Entire Stance Phase Research Articles

Does chronic ankle instability affect side-cutting in female soccer players?

Lateral ankle sprains have a high recurrence rate, often developing into chronic ankle instability (CAI). CAI affects movement strategy during side-cutting maneuvers, with inconsistent results in many studies. This study aimed to clarify the characteristics of movement strategies during side-cutting maneuvers in female soccer players with and without CAI. Thirteen female soccer players with CAI and twelve healthy controls performed 10 successful trials of side-cutting maneuvers in three directions (anterolateral, lateral, and posterolateral) under unanticipated conditions. Compared to the control group, the CAI group displayed an increased stance time in the lateral and posterolateral side-cutting maneuvers (lateral: p = .021, effect size = 0.97, posterolateral: p = .014, effect size = 1.00). In posterolateral side-cutting maneuvers, the CAI group displayed a decreased posterior ground reaction force at 19-30 % and 42-54 % of the entire stance phase compared with the control group (p = .001, effect size = 1.30-1.42). Female soccer players with CAI may display increased stance time to compensate for self-reported ankle instability and may also exhibit decreased braking and propulsive force when side-cutting to sharper angles. These observations suggest a hypothesis that could help in the assessment of cutting maneuvers under unanticipated conditions after ankle sprains.

Residual Performance and Biomechanical Asymmetries During Jumping Tasks in Female Athletes at 9 Months After Anterior Cruciate Ligament Reconstruction.

Biomechanics and anterior cruciate ligament injury mechanisms differ in males and females. There is a need for more data on between-limb biomechanical differences after anterior cruciate ligament reconstruction (ACLR) in females. To explore biomechanical asymmetries throughout the kinetic chain during the single-legged (SL) and double-legged (DL) countermovement jump (CMJ) and drop jump (DJ) in female athletes after ACLR. Descriptive laboratory study. Kinematic and kinetic between-limb differences were analyzed during the SL and DL CMJ and DJ in 67 female athletes 9 months after ACLR. Biomechanical and performance asymmetries between limbs during the jumps and isokinetic strength testing were analyzed with statistical parametric mapping. The entire stance phase was used for the paired t tests of the biomechanical variables, with Cohen d effect sizes of significant portions of the stance phase (reported as % of stance) calculated in a point-by-point manner. Decreased vertical ground-reaction force, internal knee abduction moment, knee internal rotation angle, hip external rotation angle, internal ankle eversion, and external rotation moments were seen in the ACLR limb during all 4 vertical jump tests. The greatest number and highest value of differences were found during the DLDJ, with asymmetries having medium to large effect sizes. They tended to appear more frequently in the concentric phase (50% to 100% of stance) during the SLCMJ and DLCMJ and in the eccentric (0% to 49% of stance) and concentric (50% to 100% of stance) phase during the SLDJ and DLDJ. For the SLCMJ, SLDJ, and quadriceps strength, performance asymmetries of >15% were detected but not for change of direction. The findings suggest that return-to-play testing in female athletes should examine the entire stance phase and include assessments of kinetic and kinematic variables throughout the kinetic chain. Greater deficits were highlighted in the DJ than in the CMJ, and greater performance asymmetries were evident in the SL tasks, with greater kinetic and kinematic and compensatory strategies evident in the DL tests. Biomechanical analysis focusing on contralateral compensation strategies and sex-specific interventions are necessary before return to play.

Effects of overweight and obesity on lower limb walking characteristics from joint kinematics to muscle activations

BackgroundObesity is a crucial factor that increases the risk of initiating and advancing knee osteoarthritis. However, it remains unclear how obesity directly impacts the biomechanical experience of the lower limb joints, potentially triggering or exacerbating joint degeneration. This study investigated the interactive effects of BMI augmentation on lower limb kinematics, kinetics, and muscle activations during walking. MethodologyA group of 60 participants underwent a three-dimensional gait analysis. These individuals were categorized into three groups based on their body mass index (BMI): those with a BMI below 25 were classified as having a healthy weight, those with a BMI between 25 and 30 were categorized as overweight, and those with a BMI exceeding 30 were considered obese. This study analyzed the gait of 60 participants categorized by BMI. During walking trials, they recorded ground reaction forces electromyography of leg muscles like the gastrocnemii, hamstrings, and quadriceps. Lower limb joint angles and net moments were also calculated. Statistical mapping identified variations in kinematic, kinetic, and muscle activation patterns across the stance phase between BMI groups. ResultsThe results displayed distinct biomechanical patterns in obese individuals. Notably, there was a significant increase in flexion observed in the hip and knee joints (P < 0.001) during the initial stance phase and an increase in hip and knee adduction angles and moments throughout the entire stance phase (P < 0.001). Additionally, muscle activations underwent significant changes (P < 0.01), with a positive correlation noted with the BMI factor. This correlation was most pronounced during the early stance phase for the quadriceps and hamstring muscles and the late stance phase for the gastrocnemius. ConclusionThese findings represent a comprehensive picture that contributes to understanding how excess weight and obesity influence joint biomechanics, highlighting the associated risk of joint osteoarthritis.

