susceptible to abnormal thermoregulation.

The human foot functions like a spring of adjustable stiffness during running

Like other animals, humans use their legs like springs to save energy during running. One potential contributor to leg stiffness in humans is the longitudinal arch (LA) of the foot. Studies of cadaveric feet have demonstrated that the LA can function like a spring, but it is unknown whether humans can adjust LA stiffness in coordination with more proximal joints to help control leg stiffness during running. Here, we used 3D motion capture to record 27 adult participants running on a forceplate-instrumented treadmill, and calculated LA stiffness using beam bending and midfoot kinematics models of the foot. Because changing stride frequency causes humans to adjust overall leg stiffness, we had participants run at their preferred frequency and frequencies 35% above and 20% below preferred frequency to test for similar adjustments in the LA. Regardless of which foot model we used, we found that participants increased LA quasi-stiffness significantly between low and high frequency runs, mirroring changes at the ankle, knee and leg overall. However, among foot models, we found that the model incorporating triceps surae force into bending force on the foot produced unrealistically high LA work estimates, leading us to discourage this modeling approach. Additionally, we found that there was not a consistent correlation between LA height and quasi-stiffness values among the participants, indicating that static LA height measurements are not good predictors of dynamic function. Overall, our findings support the hypothesis that humans dynamically adjust LA stiffness during running in concert with other structures of the leg.

The Biomechanical Behavior of Distal Foot Joints in Patients with Isolated, End-Stage Tibiotalar Osteoarthritis Is Not Altered Following Tibiotalar Fusion

Ankle arthrodesis is considered to be an optimal treatment strategy to relieve pain during walking in patients with isolated, end-stage tibiotalar osteoarthritis. The aim of this study was to investigate the post-operative effect of an arthrodesis on the ankle and foot joint biomechanics. We included both patients (n = 10) and healthy reference data (n = 17). A multi-segment foot model was used to measure the kinematics and kinetics of the ankle, Chopart, Lisfranc, and first metatarsophalangeal joints during a three-dimensional (3D) gait analysis. These data, together with patient reported outcome measures, were collected at baseline (pre-operative) and one year post-operatively. Patients experienced a decrease in pain and an increase in general well-being after surgery. Compared to the baseline measurements, patients only demonstrated a significant average post-operative increase of 0.22 W/kg of power absorption in the ankle joint. No other significant differences were observed between baseline and post-operative measurements. Current findings suggest that the biomechanical behavior of distal foot joints is not altered one year after fusion. The pain relief achieved by the arthrodesis improved the loading patterns during walking. Clinical significance of this study dictates that patients do not have to fear a loss in biomechanical functionality after an ankle arthrodesis.

Walking with added mass magnifies salient features of human foot energetics

The human foot serves numerous functional roles during walking, including shock absorption and energy return. Here, we investigated walking with added mass to determine how the foot would alter its mechanical work production in response to a greater force demand. Twenty-one healthy young adults walked with varying levels of added body mass: 0%, +15% and +30% (relative to their body mass). We quantified mechanical work performed by the foot using a unified deformable segment analysis and a multi-segment foot model. We found that walking with added mass tended to magnify certain features of the foot's functions. Magnitudes of both positive and negative mechanical work, during stance in the foot, increased when walking with added mass. Yet, the foot preserved similar amounts of net negative work, indicating that the foot dissipates energy overall. Furthermore, walking with added mass increased the foot's negative work during early stance phase, highlighting the foot's role as a shock-absorber. During mid to late stance, the foot produced greater positive work when walking with added mass, which coincided with greater work from the structures spanning the midtarsal joint (i.e. arch). While this study captured the overall behavior of the foot when walking with varying force demands, future studies are needed to further determine the relative contribution of active muscles and elastic tissues to the foot's overall energy.

Intrinsic foot joints adapt a stabilized-resistive configuration during the stance phase

BACKGROUND

This study evaluated the 3D angle between the joint moment and the joint angular velocity vectors at the intrinsic foot joints, and investigated if these joints are predominantly driven or stabilized during gait.

