Active regulation of longitudinal arch compression and recoil during walking and running

Barefoot vs shod walking and jogging on the electromyographic activity of the medial and lateral gastrocnemius

Gastrocnemius weakness is associated with Achilles tendinopathies and muscle strains, with the medial gastrocnemius (MG) more commonly injured than the lateral gastrocnemius (LG). Walking and jogging are common in daily activities and sports, and biomechanical differences between shod and barefoot exercise may influence MG and LG activation. Understanding these activation patterns could help optimize training programs for injury prevention and/or rehabilitation. The aim was to compare MG and LG electromyographic activity during walking and jogging, both shod and barefoot. Twenty-nine participants (25.28 ± 4.53 years, 171.31 ± 0.76 cm, 72.68 ± 6.36 kg) completed a warm-up followed by 1 min of walking (80-99 steps/min) and jogging (130-150 steps/min) in both conditions (barefoot and shod, random order). Electromyographic signals were recorded using wearable devices (mDurance Solutions S.L., Granada, Spain; 1024 Hz sampling rate). We measured the root-mean-square (RMS) amplitudes for an entire stride cycle and digitally filtered the signals. For analysis, we normalized electromyographic values to the average peak values obtained during two sprints. We analyzed differences with a repeated-measures analysis of variance. Significant effects of condition (barefoot-shod) and gastrocnemius (MG-LG) were observed (all p ≤ 0.023, ƞp2 = 0.17-0.39), with higher MG activation compared to LG in the barefoot conditions (p = 0.004-0.027, d = 0.72-0.83), and nonsignificant differences between muscles in the shod conditions (p > 0.05). Shod exercise compared to barefoot resulted in lower MG activation (p = 0.001-0.003, d = 0.62-0.63) and non-significant differences in LG activation. These results indicate that barefoot walking and jogging increase MG activation compared to shod conditions, with no differences in LG activation. Additionally, footwear reduces differences between MG and LG.

Development of a novel technique to insert intramuscular electromyography electrodes into the deep intrinsic foot muscles via the dorsum of the foot

This study aimed to develop an insertion technique for intramuscular EMG recording of the oblique head of adductor hallucis (AddH) and first dorsal interosseous (FDI) muscles in humans via the dorsum of the foot, and report feasibility of intramuscular EMG data acquisition during walking in shoes. In eight individuals without musculoskeletal pain or injury (5 males; 32 ± 8 years), intramuscular electrodes were inserted into AddH (oblique head) and FDI through the right foot's dorsum (between metatarsals I-II) with ultrasound guidance. The ultrasound transducer was positioned on the plantar surface. Intramuscular EMG was also recorded from abductor hallucis, tibialis posterior, flexor digitorum longus and peroneus longus. Participants performed six overground walking trials wearing modified shoes, and rated pain associated with the intramuscular electrodes during walking (numerical rating scale, 0-10). High-quality EMG recordings were obtained from intrinsic and extrinsic foot muscles. Analyses of power spectral densities indicated that movement artefacts commonly observed during gait were removed by filtering. Pain associated with AddH/FDI electrodes during walking was low (median[IQR] 1[2]; range 0-4) and similar to other sites. Findings demonstrate that intramuscular EMG recording from AddH (oblique head) and FDI using this insertion technique is feasible and associated with minimal pain when walking in shoes.

Differences in muscle activity of extrinsic and intrinsic foot muscles in toe grip and push-down movements of the great toe

Toe flexor strength is generated primarily by the flexor hallucis longus (FHL) of the extrinsic foot muscles (EFMs) and the plantar intrinsic foot muscles (PIFMs) of the great toe. Toe flexion methods can be broadly classified into toe grip (TG) and toe push-down (TP). Additionally, TP's interphalangeal joint (IPJ) position may influence the FHL and PIFMs activity ratios. This study aimed to elucidate the differences in the muscle activity and muscle activity ratios of the FHL and AbdH during TG, TP with IPJ flexion (TPIF), and TP with IPJ extension (TPIE). Surface electromyography and a custom-made instrument were used to measure the FHL and AbdH muscle activity during TG, TPIF, and TPIE of the great toe in 28 healthy men. The muscle activity and AbdH/FHL muscle activity ratio in the three conditions were statistically compared. The FHL activity was significantly higher during TG and TPIF than during TPIE. The AbdH muscle activity was significantly higher during TPIF and TPIE than that during TG. The AbdH/FHL muscle activity ratio was significantly higher for TPIE, TPIF, and TG in that order. This study showed that the FHL and AbdH muscle activity differed depending on the TG and TP of the great toe, and that the AbdH/FHL muscle activity ratio was different in the IPJ position. These results suggest that selecting a toe flexion method according to the target muscle when measuring and training the great toe flexor strength is important.

Joint synergy and muscle activity in the motion of the ankle-foot complex

The movement of the ankle-foot complex joints is coupled as a result of various physiological and physical constraints. This study introduces a novel approach to the analysis of joint synergies and their physiological basis by focusing on joint rotational directions and the types of muscle contractions. We developed a biomimetic model of the ankle-foot complex with seven degrees of freedom, considering the skeletal configuration and physiological axis directions. Motion capture experiments were conducted with eight participants performing dorsiflexion and plantarflexion in open-chain states, as well as various walking tasks in closed-chain states, across different ground inclinations (±10, ±5, 0 deg) and walking speeds (3 and 4 km h-1). Hierarchical cluster analysis identified joint synergy clusters and motion primitives, revealing that in open-chain movements, plantarflexion of the ankle, tarsometatarsal and metatarsophalangeal joints exhibited synergy with the inversion of the remaining joints in the complex; meanwhile, dorsiflexion was aligned with eversion. During closed-chain movements, the synergies grouping was exchanged in the subtalar, talonavicular and metatarsophalangeal joints. Further analysis showed that in open-chain movements, synergy patterns influenced by multi-joint muscles crossing oblique joint axes contribute to foot motion. In closed-chain movements, these changes in synergistic patterns enhance the propulsion of the center of mass towards the contralateral leg and improve foot arch compliance, facilitating human motion. Our work enhances the understanding of the physiological mechanisms underlying synergistic motion within the ankle-foot complex.

Individuals with asymptomatic hallux valgus exhibit altered foot kinematics during gait regardless of their foot posture

BACKGROUND

A flatfoot has been believed to be closely associated with the development of hallux valgus; however, the association is still controversial. Abnormal foot kinematics has been identified as a possible risk factor for the development of hallux valgus, but it remains unclear whether foot posture contributes to abnormal foot kinematics. This is the first study to investigate the differences in foot kinematics during gait between individuals with and without hallux valgus, while controlling for foot posture.

METHODS

Twenty-five females with hallux valgus and 25 healthy females aged 18 to 22 were recruited. Foot posture was measured using normalized navicular height truncated and the leg-heel angle. Foot kinematic and kinetic data during gait were recorded by a three-dimensional motion capture system. To investigate the characteristics of foot kinematics in individuals with hallux valgus while controlling for foot posture, we used a propensity score matching method. The matching was obtained by using the 1:1 nearest-neighbor procedure and a caliper width of 0.2.

FINDINGS

Twelve pairs were matched. Individuals with hallux valgus had significantly increased midfoot dorsiflexion from 56% to 80% during stance phase, rearfoot eversion from 53% to 71%, and forefoot abduction from 5% to 29% compared with control.

INTERPRETATION

Individuals with hallux valgus have a flexible foot that cannot suppress the dynamic deformation of the rearfoot and midfoot during gait. To suppress the development of hallux valgus, interventions that aim to prevent dynamic deformations of the rearfoot and midfoot during gait may be necessary, regardless of their static foot posture.

A 3 month nutrition and exercise program improved hallux strength among senior daycare center users in Korea: a cluster randomized controlled trial

Introduction

With a growing aging population, the focus on the health and well-being of older adults, especially in preventing falls, becomes crucial. This 3 month study, initiated in July 2022, aimed to assess the impact of a nutrition and exercise program in senior daycare centers in Chuncheon, South Korea.

