Inter-segmental motions of the foot: differences between younger and older healthy adult females

The influence of women's age and fall history on foot and lower limb kinematics during transition step descent

Falls are a major public health concern, with older women being at the greatest risk to experience a fall. Step descent increases the likelihood of a fall injury, yet the influence of age and fall history on lower extremity kinematics have not been extensively studied. The purpose of this study was to examine lower extremity and foot kinematics of women with and without a fall history during single step descent. Hip, knee, and foot kinematics of young women (n = 15, age = 22.6 ± 3.2 years), older women with no recent falls (n = 15, age = 71.6 ± 4.4 years), and older women with a fall history (n = 15, age = 71.5 ± 5.0 years) as they descended a 17 cm step were examined. Differences in initial contact angles and ROM during landing were examined with between group MANOVA tests. Distal foot initial contact angles were not significant between groups. For range of motion, both older groups went through greater hip extension (p = 0.003, partial η2 = 0.25), but less hip adduction (p = 0.002, partial η2 = 0.27) and less lateral midfoot dorsiflexion (p = 0.001, partial η2 = 0.28) than the younger women. The older fall group had reduced knee flexion (p = 0.004, partial η2 = 0.23) than the younger group, and the older non-fallers slightly plantarflexed at the medial midfoot (p = 0.005, partial η2 = 0.23) while the young women dorsiflexed. Thelanding phase ROMdifferences exhibited by the older adult groupsmayincrease the likelihood of a misstep, which may result in a fall.

Comparison of Foot Kinematics Between Normal Arch and Flexible Flatfoot Using the Oxford Foot Model: A Matched Case-Control Study

Background

Symptomatic flexible flatfoot causes alterations in gait, but exactly how this condition affects the intersegmental motion of the foot during the gait cycle remains unclear. Previous studies have examined the kinematics, yielding inconsistent findings. Therefore, the objective of this study was to investigate how flexible flatfoot deformity, defined as Johnson and Strom classification staging II, affects the intersegmental motion of the foot during fast walking based on a comparison with the matched control group.

Methods

Eleven participants with symptomatic flexible flatfoot and 11 healthy matched control participants were recruited using a foot screening protocol incorporated through a foot physical examinations and radiographic measurements. All demographic characteristics exhibited comparable profiles between the groups. During controlled walking, kinematic outcomes pertaining to the hallux, hindfoot, forefoot, and tibia were collected using the multisegmental Oxford Foot Model.

Results

All spatiotemporal parameters were comparable between the groups. In comparison to the control group, individuals with symptomatic flexible flatfoot demonstrated increased hallux valgus and plantarflexion, increased forefoot abduction, heightened hindfoot eversion, and internal rotation. Notably, no significant major differences were observed in the tibia motion segment. Further, significant correlations were identified between static foot measurements and the extent of the maximum deviation observed during dynamic kinematic assessments.

Conclusion

Compared with age- and gender-matched controls, participants with symptomatic flexible flatfoot exhibited significant gait pattern deviations. A significant correlation also exists between static foot deformity measurements and dynamic kinematic deviations. Collectively, these findings have implications for developing targeted therapeutic interventions to address flexible flatfoot.

Level of evidence

Level III, diagnostic study.

Development of a clinically useful multi-segment kinetic foot model

BACKGROUND

Traditionally, gait analysis studies record the foot as a single rigid segment, leaving movements and loads within the foot undetected. In addition, very few data of multi-segment foot kinetics have been represented in the literature due to measurement and equipment limitations. As a result, this study aims to develop a novel multi-segment kinetic foot model that is clinically feasible and enables both kinematic and kinetic analysis of large patient groups.

RESULTS

Outcome measurements include rotation angles of intersegmental dorsi/plantar flexion, inversion/eversion, and internal/external rotation, joint moments, joint powers and the medial longitudinal arch (MLA) height/length ratio. Repeatability of joint motions was calculated using coefficients of multiple correlation. Most joint motions measured by this foot model showed strong within-subject reliability (R > 0.7) in healthy adults. Outcome measures were in agreement with other multi-segment foot models found in the biomechanics literature.

