Foot Progression Angle Research Articles

Unilateral hip osteoarthritis: The effect of compensation strategies and anatomic measurements on frontal plane joint loading.

In order to reduce pain caused by the affected hip joint, unilateral hip osteoarthritis patients (HOAP) adopt characteristic gait patterns. However, it is unknown if the knee and hip joint loading in the non-affected (limbnon-affected ) and the affected (limbaffected ) limb differ from healthy controls (HC) and which gait parameters correlate with potential abnormal joint loading. Instrumented 3D-gait analysis was performed on 18 HOAP and 18 sex, age, and height matched HC. The limbnon-affected showed greater first and second peak external hip adduction moments (first HAM: +15%, p = 0.014; second HAM: +15%, p = 0.021, respectively), than seen in HC. In contrast, the second peak external knee adduction moment (KAM) in the limbaffected is reduced by about 23% and 30% compared to the limbnon-affected and HC, respectively. Furthermore, our patients showed characteristic gait compensation strategies including reduced peak vertical forces (pvF), a greater foot progression angle (FPA), and reduced knee range of motion (ROM) in the limbaffected . The limbaffected was 5.6 ± 3.8 mm shorter than the limbnon-affected . Results of stepwise regression analyses showed that increased first pvF explain 16% of first HAM alterations, whereas knee ROM and FPA explain 39% of second KAM alterations. We therefore expect an increased rate of progression of OA in the hip joint of the limbnon-affected and suggest that the shift in the medial-to-lateral knee joint load distribution may impact the rate of progression of OA in the limbaffected . The level of evidence is III. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1764-1773, 2017.

Comprehensive long-term outcomes 13.5 years following selective dorsal rhizotomy

The purpose of this study was to compare the rotational profile of adults with higher versus lower foot progression angles (FPA). Tibial torsion, femoral torsion, hip internal and external rotation and FPA data were collected on one hundred two healthy volunteers. Data were stratified into Low, Mid, and High FPA groups to study relationships among the components of the rotational profile and if there were group differences in the magnitude of torsion angles. Direction of torsion was also studied as an attempt to look at the incidence of offsetting between the tibia and femur. Tibial torsion was significantly higher in the High FPA group (p < 0.001) and was significantly related to the FPA (p ≤ 0.01). Femoral torsion was related to hip internal rotation (p < 0.05). Offsetting tibial and femoral torsions occurred in 59% of subjects with low FPA and 56% of subjects with high FPA. All subjects in the low FPA group with offsetting had tibial torsion that followed the FPA and the femurs that were directed opposite. In the High FPA group, 68% of subjects with offsetting had tibias that followed the FPA. Stratifying the data by FPA revealed there were significant differences in tibial torsion among the groups and provided evidence that tibial torsion influences the direction and magnitude of the FPA. Offsetting torsions between the tibia and femur were more common in people with higher and lower FPA and had clearer patterns where the tibia tended to follow the direction of the FPA.

Are the medial gastrocnemius muscles of spastic cerebral palsy children altered following repeat botulinum toxin injections when compared with an un-injected muscle?

The purpose of this study was to compare the rotational profile of adults with higher versus lower foot progression angles (FPA). Tibial torsion, femoral torsion, hip internal and external rotation and FPA data were collected on one hundred two healthy volunteers. Data were stratified into Low, Mid, and High FPA groups to study relationships among the components of the rotational profile and if there were group differences in the magnitude of torsion angles. Direction of torsion was also studied as an attempt to look at the incidence of offsetting between the tibia and femur. Tibial torsion was significantly higher in the High FPA group (p < 0.001) and was significantly related to the FPA (p ≤ 0.01). Femoral torsion was related to hip internal rotation (p < 0.05). Offsetting tibial and femoral torsions occurred in 59% of subjects with low FPA and 56% of subjects with high FPA. All subjects in the low FPA group with offsetting had tibial torsion that followed the FPA and the femurs that were directed opposite. In the High FPA group, 68% of subjects with offsetting had tibias that followed the FPA. Stratifying the data by FPA revealed there were significant differences in tibial torsion among the groups and provided evidence that tibial torsion influences the direction and magnitude of the FPA. Offsetting torsions between the tibia and femur were more common in people with higher and lower FPA and had clearer patterns where the tibia tended to follow the direction of the FPA.

