Gait Analysis Research Articles

Use of Gait Profile Score and Gait Variable Score to quantify patient improvement immediately following neuro-orthopedic surgery in patients with cerebral palsy – A prospective cohort study

BackgroundThe Gait Profile Score (GPS) and the Gait Variable Score (GVS) are summary measures used to assess the long-term effects of neuro-orthopedic surgery (NOS) in children with cerebral palsy (cwCP). Research questionWhat are the immediate changes after NOS as assessed by GPS and GVS, and how does GPS variation (ΔGPS) compare to the clinical opinion of the NOS outcome? MethodsProspective single-arm cohort study. CwCP were assessed before NOS and after the first month of weight-bearing. Popliteal angle, ankle passive dorsiflexion (pDF), and spasticity were collected at the bedside. During walking, pain was assessed using NPRS, and speed was obtained from gait analysis data, as well as GPS and GVS. Longitudinal variations were analyzed using the Wilcoxon test. Children were classified as Improved (I), Stable (S), or Worsened (W) according to ΔGPS and the cut-off threshold recommended in literature. Two clinicians independently classified patients either as I, S, or W based on surgical outcome. Agreement between these two classifications was analyzed using Cohen’s k. ResultsTwenty cwCP, 11.4 (3.4) years, were included. At the follow-up: the popliteal angle was reduced by 20° (p=0.015); pDF increased by 10° (p<0.001), and triceps surae spasticity decreased (p=0.008). Pain decreased in four children. GPS decreased from 12.7 (range 8.1–27.7) to 11.8 (7.6–17.6) (ES=0.514, p=0.046), despite a decrease in gait speed (p<0.001). GVS better highlighted the effect of NOS after single-level surgery. Clinically, 18/1/1 children were classified I/S/W. Based on ΔGPS, 9/8/3 children were classified I/S/W. Such disagreement (k=0.119, p=0.227) was mainly due to the different focus of the two assessments. SignificanceFollowing NOS, immediate improvements in walking kinematics were observed.

High-fat diet-induced obesity exacerbated collagenase-induced tendon injury with upregulation of interleukin-1beta and matrix metalloproteinase-1

ABSTRACT Aims Obesity increases tendinopathy’s risk, but its mechanisms remain unclear. This study examined the effect of high-fat diet (HFD)-induced obesity on the outcomes and inflammation of collagenase-induced (CI) tendon injury. Methods Mice were fed with standard chow (SC) or HFD for 12 weeks. Bacterial collagenase I or saline was injected over the patellar tendons of each mouse. At weeks 2 and 8 post-injection, the patellar tendons were harvested for histology, immunohistochemical staining, and gait analysis. The difference (Δ) of limb-idleness index (LII) at the time of post-injury and pre-injury states was calculated. Biomechanical test of tendons was also performed at week 8 post-injection. Results HFD aggravated CI tendon injury with an increase in vascularity and cellularity compared to SC treatment. The histopathological score (week 2: p = 0.025; week 8: p = 0.013) and ΔLII (week 2: p = 0.012; week 8: p = 0.005) were significantly higher in the HFD group compared to those in the SC group after CI tendon injury. Stiffness (saline: p = 0.003; CI: p = 0.010), ultimate stress (saline: p < 0.001; CI: p = 0.006), and Young’s modulus (saline: p = 0.017; CI: p = 0.007) were significantly lower in the HFD group compared to the SC group at week 8 after saline or collagenase injection. HFD induced higher expression of IL-1β (week 2: p = 0.010; week 8: p = 0.025) and MMP-1 (week 2: p = 0.010; week 8: p = 0.004) compared to SC treatment after CI tendon injury at both time points. Conclusions HFD-induced obesity exacerbated histopathological, functional, and biomechanical changes in the CI tendon injury model, which was associated with an upregulation of IL-1β and MMP-1.

Surface Electromyography and Gait Features in Patients after Anterior Cruciate Ligament Reconstruction.