Methods

A 3 month study, beginning in July 2022, included 204 older adults from 10 senior daycare centers in Chuncheon, South Korea. Randomly assigned to intervention or control groups, the intervention involved nutrition, daily toe exercises, or both. Control centers received interventions post-measurements. Pre- and post-intervention analyses used paired t-tests and multiple linear regression, assessing metrics like toe grip strength for significance. While 204 were initially enrolled, the analysis included 151 participants due to dropouts.

Results

Participants, with a mean age of 83.3 years (43.1% aged ≥ 85 years), exhibited mild to moderate cognitive impairment and multiple chronic illnesses. Health data indicated that 37.3% were obese, and the average BMI was 24.0 kg/m2. Both the intervention and control groups showed significant improvements in toe grip strength post-intervention. Specifically, the exercise-only and combined exercise-nutrition groups demonstrated significant differences in hallux strength compared to the control group after adjusting for age and gender.

Conclusion

The study showed that a basic nutrition and exercise program increased toe strength in older adults with chronic diseases, including mild cognitive impairments. This intervention holds potential to prevent muscle strength decline and reduce fall risks in older individuals. As the first of its kind in Korean senior daycare centers, it emphasizes the need for future research and standardized programs for senior daycare users.

Human in vivo midtarsal and subtalar joint kinematics during walking, running and hopping

The interaction among joints of the midtarsal complex and subtalar joint is important for locomotor function; however, its complexity poses substantial challenges in quantifying the joints' motions. We determine the mobility of these joints across locomotion tasks and investigate the influence of individual talus morphology on their motion. Using highly accurate biplanar videoradiography, three-dimensional bone kinematics were captured during walking, running and hopping. We calculated the axis of rotation of the midtarsal complex and subtalar joint for the landing and push-off phases. A comparison was made between these rotation axes and the morphological subtalar axis. Measurement included total rotation about and the orientation of the rotation axes in the direction of the subtalar joint and its deviation via spatial angles for both phases. The rotation axes of all three bones relative to the talus closely align with the morphological subtalar axis. This suggests that the midtarsal and subtalar joints' motions might be described by one commonly oriented axis. Despite having such an axis, the location of the axes and ranges of motion differed among the bones. Our results provide a novel perspective of healthy foot function across different sagittal plane-dominant locomotion tasks underscoring the importance of quantifying midtarsal complex and subtalar motion while accounting for an individual's talus morphology.

Technical note: A volumetric method for measuring the longitudinal arch of human tracks and feet

Fossil footprints (i.e., tracks) were believed to document arch anatomical evolution, although our recent work has shown that track arches record foot kinematics instead. Analyses of track arches can thereby inform the evolution of human locomotion, although quantifying this 3-D aspect of track morphology is difficult. Here, we present a volumetric method for measuring the arches of 3-D models of human tracks and feet, using both Autodesk Maya and Blender software. The method involves generation of a 3-D object that represents the space beneath the longitudinal arch, and measurement of that arch object's geometry and spatial orientation. We provide relevant tools and guidance for users to apply this technique to their own data. We present three case studies to demonstrate potential applications. These include, (1) measuring the arches of static and dynamic human feet, (2) comparing the arches of human tracks with the arches of the feet that made them, and (3) direct comparisons of human track and foot arch morphology throughout simulated track formation. The volumetric measurement tool proved robust for measuring 3-D models of human tracks and feet, in static and dynamic contexts. This tool enables researchers to quantitatively compare arches of fossil hominin tracks, in order to derive biomechanical interpretations from them, and/or offers a different approach for quantifying foot morphology in living humans.

Increasing midtarsal joint stiffness reduces triceps surae metabolic costs in walking simulations but has little effect on total stance limb metabolic cost

The human foot's arch is thought to be beneficial for efficient gait. This study addresses the extent to which arch stiffness changes alter the metabolic energy requirements of human gait. Computational musculoskeletal simulations of steady state walking using direct collocation were performed. Across a range of foot arch stiffnesses, the metabolic cost of transport decreased by less than 1% with increasing foot arch stiffness. Increasing arch stiffness increased the metabolic efficiency of the triceps surae during push-off, but these changes were almost entirely offset by other muscle groups consuming more energy with increasing foot arch stiffness.

A three-dimensional musculoskeletal model of the pelvis and lower limb of Australopithecus afarensis

OBJECTIVES

Musculoskeletal modeling is a powerful approach for studying the biomechanics and energetics of locomotion. Australopithecus (A.) afarensis is among the best represented fossil hominins and provides critical information about the evolution of musculoskeletal design and locomotion in the hominin lineage. Here, we develop and evaluate a three-dimensional (3-D) musculoskeletal model of the pelvis and lower limb of A. afarensis for predicting muscle-tendon moment arms and moment-generating capacities across lower limb joint positions encompassing a range of locomotor behaviors.

MATERIALS AND METHODS

A 3-D musculoskeletal model of an adult A. afarensis pelvis and lower limb was developed based primarily on the A.L. 288-1 partial skeleton. The model includes geometric representations of bones, joints and 35 muscle-tendon units represented using 43 Hill-type muscle models. Two muscle parameter datasets were created from human and chimpanzee sources. 3-D muscle-tendon moment arms and isometric joint moments were predicted over a wide range of joint positions.

RESULTS

Predicted muscle-tendon moment arms generally agreed with skeletal metrics, and corresponded with human and chimpanzee models. Human and chimpanzee-based muscle parameterizations were similar, with some differences in maximum isometric force-producing capabilities. The model is amenable to size scaling from A.L. 288-1 to the larger KSD-VP-1/1, which subsumes a wide range of size variation in A. afarensis.

DISCUSSION

This model represents an important tool for studying the integrated function of the neuromusculoskeletal systems in A. afarensis. It is similar to current human and chimpanzee models in musculoskeletal detail, and will permit direct, comparative 3-D simulation studies.

Neuromechanical characterization of the abductor hallucis and its potential role in upright postural control

There is growing evidence to support a role for the abductor hallucis (AH) in standing balance control; however, functional properties of the muscle that may provide more insight into AH's specific contribution to upright posture have yet to be characterized. This study was conducted to quantify functional neuromechanical properties of the AH and correlate the measures with standing balance variables. We quantified strength and voluntary activation during maximal voluntary isometric contractions of the great toe abductor in nine (3 females and 6 males) healthy, young participants. During electrically evoked twitch and tetanic contractions, we measured great toe abduction peak force and constructed a force-frequency curve. We also evaluated peak abduction force, contraction time (CT), half-relaxation time (HRT), rate of force development (RFD), and relaxation rate (RR) from twitch contractions evoked using doublet stimuli. Strength, VA, CT, HRT, RFD, and RR were correlated to centre of pressure standard deviation (COP SD) and velocity (COP VEL) variables of the traditional COP trace and its rambling and trembling components during single-legged stance. AH twitch properties (e.g., CT: 169.8 ± 32.3 ms; HRT: 124.1 ± 29.2 ms) and force-frequency curve were similar to other slow contractile muscles. Contractile speed related negatively with COP VEL, suggesting AH may be appropriate for slow, prolonged tasks such as ongoing postural balance control. Correlation coefficient outcomes for all variables were similar between rambling and trembling components. Our results provide further evidence for the importance of AH neuromechanical function for standing balance control, at least during a challenging single-legged posture.