Explorative analysis into the association between gait kinematics and energy cost in children with cerebral palsy

The purpose of this study was to compare the rotational profile of adults with higher versus lower foot progression angles (FPA). Tibial torsion, femoral torsion, hip internal and external rotation and FPA data were collected on one hundred two healthy volunteers. Data were stratified into Low, Mid, and High FPA groups to study relationships among the components of the rotational profile and if there were group differences in the magnitude of torsion angles. Direction of torsion was also studied as an attempt to look at the incidence of offsetting between the tibia and femur. Tibial torsion was significantly higher in the High FPA group (p < 0.001) and was significantly related to the FPA (p ≤ 0.01). Femoral torsion was related to hip internal rotation (p < 0.05). Offsetting tibial and femoral torsions occurred in 59% of subjects with low FPA and 56% of subjects with high FPA. All subjects in the low FPA group with offsetting had tibial torsion that followed the FPA and the femurs that were directed opposite. In the High FPA group, 68% of subjects with offsetting had tibias that followed the FPA. Stratifying the data by FPA revealed there were significant differences in tibial torsion among the groups and provided evidence that tibial torsion influences the direction and magnitude of the FPA. Offsetting torsions between the tibia and femur were more common in people with higher and lower FPA and had clearer patterns where the tibia tended to follow the direction of the FPA.

Learning to walk: Identifying independent components and gait domains in newly walking infants

The purpose of this study was to compare the rotational profile of adults with higher versus lower foot progression angles (FPA). Tibial torsion, femoral torsion, hip internal and external rotation and FPA data were collected on one hundred two healthy volunteers. Data were stratified into Low, Mid, and High FPA groups to study relationships among the components of the rotational profile and if there were group differences in the magnitude of torsion angles. Direction of torsion was also studied as an attempt to look at the incidence of offsetting between the tibia and femur. Tibial torsion was significantly higher in the High FPA group (p < 0.001) and was significantly related to the FPA (p ≤ 0.01). Femoral torsion was related to hip internal rotation (p < 0.05). Offsetting tibial and femoral torsions occurred in 59% of subjects with low FPA and 56% of subjects with high FPA. All subjects in the low FPA group with offsetting had tibial torsion that followed the FPA and the femurs that were directed opposite. In the High FPA group, 68% of subjects with offsetting had tibias that followed the FPA. Stratifying the data by FPA revealed there were significant differences in tibial torsion among the groups and provided evidence that tibial torsion influences the direction and magnitude of the FPA. Offsetting torsions between the tibia and femur were more common in people with higher and lower FPA and had clearer patterns where the tibia tended to follow the direction of the FPA.

Long-term follow-up after Tibialis Anterior Tendon Shortening in combination with Achilles Tendon Lengthening in spastic equinus in cerebral palsy

The purpose of this study was to compare the rotational profile of adults with higher versus lower foot progression angles (FPA). Tibial torsion, femoral torsion, hip internal and external rotation and FPA data were collected on one hundred two healthy volunteers. Data were stratified into Low, Mid, and High FPA groups to study relationships among the components of the rotational profile and if there were group differences in the magnitude of torsion angles. Direction of torsion was also studied as an attempt to look at the incidence of offsetting between the tibia and femur. Tibial torsion was significantly higher in the High FPA group (p < 0.001) and was significantly related to the FPA (p ≤ 0.01). Femoral torsion was related to hip internal rotation (p < 0.05). Offsetting tibial and femoral torsions occurred in 59% of subjects with low FPA and 56% of subjects with high FPA. All subjects in the low FPA group with offsetting had tibial torsion that followed the FPA and the femurs that were directed opposite. In the High FPA group, 68% of subjects with offsetting had tibias that followed the FPA. Stratifying the data by FPA revealed there were significant differences in tibial torsion among the groups and provided evidence that tibial torsion influences the direction and magnitude of the FPA. Offsetting torsions between the tibia and femur were more common in people with higher and lower FPA and had clearer patterns where the tibia tended to follow the direction of the FPA.