An important reason for the poor recovery of anterior cruciate ligament (ACL) injuries is the poor recovery of muscle function. Therefore, we used surface electromyography (sEMG) and gait analysis to explore the muscle activation patterns and gait characteristics between lower limbs under different exercise states in patients, following anterior cruciate ligament reconstruction (ACLR). Forty-one adults with unilateral ACL injuries in Binzhou Medical University Hospital from October 2022 to June 2023 were allocated to three groups according to the time after ACL reconstruction: group A (≤3 months, 16), group B (3 months-1 year, 13), and group C (>1 year, 12). Patients were tested by sEMG and gait, while straight leg raising (SLR), walking at normal speed, fast walking, and walking up and down the stairs. Two related sample tests were performed for the normalized root mean square (RMS) values and gait parameters. Muscle function changes varied in different training tasks. The RMS value of the involved side was more than the uninvolved side in biceps femoris and semitendinosus of group A (p < 0.010), and for the bilateral rectus femoris (RS), vastus medialis (VM), and vastus lateralis in group B, only the comparison of the RS was significant in group C during fast walking and going up and down the stairs. The ground impact (0.90 [0.63, 1.33] vs. 0.71 [0.43, 1.02], p = 0.035) of the uninvolved side was significantly decreased compared to those of the involved side in patients with ACLR when going down the stairs. Different muscles need to be focused on at different stages of the postoperative period. sEMG and gait analysis can guide the development of a rehabilitation program.

Multibody dynamics-based musculoskeletal modeling for gait analysis: a systematic review.

Beyond qualitative assessment, gait analysis involves the quantitative evaluation of various parameters such as joint kinematics, spatiotemporal metrics, external forces, and muscle activation patterns and forces. Utilizing multibody dynamics-based musculoskeletal (MSK) modeling provides a time and cost-effective non-invasive tool for the prediction of internal joint and muscle forces. Recent advancements in the development of biofidelic MSK models have facilitated their integration into clinical decision-making processes, including quantitative diagnostics, functional assessment of prosthesis and implants, and devising data-driven gait rehabilitation protocols. Through an extensive search and meta-analysis of over 116 studies, this PRISMA-based systematic review provides a comprehensive overview of different existing multibody MSK modeling platforms, including generic templates, methods for personalization to individual subjects, and the solutions used to address statically indeterminate problems. Additionally, it summarizes post-processing techniques and the practical applications of MSK modeling tools. In the field of biomechanics, MSK modeling provides an indispensable tool for simulating and understanding human movement dynamics. However, limitations which remain elusive include the absence of MSK modeling templates based on female anatomy underscores the need for further advancements in this area.

Quantifying Asymmetric Gait Pattern Changes Using a Hidden Markov Model Similarity Measure (HMM-SM) on Inertial Sensor Signals.

Wearable gait analysis systems using inertial sensors offer the potential for easy-to-use gait assessment in lab and free-living environments. This can enable objective long-term monitoring and decision making for individuals with gait disabilities. This study explores a novel approach that applies a hidden Markov model-based similarity measure (HMM-SM) to assess changes in gait patterns based on the gyroscope and accelerometer signals from just one or two inertial sensors. Eleven able-bodied individuals were equipped with a system which perturbed gait patterns by manipulating stance-time symmetry. Inertial sensor data were collected from various locations on the lower body to train hidden Markov models. The HMM-SM was evaluated to determine whether it corresponded to changes in gait as individuals deviated from their baseline, and whether it could provide a reliable measure of gait similarity. The HMM-SM showed consistent changes in accordance with stance-time symmetry in the following sensor configurations: pelvis, combined upper leg signals, and combined lower leg signals. Additionally, the HMM-SM demonstrated good reliability for the combined upper leg signals (ICC = 0.803) and lower leg signals (ICC = 0.795). These findings provide preliminary evidence that the HMM-SM could be useful in assessing changes in overall gait patterns. This could enable the development of compact, wearable systems for unsupervised gait assessment, without the requirement to pre-identify and measure a set of gait parameters.

Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study.

Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). The participants' mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level.

Comparative biomechanical analysis of a conventional/novel hip prosthetic socket.

The aim of this study was to investigate and compare the biomechanical properties of the conventional and novel hip prosthetic socket by using the finite element and gait analysis. According to the CT scan model of the subject's residual limb, the bones, soft tissues, and the socket model were reconstructed in three dimensions by using inverse modeling. The distribution of normal and shear stresses at the residual limb-socket interface under the standing condition was investigated using the finite element method and verified by designing a pressure acquisition module system. The gait experiment compared and analyzed the conventional and novel sockets. The results show that the simulation results are consistent with the experimental data. The novel socket exhibited superior stress performance and gait outcomes compared to the conventional design. Our findings provide a research basis for evaluating the comfort of the hip prosthetic socket, optimizing and designing the structure of the socket of the hip.

Analysis of Spatiotemporal Gait Variables before and after Unilateral Total Knee Arthroplasty

This study aimed (a) to evaluate the spatiotemporal gait variables of total knee arthroplasty (TKA) before (pre-) and after the procedure (post-), and (b) to investigate the influence of the surgical side on these variables. Twenty-one volunteers (13 females and 8 males) participated, undergoing assessments pre-surgery and nine to 12 months post-surgery. Clinical tests indicated significant reductions in knee pain and improvements in active and passive extension post-surgery. TKA resulted in decreased pain, extension deficits, and functional assessments, with lower scores on the WOMAC questionnaire. A gait analysis showed post-surgery improvements in gait speed (5.8%), cycle time (−4.8%), step time (4.4%), double limb support time (−11.1%), step (4.4%) and stride (6.3%) lengths, and step (5.1%) and stride (5.0%) cadences. Comparisons between surgical side and limb dominance indicated significant differences in gait speed, stance, swing and step times, double limb support time, step and stride lengths, and step cadence. The non-dominant limb demonstrated greater improvements across most parameters compared to the dominant limb. These findings emphasize the importance of considering the limb dominance of patients with knee osteoarthritis when evaluating post-TKA function. These conclusions can be helpful for personalized rehabilitation programs, allowing tailored interventions for individuals undergoing knee surgery.

Intra- and interlimb effects of gait retraining in individuals with knee hyperextension

BackgroundGait retraining, which typically focuses on the most severely affected limb or joint, has shown promising results in treating faulty running and walking patterns. The closed-chain nature of gait during the stance phase may influence kinematic changes in the adjacent joints of the trained leg. In addition, the coupled nature of the lower extremity motion of gait suggests that changes in one leg may transfer to the other. This study aimed to assess the intra- and inter-limb transfer of kinematic changes following gait retraining to reduce knee extension in individuals with hyperextension walking patterns. MethodsSeventeen women with knee hyperextension gait patterns participated in six treadmill retraining sessions. All participants received verbal and real-time visual kinematic feedback in the form of knowledge of results. This intervention study took place at the Gait Analysis Laboratory at the University of Iowa. Mean peak sagittal-plane lower extremity joint kinematics during overground walking at pretraining, post-training, and 1- and 8-month follow-ups were calculated for analysis and comparisons. FindingsThe post-training changes in ankle range of motion returned to baseline values by the 8-month follow-up. There was a significant transfer effect of kinematic changes to the untrained knee following gait retraining. InterpretationTraining one knee did not result in long-term compensatory kinematic changes in the other joints. In addition, the improvements in knee extension range of motion were transferred to the untrained knee and retained at the 8-month follow-up. This study supports the use of gait retraining as an effective clinical intervention.