Capitalizing on skin in orthotics design: the effects of texture on plantar intrinsic foot muscles during locomotion

Foot orthoses (FO) are a commonly prescribed intervention to alter foot function during walking although their effects have been primarily studied in the extrinsic muscles of the foot. Furthermore, enhancing sensory feedback under the foot sole has been recently shown to alter extrinsic muscle activity during gait; however, the effects of FOs with enhanced sensory feedback on plantar intrinsic foot muscles (PIFMs) remain unknown. Thus, the purpose of this study was to investigate the effect of FOs with and without sensory facilitation on PIFM activity during locomotion. Forty healthy adults completed a series of gait trials in non-textured and textured FOs when walking over hard and soft flooring. Outcome measures included bilateral joint kinematics and electromyography (EMG) of four PIFMs. Results of this study highlight the distinct onset and cessations of each PIFM throughout the stance phase of gait. PIFMs remained active during mid-stance when wearing FOs and textured FOs facilitated muscle activity across the stance phase of gait. Increasing cutaneous input from foot sole skin, via the addition of texture under the foot sole, appears to alter motor-neuron pool excitation of PIFMs. Future academics are encouraged to increase our understanding on which pathologies, diseases, and/or medical conditions would best benefit from textured FOs.

Lower-limb dominance does not explain subject-specific foot kinematic asymmetries observed during walking and running

Studies of human locomotion have observed asymmetries in lower-limb kinematics, especially at the more distal joints. However, it is unclear whether these asymmetries are related to functional differences between the dominant and non-dominant limb. This study aimed to determine the effect of lower-limb dominance on foot kinematics during human locomotion. Range of motion for the metatarsophalangeal joint (MPJ) and medial longitudinal arch (MLA), as well as time duration of windlass mechanism engagement, were recorded from healthy young adults (N = 12) across a range of treadmill walking and running speeds. On the group level, there were no differences in MPJ or MLA range of motion, or windlass engagement timing, between the dominant and non-dominant limb (p > 0.05). While not explained by limb dominance, between-limb differences in MPJ and MLA ranges of motion were observed for individual participants on the order of ∼2-6°, which could be clinically relevant or impact interpretation of research data.

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.

Reliability of lower leg muscle elasticity using shear wave elastography in non-weight-bearing and weight-bearing

PURPOSE

Muscle elasticity can be quantified with shear wave elastography (SWE) and has been used as an estimate of muscle force but reliability has not been established for lower leg muscles. The purpose of this study was to examine the intra-rater and inter-rater reliability of elasticity measures in non-weight-bearing (NWB) and weight-bearing (WB) for the tibialis anterior (TA), tibialis posterior (TP), peroneal longus (PL), and peroneal brevis (PB) muscles using SWE.

METHODS

A total of 109 recreationally active healthy adults participated. The study employed a single-cohort, same-day repeated-measures test-retest design. Elasticity, measured in kilopascals as the Young's modulus, was converted to the shear modulus. All four muscles were measured in NWB and at 90% WB.

RESULTS

Intra-rater reliability estimates were good to excellent for NWB (ICC = 0.930-0.988) and WB (ICC = 0.877-0.978) measures. Inter-rater reliability estimates were moderate to good (ICC = 0.500-0.795) for NWB measures and poor to good (ICC = 0.346-0.910) for WB measures.

CONCLUSION

Despite the studies poor to good inter-rater variability, the intra-rater reproducibility represents the potential benefit of SWE in NWB and WB. Establishing the reliability of SWE with clinical and biomechanical approaches may aid in improved understanding of the mechanical properties of muscle.

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.

Foot and Ankle Muscle Isometric Strength in Nonrearfoot Compared With Rearfoot Endurance Runners

Background

Transitioning to a forefoot strike pattern can be used to manage running-related knee injuries. However, adopting a nonrearfoot strike induces a higher load on foot and ankle structures than rearfoot strike. Sufficient foot muscle strength is also necessary to prevent excessive longitudinal arch (LA) deformation when running with nonrearfoot strike. The aim of this study was to investigate the potential differences in foot-ankle muscle strength between RF and NRF runners.

Methods

A cross-sectional study including 40 RF and 40 NRF runners was conducted. The foot posture and the maximal voluntary isometric strength (MVIS) of 6 foot-ankle muscles were measured. The footstrike pattern was determined using a 2-D camera during a self-paced run on a treadmill.

Results

NRF had higher MVIS for ankle plantar flexor (+12.5%, P = .015), ankle dorsiflexor (+17.7%, P = .01), hallux flexor (+11%, P = .04), and lesser toe flexor (+20.8%, P = .0031). We found a small positive correlation between MVIS of ankle plantar flexor with MVIS of hallux flexor (r = 0.26; P = .01) and lesser toe flexor (r = 0.28; P = .01).

Conclusion

In this cross-sectional study, we found that NRF runners on average have a higher MVIS of hallux and lesser toe flexor compared with RF runners. NRF runners also have a higher MVIS of ankle plantar flexor and dorsiflexor than RF runners. We found only a small correlation between ankle plantar flexor and foot muscle strength.

Level of Evidence

Level III, case-control study.

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.

An exploration of muscle co-activation during different walking speeds and the association with lower limb joint stiffness

The aim of this study was to determine the muscle co-activations and joint stiffnesses around the hip, knee, and ankle during different walking speeds and to define the relationships between muscle co-activation and joint stiffness. Twenty-seven healthy subjects (age: 19.6 ± 2.2 years, height: 176.0 ± 6.0 cm, mass: 69.7 ± 8.9 kg) were recruited. Muscle co-activations (CoI) and lower limb joints stiffnesses were investigated during stance phase at different walking speeds using Repeated Measures ANOVA with Sidak post-hoc tests. Correlations between muscle co-activations, joints stiffnesses, and walking speeds were also investigated using Pearson Product Moment correlations. The results indicated that the hip and ankle joints stiffness increased with walking speed (p < 0.001) during the weight acceptance phase, and positive correlations were seen between walking speed and Rectus Femoris (RF) and Biceps Femoris (BF) CoI (p < 0.001), and a negative correlation was seen between walking speed and tibialis anterior (TA) and lateral gastrocnemius (LG) CoI (p < 0.001) during the weight acceptance phase, and the RF/BF CoI during pre-swing. These results provide new information on the variations in muscle co-activation around the hip, knee and ankle joints and their association with joint stiffness, and on the responses of stiffness and muscle co-activation to walking speed. The techniques presented could have further application and help our understanding of the effects of gait retraining and injury mechanisms.

Current evidence regarding 2D ultrasonography monitoring of intrinsic foot muscle properties: A systematic review

Background

Ultrasonography can discriminate between intrinsic and extrinsic foot muscle properties and has therefore gained considerable popularity as an indirect strength evaluation. However, an overview on the use of ultrasound for assessing intrinsic foot musculature (IFM) is currently lacking.

Research question

What is the current evidence regarding (1) 2D ultrasonography protocols and its reliability? (2) Reference values for cross-sectional area and dorso-plantar thickness evaluation in asymptomatic and symptomatic persons?

Methods

The PRISMA guidelines were used to conduct this systematic review. Eight databases (PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, SPORTDiscus and EuropePMC) were searched up to November 1, 2021. Studies reporting quantitative 2D ultrasound findings of the intrinsic foot muscles with no limitation to sex, BMI, ethnicity or physical activity were included. Studies were assessed for methodological quality using the Downs and Black checklist.

Results

Fifty-three studies were retained. Protocols showed an overall good to great reliability, suggesting limits of agreement between 8 and 30% of relative muscle size with minimal detectable changes varying from 0.10 to 0.29 cm² for cross-sectional area and 0.03-0.23 cm for thickness. Reference values are proposed for both cross-sectional area and thickness measurements of the abductor hallucis, flexor digitorum brevis, flexor hallucis brevis and quadratus plantae in asymptomatic persons. This could not be performed in the symptomatic studies due to a limited number of relevant studies addressing the symptomatic population, therefore a clinical overview is outlined. Clinically, IFM properties have been studied in ten distinct pathological conditions, predominantly pointing towards decreased muscle properties of the abductor hallucis.

Significance

We provide a clear and comprehensive overview of the literature regarding 2D ultrasonography of the IFM, making the available evidence more accessible to decision makers and researchers.