The rotational profile: A study of lower limb axial torsion, hip rotation, and the foot progression angle in healthy adults

The purpose of this study was to compare the rotational profile of adults with higher versus lower foot progression angles (FPA). Tibial torsion, femoral torsion, hip internal and external rotation and FPA data were collected on one hundred two healthy volunteers. Data were stratified into Low, Mid, and High FPA groups to study relationships among the components of the rotational profile and if there were group differences in the magnitude of torsion angles. Direction of torsion was also studied as an attempt to look at the incidence of offsetting between the tibia and femur. Tibial torsion was significantly higher in the High FPA group (p<0.001) and was significantly related to the FPA (p≤0.01). Femoral torsion was related to hip internal rotation (p<0.05). Offsetting tibial and femoral torsions occurred in 59% of subjects with low FPA and 56% of subjects with high FPA. All subjects in the low FPA group with offsetting had tibial torsion that followed the FPA and the femurs that were directed opposite. In the High FPA group, 68% of subjects with offsetting had tibias that followed the FPA. Stratifying the data by FPA revealed there were significant differences in tibial torsion among the groups and provided evidence that tibial torsion influences the direction and magnitude of the FPA. Offsetting torsions between the tibia and femur were more common in people with higher and lower FPA and had clearer patterns where the tibia tended to follow the direction of the FPA.

Novel Foot Progression Angle Algorithm Estimation via Foot-Worn, Magneto-Inertial Sensing.

The foot progression angle (FPA) is an important clinical measurement but currently can only be computed while walking in a laboratory with a marker-based motion capture system. This paper proposes a novel FPA estimation algorithm based on a single integrated sensor unit, consisting of an accelerometer, gyroscope, and magnetometer, worn on the foot. The algorithm introduces a real-time heading vector with a complementary filter and utilizes a gradient descent method and zero-velocity update correction. Validation testing was performed by comparing FPA estimation from the wearable sensor with the standard FPAs computed from a marker-based motion capture system. Subjects performed nine walking trials of 2.5 min each on a treadmill. During each trial, subjects walked at one speed out of three options (1.0, 1.2, and 1.4 m/s) and walked with one gait pattern out of three options (normal, toe-in, and toe-out). The algorithm estimated FPA to within 0.2 ° of error or less for each walking conditions. A novel FPA algorithm has been introduced and described based on a single foot-worn sensor unit, and validation testing showed that FPA estimation was accurate for different walking speeds and foot angles. This study enables future wearable systems gait research to assess or train walking patterns outside a laboratory setting in natural walking environments.

Impact of foot progression angle modification on plantar loading in individuals with diabetes mellitus and peripheral neuropathy

To determine if participants can reduce foot progression angle (FPA), and if FPA reduction decreases regional plantar stresses and forces in individuals with diabetes. Design: Three-group cross-sectional design with repeated measures. subjects: twenty-eight participants either with diabetes mellitus (DM), diabetes and peripheral neuropathy with (DMPN+NPU) or without a prior history of ulceration (DMPN-NPU) were studied. Intervention: Participants were first instructed to walk over a 3.6 m walkway at their preferred FPA, and then to walk with their foot aligned parallel with the line of gait progression at their self-selected speed. Dynamic plantar kinetics in six masked regions were collected using an EMED-st-P-2 pedobarograph. Main measures: Primary outcome measures were FPA, peak plantar pressure (PPP), and force-time integral (FTI). A repeated measures ANOVA was conducted to determine group differences in FPA for both walking conditions. Regional differences in PPPs and FTIs between preferred and corrected walking conditions were analyzed using repeated measures ANCOVA. Participants showed a reduction in FPA magnitude on the 'Involved' foot between the preferred and corrected walking conditions (p<0.01). There were no differences in PPPs or FTIs in any mask between walking conditions (p>0.05). Results from this investigation offer important evidence that people with diabetes can modify their FPA with a simple intervention of visual and verbal cueing. Future research should examine if gait retraining strategies in regular footwear more effectively offload areas of elevated regional plantar stresses and forces in adults with diabetes mellitus and peripheral neuropathy.

