Lower Limb Pathology Research Articles

Foot kinematics and kinetics data for different static foot posture collected using a multi-segment foot model

This dataset presents human foot joints kinematics and kinetics data during walking, classified by static foot posture, filling a gap in existing lower limb databases that lack data on foot joints beyond the ankle or on static posture data, despite its link to foot and lower limb pathologies. Kinematics were recorded using a three-dimensional mocap system, and kinetics through a pressure platform, employing a multi-segment foot model including the ankle, midtarsal and first metatarsophalangeal joint. The dataset contains 350 recordings of right foot joint angles and moments and contact pressures from 70 healthy subjects with varying static posture (highly pronated, highly supinated and normal). Data were collected at 100 Hz, filtered and resampled to 100 frames throughout the stance phase. Descriptive data are also provided: age, weight, height, BMI and foot anthropometric data and foot posture index. Plots, tables and ANOVAs are included for validation. Presented in .xlsx and .mat formats, this database can assist professionals in corrective footwear design, insole customization, surgical planning, and evaluating interventions on foot dynamics.

The impact of pre-existing venous pathology on lower limb free flap reconstruction and the role of preoperative screening: a systematic review.

Lower limb reconstruction is performed to replace like with like and achieve tissue durability. Free flaps are a method of reconstruction commonly used to manage cases of lower limb deficits. However, the failure rate is 8.5%, with venous thrombosis and congestion playing a significant role. Despite this, preoperative venous mapping of recipient site before free flap reconstruction is not routinely practiced, often resulting in pathologies remaining unidentified until the intraoperative stage. The aim of the review was to evaluate the existing literature on the topic of lower limb preoperative venous assessment, screening, and its effect on lower limb free flap survival. Five different databases were searched from their inception to August 2021. The search terms and included studies were independently reviewed by two investigators for their eligibility. Eleven articles were eligible for inclusion, with a combined patient population of 99, and 107 flaps were identified to have lower limb pathology at the donor or recipient vein. Venous pathology was detected preoperatively in 69 veins using ultrasound duplex scanning and computed tomography angiography; of them, 3 (4.34%) resulted in failure. In comparison, 38 veins were diagnosed with venous pathology intraoperatively; of them, 5 (13.85%) failed. The studies evaluated in this review demonstrated that preoperative screening for venous pathology showed a higher flap survival rate. It can therefore be inferred that developing a standardized preoperative process for identifying venous issues in lower limb free flap reconstruction may improve outcomes. This can be explored in future research, with a focus on assessing the validity and efficacy of such screening tools, and their role in the management of patients identified with venous pathology.

Analysis of specialized care for patients with diabetic foot syndrome in St. Petersburg for 2010–2021

BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus.AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021.MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices «Diabetic foot» (DFO) from 2010 to 2021 were analyzed.RESULTS: The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers — 8,9%, with Charcot’s arthropathy — less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality — from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021.CONCLUSION: An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality.

Pictorial Review of Lesion Localization for Patients With Stroke, Upper Limb and Lower Limb Pathology

Localization is a foundational skill in clinical neuroscience and a vital aspect of teaching and learning for students and educators. Stroke syndromes, brachial plexus injury, and lumbosacral nerve pathology are among some of the most challenging clinical scenarios for learners to understand and

653 The Impact of Preoperative Screening for Venous Pathology on Lower Limb Free Flap Reconstruction

Abstract Aim Lower limb reconstruction free flap failure rate is 8.5% and is contributed to by venous thrombosis and congestion. Mapping of free flaps and the recipient site to identify venous pathology is not standard and often pathology is only found intraoperatively leading to changes in reconstructive plans. There are no guidelines on preoperative venous assessment. We aimed to review available evidence to delineate the impact preoperative venous imaging has on flap outcomes Method A systematic review of MEDLINE, Scopus, Web of Science, Cochrane Library and Embase were searched in August 2021. The reference lists of retrieved publications were checked manually and backward searched using Web of Science and Google Scholar. Data was reviewed by two researchers independently and compared. Results Eleven articles were eligible for inclusion encompassing 99 patients and 107 flaps with lower limb pathology at either the donor or recipient vein. Venous pathology was detected preoperatively in 69 veins using USS duplex scanning or CT angiography. Interventions included using another vein, intraoperative thrombectomy, and preoperative anticoagulation. 3 out of 69 (4.34%) of these free flaps resulted in failure. 38 veins diagnosed with venous pathology intraoperatively were managed by using an alternative vein, venotomy, thrombectomy, embolectomy or heparinising the vein. 5 out of 38 flaps failed (13.15%). Conclusions Preoperative screening for venous pathology showed higher flap survival rate. A standardised approach for identifying venous issues in lower limb free flap reconstruction is needed. Future studies should focus on the prognostic validity of preoperative screening tools and management of identified venous pathology.