Plantar Flexor Muscle Activity and Fascicle Behavior in Gastrocnemius Medialis During Running in Highly Cushioned Shoes With Carbon-Fiber Plates.

The purposes of this study were to clarify the electromyography (EMG) of plantar flexors and to analyze the fascicle and tendon behaviors of the gastrocnemius medialis (GM) during running in the carbon-fiber plate embedded in thicker midsole racing shoes, such as the Nike ZoomX Vaporfly (VF) and traditional racing shoes (TRAD). We compared the fascicle and series elastic element behavior of the GM and EMG of the lower limb muscles during running (14km/h, 45s) in athletes wearing VF or TRAD. GM EMGs in the push-off phase were approximately 50% lower in athletes wearing VF than in TRAD. Although the series elastic element behavior and/or mean fascicle-shortening velocity during the entire stance phase were not significantly different between VF and TRAD, a significant difference was found in both the mean EMG and integral EMG of the GM during the push-off phase. EMG of the gastrocnemius lateralis (GL) during the first half of the push-off phase was significantly different between VF and TRAD. Present results suggest that VF facilitates running propulsion, resulting in a decrease in GM and GL EMGs at a given running velocity during the push-off phase, leading to a reduction in metabolic cost.

Neuromuscular and trunk control mediate factors associated with injury in fatigued runners

This study aimed to determine how fatigue affects factors associated with injury, neuromuscular activity, and control in recreational runners. Previously identified injury risk factors were defined as peak vertical instantaneous loading rates (pVILR) for tibial stress fracture (TSF) and peak hip adduction (pHADD) for patellofemoral pain syndrome and iliotibial band syndrome. Kinematics, kinetics, and electromyography data were collected from 11 recreational runners throughout a fatiguing run. Three trials were collected in the first and final minutes of the run. Coactivation was quantified about the knee and ankle for the entire stance phase and anticipatory, weight acceptance (WA), and propulsion sub-phases of stance. Trunk control was quantified by the peak mediolateral lean, peak forward lean, and flexion range of motion (ROM). There were significant increases in pHADD and pVILR when fatigued. Significant decreases in coactivation around the knee were found over the entire stance phase, in the anticipatory phase, and WA phase. Coactivation decreased about the ankle during WA. Lateral trunk lean significantly increased when fatigued, but no significant changes were found in flexion ROM or lean. Mediation analyses showed changes in ankle coactivation during WA, and lateral trunk lean are significant influences on pVILR, a measure associated with TSF. Fatigue-induced adaptations of decreasing ankle coactivation during WA and increased lateral trunk lean may increase the likelihood of TSF. In this study, a fatiguing run influenced changes in control in recreational runners. Further investigation of causal fatigue-induced injuries is necessary to better understand the effects of coactivation and trunk control.

Advancing our ability to quantify an individual’s habitual motion path and deviation when running

The habitual motion path theory states that exhibiting kinematic differences between running and habitual movement tasks may increase the risk of running-related injury. Staying near one’s habitual motion path when running has been shown to reduce compression of the knee joint cartilage, a proxy for decreased soft tissue loading. Previous efforts to quantify one’s habitual motion path and deviation when running have utilised just one habitual movement and one time point during the stance phase of running. The methodology advancement described in this manuscript focused on advancing habitual motion path theory research by (1) increasing the number of movements for quantifying an individual’s habitual motion path; and (2) utilising the entire stance phase when running to quantify deviations as opposed to one time point. We liken the advancements in the method described in this manuscript as with the first method we were using a ruler to assess one’s habitual motion path and deviations, and now we are using calipers; providing a more accurate understanding of an individual’s unique habitual movement and deviation when running. We also discuss future potential research avenues related to understanding running biomechanics and footwear effects that this tool will allow us to explore.