Influence of orthosis on the foot progression angle in children with spastic cerebral palsy

We retrospectively assessed the effect of ankle–foot orthosis (AFO) on the foot progression angle (FPA) of 97 children with spastic cerebral palsy (CP) who had undergone comprehensive computer-based gait analysis both barefoot and with their orthosis, during the same session. The physical examination results and the gait study temporal and kinematic parameters comprise the study data. We focused on the peak FPA reached during stance and swing phases and at mid-stance and mid-swing, and also measured the transverse rotations of the pelvis, the femur and the tibia. AFOs improved gait, as reflected by improved temporal parameters, but they also increased internal rotation of the feet in diplegic CP children by 4.29 degrees for mid-stance, and by 3.72 degrees for mid-swing. The correlation between components of the rotational profile and FPA was significant for the diplegic group. AFOs did not produce any noteworthy differences between walking barefoot and walking with the brace in the hemiplegic group in what concerns FPA. Children with diplegic CP who use AFOs walk with increased internal FPAs in their orthoses. These findings might be explained by anatomical attributes as well as dynamic features during gait.

Gait neuromechanics in women with and without joint hypermobility

s / Gait & Posture 39S (2014) S1–S141 S7 legs, dependent on affected side, and three trials of participants were considered. Linear MixedModels were used to determine the main effects within retained principal components (PCs). Results: PatientsmeanAntetorsionwas38.6◦(SD6.1◦), basedon CT-scans. There were no significant group differences in sex, age, BMI and walking speed, but patients showed significant less hip external rotation in clinical examination. Group effects based on LinearMixedModels revealed that patientswalkedwith significant more internal foot progression angle (FPA) andmore external ankle rotation (ARA) than controls. There were no alterations observed in knee kinematics. Patients walked with significant more anterior pelvic tilt (SPA) and at hip joint level with more internally rotated (THA) and flexed (SHA) hips. Group effects in kinetics revealed that patients showed a significant lower knee adductionmoment (FKM) andhip adductionmoment (FHM).Differentiation into primary and secondary passive effects was derived from clinical considerations. Discussion and conclusions: Deviations in FPA and THA were stated as primary deviations. Due to the reduced hip external rotation patientswere not able to counterbalance for primary deviations. Passive secondary effects were detected in ARA, SHA, SPA, FKM and FHM. In order to achieve normal gait, patients walked with external ankle rotation, flexed hips and more anterior pelvic tilt. During gait internal hip rotation induced anterior pelvic tilt andmore hip flexion by straining iliofemoral ligaments. Moreover, anterior pelvic tilt may have wide-ranging consequences as it may induce increased lordosis of the lumbar spine and extension of the thoracic spine. Although in the current study FKM mean gait waveform indicated a tendency for an increased knee adduction moment in patients, the application of Linear Mixed Models on PC-scores of retained PCs showed a significant group effect in PC3 (explaining 16.74% of total variance), representing a lower knee adduction moment in patients. In hip the only significant group effect corresponded to a lower hip adduction moment in patients (PC2, explaining 15.32% of total variance), whereas mean gait waveform indicated a higher hip adduction moment. In summary coxa antetorta is not mainly a cosmetic problem in general. Modifications in kinematics and kinetics may cause physical complaints and osteoarthritis in future. Therefore, conducting 3DGA is recommended for individual clinical decision-making and planning surgical corrections in patients with coxa antetorta.