METHODS

The participants were 20 asymptomatic subjects. A four-segment kinetic foot model was used to calculate and estimate intrinsic foot joint moments, powers and angular velocities during gait. 3D angles between the joint moment and the joint angular velocity vectors were calculated for the intrinsic foot joints defined as follows: ankle joint motion described between the foot and the shank for the one-segment foot model (hereafter referred as Ankle), and between the calcaneus and the shank for the multi-segment foot model (hereafter referred as Shank-Calcaneus); joint motion described between calcaneus and midfoot segments (hereafter referred as Chopart joint); joint motion described between midfoot and metatarsus segments (hereafter referred as Lisfranc joint); joint motion described between first phalanx and first metatarsal (hereafter referred as First Metatarso-Phalangeal joint). When the vectors were approximately aligned, the moment was considered to result in propulsion (3D angle <60^o) or resistance (3D angle >120^o) at the joint. When the vectors are approximately orthogonal (3D angle close to 90°), the moment was considered to stabilize the joint.

RESULTS

The results showed that the four intrinsic joints of the foot are never fully propelling, resisting or being stabilized, but are instead subject to a combination of stabilization with propulsion or resistance during the majority of the stance phase of gait. However, the results also show that during pre-swing all four the joints are subject to moments that result purely in propulsion. At heel off, the propulsive configuration appears for the Lisfranc joint first at terminal stance, then for the other foot joints at pre-swing in the following order: Ankle, Chopart joint and First Metatarso-Phalangeal joint.

CONCLUSIONS

Intrinsic foot joints adopt a stabilized-resistive configuration during the majority of the stance phase, with the exception of pre-swing during which all joints were found to adopt a propulsive configuration. The notion of stabilization, resistance and propulsion should be further investigated in subjects with foot and ankle disorders.

Redistribution of joint moments and work in older women with and without hallux valgus at two walking speeds

BACKGROUND

Hallux valgus (HV) is a highly prevalent foot deformity in older women. Differences in lower extremity joint function of older women with and without HV during walking at slower and faster speeds are unknown.

RESEARCH QUESTION

Does walking speed affect lower extremity joint range of motion (ROM) and net extensor joint moment and associated work in older women with and without HV?

METHODS

Thirteen older women with HV and 13 controls completed five walking trials at 1.1 and 1.3 m·s^-1 as kinematic marker position and ground reaction force data were collected. Net ankle, knee, and hip joint moments were computed using inverse dynamics during the stance phase. Positive joint work was calculated by integrating hip power in early stance, knee power in mid stance, and ankle power in late stance.

RESULTS

Average ankle ROM and plantarflexor moment did not increase with walking speed in the HV group, while in the control group these variables were greater for the faster compared to the slower speed (p < 0.05). The magnitude of increase in ankle joint work with speed was 12 % lesser in the HV compared to the control group (p = 0.008). The hip ROM, extensor moment, and associated work was greater in the HV compared to the control group (p < 0.05). Knee and hip joint ROM, extensor moments, and work increased with walking speed in both groups (p < 0.05).

SIGNIFICANCE

Older women with HV compared to older women without HV demonstrate a distal-to-proximal redistribution by increasing hip motion and effort to compensate for reduced ankle contribution during walking.

The foot is more than a spring: human foot muscles perform work to adapt to the energetic requirements of locomotion

The foot has been considered both as an elastic mechanism that increases the efficiency of locomotion by recycling energy, as well as an energy sink that helps stabilize movement by dissipating energy through contact with the ground. We measured the activity of two intrinsic foot muscles, flexor digitorum brevis (FDB) and abductor hallucis (AH), as well as the mechanical work performed by the foot as a whole and at a modelled plantar muscle-tendon unit (MTU) to test whether these passive mechanics are actively controlled during stepping. We found that the underlying passive visco-elasticity of the foot is modulated by the muscles of the foot, facilitating both dissipation and generation of energy depending on the mechanical requirements at the centre of mass (COM). Compared to level ground stepping, the foot dissipated and generated an additional -0.2 J kg^-1 and 0.10 J kg^-1 (both p < 0.001) when stepping down and up a 26 cm step respectively, corresponding to 21% and 10% of the additional net work performed by the leg on the COM. Of this compensation at the foot, the plantar MTU performed 30% and 89% of the work for step-downs and step-ups, respectively. This work occurred early in stance and late in stance for stepping down respectively, when the activation levels of FDB and AH were increased between 69 and 410% compared to level steps (all p < 0.001). These findings suggest that the energetic function of the foot is actively modulated by the intrinsic foot muscles and may play a significant role in movements requiring large changes in net energy such as stepping on stairs or inclines, accelerating, decelerating and jumping.