Analysis of mechanical characteristics of walking and running foot functional units based on non-negative matrix factorization

Objective: To explore the characteristics of Non-Negative Matrix Factorization (NNMF) in analyzing the mechanical characteristics of foot functional units during walking and running. Methods: Eighteen subjects (9 males and 9 females) were recruited, and the ground reaction force curves of each foot region during walking and running were collected using a plantar pressure measurement system. NNMF was used to extract the mechanical features of different foot regions and to determine the number of foot functional units. The differences between the base matrices of walking and running were compared by traditional t-tests, and the differences in coefficient matrices were compared by one-dimensional statistical parameter mapping. Results: 1) When the number of foot functional units for walking and running were both 2, the Variability Accounted For (VAF) by the matrix exceeded 0.90 (VAF walk = 0.96 ± 0.02, VAF run = 0.95 ± 0.04); 2) In foot functional unit 1, both walking and running exhibited buffering function, with the heel region being the main force-bearing area and the forefoot also participating in partial buffering; 3) In foot functional unit 2, both walking and running exhibited push-off function, with the middle part of the forefoot having a higher contribution weight; 4) In foot functional unit 1, compared to walking, the overall force characteristics of the running foot were greater during the support phase of the 0%-20% stage, with the third and fourth metatarsal areas having higher contribution weights and the lateral heel area having lower weights; 5) In foot functional unit 2, compared to walking, the overall force was higher during the beginning and 11%-69% stages of running, and lower during the 4%-5% and 73%-92% stages. During running, the thumb area, the first metatarsal area and the midfoot area had higher contribution weights than during walking; in the third and fourth metatarsal areas, the contribution weights were lower during running than during walking. Conclusion: Based on the mechanical characteristics of the foot, walking and running can both be decomposed into two foot functional units: buffering and push-off. The forefoot occupies a certain weight in both buffering and push-off functions, indicating that there may be a complex foot function transformation mechanism in the transverse arch of foot. Compared to walking, running completes push-off earlier, and the force region is more inclined towards the inner side of the foot, with the hallux area having a greater weight during push-off. This study suggests that NNMF is feasible for analyzing foot mechanical characteristics.

Difference in the recruitment of intrinsic foot muscles in the elderly under static and dynamic postural conditions

Background

The effect of foot, especially intrinsic muscles, on postural control and its related mechanisms remain unclear due to the complex structure. Therefore, this study aims to investigate the activation of intrinsic foot muscles in the elderly under static and dynamic postural tasks.

Methods

Twenty-one elderly participants were included to perform different postural tests (sensory organization test (SOT), motor control test (MCT), limit of stability test (LOS), and unilateral stance test) by a NeuroCom Balance Manager System. The participants were instructed to maintain postural stability under conditions with combined different sensory inputs (vision, vestibular, and proprioception) in SOT as well as conditions with translation disturbance in MCT, and to perform an active weight-shifting tasks in LOS. During these tasks, muscle activation were simultaneously acquired from intrinsic foot muscles (abductor halluces (AbH) and flexor digitorum brevis (FDB)) and ankle muscles (anterior tibialis, medial head of gastrocnemius, lateral head of gastrocnemius, and peroneus longus). The root-mean-square amplitude of these muscles in postural tasks was calculated and normalized with the EMG activity in unilateral stance task.

Results

The activation of intrinsic foot muscles significantly differed among different SOT tasks (p < 0.001). Post-hoc tests showed that compared with that under normal condition 1 without sensory interference, EMGs increased significantly under sensory disturbance (conditions 2-6). By contrast, compared with that under the single-sensory disturbed conditions (conditions 2-4; 2 for disturbed vision, 3 for disturbed vestibular sensation, 4 for disturbed proprioception), activation was significantly greater under the dual-sensory disturbed postural tasks (conditions 5 and 6; 5 for disturbed vision and proprioception, 6 for disturbed vestibular sensation and proprioception). In MCT, EMGs of foot muscles increased significantly under different translation speeds (p < 0.001). In LOS, moderate and significant correlations were found between muscle activations and postural stability parameters (AbH, r = 0. 355-0.636, p < 0.05; FDB, r = 0.336-0.622, p < 0.05).

Conclusion

Intrinsic foot muscles play a complementary role to regulate postural stability when disturbances occur. In addition, the recruitment magnitude of intrinsic foot muscles is positively correlated with the limit of stability, indicating their contribution to increasing the limits of stability in the elderly.

Three-Dimensional Analysis of the Windlass Mechanism Using Weightbearing Computed Tomography in Healthy Volunteers

BACKGROUND

The windlass mechanism (WM) increases the longitudinal arch of the foot via tension of the plantar aponeurosis during dorsiflexion of the metatarsophalangeal (MTP) joint. The purpose of this study was to perform a 3-dimensional evaluation of the displacement of each joint and the height of the navicular during dorsiflexion of the first MTP joint by using weightbearing computed tomography (CT).

METHODS

Participants were 6 men and 8 women with 23 healthy feet. CT of the foot with a load equivalent to the participant's body weight was performed. The first MTP joint was in the neutral position and dorsiflexed 30 degrees. Between the conditions, we measured the (1) rotation of each bone, (2) rotation of the distal bone with respect to the proximal bone at each joint, and (3) height of the navicular.

RESULTS

With respect to the tibia, the calcaneus was at 0.8 ± 0.7 degrees dorsiflexion and 1.4 ± 0.9 degrees inversion, while the talus was at 2.0 ± 1.2 degrees dorsiflexion and 0.1 ± 0.8 degrees eversion. The navicular was at 1.3 ± 1.2 degrees dorsiflexion and 3.2 ± 2.1 degrees inversion, whereas the medial cuneiform was at 0.3 ± 0.6 degrees plantarflexion and 1.3 ± 1.1 degrees inversion. At the talonavicular joint, the navicular was at 0.7 ± 1.3 degrees plantarflexion, whereas at the cuneonavicular joint, the medial cuneiform bone was at 1.4 ± 1.4 degrees plantarflexion. The height of the navicular increased by 1.1 ± 0.6 mm.

CONCLUSION

We 3-dimensionally confirmed the dynamics of WM and found that the calcaneus, navicular, and medial cuneiform moved in all 3 planes. The results suggest that the cuneonavicular joint has the greatest movement among the joints. We believe that these findings will help to elucidate the pathogenesis of WM-related diseases and lead to advances in treatments for pathologies involving the longitudinal arch.

LEVEL OF EVIDENCE

Level IV, case series.

Mobility of the human foot's medial arch helps enable upright bipedal locomotion

Developing the ability to habitually walk and run upright on two feet is one of the most significant transformations to have occurred in human evolution. Many musculoskeletal adaptations enabled bipedal locomotion, including dramatic structural changes to the foot and, in particular, the evolution of an elevated medial arch. The foot's arched structure has previously been assumed to play a central role in directly propelling the center of mass forward and upward through leverage about the toes and a spring-like energy recoil. However, it is unclear whether or how the plantarflexion mobility and height of the medial arch support its propulsive lever function. We use high-speed biplanar x-ray measurements of foot bone motion on seven participants while walking and running and compare their motion to a subject-specific model without arch recoil. We show that regardless of intraspecific differences in medial arch height, arch recoil enables a longer contact time and favorable propulsive conditions at the ankle for walking upright on an extended leg. The generally overlooked navicular-medial cuneiform joint is primarily responsible for arch recoil in human arches. The mechanism through which arch recoil enables an upright ankle posture may have helped drive the evolution of the longitudinal arch after our last common ancestor with chimpanzees, who lack arch plantarflexion mobility during push-off. Future morphological investigations of the navicular-medial cuneiform joint will likely provide new interpretations of the fossil record. Our work further suggests that enabling medial arch recoil in footwear and surgical interventions may be critical for maintaining the ankle's natural propulsive ability.