Gait deviations and compensations in adolescents with coxa antetorta

s / Gait & Posture 39S (2014) S1–S141 S7 legs, dependent on affected side, and three trials of participants were considered. Linear MixedModels were used to determine the main effects within retained principal components (PCs). Results: PatientsmeanAntetorsionwas38.6◦(SD6.1◦), basedon CT-scans. There were no significant group differences in sex, age, BMI and walking speed, but patients showed significant less hip external rotation in clinical examination. Group effects based on LinearMixedModels revealed that patientswalkedwith significant more internal foot progression angle (FPA) andmore external ankle rotation (ARA) than controls. There were no alterations observed in knee kinematics. Patients walked with significant more anterior pelvic tilt (SPA) and at hip joint level with more internally rotated (THA) and flexed (SHA) hips. Group effects in kinetics revealed that patients showed a significant lower knee adductionmoment (FKM) andhip adductionmoment (FHM).Differentiation into primary and secondary passive effects was derived from clinical considerations. Discussion and conclusions: Deviations in FPA and THA were stated as primary deviations. Due to the reduced hip external rotation patientswere not able to counterbalance for primary deviations. Passive secondary effects were detected in ARA, SHA, SPA, FKM and FHM. In order to achieve normal gait, patients walked with external ankle rotation, flexed hips and more anterior pelvic tilt. During gait internal hip rotation induced anterior pelvic tilt andmore hip flexion by straining iliofemoral ligaments. Moreover, anterior pelvic tilt may have wide-ranging consequences as it may induce increased lordosis of the lumbar spine and extension of the thoracic spine. Although in the current study FKM mean gait waveform indicated a tendency for an increased knee adduction moment in patients, the application of Linear Mixed Models on PC-scores of retained PCs showed a significant group effect in PC3 (explaining 16.74% of total variance), representing a lower knee adduction moment in patients. In hip the only significant group effect corresponded to a lower hip adduction moment in patients (PC2, explaining 15.32% of total variance), whereas mean gait waveform indicated a higher hip adduction moment. In summary coxa antetorta is not mainly a cosmetic problem in general. Modifications in kinematics and kinetics may cause physical complaints and osteoarthritis in future. Therefore, conducting 3DGA is recommended for individual clinical decision-making and planning surgical corrections in patients with coxa antetorta.

Effect of Running Retraining on Pain, Function, and Lower-Extremity Biomechanics in a Female Runner With Iliotibial Band Syndrome

Iliotibial-band syndrome (ITBS) is a common overuse running injury. There is inconclusive evidence to support current management strategies, and few advances have been made in the past few years. New management approaches should thus be developed and evaluated. To assess the effects of a real-time running-retraining program on lower-extremity biomechanics, pain while running, and function. Single-subject experimental study. University motion-analysis laboratory. Female recreational runner with ITBS. Nine real-time running-retraining sessions were implemented based on the biomechanical alterations of the participant's symptomatic lower limb, including pelvic and knee movement in the transverse plane, as well as foot movement in the frontal plane. Real-time visual feedback of the pelvic-rotation angle was provided during the running-retraining sessions. 3-dimensional lower-extremity running kinematics, pain on a verbal analog scale while running on a treadmill, and the Lower Extremity Functional Scale (LEFS). Pelvic external rotation decreased, although the aim was to increase pelvic external rotation and knee rotation. The foot-progression angle improved after the intervention and at 1-mo follow-up. There was a 12.5% improvement in running time, and the pain score while running improved by 50% postintervention; these improvements were maintained at 1-mo follow-up. The mean LEFS score, indicative of function, improved by 8.75% and by 10% at the end of the intervention and at 1-mo follow-up, respectively. The real-time running-retraining program improved pain while running, as well as function, and was effective in addressing the lower-limb biomechanical alterations of the knee and foot in a female runner with ITBS. The application, effectiveness, and feasibility of real-time training should be addressed in larger studies in the future.

Discrimination of Abnormal Gait Parameters Due to Increased Femoral Anteversion from other Effects in Cerebral Palsy