Mechanics of the foot and ankle joints during running using a multi-segment foot model compared with a single-segment model.

The primary purpose of this study was to compare the ankle joint mechanics, during the stance phase of running, computed with a multi-segment foot model (MULTI; three segments) with a traditional single segment foot model (SINGLE). Traditional ankle joint models define all bones between the ankle and metatarsophalangeal joints as a single rigid segment (SINGLE). However, this contrasts with the more complex structure and mobility of the human foot, recent studies of walking using more multiple-segment models of the human foot have highlighted the errors arising in ankle kinematics and kinetics by using an oversimplified model of the foot. This study sought to compare whether ankle joint kinematics and kinetics during running are similar when using a single segment foot model (SINGLE) and a multi-segment foot model (MULTI). Seven participants ran at 3.1 m/s while the positions of markers on the shank and foot were tracked and ground reaction forces were measured. Ankle joint kinematics, resultant joint moments, joint work, and instantaneous joint power were determined using both the SINGLE and MULTI models. Differences between the two models across the entire stance phase were tested using statistical parametric mapping. During the stance phase, MULTI produced ankle joint angles that were typically closer to neutral and angular velocities that were reduced compared with SINGLE. Instantaneous joint power (p<0.001) and joint work (p<0.001) during late stance were also reduced in MULTI compared with SINGLE demonstrating the importance of foot model topology in analyses of the ankle joint during running. This study has highlighted that considering the foot as a rigid segment from ankle to MTP joint produces poor estimates of the ankle joint kinematics and kinetics, which has important implications for understanding the role of the ankle joint in running.

The topographical attenuation of cutaneous input is modulated at the ankle joint during gait.

The attenuation of sensory inputs via various methods has been demonstrated to impair balance control and alter locomotor behavior during human walking; however, the effects of attenuating foot sole sensation under distinct areas of the foot sole on lower extremity motor output remains poorly understood. Thus, the purpose of this study was to attenuate cutaneous feedback via regional hypothermia under five different areas of the foot sole and investigate the resultant modulation of kinematic and muscle activity during level walking. Electromyography from eight lower leg muscles, kinematics, and location of center of pressure was recorded from 48 healthy young adults completing walking trials with normal and reduced cutaneous sensation from bilateral foot soles. The results of this study highlight the modulatory response of the tibialis anterior in terminal stance (propulsion and toe-off) and medial gastrocnemius muscle throughout the entire stance phase of gait. The topographical organization of foot sole skin in response to the attenuation of cutaneous feedback from different areas of the foot sole significantly modified locomotor activity. Furthermore, the locomotor response to cutaneous attenuation under the same regions that we previously facilitated with tactile feedback do not oppose each other, suggesting different physiological changes to foot sole skin generate unique gait behaviors.

Comparison of discrete and continuous analysis approaches for evaluating gait biomechanics in individuals with anterior cruciate ligament reconstruction

BackgroundAberrant gait biomechanics contribute to post-traumatic knee osteoarthritis development following anterior cruciate ligament reconstruction (ACLR). Walking gait biomechanics are typically evaluated post-ACLR by identifying discrete, peak values in the load acceptance phase of gait (i.e. first 50 %). As these approaches evaluate a single time instant during the gait cycle, functional data analysis (FDA) techniques that evaluate the entire stance phase waveform are becoming more common in the literature. However, it is unclear if these analysis approaches identify the same biomechanical phenomena. Research questionThe purpose of this study was to determine whether four gait biomechanics analysis approaches identify the same aberrant gait characteristics in individuals with ACLR. MethodsTwenty-four individuals with ACLR and 24 healthy controls completed gait analyses on an instrumented treadmill. Four analysis approaches were employed to compare the vertical ground reaction force and sagittal knee angles and moments during the first 50 % of the stance phase between groups and between limbs in the ACLR cohort: 1) comparison of peak values from individual trials (Peak), 2) comparison of peak values from time-normalized ensemble waveforms (Ensemble Peak), 3) FDA via functional ANCOVA (FANCOVA), and 4) FDA evaluating overlap of the 95 % confidence intervals for each waveform (FDA-CI). ResultsThe Peak, Ensemble Peak, and FANCOVA approaches identified highly similar group and limb differences in the biomechanics outcomes with respect to both magnitude and temporal location. However, the FANCOVA approach indicated that these differences were distributed across large portions of the load acceptance phase and that differences existed outside the first 50 % of stance. The FDA-CI approach was generally not effective for identifying aberrant gait biomechanics. SignificancePeak and FANCOVA approaches to gait analysis provide similar findings. Future research is necessary to determine if the additional information afforded by FANCOVA provides insight regarding the mechanical pathogenesis of post-traumatic knee osteoarthritis.