Massage application to increase the spread of local anesthesia in sciatic nerve blocks: A cadaveric study

IntroductionSciatic nerve blocks are essential for surgical treatment of various lower limb pathologies. Due to the complexity and variation of anatomical landmarks, ultrasound (US) guided injection of local anesthesia has become common practice. In patients with thicker thigh girth (i.e., obese patients) excess tissue may distort US penetration thereby diminishing efficacy of the nerve block and/or cause severe post‐operative pain. Dye tracing techniques have been used to test the effectiveness of nerve blocks, but there is little research on using massage to manipulate anesthetic spread. Therefore, the aim of this study is to assess the effects of massage to manipulate local anesthesia spread in sciatic nerve blocks. We hypothesize massaging after injection will increase the spread of local anesthesia compared to non‐massage post injection.MethodsForty un‐fixed cadaveric legs were injected with a mixture of methylene blue dye and 2% Lidocaine Hydrochloride. Specimens were divided into non‐massage (control) (n=20) and massage (n=20) groups. Sciatic nerve blocks were performed by a nurse anesthetist using US guidance at the popliteal fossa traveling proximally until the sciatic nerve was identified and the location was tagged. Immediately following, massage group specimens received five repeated proximally directed massages with the US transducer head. Specimens from both groups were then dissected to expose the sciatic nerve. Measurements of the distance traveled from marked site of injection to proximal end of dyed area were measured and compared.ResultsSpread of local anesthesia in the inferior‐superior direction was significantly higher in the massage group than the control group (p≤0.05).ConclusionsMassaging post‐injection caused a greater spread of local anesthesia during sciatic nerve block.SignificanceSciatic nerve block techniques often utilize nerve stimulation to identify the sciatic nerve location. This may be due to lack of US penetration through the gluteus maximus muscle. In patients with thicker thigh girth due to subcutaneous fat, imaging visibility may be more difficult as well. Our findings suggest that clinicians may block the sciatic nerve at a more distal location with US guidance and manipulate the anesthesia to the region of interest.

The Impact of the COVID-19 Pandemic on the Workload, Case Mix and hospital Resources at a Tertiary Vascular Unit

Background: The aim of this study was to examine the COVID-19 pandemic and its associated impact on the provision of vascular services, and the pattern of presentation and practice in a tertiary referral vascular unit.Methods: This is a retrospective observational study from a prospectively maintained data-base comparing two time frames, Period 1(15th March-30th May 2019-P1) and Period 2(15th March-30th May 2020-P2)All the patients who presented for a vascular review in the 2 timeframes were included. Metrics of service and patient care episodes were collected and compared including, the number of emergency referrals, patient encounters, consultations, emergency admissions and interventions. Impact on key hospital resources such as critical care and imaging facilities during the two time periods were also examined.Results: There was an absolute reduction of 44% in the number of patients who required urgent or emergency treatment from P1 to P2 (141 vs 79). We noted a non-significant trend towards an increase in the proportion of patients presenting with Chronic Limb Threatening Ischaemia (CLTI) Rutherford 5&6 (P=0.09) as well as a reduction in the proportion of admissions related to Aortic Aneurysm (P=0.21). There was a significant absolute reduction of 77% in all vascular interventions from P1 to P2 with the greatest reductions noted in Carotid (P=0.02), Deep Venous (P=0.003) and Aortic interventions (P=0.016). The number of lower limb interventions also decreased though there was a significant increase as a relative proportion of all vascular interventions in P2 (P=0.001). There was an absolute reduction in the number of scans performed for vascular pathology; Duplex scans reduced by 86%(P<0.002), CT scans by 68%(P<0.003) and MRIs by 74%(P<0.009).Conclusion: We report a decrease in urgent and emergency vascular presentations, admissions and interventions. The reduction in patients presenting with lower limb pathology was not as significant as other vascular conditions, resulting in a significant rise in interventions for CLTI and DFI as a proportion of all vascular interventions. These observations will help guide the provision of vascular services during future pandemics.