The effects of increased femoral anteversion (IFA) on gait pattern have a complex relationship with other orthopaedic and neurological abnormalities of cerebral palsy (CP). The aim of this study was to differentiate the effects of IFA from other factors in CP. The four groups in this study included: 15 typically developing children (Group: TDC) (age: 9.7 ± 0.5); 14 TDC with IFA (7.5 ± 1.7) (Group: TDC-IFA); 8 CP participants with IFA (age: 6.3 ± 1.7) (Group: CP IFA); and 10 CP participants with nearly normal femoral anteversion (age: 10.3 ± 4.7) (Group: CP-NFA). Altered peak knee-extension angle and stance-time, increased internal hip-rotation, internal foot-progression (p≤0.05) were influenced by IFA in both groups of CP-NFA and TDC-IFA. For the TDC groups; pelvic-rotation increased and peak knee and hip-extension, knee flexion-moment, peak knee-power generation in late-stance decreased among children with IFA (p≤0.05). For CP children; anterior pelvic-tilt, hip-flexion and peak knee-extension, hip power-absorbsion and generation, and peak knee power-absorsion (K3) increased and peak knee-flexion was delayed by IFA (p≤0.05). Therefore, IFA effects are different in CP and TDC. Peak knee-extension angle increased in TDC and decreased in CP with IFA. Besides the well known gait parameters related to IFA which are increased internal hip-rotation and foot-progression angle, it is recognised that peak knee-extension and stance-time are also influenced. Therefore, before muscle lengthening, femoral derotational osteotomy should be considered in the early stages of growth in CP to improve pelvic stability and the knee extensor mechanism.

Altering foot progression angle in people with medial knee osteoarthritis: the effects of varying toe-in and toe-out angles are mediated by pain and malalignment

To evaluate if altering the foot progression angle (FPA) by varying magnitudes during gait alters the external knee adduction moment (KAM), knee flexion moment (KFM), knee extension moment (KEM) and/or symptoms in people with medial knee osteoarthritis (OA). Potential influence of pain and knee malalignment on load-modifying effects of FPA was investigated. Participants (n=22) underwent 3-dimensional gait analysis to measure KAM peaks, KAM impulse, KFM and KEM peaks. Following natural gait, five altered FPA conditions were performed in random order (10° toe-in, 0° FPA, 10° toe-out, 20° toe-out and 30° toe-out). A projection screen displayed their real-time FPA. Pain/discomfort at knees and feet/ankles were evaluated for each condition. Linear mixed models were used for statistical analysis. Toe-in reduced the early stance peak KAM and KEM but increased the KAM impulse, late stance peak and KFM. Toe-out reduced the KAM impulse, late stance peak and KFM (P<0.001) but increased the early stance peak KAM and KEM. All effects were greater in participants with more varus knees. Pain significantly mediated the effect of altered FPA on the KAM impulse and late stance peak. In more painful individuals, toe-in was predicted to reduce the KAM impulse and late stance peak, and increase them for toe-out gait. There were no immediate symptomatic changes. Effects of altered FPA vary across all medial knee load parameters and it is difficult to determine an optimal direction of FPA change. Future studies should consider Western Ontario McMaster Universities OA Index (WOMAC) pain to judge the likely effects of altered FPA.

Femoral anteversion and tibial torsion only explain 25% of variance in regression analysis of foot progression angle in children with diplegic cerebral palsy

BackgroundThe relationship between torsional bony deformities and rotational gait parameters has not been sufficiently investigated. This study was to investigate the degree of contribution of torsional bony deformities to rotational gait parameters in patients with diplegic cerebral palsy (CP).MethodsThirty three legs from 33 consecutive ambulatory patients (average age 9.5 years, SD 6.9 years; 20 males and 13 females) with diplegic CP who underwent preoperative three dimensional gait analysis, foot radiographs, and computed tomography (CT) were included. Adjusted foot progression angle (FPA) was retrieved from gait analysis by correcting pelvic rotation from conventional FPA, which represented the rotational gait deviation of the lower extremity from the tip of the femoral head to the foot. Correlations between rotational gait parameters (FPA, adjusted FPA, average pelvic rotation, average hip rotation, and average knee rotation) and radiologic measurements (acetabular version, femoral anteversion, knee torsion, tibial torsion, and anteroposteriortalo-first metatarsal angle) were analyzed. Multiple regression analysis was performed to identify significant contributing radiographic measurements to adjusted FPA.ResultsAdjusted FPA was significantly correlated with FPA (r=0.837, p<0.001), contralateral FPA (r=0.492, p=0.004), pelvic rotation during gait (r=−0.489, p=0.004), knee rotation during gait (r=0.376, p=0.031), and femoral anteversion (r=0.350, p=0.046). In multiple regression analysis, femoral anteversion (p=0.026) and tibial torsion (p=0.034) were found to be the significant contributing structural deformities to the adjusted FPA (R2=0.247).ConclusionsFemoral anteversion and tibial torsion were found to be the significant structural deformities that could affect adjusted FPA in patients with diplegic CP. Femoral anteversion and tibial torsion could explain only 24.7% of adjusted FPA.