The effects of ankle stiffness on mechanics and energetics of walking with added loads: a prosthetic emulator study

BACKGROUND

The human ankle joint has an influential role in the regulation of the mechanics and energetics of gait. The human ankle can modulate its joint 'quasi-stiffness' (ratio of plantarflexion moment to dorsiflexion displacement) in response to various locomotor tasks (e.g., load carriage). However, the direct effect of ankle stiffness on metabolic energy cost during various tasks is not fully understood. The purpose of this study was to determine how net metabolic energy cost was affected by ankle stiffness while walking under different force demands (i.e., with and without additional load).

METHODS

Individuals simulated an amputation by using an immobilizer boot with a robotic ankle-foot prosthesis emulator. The prosthetic emulator was controlled to follow five ankle stiffness conditions, based on literature values of human ankle quasi-stiffness. Individuals walked with these five ankle stiffness settings, with and without carrying additional load of approximately 30% of body mass (i.e., ten total trials).

RESULTS

Within the range of stiffness we tested, the highest stiffness minimized metabolic cost for both load conditions, including a ~ 3% decrease in metabolic cost for an increase in stiffness of about 0.0480 Nm/deg/kg during normal (no load) walking. Furthermore, the highest stiffness produced the least amount of prosthetic ankle-foot positive work, with a difference of ~ 0.04 J/kg from the highest to lowest stiffness condition. Ipsilateral hip positive work did not significantly change across the no load condition but was minimized at the highest stiffness for the additional load conditions. For the additional load conditions, the hip work followed a similar trend as the metabolic cost, suggesting that reducing positive hip work can lower metabolic cost.

CONCLUSION

While ankle stiffness affected the metabolic cost for both load conditions, we found no significant interaction effect between stiffness and load. This may suggest that the importance of the human ankle's ability to change stiffness during different load carrying tasks may not be driven to minimize metabolic cost. A prosthetic design that can modulate ankle stiffness when transitioning from one locomotor task to another could be valuable, but its importance likely involves factors beyond optimizing metabolic cost.

Ankle and midtarsal joint quasi-stiffness during walking with added mass

Examination of how the ankle and midtarsal joints modulate stiffness in response to increased force demand will aid understanding of overall limb function and inform the development of bio-inspired assistive and robotic devices. The purpose of this study is to identify how ankle and midtarsal joint quasi-stiffness are affected by added body mass during over-ground walking. Healthy participants walked barefoot over-ground at 1.25 m/s wearing a weighted vest with 0%, 15% and 30% additional body mass. The effect of added mass was investigated on ankle and midtarsal joint range of motion (ROM), peak moment and quasi-stiffness. Joint quasi-stiffness was broken into two phases, dorsiflexion (DF) and plantarflexion (PF), representing approximately linear regions of their moment-angle curve. Added mass significantly increased ankle joint quasi-stiffness in DF (p < 0.001) and PF (p < 0.001), as well as midtarsal joint quasi-stiffness in DF (p < 0.006) and PF (p < 0.001). Notably, the midtarsal joint quasi-stiffness during DF was ~2.5 times higher than that of the ankle joint. The increase in midtarsal quasi-stiffness when walking with added mass could not be explained by the windlass mechanism, as the ROM of the metatarsophalangeal joints was not correlated with midtarsal joint quasi-stiffness (r = -0.142, p = 0.540). The likely source for the quasi-stiffness modulation may be from active foot muscles, however, future research is needed to confirm which anatomical structures (passive or active) contribute to the overall joint quasi-stiffness across locomotor tasks.

The Receptive and Propulsive Behavior of Human Foot Joints During Running With Different Striking Strategies

Foot structure and kinematics have long been considered as risk factors for foot and lower-limb running injuries. The authors aimed at investigating foot joint kinetics to unravel their receptive and propulsive characteristics while running barefoot, both with rearfoot and with midfoot striking strategies. Power absorption and generation occurring at different joints of the foot in 6 asymptomatic adults were calculated using both a 3-segment and a 4-segment kinetic model. An inverse dynamic approach was used to quantify mechanical power. Major power absorption and generation characteristics were observed at the ankle joint complex as well as at the Chopart joint in both the rearfoot and the midfoot striking strategies. The power at the Lisfranc joint, quantified by the 4-segment kinetic model, was predominantly generated in both strategies, and at the toes, it was absorbed. The overall results show a large variability in the receptive and propulsive characteristics among the analyzed joints in both striking strategies. The present study may provide novel insight for clinical decision making to address foot and lower-limb injuries and to guide athletes in the adoption of different striking strategies during running.