The relationship of trunk kinematics and kinetics with lower limb pathology during gait in children with spastic cerebral palsy

BackgroundTrunk control during gait in children with cerebral palsy (CP) is known to be impaired. While differentiation of trunk movement between CP subtypes (unilateral/bilateral) has been examined, differentiation of lower lumbar spinal loading has not been considered. Furthermore, the relationship between lower lumbar loading and lower limb pathology has not been reported. Research QuestionHow do lower lumbar spinal kinetics differ during unilateral and bilateral CP gait and what is the relationship between trunk kinematics and L5/S1 kinetics with lower limb pathology? MethodsThree-dimensional thorax kinematics and L5/S1 kinetics were measured during gait with children divided into 3 groups (unilateral CP (n = 21), bilateral CP (n = 31) and typical development (TD) (n = 26)). Differences in thorax kinematics and reactive forces and moments at L5/S1 between groups were analysed using Statistical Parametric Mapping. Correlation coefficients were calculated between Gait Profile Score (GPS) and kinematic measures of the thorax and kinetics at L5/S1. ResultsAn increased ipsilateral bending moment was present for unilateral CP in the coronal plane (55–70% Gait Cycle (GC), p < 0.001), while children with bilateral CP demonstrated two distinct increased peaks during mid-stance (10–30 % GC, p < 0.001) and mid-swing (60–80% GC, p = 0.004) compared to TD. RMS and RoM thorax flexion, side flexion and L5/S1 lateral bend moment demonstrated significant moderate correlations with GPS. SignificanceThis study confirmed an increased involvement at the trunk and of lower lumbar spinal loading for children with bilateral CP compared to unilateral CP. It has been suggested that altered trunk movement in CP gait may be a combination of both a compensation for lower limb pathology and an underlying deficit. Our result of positive yet moderate correlations between GPS and trunk movement and lower spinal loading support this theory.

The Impact of a High/Low Fulcrum Rotating Balance Platform on Standing Postural Stability in Healthy Young Adults

Back or lower limb pathology may interfere with standing balance. Knowing the impact of high and low fulcrum balance platforms on tracking rotational activities could tailor stability training interventions. Purpose: To determine the influence of a low and high fulcrum balance platform combined with tracking tasks on postural sway while standing. Method: Twenty-five participants performed seven activities at two difficulty levels. The total sway area and medial-lateral (ML) and anterior-posterior (AP) sway direction, velocity, and distance were measured during balance activities with various tracking platforms with a fixed middle fulcrum. Results: MANOVA revealed that postural sway area (m^2/s^4) with a high fulcrum decreased in front to back, rear twist, and front twist (p = 0.05) balance activities. The Mean velocity (m/s) analysis showed that tasks with a high fulcrum elicited slower velocities in the ML direction than those with low fulcrum activity (p

A 3D-CT Analysis of Femoral Symmetry-Surgical Implications.

Background: Mirroring the image of the affected side is a widely used technique for surgical planning in orthopedic surgery, especially for fractures and custom-made prostheses. Our objective is to evaluate the three-dimensional symmetry of the femurs using finite element analysis and manual alignment. Methods: Using the computed tomography of 15 patients without lower limb pathology, 30 3D biomodels of their femurs were obtained. The error obtained through image manipulation was calculated and broken down into a rendering error and a manual overlay error. The Hausdorff–Besicovitch method was applied to obtain the total asymmetry. The manipulation error was theb subtracted from it to obtain the intrapersonal asymmetry. Results: The mean intrapersonal asymmetry was 0.93 mm. It was obtained by subtracting the error derived from rendering and alignment of 0.59 mm (SD 0.17 mm) from the overall mean error of 1.52 mm (SD 1.45). Conclusions: Intrapersonal femoral asymmetry is low enough to use the mirror image of the healthy side as a reference for three-dimensional surgical planning. This type of planning is especially useful in deformity surgery when the objective of the surgery is not to restore only one specific parameter but to obtain a general functional morphology when a healthy contralateral femur is available.

To Brace or Not to Brace - A Report About Orthotic Use in the Pediatric Orthopaedic Community

Purpose: Certain pediatric conditions of the lower extremity are self-limiting and have no known long-term prognostic effects. The Pediatric Orthopaedic Society of North America (POSNA) and American Academy of Orthopaedic Surgeons (AAOS) have guidelines regarding the use of orthotics for lower limb pathologies, but it is unknown whether these guidelines are adhered to. Additionally, we sought to evaluate the reasoning and frequency of why POSNA members are prescribing braces to patients. Methods: An anonymous online questionnaire was sent to all POSNA members (n=1402). The survey assessed provider experience, how often they prescribed orthotics and why …