Effects Of Low-Dye Taping On Plantar Fascia Strain And Kinematics In Individuals With Plantar Fasciitis

Plantar fasciitis is thought to be caused by excessive strain of the plantar fascia, which may occur due to altered foot kinematics displayed by individuals with plantar fasciitis. The low-Dye taping method has been found to be effective at reducing pain and increasing function in individuals with plantar fasciitis, although the exact mechanisms for these changes are unclear. PURPOSE: To determine the effects of low-Dye taping on plantar fascia strain and foot kinematics in individuals with plantar fasciitis. METHODS: Fifteen adults with plantar fasciitis completed the repeated measures study. Each participant walked barefoot at a self-selected speed while untaped and while their pathological foot was taped with the low-Dye taping method. A six-segment musculoskeletal model of the foot was used to provide estimates of plantar fascia and other foot ligament strains. Statistical Parametric Mapping (SPM) was used to compare plantar fascia strain, and post hoc SPM analyses of several foot joint kinematics were conducted to explain the differences in plantar fascia strain. Finally, strains of several foot ligaments were investigated using SPM procedures. RESULTS: Significantly greater plantar fascia strain was found during the untaped condition between 67-79% of stance phase (p = 0.001), which does not include the time in which peak strain occurred. The low-Dye taping method also reduced dorsiflexion of the talonavicular joint from 52-86% of stance phase (p < 0.001), which represents a reduction in arch collapse. In addition, significant strain reductions in the taped condition were noted in the superior and inferior slips of the spring ligament from 14-87% (p < 0.001) and 16-87% (p < 0.001) of stance phase, respectively, as well as in the 2nd, 3rd, and 4th slips of the long plantar ligament from 56-86% (p < 0.001), 59-86% (p < 0.001), and 68-81% (p < 0.001) of stance phase, respectively. CONCLUSIONS: Our findings suggest that if low-Dye taping is effective for individuals with plantar fasciitis, it is not by reducing peak plantar fascia strain, but instead by reducing cumulative strain across the entire stance phase. This reduction in strain during stance phase occurs due to the reduction in arch collapse. Furthermore, several other ligaments are significantly affected by the low-Dye taping method.

Achilles tendon mechanical properties during walking and running are underestimated when its curvature is not accounted for

Achilles tendon (AT) mechanical properties can be estimated using an inverse dynamic approach, taking into account the tendon internal moment arm (IMA) and its kinematic behavior. Although AT presents a curvilinear line of action, a straight-line function to estimate IMA and AT length is often utilized in the literature. In this study, we combined kinetic, kinematic and ultrasound data to understand the impact of two different approaches (straight-line vs. curvilinear) in determining AT mechanical properties in vivo (during walking and running at the self-selected speed). AT force and power were calculated based on data of AT IMA and AT length derived by both respective methods. All investigated parameters were significantly affected by the method utilized (paired t-test; p < 0.05): when using the curvilinear method IMA was about 5% lower and AT length about 1.2% higher, whereas peak and mean values of AT force and power were 5% higher when compared to the straight-line method (both in walking and running). Statistic-parametric mapping (SMP) analysis revealed significant differences in IMA during the early and the late stance phase of walking and during the late stance phase of running (p < 0.01); SPM revealed significant differences also in AT length during the entire stance phase in both locomotion modes (p < 0.01). These results confirm and extend previous findings to human locomotion: neglecting the AT curvature might be a source of error, resulting in underestimates not only of internal moment arm and tendon length, but also of tendon force and power.

