Gait and strength assessment following surgical repair by intramedullary nailing of isolated tibial shaft fracture

The objective of the study was to evaluate the long-term strength and gait outcomes after intramedullary nailing of isolated tibial diaphyseal fractures. This retrospective cohort study was conducted at an academic Level I trauma center. Fifteen participants with isolated tibial diaphyseal fractures (OTA/AO 42) at least 2 years postoperative from intramedullary nailing (IMN) provided informed consent. The average age was 40 ± 14 (range, 24-69); there were nine men and six women. Knee flexion-extension strength data were collected. Temporal-spatial, kinematic, and kinetic gait parameters were measured and compared to historic control data. Participants completed the SF-36 and shortened musculoskeletal function assessment questionnaires. The mean length of follow-up between surgery and gait analysis was 6 ± 2 years. The fractured limb demonstrated deficits in quadriceps strength between 9.8% and 23.4% compared to the unaffected limb. Temporal-spatial parameters revealed slower walking speed, shorter stride length, decreased cadence, and shorter single-limb support time in the fractured limb. Altered kinematic and kinetic findings included a knee extension shift during stance, with an increased knee flexor moment demand and decreased total knee power during loading and midstance. These findings represent deficits in concentric and eccentric knee extensor activity. Additionally, the fractured limb demonstrated decreased ankle dorsiflexion during stance and diminished ankle push-off power. Long-term outcomes after IMN of tibial diaphyseal fractures demonstrate decreased quadriceps strength and altered gait parameters that may have implications to the high incidence of knee and ankle pain in the fractured limb.

Multi-segment foot kinematics during gait following ankle arthroplasty

Ankle arthritis is a debilitating disease marked by pain and limited function. Total ankle arthroplasty improves pain while preserving motion and offers an alternative to the traditional treatment of ankle fusion. Gait analysis and functional outcomes tools can provide an objective balanced analysis of ankle replacement for the treatment of ankle arthritis. Twenty-nine patients with end-stage ankle arthritis were evaluated before and after ankle arthroplasty. Multi-segment foot and ankle kinematics were assessed annually following surgery (average 3.5 years, range 1-6 years) using the Milwaukee Foot Model and a Vicon video motion analysis system. Functional outcomes (American Orthopedic Foot and Ankle Society [AOFAS] ankle/hindfoot scale, short form 36 [SF-36] questionnaire) and temporal-spatial parameters were also assessed. Kinematic results were compared to findings from a previously collected group of healthy ambulators. AOFAS and SF-36 mean scores improved postoperatively. Walking speed and stride length increased after surgery. There were significant improvements in tibial sagittal range of motion in terminal stance and hindfoot sagittal range of motion in preswing. Decreased external rotation of the tibia and increased external rotation of the hindfoot were noted throughout the gait cycle. Pain and function improved after ankle replacement as supported by better outcomes scores, increased temporal-spatial parameters, and significant improvement in tibial sagittal range of motion during terminal stance and hindfoot sagittal range of motion during preswing. While multi-segment foot kinematics were improved, they were not restored to control values. Statement of clinical significance: Total ankle arthroplasty does not fully normalize mutli-segment gait kinematics despite improved patient-reported outcomes and gait mechanics.

Distribution of segmental foot kinematics in patients with degenerative joint disease of the ankle

Degenerative joint disease (DJD) of the ankle is a debilitating chronic disease associated with severe pain and dysfunction resulting in antalgic gait alteration. Little information is available about segmental foot and ankle motion distribution during gait in ankle osteoarthritis. The aim of the current study was to dynamically characterize segmental foot and ankle kinematics of patients with severe ankle arthrosis requiring total ankle replacement. This was a prospective study involving 36 (19 M, 17 F) adult patients with a clinical diagnosis of ankle arthrosis ("DJD" group) and 36 (23 M, 13 F) healthy subjects ("Control" group). Motion data were collected at 120 Hz using a 3-D motion camera system at self-selected speed along a 6-m walkway and processed using the Milwaukee Foot Model (MFM). The SF-36 Health Survey and Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were administered to evaluate functional levels. Findings include decreases in walking speed, cadence, stride length and swing phase, and reduced outcomes scores (SF-36 and AOFAS). Multisegemental motion in patients with ankle DJD demonstrates significant changes in foot mechanics characterized by altered segment kinematics and significant reduction in dynamic ROM at the tibia, hindfoot, forefoot, and hallux when compared to controls. The results demonstrate decreased temporal-spatial parameters and low outcomes scores indicative of functional limitations. Statement of clinical significance: Altered segment kinematics and reduced overall range of motion demonstrate how a single joint pathology affects kinematic distribution in the other segments of the foot and ankle and alters patients' overall gait. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1739-1746, 2018.

Multisegmental foot and ankle motion analysis after hallux valgus surgery

BACKGROUND

Gait changes in patients with hallux valgus, including altered kinematic and temporal-spatial parameters, have been documented in the literature. Although operative treatment can yield favorable clinical and radiographic results, restoration of normal gait in this population remains unclear. Segmental kinematic changes within the foot and ankle during ambulation after operative correction of hallux valgus have not been reported. The aim of this study was to analyze changes in multisegmental foot and ankle kinematics in patients who underwent operative correction of hallux valgus.

