Analysis of Plantar Foot Pressure during the Non-crutch, Two-point, and Four-point Crutch Gait performed by Healthy Volunteers

Walking with unilateral ankle-foot unloading: a comparative biomechanical analysis of three assistive devices

BACKGROUND

Foot and ankle unloading is essential in various clinical contexts, including ulcers, tendon ruptures, and fractures. Choosing the right assistive device is crucial for functionality and recovery. Yet, research on the impact of devices beyond crutches, particularly ankle-foot orthoses (AFOs) designed to unload the ankle and foot, is limited. This study investigates the effects of three types of devices-forearm crutches, knee crutch, and AFO-on biomechanical, metabolic, and subjective parameters during walking with unilateral ankle-foot unloading.

METHODS

Twenty healthy participants walked at a self-selected speed in four conditions: unassisted able-bodied gait, and using three unloading devices, namely forearm crutches, iWalk knee crutch, and ZeroG AFO. Comprehensive measurements, including motion capture, force plates, and metabolic system, were used to assess various spatiotemporal, kinematic, kinetic, and metabolic parameters. Additionally, participants provided subjective feedback through questionnaires. The conditions were compared using a within-subject crossover study design with repeated measures ANOVA.

RESULTS

Significant differences were found between the three devices and able-bodied gait. Among the devices, ZeroG exhibited significantly faster walking speed and lower metabolic cost. For the weight-bearing leg, ZeroG exhibited the shortest stance phase, lowest braking forces, and hip and knee angles most similar to normal gait. However, ankle plantarflexion after push-off using ZeroG was most different from normal gait. IWalk and crutches caused significantly larger center-of-mass mediolateral and vertical fluctuations, respectively. Participants rated the ZeroG as the most stable, but more participants complained it caused excessive pressure and pain. Crutches were rated with the highest perceived exertion and lowest comfort, whereas no significant differences between ZeroG and iWalk were found for these parameters.

CONCLUSIONS

Significant differences among the devices were identified across all measurements, aligning with previous studies for crutches and iWalk. ZeroG demonstrated favorable performance in most aspects, highlighting the potential of AFOs in enhancing gait rehabilitation when unloading is necessary. However, poor comfort and atypical sound-side ankle kinematics were evident with ZeroG. These findings can assist clinicians in making educated decisions about prescribing ankle-foot unloading devices and guide the design of improved devices that overcome the limitations of existing solutions.

Load distribution on the foot and lofstrand crutches of amputee football players

BACKGROUND

Amputee football is a worldwide popular sport with positive physical and psychological effects on the disabled. Amputee players use their hands dominantly for locomotion. However, the effect of using upper extremity which is not accommodated to loading is not very well known.

RESEARCH QUESTION

The objective of this study was to determine the load distribution of amputee football players during walking, running and kicking the ball.

METHODS

This study was conducted with 15 certified amputee football players (age 24.5 ± 5.8 years, body weight 62.3 ± 10.9 kg, height 171.6 ± 7.7 cm). The loads on their non-amputated lower extremity were measured with F-Scan mobile system sensors inserted in their shoes, and the loads on their upper extremities were measured with F-Grip system sensors affixed to the gloves. The participants were asked to walk, run and kick the ball using Lofstrand Crutches.

RESULTS

The maximum loading on the upper extremities during walking, running and kicking the ball varied between 111% and 175% of the body weight. While loading during walking and running was similar, the loading on the upper extremity during kicking the ball exceeded that of walking by 58.1% and running by 47.4%. The maximum loading on the non-amputated lower extremity varied between 134% and 196% of the body weight. Loading during running was 46.2% higher than that of walking. The loading on the foot during kicking the ball was 45.7% higher than that of walking. The loading on the foot during running and kicking were similar.

SIGNIFICANCE

Walking-running-kicking the ball with LC resulted in unusual loading particularly on the upper extremity. During running, the increased loading was transferred to the foot rather than the hands. During kicking, the loading increased extremely and was mainly transferred to the hands. The frequent repetition of kicking during the game may therefore increase the incidence of upper extremity injuries.

Effects of orthosis on balance and gait in healthy adults

[Purpose] This study evaluated the effects of an oral orthosis that can change body alignment on the balance ability and gait of healthy adults. [Subjects and Methods] The subjects of this study were 21 University students. A gait analyzer was used to analyze the subjects’ balance ability and gait quality. Two walking speeds were used: 2 km/h, a comfortable speed, and 4 km/h, a slightly faster walking speed. [Results] The step length, and base of gait at 2 km/h differed significantly after the intervention. The total step time and step length increased significantly after the intervention. Furthermore, the total base of gait decreased significantly after the intervention. The step times of the left lower limb at 4 km/h differed significantly after the intervention. [Conclusion] The oral orthosis tested positively affects the balance ability and gait of healthy adults.

Analysis of Crutch Position in the Horizontal Plane to Estimate the Stability of the Axillary Pad in the Axilla during Single-crutch Walking

[Purpose] The aim of this study was to estimate the stability of the axillary pad in the axilla during single-crutch walking through kinematic analysis of the crutch position in the horizontal plane. [Subjects] The subjects were 19 healthy young males. [Methods] The subjects were instructed to walk 5 m in a straight line while using a single crutch. This was repeated 10 times. Repeated-measures analysis of variance and Tukey’s honest significance test were used to compare crutch angles across three time points during crutch stance (crutch contact, mid stance and crutch off) for each subject. [Results] A statistically significant effect of time was found in 17 of the 19 subjects. Sixteen of these 17 subjects rotated the crutch externally from crutch contact to crutch off. [Conclusion] External rotation of the crutch throughout the stance phase is important to enable the axillary pad to be held tightly against the chest wall. These results may lead to alterations of the instructions for crutch use and the prevention of falls.