Functional relationship between the foot intrinsic and extrinsic muscles in walking

The intrinsic and extrinsic muscles are considered to stabilize the foot and contribute to propulsion during walking. This study aimed to clarify the functional relationship between intrinsic and extrinsic muscles during walking. Thirteen healthy men participated in this study. The muscle activities of the intrinsic muscles (quadratus plantae and abductor hallucis), and the extrinsic muscles (flexor hallucis longus, flexor digitorum longus, and tibialis posterior) were measured using fine-wire and surface electromyography during walking. The muscle onset timing after foot contact was calculated and compared among muscles using the one-way ANOVA. The stance phase was divided into early and late braking, and early and late propulsion phases. Muscle activity among phases was compared using repeated-measures ANOVA. The onset time of the abductor hallucis was significantly earlier than those of the flexor digitorum longus and tibialis posterior. The quadratus plantae demonstrated significantly earlier onset than that of the tibialis posterior. In the late propulsion phase, the activity of extrinsic muscles decreased, whereas intrinsic muscles were continuously active. Early activation of the intrinsic muscles may stabilize the foot for efficient torque production by the extrinsic muscles. Furthermore, the intrinsic muscles may contribute to the final push-off after the deactivation of extrinsic muscles.

The Rehabilitation Program Improves Balance Control in Children with Excessive Body Weight and Flat Feet by Activating the Intrinsic Muscles of the Foot: A Preliminary Study

BACKGROUND

determining the appropriate rehabilitation protocol is essential to influence the correction of flat feet, e.g., by activating the intrinsic muscles of the foot. Therefore, this study aimed to determine the impact of the exercises activating the intrinsic foot muscles for postural control in children with flat feet, with normal and excessive body weight.

METHODS

Fifty-four children aged 7 to 12 were enrolled in the research. Forty-five children were qualified for the final evaluation. Each child in the experimental group was demonstrated an appropriate technique for performing a short foot exercise without compensation by extrinsic muscle. The participants then performed a supervised short foot training session once a week and on other days of the week under the supervision of caregivers for 6 weeks. Flat feet were scored on the foot posture index scale. A postural test was evaluated with a Biodex balance system SD. Statistical significance in the foot posture index scale and postural test were evaluated using an analysis of variance (ANOVA) with Tukey's post-hoc test.

RESULTS

according to the six indices of the foot posture index scale, five indicators showed statistically significant improvement after rehabilitation. At the 8-12 platform mobility level, it was revealed that the excessive body weight group had significant improvements in the overall stability index and medio-lateral stability index, with eyes closed.

CONCLUSION

our results indicate that a 6-week rehabilitation program based on the activation of the intrinsic muscles of the foot resulted in an improvement in the foot position. This, in turn, affected balance control, especially in children with excess body weight in conditions of closed eyes.

Plantar intrinsic foot muscle activation during functional exercises compared to isolated foot exercises in younger adults

BACKGROUND

Training the plantar intrinsic foot muscles (PIFMs) has the potential to benefit patients with lower extremity musculoskeletal conditions as well as the aged population. Isolated foot exercises, often standard in clinical practice, are difficult to perform, whereas functional exercises are much easier to accomplish. However, it is unclear whether functional exercises are comparable to isolated foot exercises in activating the PIFMs.

OBJECTIVE

This study aims to compare the activation of PIFMs between functional exercises versus isolated foot exercises.

METHODS

Using surface electromyography (EMG), muscle activation of three PIFMs was measured in four functional exercises (i.e. normal/unstable toe stance, toe walking, and hopping) versus a muscle-specific isolated foot exercise in 29 younger adults, resulting in 12 comparisons.

RESULTS

Functional exercises showed larger mean EMG amplitudes than the isolated foot exercises in 25% of the 12 comparisons, while there was no difference in the remaining 75%.

CONCLUSION

Functional exercises provoked comparable or even more activation of the PIFMs than isolated foot exercises. Given that functional exercises are easier to perform, this finding indicates the need to further investigate the effectiveness of functional exercises in physical therapy to improve muscle function and functional task performance in populations that suffer from PIFM weakness or dysfunction.

Characterizing the mechanical function of the foot's arch across steady-state gait modes

The arch of the human foot has historically been likened to either a truss, a rigid lever, or a spring. Growing evidence indicates that energy is stored, generated, and dissipated actively by structures crossing the arch, suggesting that the arch can further function in a motor- or spring-like manner. In the present study, participants walked, ran with a rearfoot strike pattern, and ran with a non-rearfoot strike pattern overground while foot segment motions and ground reaction forces were recorded. To quantify the midtarsal joint's (i.e., arch's) mechanical behavior, a brake-spring-motor index was defined as the ratio between midtarsal joint net work and the total magnitude of joint work. This index was statistically significantly different between each gait condition. Index values decreased from walking to rearfoot strike running to non-rearfoot strike running, indicating that the midtarsal joint was most motor-like when walking and most spring-like in non-rearfoot running. The mean magnitude of elastic strain energy stored in the plantar aponeurosis mirrored the increase in spring-like arch function from walking to non-rearfoot strike running. However, the behavior of the plantar aponeurosis could not account for a more motor-like arch in walking and rearfoot strike running, given the lack of main effect of gait condition on the ratio between net work and total work performed by force in the plantar aponeurosis about the midtarsal joint. Instead, the muscles of the foot are likely altering the motor-like mechanical function of the foot's arch, the operation of these muscles between gait conditions warrants further investigation.

The Lower Limb Stiffness, Moments, and Work Mode During Stair Descent Among the Older Adults

OBJECTIVE

Lower limb stiffness strategies and work mode changes between young and older adults during stair descent are unclear. This study investigated the effect of aging on the lower limb stiffness, moments, and joint work mode during stair descent.

DESIGN

Twenty young adults and 20 older adults were recruited from the local community for stair descent test. Kinematics and kinetics data were collected by Vicon system and Kistler force plate. The lower limb stiffness, moments, and work mode were calculated and assess between groups.

RESULTS

No significant differences in gait parameters were detected between groups. Compared with young adults, older adults have decreased leg stiffness, knee and ankle stiffness, increased peak hip extension moment, hip stiffness, and ankle work contribution.

CONCLUSIONS

The older adults actively reduce the lower limb stiffness to reduce the risk of injury during stair descent. The hip joint strategy reduces the risk of forwarding falls and ankle joint compensation work mode to make up for the lack of knee extension strength. This provides a reference for the focus of exercise intervention and rehabilitation strategies for older adults.

Intrinsic muscles of the foot: Anatomy, function, rehabilitation

The intrinsic muscles of the foot are underappreciated structures in evaluating and treating lower extremity dysfunction. These muscles play a crucial role in the proper function of the foot during sport activities. The functions of these muscles are not generally well understood. Intrinsic dysfunction can lead to a variety of problems. Therefore, it is important for clinicians to have a good understanding of the anatomy and function of the intrinsic foot muscles in order to properly diagnose and treat foot injuries in patients. Published research on the rehabilitation of the intrinsic muscles provides insight into the function as well as benefits of treatment. The purpose of this review is to summarize the published research on the anatomy, function, contribution to pathology, as well as rehabilitation options for the intrinsic muscles of the foot.

Arched footprints preserve the motions of fossil hominin feet

The longitudinal arch of the human foot is viewed as a pivotal adaptation for bipedal walking and running. Fossil footprints from Laetoli, Tanzania, and Ileret, Kenya, are believed to provide direct evidence of longitudinally arched feet in hominins from the Pliocene and Pleistocene, respectively. We studied the dynamics of track formation using biplanar X-ray, three-dimensional animation and discrete element particle simulation. Here, we demonstrate that longitudinally arched footprints are false indicators of foot anatomy; instead they are generated through a specific pattern of foot kinematics that is characteristic of human walking. Analyses of fossil hominin tracks from Laetoli show only partial evidence of this walking style, with a similar heel strike but a different pattern of propulsion. The earliest known evidence for fully modern human-like bipedal kinematics comes from the early Pleistocene Ileret tracks, which were presumably made by members of the genus Homo. This result signals important differences in the foot kinematics recorded at Laetoli and Ileret and underscores an emerging picture of locomotor diversity within the hominin clade.