Arthroscopic removal of the fragmented medial coronoid process in dogs - Evaluation of treatment results with special reference to postoperative computed tomography and residual particles

The aim of this study was to assess the treatment success of dogs with medial coronoid disease (here: Fragmented Coronoid Process [FCP]) following arthroscopically performed subtotal coronoidectomy by the use of subjective and objective gait analysis and the evaluation of osteoarthritis progression in addition to their correlation with the findings from postoperative computed tomography. In particular, the clinical relevance of residual particles remaining postoperatively was to be evaluated. Thirty elbows from 24 dogs of different breeds were examined clinically, orthopedically, using gait analysis as well as radiographically at least 6 months after unilateral or bilateral subtotal coronoidectomy. The results were compared with the preoperative findings of the corresponding examinations and postoperative computed tomography. 79.2% (19/24) of the patients improved by at least one degree of lameness in the orthopedic examination, 66.7% (16/24) were free of lameness. 60% (18/30 joints) showed an increase in the degree of arthrosis. Postoperative computed tomography revealed small residual bone particles (<1 mm) in the joint space or soft tissue in 56.7% (17/30) of the joints. No significant association was evident between residual lameness and residual particles remaining within the joint postoperatively. An association between persistent lameness and progression of arthrosis was also not be demonstrable. No evidence was apparent supporting a link between residues of small bone particles after arthroscopic subtotal coronoidectomy and postoperative lameness. The progression of osteoarthritis could not be interrupted despite the surgical intervention. When small residual particles (<1 mm) remain after subtotal coronoidectomy, these do not appear to have any influence on the clinical outcome.

Radiographic Measurements of the Hip Joint in Capuchin Monkeys (Sapajus spp.).

Radiographs are useful for the initial evaluation of the hip joints. The information can be utilized for the betterment of animal health or other goals such as anatomic studies and gait analysis, among others. Therefore, this study aimed to evaluate radiographic measurements of the hip joint in capuchin monkeys, kept under human care at a reference center for wildlife. Twelve capuchin monkeys (Sapajus spp.) (three adult males, seven adult females, and two sub-adult females) were evaluated. Ventrodorsal radiographic views were taken under chemical restraint. All measurements on the digital images were performed in triplicate by one examiner. None of the measurements evaluated were statistically different between males and females. No statistical differences were found between hind limbs. The mean (±SD) Norberg angle was 104.92° (±2.82°) and the Wiberg angle was 15.26° (±1.86°). The percentage of the femoral head covered by the acetabulum was 68.57% (±3.65%) and the acetabular index depth to width ratio was 54.66% (±3.85%). In conclusion, the radiographic measurements showed certain morphological features of the hip joint in Sapajus spp. that contribute to improving species knowledge.

370P Gait analysis in children with Duchenne muscular dystrophy: overground vs. treadmill walking

370P Gait analysis in children with Duchenne muscular dystrophy: overground vs. treadmill walking

Influence of Walking Modification Strategies on Frontal Plane Hip Joint Moment and Gait Naturalness in Healthy Adults

OBJECTIVE: To evaluate the effects of lateral trunk lean and step width modification on hip adduction moment in healthy participants and examine their influence on walking naturalness. METHODS: Ten healthy participants underwent gait analysis under 4 walking conditions: natural walking, large trunk lean, doubled step width, and combined modification with slight trunk lean and 1.5 times step width. Early stance and late stance hip adduction moment were analyzed and compared using repeated-measures analysis of variance. Subjective naturalness of gait was also recorded. RESULTS: We observed a significant effect of walking condition on the hip adduction moment during early stance (F3,36 = 6.665, P = .001) and gait naturalness (F3,36 = 30.519, P&lt;.001), but not hip adduction moment during late stance ( P = .733). Pairwise comparison indicated significantly reduced hip adduction moment during early stance with large trunk lean when compared to natural walking (36.7% less, P = .002, Cohen’s d = −1.41). Both combined and doubled step width modifications did not yield the expected hip adduction moment reduction ( P&gt;.296). The perceived naturalness of the doubled step width modification was most comparable to natural walking ( P = .529), while the trunk lean modification was significantly less natural than natural walking and the least natural modification overall (81.1% less, P&lt;.001, Cohen’s d = −4.34). CONCLUSION: Although trunk lean modification effectively reduces hip joint loading, it is perceived as the least natural pattern. Step width was more challenging to modify than trunk lean. JOSPT Open 2024;2(4):306-314. Epub 7 August 2024. doi:10.2519/josptopen.2024.0463

Remote Gait Analysis Using Ultra-Wideband Radar Technology Based on Joint Range-Doppler-Time Representation.