Number of Segments Within Musculoskeletal Foot Models Influences Ankle Kinematics and Strains of Ligaments and Muscles

Multi-segment foot models (MFMs) are becoming a common tool in musculoskeletal research on the ankle-foot complex. The purpose of this study was to compare ankle joint kinematics as well as ligament and muscle strains that result from MFM with a different number of segments during vertical hopping. Ten participants were recruited and performed double-limb vertical hops. Marker positions and ground reaction forces were collected. Two-segment (2MFM), three-segment (3MFM), and five-segment MFM (5MFM) were used to calculate ankle kinematics and the strains of the anterior talofibular and calcaneofibular ligaments and of the soleus and gastrocnemius muscles. Ranges of motion and peak strains were analyzed with Kruskal-Wallis and post hoc tests, whereas the time-series of the ankle kinematics and ligament and muscle strains were analyzed with statistical parametric mapping. There were significant main effects for MFM in the talocrural joint range of motion and peak strains of ligaments and muscles. In addition, there were significant main effects for MFM in time-series data of the talocrural joint angle as well as for ligament and muscle strains. In all cases, the post hoc analyses showed that the 2MFM consistently overestimated the range of motion and tissue strains compared to the 3MFM and 5MFM, while 3MFM and 5MFM did not differ from each other in the most variables. This study showed that the number of segments in MFM significantly affects the biomechanical estimates of joint kinematics and tissue strains during hopping. Clinical significance: MFM that combine all foot structures beyond the talus into one segment likely overestimate ankle joint biomechanics. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2231-2240, 2019.

The foot and ankle structures reveal emergent properties analogous to passive springs during human walking

An objective understanding of human foot and ankle function can drive innovations of bio-inspired wearable devices. Specifically, knowledge regarding how mechanical force and work are produced within the human foot-ankle structures can help determine what type of materials or components are required to engineer devices. In this study, we characterized the combined functions of the foot and ankle structures during walking by synthesizing the total force, displacement, and work profiles from structures distal to the shank. Eleven healthy adults walked at four scaled speeds. We quantified the ground reaction force and center-of-pressure displacement in the shank’s coordinate system during stance phase and the total mechanical work done by these structures. This comprehensive analysis revealed emergent properties of foot-ankle structures that are analogous to passive springs: these structures compressed and recoiled along the longitudinal axis of the shank, and performed near zero or negative net mechanical work across a range of walking speeds. Moreover, the subject-to-subject variability in peak force, total displacement, and work were well explained by three simple factors: body height, mass, and walking speed. We created a regression-based model of stance phase mechanics that can inform the design and customization of wearable devices that may have biomimetic or non-biomimetic structures.

An easily applicable method to analyse the ankle-foot power absorption and production during walking

BACKGROUND

Power and work at the ankle joint during gait are usually computed considering the foot as a rigid body [1-6] (Ankle Joint method, AJ). The foot is instead a deformable structure and can absorb and produce work by pronation/supination, foot arch deformation and other intrinsic movements. A different approach, named "the Distal Shank method (DS)" [7-12] considers all these aspects without increasing the complexity of the protocol, and thus it seems promising for clinical applications [12].

RESEARCH QUESTIONS

a) To characterize the differences in power and work computed using the two mentioned methods for a relatively large number of subjects walking at different velocities, barefoot and with different shoes; b) To assess the practical feasibility of the DS method for clinical applications.

MATERIALS AND METHODS

Eighteen healthy subjects were evaluated while walking barefoot at slow, natural and fast velocity. Shod walking was analysed at natural velocity. Four subjects were also analysed while walking in high-heel shoes. The power at the ankle joint was computed with both the AJ and the DS methods. We then compared the obtained results.