Effect of sciatic nerve neurodynamic sustained natural apophyseal glides on individuals with pelvic crossed syndrome: A randomized controlled trial

Background: Pelvic crossed syndrome (PCS) is a common predisposing factor of low back pain. If left untreated, PCS could result in various spinal and lower-limb pathologies which would hinder an individual's functional abilities and affect their quality of life. Aims: The study aimed to evaluate the effect of sciatic nerve neurodynamic sustained natural apophyseal glides (SNAGs) along with a stretching-strengthening protocol on individuals with symptomatic PCS. Settings and Design: This study was conducted in a tertiary care center; this was a randomized controlled trial. Materials and Methods: Forty-two individuals were randomly allocated to control group (conventional physical therapy) and experimental group (sciatic nerve neurodynamic SNAGs along with conventional physical therapy) using envelope method. The outcome measures – pressure pain threshold, degree of lumbar lordosis, modified Thomas test, finger-to-floor test, and Modified Oswestry Disability Questionnaire (MODQ) were obtained from the participants on day 1 and posttreatment on day 6, respectively. Both the groups received the treatment for 45 min per session for 6 consecutive days. Statistical Analysis Used: Parametric dependent t-test was applied through R software 3.5.1. Results: Intragroup analysis revealed statistically significant changes in all outcome measures in both the groups. Statistically significant changes were observed in the intergroup analysis of all the outcome measures (P Conclusion: Sciatic nerve neurodynamic SNAGS when given along with conventional therapy resulted in significant and superior improvement as compared to conventional therapy alone in patients with symptomatic PCS in terms of pain sensitivity and flexibility.

Peregrine’s sore. An analysis of the hagiographical reports on the leg disease of Saint Peregrine Laziosi of Forlì (1256–1345)

Saint Peregrine Laziosi of Forlì (1265–1345), healed in slumber by the Christ from a fatal leg lesion at the age of sixty, is considered in the Catholic tradition as the patron Saint of people suffering from incurable malignancies. On the basis of later sources relating his miraculous healing, both Roman Church and contemporary medical literature have hitherto endorsed various diagnostic interpretations of Saint Peregrine’s disease, either to ascertain its incurability and therefore the truthfulness of the miracle described by the sources, or, on the contrary, aiming to provide a complete naturalistic account of his lesion and instant healing. Albeit conflicting, both perspectives rest upon a literal reading of the available texts about Peregrine’s life. Medical scholarship on the subject, in particular, taking hagiographical reports as reliable sources to establish the ‘clinical’ truth of the matter, ends up neglecting the religious nature and the edifying purposes of extant written witnesses. I propose in this article to tackle this problem through a narratological lens, stressing on the literary templates and the medical terminology which shape the most ancient and authoritative report about Peregrine’s lower limb pathology. A retrospective diagnosis of venous varicosity complications may indeed appear convincing, although not beyond every doubt: notwithstanding its terminological accuracy, consistent with ancient and medieval medical accounts of infected leg ulcerations, this text builds strongly on a traditional scriptural and hagiographical background, ranging from the Old Testament and the Gospels to early Byzantine Lives of Saints. The impossibility to clearly distinguish the literate convention from the historical account prevents us from stating with certainty the originality of Peregrine’s pathological history, and hence the reliability of our sources as clinical reports.

Impact of a physiotherapy general rehabilitation class on patient outcomes with lower limb pathology

Impact of a physiotherapy general rehabilitation class on patient outcomes with lower limb pathology

Prediction of mild anatomical leg length discrepancy based on gait kinematics and linear regression model

BackgoundLeg length discrepancy (LLD) can be related to different pathologies, due to an inadequate distribution of mechanical loads, as well as gait kinematics asymmetries resulted from LLD. Research questionTo validate a model to predict anatomical LLD (ALLD) based on gait kinematics. MethodsGait of 39 participants with different lower limb pathologies and mild discrepancy were collected. Pelvic, hip, knee and ankle kinematics were measured with a 3D motion analysis system and ALLD, femur discrepancy (FD) and tibia discrepancy (TD) were measured by a computerized digital radiograph. Three multiple linear regression models were used to identify the ability of kinematic variables to predict ALLD (model 1), FD (model 2) and TD (model 3). ResultsDifference between peak knee and hip flexion of the long and short lower limb was selected by models 1 (p < 0.001) and 2 (p < 0.001). Hip adduction was selected as a predictor only by model 1 (p = 0.05). Peak pelvic obliquity and ankle dorsiflexion were not selected by any model and model 3 did not retain any dependent variable (p > 0.05). Regression models predicted mild ALLD with moderate accuracy based on hip and knee kinematics during gait, but not ankle strategies. Excessive hip flexion of the longer limb possibly occurs to reduce the limb to equalize the LLD, and discrepancies of the femur and tibia affects gait cycle in a different way. SignificanceThis study showed that kinematic variables during gait could be used as a screening tool to identify patients with ALLD, reducing unnecessary x-ray exposure and assisting rehabilitation programs.