Effect of Arch Height Flexibility in Individuals With Flatfoot on Abductor Hallucis Muscle Activity and Medial Longitudinal Arch Angle During Short Foot Exercises

Flatfoot presents decreased medial longitudinal arch (MLA), and such foot deformity involves intrinsic foot muscles dysfunction. Flatfoot can be classified into flexible and stiff types according to arch height flexibility (AHF). Short foot exercise (SFE) is an intrinsic foot muscle strengthening exercise, which is reportedly effective against flatfoot. However, its effectiveness against flexible or stiff types in flatfoot is unclear. We examined the effect of AHF in individuals with flatfoot during abductor hallucis muscle (AbH) activity and medial longitudinal arch during SFE. Foot alignment was assessed using the arch height index during standing, and individuals with flatfoot (N = 16) were recruited. The AbH activity and MLA angle during SFE while maintaining single-leg standing were assessed. The relationship between AHF and AbH activity and between AHF and MLA angle ratio was analyzed using correlation coefficients. Additional correlations between AHF and AbH activity were observed with the outliers removed. There were no correlations between AHF and AbH muscle activity and between AHF and MLA angle ratio. However, with the 2 outliers removed, moderate correlations between AHF and AbH activity were significant (r = 0.64, p = .01). AbH activity during SFE increased in individuals with flatfoot for high AHF (flexible type). Thus, SFE may be more effective for individuals with flatfoot having a high AHF. These findings may be helpful when making decisions for surgery and rehabilitation.

Effects of arch support doses on the center of pressure and pressure distribution of running using statistical parametric mapping

Insoles with an arch support have been used to address biomechanical risk factors of running. However, the relationship between the dose of support and running biomechanics remains unclear. The purpose of this study was to determine the effects of changing arch support doses on the center of pressure (COP) and pressure mapping using statistical parametric mapping (SPM). Nine arch support variations (3 heights * 3 widths) and a flat insole control were tested on fifteen healthy recreational runners using a 1-m Footscan pressure plate. The medial-lateral COP (COPML) coordinates and the total COP velocity (COPVtotal) were calculated throughout the entirety of stance. One-dimensional and two-dimensional SPM were performed to assess differences between the arch support and control conditions for time series of COP variables and pressure mapping at a pixel level, respectively. Two-way ANOVAs were performed to test the main effect of the arch support height and width, and their interaction on the peak values of the COPVtotal. The results showed that the COPVtotal during the forefoot contact and forefoot push off phases was increased by arch supports, while the COP medial-lateral coordinates remained unchanged. There was a dose-response effect of the arch support height on peak values of the COPVtotal, with a higher support increasing the first and third valleys but decreasing the third peak of the COPVtotal. Meanwhile, a higher arch support height shifted the peak pressure from the medial forefoot and rearfoot to the medial arch. It is concluded that changing arch support doses, primarily the height, systematically altered the COP velocities and peak plantar pressure at a pixel level during running. When assessing subtle modifications in the arch support, the COP velocity was a more sensitive variable than COP coordinates. SPM provides a high-resolution view of pressure comparisons, and is recommended for future insole/footwear investigations to better understand the underlying mechanisms and improve insole design.

Foot arch rigidity in walking: In vivo evidence for the contribution of metatarsophalangeal joint dorsiflexion

Human foot rigidity is thought to provide a more effective lever with which to push against the ground. Tension of the plantar aponeurosis (PA) with increased metatarsophalangeal (MTP) joint dorsiflexion (i.e., the windlass mechanism) has been credited with providing some of this rigidity. However, there is growing debate on whether MTP joint dorsiflexion indeed increases arch rigidity. Further, the arch can be made more rigid independent of additional MTP joint dorsiflexion (e.g., when walking with added mass). The purpose of the present study was therefore to compare the influence of increased MTP joint dorsiflexion with the influence of added mass on the quasi-stiffness of the midtarsal joint in walking. Participants walked with a rounded wedge under their toes to increase MTP joint dorsiflexion in the toe-wedge condition, and wore a weighted vest with 15% of their body mass in the added mass condition. Plantar aponeurosis behavior, foot joint energetics, and midtarsal joint quasi-stiffness were compared between conditions to analyze the mechanisms and effects of arch rigidity differences. Midtarsal joint quasi-stiffness was increased in the toe-wedge and added mass conditions compared with the control condition (both p < 0.001). In the toe-wedge condition, the time-series profiles of MTP joint dorsiflexion and PA strain and force were increased throughout mid-stance (p < 0.001). When walking with added mass, the time-series profile of force in the PA did not increase compared with the control condition although quasi-stiffness did, supporting previous evidence that the rigidity of the foot can be actively modulated. Finally, more mechanical power was absorbed (p = 0.006) and negative work was performed (p < 0.001) by structures distal to the rearfoot in the toe-wedge condition, a condition which displayed increased midtarsal joint quasi-stiffness. This indicates that a more rigid foot may not necessarily transfer power to the ground more efficiently.

Symptomatic and asymptomatic pronated feet show differences in the forefoot abduction motion during jogging, but not in the arch deformation

Pronated feet have been associated with higher risks of running-related overuse injuries than neutral feet. However, it remains unclear why some pronated feet develop running-related injuries, while others do not. This study aimed to examine the differences in foot kinematics during jogging among individuals with symptomatic pronated feet (SP), asymptomatic pronated feet (AP) and asymptomatic neutral feet (AN). Thirty-nine recreational runners were recruited and classified into the SP, AP and AN groups. Statistical parametric mapping (SPM) and ANOVA were used to identify kinematic differences among three groups. The SPM results showed that the SP had larger forefoot abduction than the AN and AP during jogging, while three groups had similar rearfoot eversion during jogging. Both the AP and SP had larger forefoot sagittal range of motion (ROM) (mean difference = 3.5 and 4.8 deg, respectively) and smaller rearfoot sagittal ROM (mean difference = 5.0 and 3.5 deg, respectively) than the AN. Forefoot abduction during jogging may have the potential to identify pronated feet at greater risk of injury. Pronated feet, symptomatic or not, have comparable large forefoot sagittal ROM, i.e., arch deformation, compared to neutral feet. The findings could have implications for the injury aetiology and intervention strategies for SP.

Effects of Barefoot and Shod on the In Vivo Kinematics of Medial Longitudinal Arch During Running Based on a High-Speed Dual Fluoroscopic Imaging System

Shoes affect the biomechanical properties of the medial longitudinal arch (MLA) and further influence the foot’s overall function. Most previous studies on the MLA were based on traditional skin-marker motion capture, and the observation of real foot motion inside the shoes is difficult. Thus, the effect of shoe parameters on the natural MLA movement during running remains in question. Therefore, this study aimed to investigate the differences in the MLA’s kinematics between shod and barefoot running by using a high-speed dual fluoroscopic imaging system (DFIS). Fifteen healthy habitual rearfoot runners were recruited. All participants ran at a speed of 3 m/s ± 5% along with an elevated runway in barefoot and shod conditions. High-speed DFIS was used to acquire the radiographic images of MLA movements in the whole stance phase, and the kinematics of the MLA were calculated. Paired sample t-tests were used to compare the kinematic characteristics of the MLA during the stance phase between shod and barefoot conditions. Compared with barefoot, shoe-wearing showed significant changes (p < 0.05) as follows: 1) the first metatarsal moved with less lateral direction at 80%, less anterior translation at 20%, and less superiority at 10–70% of the stance phase; 2) the first metatarsal moved with less inversion amounting to 20–60%, less dorsiflexion at 0–10% of the stance phase; 3) the inversion/eversion range of motion (ROM) of the first metatarsal relative to calcaneus was reduced; 4) the MLA angles at 0–70% of the stance phase were reduced; 5) the maximum MLA angle and MLA angle ROM were reduced in the shod condition. Based on high-speed DFIS, the above results indicated that shoe-wearing limited the movement of MLA, especially reducing the MLA angles, suggesting that shoes restricted the compression and recoil of the MLA, which further affected the spring-like function of the MLA.