RESULTS

The DS method showed a consistent negative peak of power absorption during the load acceptance phase, barely visible with the AJ method. The maximum power production calculated with the DS method was significantly lower. The work at the end of the stride cycle was lower with the DS method, and in most conditions even negative, thus indicating higher energy dissipation.

SIGNIFICANCE

We confirmed on a large cohort of healthy subjects and in different walking conditions that neglecting foot deformations during gait leads to underestimate power absorption and overestimate power production. The DS method does not require a complex gait analysis protocol, nor additional time for the analysis, and can provide information of clinical interest, related to foot mechanical alterations.

The impact of walking speed on the kinetic behaviour of different foot joints

BACKGROUND

The foot and ankle complex consists of multiple joints which have been hypothesized to fulfill a significant role in the lower limb kinetic chain during human locomotion. Walking speed is known to affect the lower limb kinetic chain function. Yet, this effect still has to be investigated throughout multiple joints of the foot and ankle complex.

RESEARCH QUESTION

What is the effect of walking speed on the kinetic behaviour of multiple joints of the foot and ankle complex?

METHODS

This observational cross-sectional study investigated 15 asymptomatic male subjects. A three-and four-segment kinetic foot model was used to calculate power output and mechanical work during normal and high walking speed. One-dimensional Statistical Parametric Mapping (1D-SPM) linear regression was performed to examine the relationship between walking speed and kinetic data. Effect size calculations (Cohen's D) were included to quantify the amount of effect that walking speed has on power output and mechanical work in multiple foot joints.

RESULTS

Three-segment kinetic measurements showed a significant positive correlation between walking speed and power output in the ankle (p = 0.003) and first metatarsophalangeal joint (p = 0.0007). Peak power generation increased in the ankle (d = 1.59), chopart (d = 1.51) and first metatarsophalangeal (d = 1.25) joints during high-speed walking. The three joints combined produced net +0.097 J/kg in normal and +0.201 J/kg in high-speed walking. Four-segment kinetic measurements showed a significant positive correlation between walking speed and power output at the ankle (p = 0.036), chopart (p = 0.0001), lisfranc (p < 0.0001) and first metatarsophalangeal (p = 0.0063) joints. Peak power generation increased in the ankle (d = 1.32), chopart (d = 1.27), lisfranc (d = 1.22) and first metatarsophalangeal (d = 1.47) joints during high-speed walking. Four joints combined produced net +0.162 J/kg in normal and +0.261 J/kg in high-speed walking.

SIGNIFICANCE

These results add additional insight into foot function during increased walking speed.

The functional importance of human foot muscles for bipedal locomotion

Human feet have evolved uniquely among primates, losing an opposable first digit in favor of a pronounced arch to enhance our ability to walk and run with an upright posture. Recent work suggests that muscles within our feet are key to how the foot functions during bipedal walking and running. Here we show direct evidence for the significance of these foot muscles in supporting the mechanical performance of the human foot. Contrary to expectations, the intrinsic foot muscles contribute minimally to supporting the arch of the foot during walking and running. However, these muscles do influence our ability to produce forward propulsion from one stride into the next, highlighting their role in bipedal locomotion.

Human feet have evolved to facilitate bipedal locomotion, losing an opposable digit that grasped branches in favor of a longitudinal arch (LA) that stiffens the foot and aids bipedal gait. Passive elastic structures are credited with supporting the LA, but recent evidence suggests that plantar intrinsic muscles (PIMs) within the foot actively contribute to foot stiffness. To test the functional significance of the PIMs, we compared foot and lower limb mechanics with and without a tibial nerve block that prevented contraction of these muscles. Comparisons were made during controlled limb loading, walking, and running in healthy humans. An inability to activate the PIMs caused slightly greater compression of the LA when controlled loads were applied to the lower limb by a linear actuator. However, when greater loads were experienced during ground contact in walking and running, the stiffness of the LA was not altered by the block, indicating that the PIMs’ contribution to LA stiffness is minimal, probably because of their small size. With the PIMs blocked, the distal joints of the foot could not be stiffened sufficiently to provide normal push-off against the ground during late stance. This led to an increase in stride rate and compensatory power generated by the hip musculature, but no increase in the metabolic cost of transport. The results reveal that the PIMs have a minimal effect on the stiffness of the LA when absorbing high loads, but help stiffen the distal foot to aid push-off against the ground when walking or running bipedally.