Hormonal fluctuations throughout the menstrual cycle are associated with a higher prevalence of musculoskeletal injuries in women; however, their impact at the foot and ankle level remains underexplored. The aim of this systematic review and meta-analysis was to examine the potential biomechanical effect of the ovulatory phase on foot and ankle structure compared to other phases of the menstrual cycle, given its possible association with injury occurrence. A systematic search was conducted in PubMed, Scopus, Web Of Science, and Embase (last 10 years), following PRISMA guidelines. Cohort studies, non-randomized trials, and case-control studies were included. Quality assessment was performed using the JBI critical appraisal tool. A quantitative synthesis (meta-analysis) was performed for homogeneous variables (muscle stiffness). Fifteen studies were selected. The systematic review demonstrated increase in foot length, reduction in fascial thickness, and greater longitudinal arch collapse during the ovulatory phase. Tone and stiffness of the tibialis anterior and peroneus longus muscles were greater during the menstrual phase. During ovulation, lower stiffness was observed during active contraction and increased tibialis anterior activation. Greater postural sway and oscillation were recorded during ovulation in complex static tasks, and, along with the menstrual phase, in dynamic balance tests. The meta-analysis indicated a tendency towards lower tibialis anterior stiffness during the follicular phase compared to the ovulatory phase. The ovulatory phase appears to be associated with an interaction of structural alterations (ligament laxity and arch collapse) and neuromuscular changes (reduced muscle stiffness and inefficient motor control) that, together, could constitute a risk factor for local pathologies such as plantar fasciitis and chronic ankle instability.

Lateral wedges are often prescribed to increase the first metatarsophalangeal joint (MPJ) range of motion or alter the centre of pressure (COP) in the foot. This study explored the effect of lateral wedge design and placement on first MPJ extension and COP during walking and running gait. A randomised crossover design was used and 24 healthy participants ran and walked in 10 insole conditions comprising differing combinations of inclination, placement and contour. First MPJ extension and foot COP were examined. Time-series data were analysed across the stance phase using statistical parametric mapping. Lateral wedges significantly reduced first MPJ extension during both walking (p < 0.001; 100% of stance) and running (p = 0.004; 14-72%, and p = 0.017; 76-99% of stance). Similarly, lateral wedge placement reduced first MPJ joint extension during walking (p < 0.001; 100% of stance) and running (p = 0.003; 13-69%, and p = 0.012; 78-100%). Full-length or 6° lateral wedges shifted the COP medially relative to the midline of the foot (p = 0.01). Compared to sham, lateral wedges placed on contoured insoles exhibited a smaller reduction in first MPJ during walking (p = 0.008) and shifted the COP medially during both walking (p < 0.001) and running (p = 0.020). Where the intention of using lateral wedging is to shift the COP medially, these data indicate that a wedge which is of higher inclination (6°) or spanning the full-length of the insole, should be used. Conversely, if the goal is to reduce extension at the first MPJ, these findings suggest that both 3° and 6° inclination wedges are suitable, with either forefoot or full-length applications proving effective.

Ambulant children with cerebral palsy (CP) are at a high risk of falls. It is important to identify characteristics associated with increased falls and understand which clinical measures are associated with falls in this population. This study explored parent-reported falls of 66 children with CP (Gross Motor Function Classification System [GMFCS] I - III) and the associations between lower limb functional measures (6-Minute Walk Test, Muscle Power Sprint Test, 10 Metre Walk Test, Sit-to-Stand, Lateral Step-up, Kneel-to-Stand) and the number of falls. Receiver operating characteristic (ROC) curve analysis identified score thresholds for the likelihood of falling more than average. 81% of children fell at least once in the previous month, with an average of 11 falls and 44% children who fell were injured. Children in GMFCS level II had the greatest number of falls. Poorer performance on Sit-to-Stand, Lateral-Step-Up and Kneel-To-Stand were associated with fall frequency. ROC thresholds for likelihood of above average fall frequency were identified for lateral step-up best side (score ≤17), sit-to-stand (score ≤15) and kneel-to-stand best side (score ≤ 4). Ambulant children with CP are at high risk of falls. Poor performance in several lower limb assessments incorporating balance ware associated with higher fall frequency.

Musculoskeletal (MSK) modeling and ultrasound imaging (USI) are complementary techniques that, when combined with three-dimensional gait analysis (3DGA), provide insights into muscle and/or muscle-tendon unit (MTU) characteristics during gait. Despite their potential, a synthesis of their current use during 3DGA in populations with neuromotor impairments has not been conducted. This scoping review aimed to examine how MSK modeling and USI are used alongside 3DGA to assess muscle and MTU characteristics in populations with neuromotor impairments and evaluate the potential clinical implications of these approaches on clinical assessment and decision-making. Three databases were searched up to February 2025, yielding 50 studies (42 studies used MSK modeling, 5 used USI, and 3 employed both), including 4 pathological populations (cerebral palsy, stroke, hereditary spastic paraparesis, and idiopathic toe walking), and analyzing 11 lower-limb muscles. Both MSK modeling and USI have enabled the assessment of muscle or MTU length during gait, and detection of abnormal MTU. Only MSK modeling was used to assess MTU lengthening velocity, interventions effects, and predictors of surgical outcomes. MSK modeling appears limited by modeling assumptions and lack of real-time data, whereas USI faces constraints related to data acquisition complexity and processing challenges. This review enhances understanding of neuromuscular impairments and current uses of MSK modeling and USI in clinical populations. It highlights their complementary potential with 3DGA to support personalized clinical decision-making. Future work should include broader neuromotor conditions and explore automated data analysis (e.g., deep learning for USI) to improve clinical applicability.

Brain function is important for gait, and subtle gait disturbance may identify individuals at high risk of neurodegenerative disease. However, it has been difficult to isolate the neural contribution to gait. We aimed to investigate dual-task gait that places larger demands on neural resources, and compare it to single-task gait. We included 2222 participants of the community-based Rotterdam Study (median age 72 years, 55% women), who completed a single-task and a dual-task (serial 9 s) gait assessment on GAITRite®. First, we used principal component analysis to summarize gait variables into domains. To capture intra-individual changes with dual-task, we projected dual-task measurements onto the single-task principal component space and derived domain scores. We estimated the change between single-task and dual-task measurements by taking the residuals of a Deming regression of dual-task on single-task measurements, and related those to age and sex. Virtually all participants (99.9%) performed worse on dual-task compared to single-task walking, with most profound declines on temporal gait parameters and velocity. Decline in gait upon dual-task was observed from age 45-90 years, with somewhat larger absolute decline in younger than in older participants, and similar between women and men. The Deming regression residuals also indicated slightly better dual-task performance at older age than expected based on single-task performance. In this community-based sample, a cognitive challenge during walking caused decline on virtually all observed domains of gait, from mid-life to the oldest old, and most profound for temporal measures of the Rhythm domain and velocity.