The Effect of Fatigue on Lower Limb Joint Stiffness at Different Walking Speeds

The aim of this study was to assess the stiffness of each lower limb joint in healthy persons walking at varying speeds when fatigued. The study included 24 subjects (all male; age: 28.16 ± 7.10 years; height: 1.75 ± 0.04 m; weight: 70.62 ± 4.70 kg). A Vicon three-dimensional analysis system and a force plate were used to collect lower extremity kinematic and kinetic data from the participants before and after walking training under various walking situations. Least-squares linear regression equations were utilized to evaluate joint stiffness during single-leg support. Three velocities significantly affected the stiffness of the knee and hip joint (p < 0.001), with a positive correlation. However, ankle joint stiffness was significantly lower only at maximum speed (p < 0.001). Hip stiffness was significantly higher after walking training than that before training (p < 0.001). In contrast, knee stiffness after training was significantly lower than pre-training stiffness in the same walking condition (p < 0.001). Ankle stiffness differed only at maximum speed, and it was significantly higher than pre-training stiffness (p < 0.001). Walking fatigue appeared to change the mechanical properties of the joint. Remarkably, at the maximum walking velocity in exhaustion, when the load on the hip joint was significantly increased, the knee joint’s stiffness decreased, possibly leading to joint instability that results in exercise injury.

Reversing the Mismatch With Forefoot Striking to Reduce Running Injuries

Recent studies have suggested that 95% of modern runners land with a rearfoot strike (RFS) pattern. However, we hypothesize that running with an RFS pattern is indicative of an evolutionary mismatch that can lead to musculoskeletal injury. This perspective is predicated on the notion that our ancestors evolved to run barefoot and primarily with a forefoot strike (FFS) pattern. We contend that structures of the foot and ankle are optimized for forefoot striking which likely led to this pattern in our barefoot state. We propose that the evolutionary mismatch today has been driven by modern footwear that has altered our footstrike pattern. In this paper, we review the differences in foot and ankle function during both a RFS and FFS running pattern. This is followed by a discussion of the interaction of footstrike and footwear on running mechanics. We present evidence supporting the benefits of forefoot striking with respect to common running injuries such as anterior compartment syndrome and patellofemoral pain syndrome. We review the importance of a gradual shift to FFS running to reduce transition-related injuries. In sum, we will make an evidence-based argument for the use of minimal footwear with a FFS pattern to optimize foot strength and function, minimize ground reaction force impacts and reduce injury risk.

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.

Effects of Foot-Core Training on Foot-Ankle Kinematics and Running Kinetics in Runners: Secondary Outcomes From a Randomized Controlled Trial

This study investigated the effectiveness of an 8-week foot-core exercise training program on foot-ankle kinematics during running and also on running kinetics (impact loads), with particular interest in biomechanical outcomes considered risk factors for running-related injuries in recreational runners. A single-blind, randomized, controlled trial was conducted with 87 recreational runners randomly allocated to either the control (CG) or intervention (IG) group and assessed at baseline and after 8 weeks. The IG underwent foot-core training 3 times/week, while the CG followed a placebo lower-limb stretching protocol. The participants ran on a force-instrumented treadmill at a self-selected speed while foot-segment motion was captured simultaneously with kinetic measurements. After the intervention, there were statistically significant changed in foot biomechanics, such as: IG participants strike the ground with a more inverted calcaneus and a less dorsiflexed midfoot than those in the CG; at midstance, ran with a less plantarflexed and more adducted forefoot and a more abducted hallux; and at push-off, ran with a less dorsiflexed midfoot and a less adducted and more dorsiflexed hallux. The IG runners also had significantly decreased medial longitudinal arch excursion (p = 0.024) and increased rearfoot inversion (p = 0.037). The 8-week foot-core exercise program had no effect on impact (p = 0.129) and breaking forces (p = 0.934) or on vertical loading rate (p = 0.537), but it was positively effective in changing foot-ankle kinematic patterns.”

Flexor digitorum brevis utilises elastic strain energy to contribute to both work generation and energy absorption at the foot

The central nervous system utilizes tendon compliance of the intrinsic foot muscles to aid the foot's arch spring, storing and returning energy in its tendinous tissues. Recently, the intrinsic foot muscles have been shown to adapt their energetic contributions during a variety of locomotor tasks to fulfil centre of mass work demands. However, the mechanism by which the small intrinsic foot muscles are able to make versatile energetic contributions remains unknown. Therefore, we examined the muscle–tendon dynamics of the flexor digitorum brevis during stepping, jumping and landing tasks to see whether the central nervous system regulates muscle activation magnitude and timing to enable energy storage and return to enhance energetic contributions. In step-ups and jumps, energy was stored in the tendinous tissue during arch compression; during arch recoil, the fascicles shortened at a slower rate than the tendinous tissues while the foot generated energy. In step-downs and landings, the tendinous tissues elongated more and at greater rates than the fascicles during arch compression while the foot absorbed energy. These results indicate that the central nervous system utilizes arch compression to store elastic energy in the tendinous tissues of the intrinsic foot muscles to add or remove mechanical energy when the body accelerates or decelerates. This study provides evidence for an adaptive mechanism to enable the foot's energetic versatility and further indicates the value of tendon compliance in distal lower limb muscle–tendon units in locomotion.

Summary: Demonstration of an adaptive mechanism that enables the intrinsic foot muscles to make versatile contributions to whole-body accelerations and decelerations.

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.

Determination of relationship between foot arch, hindfoot, and hallux motion using Oxford foot model: Comparison between walking and running

BACKGROUND

The foot arch plays an important role in propulsion and shock absorption during walking and running; however, the relationship among the foot arch, metatarsal locking theory, and nature of the windlass mechanism (WM) remain unclear.

RESEARCH QUESTION

What are the differences in the kinematic relationship between the foot arch, hindfoot, and hallux during walking and running?

METHODS

Relative angles within the foot were measured in 18 healthy men using the Oxford foot model (OFM). Data for barefoot walking at a comfortable speed and rearfoot running at 2.0 m/s were collected. Angles of the forefoot relative to the hindfoot (OFM-arch), hallux relative to the forefoot (Hallux) on the sagittal plane, and hindfoot relative to the shank (Hindfoot) on three anatomical planes were obtained. The medial longitudinal arch (MLA) angle was calculated to verify that OFM-arch can substitute the MLA angle. Each parameter was subjected to cross-correlation analysis and Wilcoxon signed-rank tests to examine the relationship with OFM-arch and compare them during walking and running.

RESULT

OFM-arch was similar to the conventional MLA projection angle in both trials (gait: 0.79, running: 0.96 p < 0.01). Synchronization of the OFM-arch and Hallux angles was higher in running than in walking (gait: -0.09, running: -0.75 p < 0.01). Hindfoot supination was unrelated to OFM-arch. Hindfoot angle on the transverse plane exhibited a moderate relationship with OFM-arch, indicating different correlations in walking and running (gait: 0.63, running: -0.68 p < 0.01).

SIGNIFICANCE

The elevation of the foot arch due to hallux dorsiflexion differed during walking and running; hence, other factors besides WM (such as intrinsic muscles) may affect the foot arch elevation during running. The hindfoot in the frontal plane does not contribute to arch raising and foot stability during running; it features different relationships with OFM-arch during walking and running.

Intra-assessor reliability and measurement error of ultrasound measures for foot muscle morphology in older adults using a tablet-based ultrasound machine

Background

To gain insight into the role of plantar intrinsic foot muscles in fall-related gait parameters in older adults, it is fundamental to assess foot muscles separately. Ultrasonography is considered a promising instrument to quantify the strength capacity of individual muscles by assessing their morphology. The main goal of this study was to investigate the intra-assessor reliability and measurement error for ultrasound measures for the morphology of selected foot muscles and the plantar fascia in older adults using a tablet-based device. The secondary aim was to compare the measurement error between older and younger adults and between two different ultrasound machines.

