Normal Dorsiflexion Research Articles

Effect of different custom-made foot orthotics on foot joint stiffness in individuals with structural hallux limitus: A quasi-experimental study.

Normal dorsiflexion of the first metatarsophalangeal joint during dynamic activities is critical for effective propulsion. Therapeutic foot orthotics may address the pathomechanical loading and joint kinematics issues faced by this population. This study aims to evaluate the effect of two different types of Custom-made foot orthosis compared to shod condition on the stiffness of the rearfoot, midfoot, and 1st metatarsophalangeal joint during walking in patients with Structural Hallux Limitus. This quasi-experimental study used a repeated-measures design with a single cohort. 24 participants with structural hallux limitus were sampled. Two custom-made Foot Orthotics - a cut-out and an anterior forefoot stabiliser element - were compared under three conditions using minimalist SAGURO neoprene shoes: shod, shod with cut-out custom-made foot orthosis, and shod with anterior forefoot stabiliser element foot orthosis. Kinematic data were captured using a modified Bruening model. We examined the variable stiffness (quantified in Nm/Kg/rad). Significant differences were found in dynamic stiffness only between Anterior forefoot stabiliser element custom-made foot orthosis, and the patient shod during the propulsion phase at the 1st Metatarsophalangeal joint (R2=0,07 p=0.027) and a difference of 0,86Nm/kg/rad. No significant differences were observed for dynamic stiffness in any other phase of the stance period across all conditions. The Anterior forefoot stabiliser element, in particular, significantly increases the stiffness of the 1st Metatarsophalangeal joint compared to walking shod.

The Relationship of Obesity with Range Of Motion (ROM) On The Ankle

Introduction. Obesity is weight gain beyond the limits of physical and skeletal needs due to excessive accumulation of body fat that may increase risk factors for musculoskeletal disorders. A musculoskeletal disorder that can occur is a limited range of motion of a joint. This study aimed to identify the relationship between obesity and ankle range of motion (ROM). Methods. This study was conducted using an analytical observational study with an overall sample of 311 students who met the inclusion criteria. The sample for this study was students’ class of the Muhammadiyah Palembang's School of Medicine from 2018 to 2020 and was extracted using the total extraction method. The population of this study is Palembang students. Results. The study found that 238 students (76.5%) were not obese and 65 students (20.9%) were obese. Among obese college students, 51 college students (69.9%) had normal dorsiflexion ROM and 22 college students (30.1%) had abnormal dorsiflexion ROM. Obese students had normal plantarflexion ROM in her 20 students (27.4%) and students with abnormal plantarflexion ROM in her 53 students (72.6%). 195 students (81.9%) had normal dorsiflexion ROM and 43 students (49.7%) had abnormal dorsiflexion ROM. 185 students (77.7%) had normal plantarflexion ROM and 53 students (22.3%) had abnormal plantarflexion ROM. Conclusion. Suggesting an association between obesity and the Range of Motion (ROM) in the ankle joint.

Foot kinematics and leg muscle activation patterns are altered in those with limited ankle dorsiflexion range of motion during incline walking

BackgroundLarger ankle dorsiflexion (DF) is required when walking on inclined surfaces. Individuals with limited DF range of motion (ROM) may experience greater tissue stress on sloped surfaces and walk in altered gait patterns compared to the those with normal DF ROM. Research questionWould the individuals with limited DF ROM walk with distinctive ankle DF patterns compared to those with normal DF ROM on the inclined surfaces? MethodsTen Limited DF ROM (passive ROM=35.3 ± 2.7°) and nine Normal DF ROM (passive ROM=46.4 ± 4.2°) participants walked on a treadmill at five slope angles (0°, 5°, 10°, 15°, 20°) for 2 min at a self-selected speed. The peak DF angles and the peak myoelectric activity levels of the tibialis anterior (TA) and soleus (SOL) muscles were quantified during the swing and stance phases of each walking trial, and they were compared between the two groups. ResultsParticipants with limited DF ROM walked with smaller peak DF (3.1° at 0° slope ~ 8.4° at 20° slope) and greater peak TA activity in swing than those of the Normal ROM participants (3.4° ~ 12.2°), with significant differences at 20° slope. The peak DF angle in stance (Limited: 9.6° ~ 19.0°; Normal: 10.1° ~ 21.0°) did not differ between the two groups at all slopes, but the peak activity of the SOL muscle was significantly greater for the Limited group at slopes of 10° and higher. SignificanceStudy results indicate that incline walking could be more challenging to the individuals with limited DF ROM as they need to approach and push-off the sloped surfaces with more efforts of the dorsiflexor and the plantar flexor muscles, respectively. Prolonged walking on inclined surfaces may produce faster development of muscle fatigue or tissue damage than those with normal DF ROM.