Discriminating features of ground reaction forces in overweight old and young adults during walking using functional principal component analysis

BackgroundLimited attention has been paid to age- or body size-related changes in the ground reaction forces (GRF) during walking despite their strong associations with lower limb injuries and pathology. Research questionDo the features of GRF during walking associate with age or body size? MethodsFifty-four participants were subdivided into four groups according to their age and body size: overweight old (n = 12), non-overweight old (n = 13), overweight young (n = 13), and non-overweight young (n = 16). Participants were asked to walk at their self-selected speeds on level ground with force plates embedded in the center of walkway. Functional principal component analysis (FPCA) was performed to extract major modes of variation and functional principal component scores (FPCs) in three-dimensional GRFs. Analysis of variance models were employed to investigate the effect of age, body size, or their interactions on the FPCs of each component of the GRF, with the adjustment to gait speed. ResultsSignificant age and body size effects were observed in FPC1 across all three-dimensional GRF. Both overweight and older groups showed greater braking force after heel-strike and greater propulsive forces during pre-swing when compared to the non-overweight and younger groups, respectively. The overweight old group displayed greater medial forces during mid-stance and the overweight young group showed prominently larger medial forces during pre-swing, while non-overweight old showed a tendency of flatter medial-lateral GRF waveforms during the entire stance phase. FPC2 revealed that only body size had an effect on three-dimensional GRF with the highest FPC2 scores in the overweight old group. SignificanceThree-dimensional GRF during walking could be altered by the body size and age, which were more pronounced in the overweight and older group. The more dynamic GRF pattern with greater and/or lower peaks could be contributing factors to the increased joint load and injury rates observed in overweight aged individuals.

Acute Effects of Heel-to-Toe Drop and Speed on Running Biomechanics and Strike Pattern in Male Recreational Runners: Application of Statistical Nonparametric Mapping in Lower Limb Biomechanics.

With the increased popularity of running, many studies have been conducted into footwears that are highly related to running performance and running-related injuries. Previous studies investigated different shoe types and running shoes with different heel-to-toe drops (HTDs). However, no research was found in investigating shoes with negative values with HTD. Therefore, the aim of this study was to determine the acute effect of HTD and running speed on lower limb biomechanics and strike pattern in recreational runners. Thirteen male recreational runners wearing shoes with two different HTDs (−8 and 8 mm) performed running at three different speeds (preferred speed [PS], 90% of PS, 110% of PS). Lower extremity kinematics and ground reaction forces were synchronously captured via Vicon motion analysis system and AMTI force platform. Strike index (SI), vertical average loading rate (VALR), vertical instantaneous loading rate (VILR), excursion, eversion duration, joint angles, and range of motion (ROM) of metatarsophalangeal (MTP), ankle, knee, and hip joints were calculated. Joint angles during the entire stance phase were analyzed applying the statistical nonparametric mapping (SnPM) method. SI and VILR in shoes with −8 mm HTD significantly increased by 18.99% and 31.836 BW/s compared to those with 8 mm HTD (SI: p = 0.002; VILR: p < 0.001). Significant alterations of ROM occurred in the MTP, ankle, and knee joints (p < 0.05), and HTD factor primarily accounted for these changes. Joint angles (MTP, knee, and hip) during the entire stance phase altered due to HTD and speed factors. Running speed primarily influenced the kinematics parameters of knee and hip joints, increasing knee angles in the frontal plane and hip angle in the horizontal plane at PS (p > 0.05). Compared to shoes with 8 mm HTD, shoes with −8 mm HTD may be useful to storage and return energy because of the increased ROM of MTP in the sagittal plane. Besides, forefoot strike gait retraining was recommended before transition from normal running shoes to running shoes with −8 mm HTD.

Knee joint biomechanics during gait improve from 3 to 6 months after anterior cruciate ligament reconstruction.

Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty-five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two-tailed t-tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase.

Gait Phase Subdivision and Leg Stiffness Estimation During Stair Climbing.