Methods

Ultrasound images of selected foot muscles and the plantar fascia were collected in younger and older adults by a single operator, intensively trained in scanning the foot muscles, on two occasions, 1–8 days apart, using a tablet-based and a mainframe system. The intra-assessor reliability and standard error of measurement for the cross-sectional area and/or thickness were assessed by analysis of variance. The error variance was statistically compared across age groups and machines.

Results

Eighteen physically active older adults (mean age 73.8 (SD: 4.9) years) and ten younger adults (mean age 21.9 (SD: 1.8) years) participated in the study. In older adults, the standard error of measurement ranged from 2.8 to 11.9%. The ICC ranged from 0.57 to 0.97, but was excellent in most cases. The error variance for six morphology measures was statistically smaller in younger adults, but was small in older adults as well. When different error variances were observed across machines, overall, the tablet-based device showed superior repeatability.

Conclusions

This intra-assessor reliability study showed that a tablet-based ultrasound machine can be reliably used to assess the morphology of selected foot muscles in older adults, with the exception of plantar fascia thickness. Although the measurement errors were sometimes smaller in younger adults, they seem adequate in older adults to detect group mean hypertrophy as a response to training. A tablet-based ultrasound device seems to be a reliable alternative to a mainframe system. This advocates its use when foot muscle morphology in older adults is of interest.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-022-00510-1.

The effect of interventions anticipated to improve plantar intrinsic foot muscle strength on fall-related dynamic function in adults: a systematic review

Background

The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults.

Methods

A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence.

Results

Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics.

Conclusions

This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-021-00509-0.

Surface Stiffness and Footwear Affect the Loading Stimulus for Lower Extremity Muscles When Running

ABSTRACT

Willwacher, S, Fischer, KM, Rohr, E, Trudeau, MB, Hamill, J, and Brüggemann, G-P. Surface stiffness and footwear affect the loading stimulus for lower extremity muscles when running. J Strength Cond Res 36(1): 82-89, 2022-Running in minimal footwear or barefoot can improve foot muscle strength. Muscles spanning the foot and ankle joints have the potential to improve performance and to reduce overuse injury risk. Surface stiffness or footwear use could modify the intensity of training stimuli acting on lower extremity joints during running. The purpose of this study was to systematically investigate external ankle, knee, and hip joint moments during shod and barefoot running while considering the stiffness of the running surface. Two footwear conditions (barefoot and neutral running shoe) and 4 surface conditions (Tartan, Tartan + Ethylene Vinyl Acetate [EVA] foam, Tartan + artificial turf, Tartan + EVA foam + artificial turf) were tested at 3.5 m·s-1. Repeated measures analysis of variance revealed that barefoot running in general and running barefoot on harder surfaces increased and decreased ankle (between +5 and +26%) and knee (between 0 and -11%) joint moments, respectively. Averaged over all surfaces, running barefoot was characterized by a 6.8° more plantarflexed foot strike pattern compared with running shod. Foot strike patterns were more plantarflexed on harder surfaces; the effects, however, were less than 3°. Most surface effects were stronger in barefoot compared with shod running. Surface stiffness may be used to modulate the loading intensity of lower extremity muscles (in particular extrinsic and intrinsic foot muscles) during running. These results need to be considered when coaches advise barefoot running as a method to improve the strength of extrinsic and intrinsic foot muscles or when trying to reduce knee joint loading.

Midfoot and Ankle Mechanics in Block and Incline Heel Raise Exercises

ABSTRACT

Chiu, LZF and Dæhlin, TE. Midfoot and ankle mechanics in block and incline heel raise exercises. J Strength Cond Res 35(12): 3308-3314, 2021-Although the heel raise exercise is performed to strengthen the calf muscles, the combination of calf muscle and ground reaction forces elicits moments that may deform the foot's longitudinal arch. The primary purpose of this investigation was to examine whether the foot muscles contribute to supporting the longitudinal arch during heel raises. The secondary purpose was to compare foot and ankle mechanical efforts between traditional block vs. 22° incline heel raises. Six women and 6 men performed heel raises with body mass plus a barbell loaded with 40% (BM + 40%) and 60% (BM + 60%) of their body mass. Three-dimensional motion analysis and force platform data were collected. The midfoot joint was evaluated from the angle between the forefoot and rearfoot (i.e., arch angle) and net joint moment, which may elevate or reduce the arch height. Midfoot joint arch elevator moment seemed to be greater for BM + 60% than BM + 40% (p < 0.05; Cohen's d = 1.24-1.61), with minimal change in arch angle (p < 0.05; Cohen's d = 0.15-0.19). Midfoot joint arch elevator and ankle plantar flexor moments seemed to be greater in incline vs. block heel raises for both loads (p < 0.05; Cohen's d = 0.58-0.67). The increase in midfoot joint arch elevator moment with trivial change in arch angle supports the hypothesis that the foot muscles contribute to longitudinal arch support during heel raises. Performing incline heel raises may be hypothesized to be more effective to stimulate foot and calf muscle adaptations than block heel raises.

A voluntary activation deficit in m. abductor hallucis exists in asymptomatic feet

M. abductor hallucis (AbH) is the strongest intrinsic foot muscle and its dysfunction underlies various foot disorders. Attempts to strengthen the muscle by voluntary exercises are constrained by its complex morphology and oblique mechanical action, which leads to an inability even in asymptomatic individuals to fully activate AbH. This study investigated the extent and magnitude of this inability whilst also providing preliminary evidence for the virtue of targeted sub-maximum neuromuscular electrical stimulation (NMES) as a countermeasure for an AbH activation deficit. The voluntary activation ratio (VAR) was assessed via the twitch interpolation technique in the left AbH of 13 healthy participants during maximum voluntary 1st metatarsophalangeal joint flexion-abduction contractions (MVC). Participants were grouped ("able" or "unable") based on their ability to fully activate AbH (VAR ≥ 0.9). 7 s-NMES trains (20 Hz) were then delivered to AbH with current intensity increasing from 150% to 300% motor threshold (MT) in 25% increments. Perceived comfort was recorded (10 cm-visual analogue scale; VAS). Only 3 participants were able to activate AbH to its full capacity (able, mean (range) VAR: 0.93 (0.91-0.95), n = 3; unable: 0.69 (0.36-0.83), n = 10). However, the maximum absolute forces produced during the graded sub-maximum direct-muscle NMES protocol were comparable between groups implying that the peripheral contractility of AbH is intact irrespective of the inability of individuals to voluntary activate AbH to its full capacity. These findings demonstrate that direct-muscle NMES overcomes the prevailing inability for high voluntary AbH activation and therefore offers the potential to strengthen the healthy foot and restore function in the pathological foot.

Stiffening the human foot with a biomimetic exotendon

Shoes are generally designed protect the feet against repetitive collisions with the ground, often using thick viscoelastic midsoles to add in-series compliance under the human. Recent footwear design developments have shown that this approach may also produce metabolic energy savings. Here we test an alternative approach to modify the foot-ground interface by adding additional stiffness in parallel to the plantar aponeurosis, targeting the windlass mechanism. Stiffening the windlass mechanism by about 9% led to decreases in peak activation of the ankle plantarflexors soleus (~ 5%, p < 0.001) and medial gastrocnemius (~ 4%, p < 0.001), as well as a ~ 6% decrease in positive ankle work (p < 0.001) during fixed-frequency bilateral hopping (2.33 Hz). These results suggest that stiffening the foot may reduce cost in dynamic tasks primarily by reducing the effort required to plantarflex the ankle, since peak activation of the intrinsic foot muscle abductor hallucis was unchanged (p = 0.31). Because the novel exotendon design does not operate via the compression or bending of a bulky midsole, the device is light (55 g) and its profile is low enough that it can be worn within an existing shoe.