In recent years, radar technology has been extensively utilized in contactless human behavior monitoring systems. The unique capabilities of ultra-wideband (UWB) radars compared to conventional radar technologies, due to time-of-flight measurements, present new untapped opportunities for in-depth monitoring of human movement during overground locomotion. This study aims to investigate the deployability of UWB radars in accurately capturing the gait patterns of healthy individuals with no known walking impairments. A novel algorithm was developed that can extract ten clinical spatiotemporal gait features using the Doppler information captured from three monostatic UWB radar sensors during a 6-meter walking task. Key gait events are detected from lower-extremity movements based on the joint range-Doppler-time representation of recorded radar data. The estimated gait parameters were validated against a gold-standard optical motion tracking system using 12 healthy volunteers. On average, nine gait parameters can be consistently estimated with 90-98% accuracy, while capturing 94.5% of participants' gait variability and 90.8% of inter-limb symmetry. Correlation and Bland-Altman analysis revealed a strong correlation between radar-based parameters and the ground-truth values, with average discrepancies consistently close to 0. Results prove that radar sensing can provide accurate biomarkers to supplement clinical human gait analysis, with quality similar to gold standard assessment. Radars can potentially allow a transition from expensive and cumbersome lab-based gait analysis tools toward a completely unobtrusive and affordable solution for in-home deployment, enabling continuous long-term monitoring of individuals for research and healthcare applications.

Outcome measures and their importance for effective equine back pain rehabilitation

Effective rehabilitation for equine back pain is required due to the frequency of dysfunction effecting performance and welfare. Reliable and valid measures should be used establish a baseline in pain and dysfunction levels, and used to monitor change during rehabilitation, as well as support future research assessing the efficacy of treatment interventions. Such measures are collectively known as outcome measures and can include specific objective markers of impairments such as reduced range of motion, or pain on palpation. The aim of this narrative review is to discuss the options and tools available to use as outcome measures in relation to the treatment and rehabilitation of back pain in the horse. In this paper outcome measures critically discussed relate to conformation and standing posture, muscle dimensions, palpation, range of motion, objective gait analysis, functional analysis, owner reported outcome measures and pain scales. Recommendations are made to assist with selection of a suitable outcome measure. In conclusion, complex laboratory-based analysis systems are available to be gold-standard truly objective systems, although realism for clinical practitioners working in the field limits their use. There is a requirement for new outcome measures that are not subject to observer bias nor time or financially consuming, however it is possible to use those available currently with assist in clinical decision making for the benefit of the horse.

Machine learning applied to gait analysis data in cerebral palsy and stroke: a systematic review

Machine learning applied to gait analysis data in cerebral palsy and stroke: a systematic review

Assessing PET composite prosthetic solutions: A step towards inclusive healthcare

The demand for affordable prostheses is particularly high in Low Middle-Income Countries (LMICs). Currently, sockets are predominantly manufactured using monolithic thermoplastic polymers, which lack durability and strength, or consumptive thermoset resin reinforcing with expensive composite fillers like carbon, glass, or Kevlar fibers. However, there exist unmet and demanding needs among amputees for procuring low-cost, high-strength, and faster socket manufacturing methods. We evaluate a socket made from a novel manufacturing technique utilizing an affordable and sustainable composite material called commingled PET (polyethylene terephthalate) yarn, along with a reusable vacuum bag, to produce custom-made sockets in a purpose-built curing oven. Our innovative fabrication methodology enables the production of complex-shaped patient sockets in under 4 h. To evaluate the efficacy and performance of the PET sockets, we conducted trials with both unilateral and bilateral amputees over a six-month period, in collaboration with Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) in India. Utilizing a 6-min walking test, we measured various gait parameters, including ground reaction forces and flexion angle, for both unilateral and bilateral amputees.The gait analysis conducted on amputees using our PET-based sockets demonstrated their ability to engage in daily activities without interruptions, reaffirming the functional efficacy of our approach. By combining self-reinforced PET with our novel fabrication technique, we offer a unique and accessible solution that benefits clinicians and patients alike. This study represents significant progress towards achieving affordable and personalized prostheses that cater to the needs of LMICs.