The role of footwear in attenuating impact loads in individuals with knee osteoarthritis

The role of footwear in attenuating impact loads in individuals with knee osteoarthritis

The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach

Minimally invasive total hip arthroplasty has been successfully introduced in the past decade. Nevertheless, standard approaches such as the direct lateral approach are still commonly used in orthopaedic surgery due to easy handling, good intra-operative overview and low complication rates. However, a frequent occurrence of fatty atrophy within the anterior third of the gluteus medius muscle has been demonstrated when using the modified direct-lateral approach (mDL), which may be associated with a reduction in function, limitation of internal leg rotation, gait disorders and pain. The question addressed in this study is whether mDL-approach leads to unfavourable changes in foot progression angle (FPA), gait and to more postoperative pain compared with a minimally invasive anterolateral approach (ALMI). Thirty patients with primary osteoarthritis of the hip were recruited for this study. All subjects received an uncemented THA (Alloclassic-Zweymüller stem, Allofit Cup, FA Zimmer), 15 through an ALMI-approach and 15 via the mDL-approach. Gait analyses were performed both preoperatively and 3 months after surgery to measure FPA, step length, stance duration, cadence and walking speed. Additionally, the Harris-Hip Score, pain according to the visual analogue scale and the Trendelenburg sign were evaluated. No influence of the surgical approach could be observed on the gait patterns or FPA. Furthermore, neither increased external rotation of the limb nor restriction of internal rotation during walking could be established. Pain and Harris-Hip Score did not diVer significantly between the two groups. In comparison with an ALMI approach, the mDL approach did not lead to a change in FPA postoperatively. No detrimental effect could be found on the gait pattern or pain after surgery. Based on these measurements, the minimally invasive anterolateral approach did not appear to provide functional benefits in outcome over the mDL approach. Consequently, both surgical approaches seem to be equally applicable approaches with good to very good functional results.

Plantar pressures and ankle kinematics following anterior tibialis tendon transfers in children with clubfoot

Materials and methods Thirty children (37 feet) were evaluated preand 2.0 ±0.6 yrs (range: 0.8 to 2.9) post-op following ATT transfer. Foot progression angle (FPA) and sagittal ankle kinematics were assessed using a VICON system. Plantar pressures were collected using the Emed ST Platform. Representative trials were chosen for each subject for gait and plantar pressures. Plantar pressures were divided into medial and lateral hindfoot, midfoot and forefoot. Variables included: contact time (CT%), contact area (CA% total), peak pressure (PP), hindfoot-forefoot angle [2], deviation of the center-of-pressure (COP) line and region of initial contact. Twenty age matched controls were used for comparison.

Foot progression angle and medial loading in individuals with diabetes mellitus, peripheral neuropathy, and a foot ulcer

Foot progression angle (FPA) and duration of foot medial column loading during walking were studied in individuals with diabetes mellitus (DM), peripheral neuropathy (PN), and a forefoot ulcer (DMPN), and in age-matched control subjects. FPA was calculated from EMED-ST P-2 pressure maps as the angle formed between the longitudinal axis of the foot and the forward line of progression during walking. The medial loading duration was calculated as the amount of time the center of pressure line spent in the medial side of the foot pressure map. FPA was increased in the DMPN group, on the involved and uninvolved sides [15(9)° and 13(4)° respectively] compared the control group [9(4)°]. FPA and medial loading duration were significantly correlated in the DMPN group on the involved and uninvolved sides ( r > 0.54, p < 0.036), but were not significantly correlated in the control group ( r < |0.07|, p > 0.82). This study provides evidence that FPA is an important biomechanical contributor to the pattern of foot loading in individuals with DM, PN, and a forefoot ulcer.