The Effect of Calf Stiffness on Gait, Foot Pressure and Balance in Adults

Purpose: The purpose of this study was to investigate the effects of calf tightness on gait, plantar pressure, and balance in adults. Methods: A total of 60 participants were divided into a normal group of 30 subjects with normal dorsiflexion angle (20-25 degrees) and an experimental group of 30 subjects with limited dorsiflexion angle (0-15 degrees) due to calf tightness. Gait ability and foot pressure of the subjects was measured with a treadmill, and the balance ability was measured by PROKIN system. Results: A significant difference in COP length, loading response, and single limb support was observed between groups. The COP length and single limb support ratio in the normal group was greater than in the experimental group, but the experimental group showed a higher ratio for loading response in the gait ratio. Conclusion: Our results indicated that calf tightness was negative effects on balance and gait ability, so assessment of the muscle tight ­ness should be considered during exercise and treatment.

Metatarsophalangeal joint flexion affects dorsiflexor activity in subjects with a dominant extensor hallucis longus.

Normal dorsiflexion (DF) required for normal gait is achieved through balance of the tibialis anterior (TA) and extensor hallucis longus (EHL). Imbalance may induce ankle and foot deformities and exacerbate pathology. EHL dominance is associated with progressive TA weakness, attributable to muscle non-use. When the EHL dominantly dorsiflexes the ankle, the big toe extends at the metatarsophalangeal joint (MTPJ) and pure ankle DF is absent. The effects of active MTPJ flexion on TA and EHL muscles, TA/EHL ratio, and the force applied during active DF in EHL-dominant (EHL-D) and EHL-non-dominant (EHL-ND) subjects were compared. The 38 subjects were divided into EHL-D and EHL-ND groups. All subjects performed active ankle DF with and without active MTPJ flexion. Surface electromyographic data, ankle active range of motion, and DF force were measured. Two-way mixed analysis of variance was used to evaluate differences in dependent variables. Compared to the EHL-ND group, the EHL-D group exhibited less TA activity, more EHL activity, and a reduced TA/EHL activity ratio. Active application of MTPJ flexion during DF significantly reduced muscle imbalance, whereas EHL activity decreased and the TA/EHL activity ratio increased. The DF force decreased significantly with MTPJ flexion in both groups. Active MTPJ flexion can reduce EHL and/or increase TA activity and increase the TA/EHL activity ratio during active ankle DF in both EHL-D and EHL-ND subjects.

Catapult splint: A foot dorsiflexion assist splint

Loss of dorsiflexion is a common problem in cases where an external fixator or Ilizarov assembly is applied. It results in functional impairment of the foot by affecting the swing phase of gait cycle. We devised a simple dynamic dorsiflexion assist splint for prevention, correction of equinus/cavus deformity and maintenance of normal dorsiflexion of foot. This prospective study used a rubber splint styled in the shape of a catapult, made of discarded car rubber tubes attached to the frame of fixator in 50 patients. In 17 patients there was varying amount of loss of dorsiflexion at the time of application of splint while in 22 patients it was applied soon after the application of the fixator. In the rest of patients it was applied for cavus deformity. Out of 17 patients 10 had complete recovery of dorsiflexion. 22 patients in whom it was applied at the outset had normal range of movement at ankle. Correction was achieved in all 6 cases of cavus deformity and prevented its occurrence in the rest of 5 cases. Catapult splint is a low cost foot dorsiflexion assist splint.