456P Gait analysis by IMU sensor in myotonic dystrophy type 1

456P Gait analysis by IMU sensor in myotonic dystrophy type 1

A clinical application of gait quality patterns in osteoarthritis

AimTo investigate whether a smartphone-based gait analysis tool can reliably output gait quality parameters that can be cross-analyzed to establish individual & disease-based changes in gait quality patterns. MethodsA cross-sectional study made up of a 48-patients undergoing disability certification at the “Dr. José Castro Villagrana” or the “Dr. David Fragoso Lizalde” Health Centers in Mexico City, Mexico. Their sensorimotor performance was evaluated through an in-house smartphone/IMU based digital tool. Gait was analyzed by means of frequency analysis of the acceleration of the body mass measured at the sternum. A composite gait quality score was determined through principal component analysis based primarily on the explainability and uniformity of gait. Quality independence against demographic variables (age & weight) was tested through ANCOVA. The association between gait quality and gait parameters was analyzed by using multiple linear regression. ResultsA multiple regression model developed with a limited set of gait quality parameters successfully predicted gait smoothness with a 97.05 % accuracy with a mean square error of 0.085 between predicted and actual quality scores. The model demonstrates different predictive capacities across disease groups, with Osteoarthrosis + Osteoporosis having the highest R2 at 0.98 (p < 0.001) and Coxarthrosis having the lowest explained R2 at 0.79 (p < 0.001). ConclusionsThe assessment of gait quality, in family medicine, with low-cost digital tools is an area of opportunity yet to be explored. This tool can potentially disrupt the current disability workflow between primary and specialty care to have an objective method of assessing gait within a clinical consult. Individual patient-level benchmarking can give us insights into the patient's disease status, develop practical intervention strategies, and control the cost and quality of medical care by predicting an individualized course of disability or rehabilitation. Further studies are needed to validate digital gait assessments as clinical decision support tools for day-to-day clinical operations. MeSHGait Analysis, Smartphone, Primary Health Care, Osteoarthrosis

Analysis of the interplay between proximal lower limb and foot joint structures as a mechanical predictor of neuropathic ulceration

BackgroundDiabetes-related foot ulcers are a leading cause of morbidity and mortality globally, in which the most significant contributing factor is peripheral neuropathy. The purpose of this research was to evaluate the influence of diabetic peripheral neuropathy and ulceration on lower limb and foot joint kinematics during gait. Research questionAre there any significant alterations lower limb and foot joint kinematics during gait in the presence of active and history of diabetic neuropathic ulceration? MethodsA prospective, cross-sectional study was conducted, recruiting eighty adult participants who were equally divided into four groups, namely, the diabetes (DM), diabetic peripheral neuropathy (DPN), active diabetic neuropathic ulceration (DNU) and history of diabetic neuropathic ulceration (DHNU) groups. Three-dimensional gait analysis was performed, and participants were instructed to walk barefoot over a 10-m walkway at self-selected speed. The acquired pelvic, hip, knee, ankle and foot joint segmental kinematic data was compared between individuals with and without active neuropathic ulceration. ResultsMean scores between the four independent groups was performed using the Kruskal-Wallis test. Participants within the DNU and DHNU groups demonstrated significantly reduced knee flexion, ankle dorsiflexion and first metatarsal dorsiflexion kinematics with resultant increased anterior pelvic tilt, hip flexion and midtarsal kinematics (all values p<0.01) when compared to participants within the DM and DPN groups. SignificanceThrough the integration of a more individualised, biomechanical approach, the findings in this study may provide improved preventative and management strategies of ulceration amongst the diabetic population.