Leg stiffness is considered a prevalent parameter used in data analysis of leg locomotion during different gaits, such as walking, running, and hopping. Quantification of the change in support leg stiffness during stair ascent and descent will enhance our understanding of complex stair climbing gait dynamics. The purpose of this study is to investigate a methodology to estimate leg stiffness during stair climbing and subdivide the stair climbing gait cycle. Leg stiffness was determined as the ratio of changes in ground reaction force in the direction of the support leg Fl (leg force) to the respective changes in length Ll during the entire stance phase. Eight subjects ascended and descended an instrumented staircase at different cadences. In this study, the changes of leg force and length (force-length curve) are described as the leg stiffness curve, the slope of which represents the normalized stiffness during stair climbing. The stair ascent and descent gait cycles were subdivided based on the negative and positive work fluctuations of the center-of-mass (CoM) work rate curve and the characteristics of leg stiffness. We found that the leg stiffness curve consists of several segments in which the force-length relationship was similarly linear and the stiffness value was relatively constant; the phase divided by the leg stiffness curve corresponds to the phase divided by the CoM work rate curve. The results of this study may guide biomimetic control strategies for a wearable lower-extremity robot for the entire stance phase during stair climbing.

Loading during Midstance of Gait Is Associated with Magnetic Resonance Imaging of Cartilage Composition Following Anterior Cruciate Ligament Reconstruction.

ObjectiveA complex association exists between aberrant gait biomechanics and posttraumatic knee osteoarthritis (PTOA) development. Previous research has primarily focused on the link between peak loading during the loading phase of stance and joint tissue changes following anterior cruciate ligament reconstruction (ACLR). However, the associations between loading and cartilage composition at other portions of stance, including midstance and late stance, is unclear. The objective of this study was to explore associations between vertical ground reaction force (vGRF) at each 1% increment of stance phase and tibiofemoral articular cartilage magnetic resonance imaging (MRI) T1ρ relaxation times following ACLR.DesignTwenty-three individuals (47.82% female, 22.1 ±4.1 years old) with unilateral ACLR participated in a gait assessment and T1ρ MRI collection at 12.25 ± 0.61 months post-ACLR. T1ρ relaxation times were calculated for the articular cartilage of the weightbearing medial and lateral femoral (MFC, LFC) and tibial (MTC, LTC) condyles. Separate bivariate, Pearson product moment correlation coefficients (r) were used to estimate strength of associations between T1ρ MRI relaxation times in the medial and lateral tibiofemoral articular cartilage with vGRF across the entire stance phase.ResultsGreater vGRF during midstance (46%-56% of stance phase) was associated with greater T1ρ MRI relaxation times in the MFC (r ranging between 0.43 and 0.46).ConclusionsBiomechanical gait profiles that include greater vGRF during midstance are associated with MRI estimates of lesser proteoglycan density in the MFC. Inability to unload the ACLR limb during midstance may be linked to joint tissue changes associated with PTOA development.

Posterior tibial tendon dysfunction alters the midfoot mechanics and energetics during gait

A comprehensive insight into the in vivo foot kinetics of patients with posterior tibial tendon dysfunction (PTTD) is lacking to support clinical decision making. Our goal was to study how PTTD alters the kinetic and kinematic characteristics of the foot and ankle with a special focus on the midfoot joints. Multisegment foot joint kinetics and kinematics were compared based on the Rizzoli Foot Model and inversed dynamics between a control group (n = 25), patients with PTTD Stage II (n = 21) and PTTD Stage III (n = 4) over the entire stance phase. Compared to controls, a mean decrease in power generation of 1.3 W/kg was found in the Ankle joint in PTTD II patients (p < 0.001) and PTTD III patients of 1.5 W/kg (p < 0.001). In the Chopart joint, there was a mean increase in power absorption of 0.4 W/kg in the PTTD III patients (p = 0.014) and a mean decrease in power generation of 0.6 W/kg (p < 0.001) in the PTTD II patients. The distribution of total negative work showed a shift from the Ankle and first metatarsal phalangeal joint towards the Chopart joint in both PTTD compared with the control subjects. A significant reduction in range of motion was observed among both PTTD groups. The outcome of this study will enable the possibility to customize the conservative and surgical treatment of each patient with PTTD, to improve or even restore the kinetic features. This will prevent the natural deterioration of function seen in this pathology.

Three-dimensional kinematic evaluation of lateral suture stabilization in an in vitro canine cranial cruciate deficient stifle model.