CONCLUSIONS

This novel multi-segment foot model is able to quantify intersegmental foot kinematics and kinetics and can be a useful tool for research and assessments on clinical populations.

Foot and Ankle Motion after Tibiotalocalcaneal Arthrodesis: Comparison with Tibiotalar Arthrodesis Using a Multi-Segment Foot Model

BACKGROUND

Tibiotalocalcaneal arthrodesis is an established surgical procedure for treating patients with end-stage ankle joint arthritis and subtalar joint arthritis. Although it greatly relives pain, a major drawback is loss of range of motion. Although it is known to restrict an additional subtalar joint compared to tibiotalar arthrodesis, there is a lack of gait analysis studies comparing the two methods. This study aimed to evaluate the differences in kinematics of the foot and ankle joints between tibiotalar and tibiotalocalcaneal arthrodesis. We also compared preoperative and postoperative statuses for each surgical method.

METHODS

The study included 12 and 9 patients who underwent tibiotalar and tibiotalocalcaneal arthrodesis, respectively, and 40 healthy participants were included in the control group. The DuPont foot model was used to analyze intersegmental foot and ankle kinematics during gait.

RESULTS

Compared to controls, both tibiotalar and tibiotalocalcaneal arthrodesis resulted in slow gait speed with reduced stride length, increased step width, and decreased range of sagittal plane motion. Both fusion methods showed similar range of motion in all segments and planes following surgery. Coronal positions showed more supination of the forefoot and pronation of the hindfoot segment after each operation, particularly tibiotalocalcaneal arthrodesis. Gait after tibiotalocalcaneal arthrodesis did not significantly differ from that after tibiotalar arthrodesis, but there was a tendency of more pronation in the hindfoot segment.

CONCLUSIONS

Both fusion methods limited foot and ankle motion in similar ways. Comparing tibiotalar and tibiotalocalcaneal arthrodesis suggests that additionally fusing the subtalar joint does not cause greater movement restriction in patients. Objectively comparing tibiotalar and tibiotalocalcaneal arthrodesis will facilitate further understanding of the effect of tibiotalocalcaneal arthrodesis on movement and the value of subtalar joint motion for improved preoperative counselling.

The effect of backpack load on intersegmental motions of the foot and plantar pressure in individuals with mild flatfoot

BACKGROUND

The feet play an essential role in shock absorption, and foot posture is closely related to gait. The compensatory mechanism under heavy-load conditions in individuals with mild flatfoot is poorly understood. In the authors' country, individuals with mild flatfoot are drafted as active-duty soldiers and participate in military rucking wearing heavy backpacks. This study investigated the effect of backpack load on gait and foot plantar pressure and possible differences in participants with mild flatfoot. The average weight of the backpack during military rucking (approximately 20 kg), was simulated in this study.

METHODS

This study prospectively enrolled 30 healthy young males, divided into a control group (CON, n = 15) and a mild low-arched group (MLA, n = 15), based on the presence of flatfoot. Segmental foot kinematics were evaluated using a three-dimensional multi-segment foot model, and gait data of the temporal and spatial parameters were obtained. The dynamic plantar pressure was simultaneously measured using a pedobarography platform with gait trials. The protocol was repeated with all participants wearing 20 kg backpacks. Comparisons between the baseline and loaded states, as well as comparison between groups, were conducted.

RESULTS

Although the cadence, gait speed, and stride length decreased in the loaded condition, step time and proportion of the stance phase increased in both groups. Although the MLA group showed more supinated and abducted positions of the forefoot and more pronated positions of the hindfoot than the CON group, the change in intersegmental foot and ankle motion in each group after backpack loading was minimal. However, the former showed a larger step width and a greater increase in contact area in the midfoot region, while the latter demonstrated a greater increase in peak pressure.

CONCLUSIONS

Individuals with mild flatfoot demonstrated significantly different gait curve patterns (waveforms) compared to the controls. In the loaded condition, the CON and MLA groups may have adopted different strategies to maintain balance during gait. We suggest that although individuals with asymptomatic mild flatfoot are drafted as active-duty soldiers, they should be thoroughly investigated under loaded conditions, and orthoses may be helpful.