Kinematic and Kinetic Evaluation of the Ankle Joint Before and After Tendo Achilles Lengthening in Patients With Spastic Diplegia

Fourteen patients, at a mean age of 9.1 years (range 4.1-16.6 years), who had spastic diplegic cerebral palsy were evaluated before and after tendo Achilles lengthening (TAL). Follow-up (by gait analysis) after TAL ranged from 8 to 30 months. A Vicon motion analysis system with six CCD cameras and two AMTI force plates provided three-dimensional measurements of joint motion and moments. The TAL procedure resulted in normal passive dorsiflexion of the ankle joint with the knee at 0 degrees of extension and 90 degrees of flexion, reduced plantarflexion during swing phase, and reduced premature plantarflexor moment. However, 10 degrees greater than normal dorsiflexion of the ankle joint during mid-stance phase was indicative of a mild calcaneal gait pattern. The TAL procedure improved lower extremity function as documented by both kinematic and kinetic analysis in cerebral palsy.

A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy

This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.

A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy

This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.

Kinematic and kinetic analysis of the walking pattern in hemiplegic patients with foot-drop using a peroneal nerve stimulator

Objective. To analyze the walking pattern in hemiplegic patients using a peroneal nerve stimulator to locate possible harmful mechanical effects on the musculo-skeletal system. Design. Eight hemiplegic patients participated in the study. All patients had used a peroneal nerve stimulator regularly for more than two years and were able to perform unassisted walking. Background. Peroneal nerve stimulators are widely applied for correction of foot-drop in hemiplegic patients. The stimulators do not induce normal dorsi-flexion, but a rather exaggerated dorsi-flexion and eventually eversion which might be harmful. Methods. Three-dimensional kinematic and kinetic analyses of the walking patterns at self-selected speeds were performed with the patients walking without the stimulator and with the stimulator turned on. Results. The walking speed increased on average from 0.77 (S.D., 0.83) to 0.84 (S.D., 0.11) (7.6%, P=0.005) when the stimulator was used, however no uniform changes in the walking pattern and joint loads were observed. The total work (generation + absorption) produced by the affected leg (both with and without the peroneal nerve stimulator) was significantly lower ( P=0.005) than that of the contralateral leg. Deviations from normal power profiles were observed both on the affected and the contralateral side, and the walking efficiency was 57% lower compared to normal subjects. The estimated peak bone-on-bone forces corresponded to about 50% of what previously has been observed during normal walking at self-selected speed. Conclusions. The use of the peroneal nerve stimulator do not introduce any excessive and potential harmful mechanical loads. Relevance Applied correctly, the peroneal nerve stimulator can be used as an aid for foot-drop correction in hemiplegic patients without causing excessive wear on the joints in the lower extremity.

Comparison of gait with and without shoes in children

This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.

The “entlastungsgang”

This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.

Deformity and Disability From Treated Clubfoot

To identify disability associated with treated unilateral, idiopathic clubfoot deformity, 29 patients and 23 controls were compared by morphometry, radiography, and performance testing. The average period following definitive treatment was greater than 10 years. Treatment regimens varied from prolonged casting to early posteromedial release. The most significant limitations in these treated clubfeet averaged (a) a 42% decrease in normal ankle motion, specifically lacking 65% of normal dorsiflexion, a consistent finding independent of treatment; (b) a 24% decrease in normal plantarflexor muscle strength, correlating directly to the number of heelcord lengthenings per foot; and (c) a noticeable 10% decrease in calf girth, unrelated to total time spent in cast.

Equinus Deformity in the Athlete

In brief: Equinus is a deformity in which the foot is plantarflexed either on itself or on the leg. Gastrocnemius and/or soleus equinus can be caused by either an acquired or congenitally short triceps surae. Acquired equinus involves a reduction in the length of the soleus, gastrocnemius, or both. Congenital equinus occurs when the anatomical length is insufficient to allow normal dorsiflexion. Conservative treatment consists of stretching and strengthening exercises, orthotic therapy, heel lifts, shoe modifications, and training recommendations.