The effect of center of pressure alteration on the ground reaction force during gait: A statistical model

BackgroundFoot problems and lower-limb diseases (e.g., foot ulcers, osteoarthritis, etc.), are presented with a ground reaction force (GRF) that may deviate substantially from the normal. Thus, GRF manipulation is a key parameter when treating symptoms of these diseases. In the current study, we examined the impact of footwear-generated center of pressure (COP) manipulations on the GRF components, and the ability to predict this impact using statistical models. MethodsA foot-worn biomechanical device which allows manual manipulation of the COP location was utilized. Twelve healthy young men underwent gait analysis with the device set to convey seven COP conditions: (1) a neutral condition, (2) lateral and (3) medial offset along the medio-lateral foot axis, (4) anterior and (5) posterior offset along the antero-posterior foot axis, and (6) a dorsi-flexion and (7) plantar-flexion condition. Changes in the magnitude and the early stance-phase impulse of the GRF components across COP conditions were observed. Linear models were used to describe relationships between COP conditions and GRF magnitude and impulse. ResultsWith respect to ANOVA, the vertical and antero-posterior components of the GRF were significantly influenced by the COP configuration throughout the different stages of the stance-phase, whereas the medio-lateral components were not. The models of vertical, antero-posterior and medio-lateral GRF components were statistically significant. SignificanceThe study results are valuable for the development of a method and means for efficient treatment of foot and lower-limb pathologies. The ability to predict and control the GRF components along three orthogonal axes, for a given COP location, provides a strong tool for efficient treatment of foot and lower-limb diseases and may also have relevant implications in sports shoe design. This study is a preliminary investigation for our ultimate goal to develop an effective treatment method by developing an autonomous GRF manipulations device based on closed-loop feedback.

Severe lower limb cellulitis: defining the epidemiology and risk factors for primary episodes in a population-based case-control study

ObjectiveTo describe the epidemiology and risk factors for primary episodes of severe lower leg cellulitis (LLC). MethodsThis was a longitudinal cohort study using state-wide data linkage of adults presenting to Western Australian (WA) hospitals with a first ever LLC from January 2002 to December 2013. The study aimed at determining risk factors, medical records from the index patient, together with comparable data from controls matched by age, sex, postcode, and month of admission. ResultsDuring the period, 36 276 patients presented with their first episode of LLC. The incidence increased by 4.7% per annum, reaching 204.8 (95% CI 198.6–211.1) per 100 000 population by December 2013. Analysis of 29 062 case-control pairs showed several conditions with lower limb pathology were independently associated with LLC, including varicose veins (AOR 2.95, 95% CI 2.50–3.48, p < 0.001), lymphoedema (AOR 2.65, 95% CI 1.71–4.10, p < 0.001), tinea pedis (AOR 3.05, 95% CI 1.45–6.42, p 0.003), and saphenous vein harvest during coronary artery bypass grafting (AOR 1.74, 95% CI 1.32–2.30, p < 0.001). Also associated with LLC was obesity (AOR 2.05, 95% CI 1.82–2.31, p < 0.001), renal disease (AOR 1.28, 95% CI 1.14–1.44, p < 0.001), rheumatologic conditions (AOR 2.12, 95% CI 1.72–2.60, p < 0.001), hemiplegia/paraplegia (AOR 1.31, 95% CI 1.13–1.52, p < 0.001), and liver disease (AOR 1.77, 95% CI 1.51–2.06, p < 0.001). ConclusionsLLC presents a major burden to the health sector and is increasing with an ageing population. Given the high rates of recurrence, long-term morbidity, and economic impact, efforts to reduce primary episodes should be incorporated into the infectious diseases and healthy ageing research agenda.

Effectiveness of Eccentric Exercise and a Vibration or Cryotherapy Program in Enhancing Rectus Abdominis Muscle Thickness and Inter-Rectus Distance in Patients with Chronic Mid-Portion Achilles Tendinopathy: A Randomized Clinical Trial.