The influence of subtalar axis orientation on the foot posture of older adults in a closed kinetic chain

Objectives: This study compared the influence of subtalar axis position on foot behavior in a closed kinetic chain in older and younger adults. Methods: The sample included 50 older adults and a control group of 50 younger adults. The variables were initially analyzed for both feet together, and were later analyzed separately, comparing each foot (right and left) between groups. Range of motion was assessed by validated goniometric procedures: the position of subtalar axis was evaluated by the palpation technique, while the Foot Posture Index was used to assess behavior in a closed kinetic chain. Student’s t-test / Mann-Whitney test compared the main variables according to sample distribution, while Student’s t-test / Wilcoxon test was used for paired samples. A standardized Haberman residuals test was also used to determine the connection between the position of subtalar joint axis and the Foot Posture Index. Results: Data from the right and left feet were similar for all variables. The older group had reduced mobility in the ankle and first metatarsophalangeal joint (5.42º [SD (Standard Deviation), 4.49] and 76.12º [SD, 19.24], respectively) with statistically significant values, (p < 0.001). The difference in subtalar axis position was not significant (p = 0.788), with more internal deviations in both groups. There was a significant difference in Foot Posture Index (p = 0.006, by applying the chi-square test), with the normal position more prevalent in the older group and the prone position more prevalent in the younger group. Conclusions: Regarding internal deviations in the subtalar joint axis, the older group had a higher frequency of feet in the normal position, while the younger group had a higher frequency of feet in the prone position which, in this case, agrees with the rotational balance theory. For the normal axis position, a higher frequency of normal position was found in both groups. Regarding external deviations of the subtalar joint axis, neither group followed the pattern expected in rotational balance theory. The most consistent connection in the older group was between external axis position and supine foot position, whereas in the younger group it was between normal axis position and normal foot position.

Change in intersegmental foot and ankle motion after a high tibial osteotomy in genu varum patients

High tibial osteotomy (HTO) is a well-established treatment for medial compartment knee osteoarthritis (OA), which shifts the weight-bearing axis from the medial to the lateral side of the knee. As the adjacent ankle joint may be directly affected by the change in biomechanics, this study aimed to evaluate the change in the intersegmental foot and ankle motion after HTO in patients with genu varum. The study included 24 patients who underwent HTO, and 48 older healthy participants as a control group. Segmental foot kinematics were evaluated using a 3D multisegment foot model, and gait data of temporal and spatial parameters were obtained. After HTO, normalized stride length significantly increased with a tendency for increases in gait speed. In hallux kinematics relative to the forefoot, the sagittal motions of both the patients and the control group were similar throughout the majority of the gait cycle. In forefoot kinematics relative to the hindfoot, the pre-HTO state revealed significant pronation throughout the gait cycle, while the post-HTO state showed a similar position and motion to the control group. In hindfoot kinematics relative to the tibia, coronal motions of the pre-HTO state showed supination throughout the gait cycle, while supination during the stance phase decreased after HTO. Genu varum patients with medial compartment knee OA showed different gait parameters and intersegmental motion during gait when compared with age- and gender-matched controls. The effect of HTO was demonstrated by the normalization of midfoot compensation in patients with genu varum.

Inter-segmental foot kinematics during gait in elderly females according to the severity of hallux valgus