The impact of surgical correction of cranial cruciate ligament rupture (CCLR) on 3D kinematics has not been thoroughly evaluated in dogs. The success of current techniques remains limited, as illustrated by suboptimal weightbearing and progression of osteoarthritis. The inability to restore the stifle’s 3D kinematics might be a key element in understanding these suboptimal outcomes. The objective of this study was to evaluate the impact of lateral suture stabilization (LSS) on the 3D kinematics of the canine stifle joint. We hypothesized that LSS would not restore 3D kinematics in our model. Ten cadaveric pelvic limbs collected from large dogs (25–40 kg) were tested using a previously validated apparatus that simulates gait. Three experimental conditions were compared: (a) intact stifle; (b) unstable stifle following cranial cruciate ligament transection (CCLt) and (c) CCLt stabilized by LSS. Three-dimensional kinematics were collected through 5 loading cycles simulating the stance phase of gait and curves were analyzed using a Wilcoxon signed-rank test. LSS restored baseline kinematics for the entire stance phase for cranial and lateromedial translation, flexion, and abduction. It restored distraction over 90% of the stance phase. Internal rotation was limited, but not restored. This in vitro study had limitations, as it used a simplified model of stifle motion and weight-bearing. The results of this study report that LSS can restore physiologic 3D kinematics largely comparable to those of healthy stifles. Suboptimal outcome in patients following CCLR stabilization by LSS may therefore result from causes other than immediate postoperative abnormal 3D kinematics.

Dose-response effects of forefoot and arch orthotic components on the center of pressure trajectory during running in pronated feet

BackgroundFoot orthoses are widely used in runners with pronated feet, who are characterized with large forefoot abduction and arch deformation during gait. However, the relationship between the amount of forefoot and arch orthotic correction and the alterations in foot biomechanics remains unclear. Research questionThis study aimed to determine dose-response effects of foot orthoses with forefoot wedge and arch support components on the center of pressure (COP) trajectories and pressure distribution during running in symptomatic pronated feet. MethodsFifteen recreational runners participated in this study. A pressure plate was used to measure plantar pressures during running with control shoe only and ten foot orthoses, varying in forefoot wedges (5 levels) and arch supports (2 levels). The COP trajectory across the entire stance phase was compared between orthotic and control conditions using one-dimensional statistical parametric mapping. The differences in the force-time integral (FTI) and temporal variables were explored between conditions using repeated measures ANOVAs. The main effect of the two orthotic components and their interaction on tested variables were examined using two-way ANOVAs. ResultsA forefoot wedge, whether laterally or medially located, shifted the COP trajectory laterally during some subphases of running (p < 0.05), while using an arch support only had minimal effect on the COP. Almost all orthoses reduced the FTI on the 2nd metatarsal and medial heel, and only medial forefoot wedges reduced the FTI on the hallux. There was a linear effect of forefoot wedges on the medial-lateral COP displacements during the propulsion phase, but no interactions were found between two orthotic components. SignificanceThese findings suggest that forefoot orthotic components rather than arch supports are effective in altering forefoot dynamics in runners with pronated feet. This study could have implications for foot orthotic prescription and running-related injury prevention for individuals with pronated feet.

Effects of foot progression angle on knee mechanics during an anticipated cutting task: A statistical parametric mapping approach

Cutting is considered a “high-risk” movement for anterior cruciate ligament (ACL) injuries. It has been established that sex differences exist during cutting, placing females at greater ACL injury risk. Foot progression angle (FPA) during landing has been shown to influence lower extremity mechanics, yet little is known how FPA influences mechanics during cutting. The purpose of this study was to compare two FPA conditions during cutting between males and females. Twenty-four males and females were tested using two FPA conditions: toe-in 15° (TI15) and toe-out 15° (TO15). Right knee joint kinematic and kinetic variables were measured using a motion capture system and force plate. Five successful trials were collected and compared between FPA conditions. One-dimensional statistical parametric mapping was used to assess changes in knee mechanics between males and females over the entire stance phase. The only sex × FPA effect found was knee flexion angle. Females cutting at TI15 had decreased knee flexion angle compared TO15 (p = 0.019). Significant sex main effects included knee abduction and rotation angles, and knee flexion and rotation moments. Significant FPA main effects included knee flexion, abduction and rotation angles. The results show cutting with a toe-in FPA of 15° is enough to induce changes in knee abduction angle while cutting with 15° toe-out FPA influenced knee flexion and rotation angles. These data suggest that different cutting FPAs may be influential on known ACL injury risk variables. However, more research is warranted on cutting FPA before FPA is targeted as part of ACL injury prevention protocols.