Purpose: Abdominal muscles are key in maintaining body stability and balance and an improvement in the functioning of these muscles could influence the rehabilitation process in lower limb pathologies such as Achilles Tendinopathy (AT). The aim was to explore whether calf eccentric exercise (EE) with vibration training was more effective at causing adaptation to the rectus anterior (RA) thickness and inter-rectus distance (IRD) than calf EE with cryotherapy.Methods: The investigation was a single-blinded, randomized, controlled clinical trial (NCT03515148). Sixty-one individuals diagnosed with mid-portion AT were recruited and divided in two groups: group A (n = 30) followed an EE with vibration program and group B (n = 31) an EE program with cryotherapy, for 12-weeks. RA muscle thickness and IRD were measured in maximal isometric contraction and at rest as an indication of superficial abdominal muscle activation.Results: IRD measures showed a significant (P < 0.05) decrease at baseline, 4 and at 12-weeks in both groups, but no significant differences were observed between the intervention groups. RA thickness was significantly increased (P < 0.05) in measures at baseline, 4 and 12-weeks showed a significant increase in maximal isometric contraction and at rest in favor of the EE vibration program group.Conclusions: The present study showed a RA thickness increase in both groups in favor of the EE vibration program with respect to cryotherapy added to EE in short and mid term in maximal isometric contraction and at rest in subjects with chronic mid-portion AT. IRD was decreased in both groups without between-groups differences.

Within/between-session reliability and agreement of lumbopelvic kinematics in the sagittal plane during functional movement control tasks in healthy persons

A lack of adequate lumbopelvic movement control has been suggested as an underlying mechanism contributing to the development and persistence of low back pain and lower limb pathologies. The purpose of this study was to assess the within and between session reliability (i.e. the ability to discriminate between subjects), and the agreement (i.e. whether scores are identical on repeated measures) of lumbopelvic kinematics in the sagittal plane during functional movement control tasks. Kinematics were measured with a portable inertial measurement unit system. Twenty healthy subjects (mean age = 22 (±3.6) years, 15 females) performed four tasks on two occasions, five to seven days apart: standing bow (SB), lifting a box from the floor (LIFT), stance-to-sit-to-stance (SIT) and placing a box on an overhead shelf (OVERH). Participants were asked to keep the lumbar spine in a neutral lordosis during the tasks. The maximal deviations from the neutral starting position for the lumbar spine and hip were calculated. Intraclass correlations (ICCs), standard errors of measurement (SEM), minimal detectable changes and 95% limits of agreement were used to assess reliability and agreement. SB and LIFT were substantially reliable (ICC = 0.89–0.96), SIT was moderately to substantially reliable (ICC = 0.69–0.92) and OVERH was fairly to moderately reliable (ICC = 0.40–0.67). SEMs ranged between 1.1° and 3.1° for the lumbar spine and between 0.7° and 4.8° for the hip. Based on the substantial reliability and acceptable agreement, SB and LIFT are most appropriate to quantify lumbopelvic movement control during functional tasks.

Movement coordination patterns between the foot joints during walking

BackgroundIn 3D gait analysis, kinematics of the foot joints are usually reported via isolated time histories of joint rotations and no information is provided on the relationship between rotations at different joints. The aim of this study was to identify movement coordination patterns in the foot during walking by expanding an existing vector coding technique according to an established multi-segment foot and ankle model. A graphical representation is also described to summarise the coordination patterns of joint rotations across multiple patients.MethodsThree-dimensional multi-segment foot kinematics were recorded in 13 adults during walking. A modified vector coding technique was used to identify coordination patterns between foot joints involving calcaneus, midfoot, metatarsus and hallux segments. According to the type and direction of joints rotations, these were classified as in-phase (same direction), anti-phase (opposite directions), proximal or distal joint dominant.ResultsIn early stance, 51 to 75% of walking trials showed proximal-phase coordination between foot joints comprising the calcaneus, midfoot and metatarsus. In-phase coordination was more prominent in late stance, reflecting synergy in the simultaneous inversion occurring at multiple foot joints. Conversely, a distal-phase coordination pattern was identified for sagittal plane motion of the ankle relative to the midtarsal joint, highlighting the critical role of arch shortening to locomotor function in push-off.ConclusionsThis study has identified coordination patterns between movement of the calcaneus, midfoot, metatarsus and hallux by expanding an existing vector cording technique for assessing and classifying coordination patterns of foot joints rotations during walking. This approach provides a different perspective in the analysis of multi-segment foot kinematics, and may be used for the objective quantification of the alterations in foot joint coordination patterns due to lower limb pathologies or following injuries.