METHODS

A 15-camera Vicon Motion Analysis System was used to evaluate 24 feet in 19 patients with hallux valgus preoperatively and postoperatively. The Milwaukee Foot Model was used to characterize segmental kinematics and temporal-spatial parameters (TSPs). Preoperative and postoperative kinematics and TSPs were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Outcomes were evaluated using the SF-36 assessment tool.

RESULTS

Preoperatively, patients with hallux valgus showed significantly altered temporal-spatial and kinematic parameters. Postoperatively, kinematic analysis demonstrated restoration of hallux position to normal. Hallux valgus angles and intermetatarsal angles were significantly improved, and outcomes showed a significant increase in performance of physical activities. Temporal-spatial parameters and kinematics in the more proximal segments were not significantly changed postoperatively.

CONCLUSION

Postoperative results demonstrated significant improvement in foot geometry and hallux kinematics in the coronal and transverse planes. However, the analysis did not identify restoration of proximal kinematics.

CLINICAL RELEVANCE

Further investigation is necessary to explore possible causes/clinical relevance and appropriate treatment interventions for the persistently altered kinematics.

Motion of the multisegmental foot in hallux valgus

BACKGROUND

Hallux valgus is a common condition characterized by lateral deviation of the large toe and medial deviation of the first metatarsal. While some gait analyses of patients with hallux valgus have been performed using plantar pressures, very little is known about the kinematics of gait in this population. The purpose of this study was to evaluate triplanar kinematics in patients with hallux valgus using a multisegmental foot model.

MATERIALS AND METHODS

A 15-camera Vicon Motion Analysis System was used to evaluate the gait of 38 feet in 33 patients with mild to severe hallux valgus. The Milwaukee foot model was used to characterize dynamic foot and ankle kinematics and temporal-spatial parameters. Values were compared with normal subjects. Outcomes were evaluated using the SF-36 assessment tool.

RESULTS

Patients with hallux valgus showed significantly decreased velocity and stride length and prolonged stance. Significant alterations in gait kinematics were observed in various planes in all segments (hallux, forefoot, hindfoot, and tibia) of the foot and ankle, particularly in the ranges of motion of the hallux and the forefoot.

CONCLUSION

The results demonstrate significantly altered kinematic and temporal-spatial parameters reflective of reduced ambulatory function in patients with hallux valgus. As reports describing multisegmental foot and ankle kinematics in this population are limited, this study is valuable in characterizing gait in patients with hallux valgus.

CLINICAL RELEVANCE

A better understanding of altered gait dynamics of the multisegmental foot in patients with hallux valgus provides valuable insight on how distal pathology affects proximal segments.

Quantitative motion analysis in patients with hallux rigidus before and after cheilectomy

The purpose of this study was to quantify changes in temporal-spatial parameters and multisegmental foot/ankle kinematics in a group of patients with hallux rigidus following cheilectomy. Three-dimensional motion analysis was conducted using a 15-camera Vicon Motion Analysis System on a population of 19 patients who underwent cheilectomy for hallux rigidus. Data were analyzed using the four-segment Milwaukee Foot Model. Preoperative and postoperative tests were compared using paired parametric methods. Results showed significant improvements in walking speed, cadence, stride length, and stance/swing ratio from preoperative to postoperative state. Altered hallux and forefoot positions preoperatively showed shifts towards normal after cheilectomy. Although clinical improvements in pain and passive range of motion were statistically significant, similar improvements in range of motion were not demonstrated during ambulatory testing. The results of this study provide insight into ambulatory improvements following cheilectomy, and suggest further study of the rehabilitation process to improve the recovery of functional range of motion.

Quantitative characterization of gait kinematics in patients with hallux rigidus using the Milwaukee foot model

The purpose of this study was to provide a quantitative analysis of the changes that occur in the foot and ankle during the gait of patients with hallux rigidus. Using a 15-camera Vicon Motion Analysis System, gait analysis was conducted on a population of 22 patients with hallux rigidus and compared to that of 25 healthy ambulators. Weight-bearing radiographs were measured to index marker positions to underlying bony anatomy. The Milwaukee Foot Model was used to perform three-dimensional analysis of dynamic foot and ankle motion, and temporal-spatial parameters were also calculated. Values were compared to controls using unpaired parametric methods (Student t-test, p < 0.002). The hallux rigidus population showed significant alterations in gait patterns as compared to controls in various planes in all segments (hallux, forefoot, hindfoot, and tibia) of the foot and ankle, particularly in the range of motion of the hallux and the forefoot. Prolonged stance phase was also observed. As reports regarding the quantitative study of the multisegment foot and ankle are limited, this study was useful in providing characterization of gait patterns in patients with hallux rigidus.

Multisegmental foot modeling: a review

Over the past two decades, a number of multisegmental foot models have been developed in order to characterize foot kinematics. This paper reviews methods of multisegmental foot modeling, technical elements of the models, select clinical applications of the models, and future directions in this area of research. Technical areas discussed include angular derotation mechanisms and capture technology. Models discussed address two-, three-, four-, five-, and nine-segment approaches. Additional models which address foot segments using other definitions, are also discussed. Clinical applications of multisegmental foot models include pathologic gait characterization in rheumatoid arthritis, posterior tibial tendon dysfunction, and hallux rigidus. Areas of continued development, including soft tissue artifact and nomenclature, are also discussed.