The objective of this study was to find the effect of hallux valgus (HV) deformity on the inter-segmental motion of the foot using an MFM with a 15-marker set (DuPont Foot Model, DuFM) in comparison with age and sex controlled healthy adults. Fifty-eight female symptomatic HV patients and 50 female asymptomatic older female volunteers were included in this study. According to the radiographic hallux valgus angle (HVA), the study population was divided into severe HV (SHV, HVA ≥ 40°, n = 25), moderate HV (MHV, 20° ≤ HVA < 40°, n = 47), and control (CON, n = 36). MHV group was divided into symptomatic MHV group (S-MHV, n = 33) and asymptomatic MHV group (A-MHV, n = 14) according to the symptoms associated with HV. For temporal parameters, gait speed and stride length were diminished according to the severity of HV deformity. Sagittal range of motion of hallux and hindfoot decreased significantly in SHV group. Loss of push-off during the preswing phase was observed and forefoot adduction motion during terminal stance was decreased in SHV group. In a subgroup analysis of MHV, asymptomatic HV minimally affects gait and inter-segmental motion during gait. HV deformity affects gait parameters and inter-segmental motion of the foot during gait in proportion to the severity of the deformity. However, the effect of MHV itself on foot kinematics might be limited while pain or arthritic change of the joint might cause changes in gait in patients with symptomatic HV.

Flatfoot deformity affected the kinematics of the foot and ankle in proportion to the severity of deformity

BACKGROUND

Flatfoot deformity is thought to affect gait kinematics, but the effect of flatfoot on segmental motion of the foot during gait remains unclear. Recently, multi-segmental foot models (MFMs) have been introduced for the in vivo analysis of dynamic foot kinematics. The objective of this study was to find the effect of flatfoot on segmental motion of the foot during gait in females by comparisons with age and gender controlled healthy adults.

METHODS

Thirty six symptomatic flatfeet patients (52-80 years old) and 42 symptom-free female participants without flatfoot (60-69 years old) were included in this study. According to the Meary angle (MA) on standing lateral radiograph, flatfoot patients are divided into severe (SFF, MA>20°) and moderate (MFF, 10°<MA<20°) flatfoot group. Segmental foot kinematics were evaluated using a 3D MFM of a 15-marker set (DuPont Foot Model).

RESULTS

The cadence, speed, stride length, and step width are significantly lower in flatfoot patients. ROM of sagittal and transverse plane of the hindfoot, transverse plane of the forefoot and sagittal plane of the hallux were lower in severe flatfoot group. In the SFF group, there was loss of hindfoot adduction motion during the terminal stance and pre-swing phase. In forefoot kinematics, the SFF group showed significantly supinated and abducted position throughout the gait cycle. In hindfoot kinematics, plantar flexion motion in the pre-swing phase was significantly lower in flatfoot patients in proportion to the severity of the deformity.

CONCLUSIONS

We showed that flatfoot deformity affected the kinematics of the foot and ankle in proportion to the severity of deformity. We cautiously suggest that there might be a threshold of flatfoot precluding normal foot kinematics because normal kinematic pattern of the foot might not collapse in moderate flatfoot with a Meary angle of less than 20 degrees.

Age-related differences in foot mobility in individuals with patellofemoral pain

Background

Age-related changes in midfoot mobility have the potential to influence success with foot orthoses intervention in people with patellofemoral pain (PFP). The aim of this study was to determine whether older people with PFP demonstrate less foot mobility than younger adults with PFP.

Methods

One hundred ninety four participants (113 (58%) women, age 32 ± 7 years, BMI 25 ± 4.9 kg/m²) with PFP (≥ 6 weeks duration) were included, with foot mobility quantified using reliable and valid methods. K-means cluster analysis classified participants into three homogenous groups based on age. After cluster formation, univariate analyses of co-variance (covariates: sex, weight) were used to compare midfoot height mobility, midfoot width mobility, and foot mobility magnitude between age groups (significance level 0.05).

Results

Cluster analysis revealed three distinct age groups: 18–29 years (n = 70); 30–39 years (n = 101); and 40–50 years (n = 23). There was a significant main effect for age for midfoot height mobility (p < 0.001) and foot mobility magnitude (p = 0.006). Post-hoc analyses revealed that midfoot height mobility differed across all three groups (moderate to large effect sizes), and that foot mobility magnitude was significantly less in those aged 40–50 years compared to those aged 18–25 years (moderate effect size). There were no significant main effects for age for midfoot width mobility (p > 0.05).

Conclusion

Individuals with PFP aged 40–50 years have less foot mobility than younger adults with PFP. These findings may have implications for evaluation and treatment of older individuals with PFP.