Transverse Plane Range Of Motion Research Articles

Foot biomechanics in patients with advanced subtalar- and mid-tarsal joint osteoarthritis and poorly responding to conservative treatment

BackgroundA comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb’s biomechanical characteristics during walking is lacking. Our goal was to assess joint kinematics and kinetics and compensatory mechanisms in patients with subtalar and mid-tarsal joint osteoarthritis.MethodsPatients with symptomatic and radiographically confirmed osteoarthritis of the subtalar and mid-tarsal (n = 10) and an asymptomatic control group (n = 10) were compared. Foot joint kinematics and kinetics during the stance phase of walking were quantified using a four-segment foot model.ResultsDuring pre-swing phase, the tibio-talar range of motion in the sagittal plane of the patient group decreased significantly (P = 0.001), whereas the tarso-metatarsal joint range of motion in the sagittal plane was greater in the pre-swing phase (P = 0.003). The mid-tarsal joint showed lower transverse plane range of motion in the patient group during the loading response and pre-swing phase (P < 0.001 resp. P = 0.002). The patient group showed a lower Tibio-talar joint peak plantarflexion moment (P = 0.004), peak plantarflexion velocity (P < 0.001) and peak power generation in the sagittal plane (P < 0.001), and a lower mid-tarsal joint peak adduction and abduction velocity (P < 0.001 resp. P < 0.001) and peak power absorption (P < 0.001).ConclusionsThese findings suggest that patients with subtalar and mid-tarsal joint osteoarthritis adopt a cautious walking strategy potentially dictated by pain, muscle weakness, kinesiophobia and stiffness. Since this poorly responding population faces surgical intervention on the short term, we recommend careful follow-up after fusion surgery since biomechanical outcome measures associated to this post-surgical stage is lacking.

Exploring effects of cryotherapy modalities on pain, muscle strength and joint position sense in healthy participants with induced knee pain

Keywords: Cryotherapy; Compression; Rehabilitation Purpose: In the current guidelines for acute injury management ‘optimal loading’ has been introduced to facilitate early activity to optimise recovery. Although studies have identified potential adverse effects on muscle performance and knee joint repositioning following ice, evidence supports the use of cryotherapy to provide short-term pain relief. Cryotherapy interventions which can provide short-term pain relief, yet minimise adverse effects, would allow early activity with a lower risk of injury. This study utilised a targeted compressive-cryotherapy approach on experimentally induced knee pain in healthy participants and explored the effects on muscle strength and joint position sense. Methods: 10 healthy participants (7 females, 3 males; 32.9 ± 11.6 years) were induced with experimental knee pain using capsaicin cream (0.075%). Topical capsaicin is a common experimental pain method and was applied to the participant's skin on the medial aspect of the non-dominant knee. A randomised crossover design was adopted, exploring two 20-minute cryotherapy interventions, (1) ice (wetted: 400 g cubed ice, 400 ml water) and (2) Swellaway (10 °C, 50 mmHg compression), during separate testing sessions. Four outcome measures were explored: (i) participant-reported numerical pain rating scale (NPRS), (ii) pressure pain threshold (PPT), (iii) quadriceps muscle strength and (iv) joint position sense (JPS). These outcomes were recorded at four time points: pre-capsaicin cream application (T1), post-capsaicin (T2), post-cooling intervention (T3) and 20-minutes post-cooling (T4). Repeated measures ANOVAs (3 × 2) with post-hoc pairwise comparisons were used to assess change in outcomes between time points. Results: Complete pain relief (≥93% pain reduction) was achieved immediately post-cooling in 7 participants for Swellaway and in 4 participants for ice. Participant NPRS was reduced by 100% (Swellaway) and 91% (ice) 20-minutes post-cooling. No statistically significant differences were found in short-term pain relief between interventions. Significant increases in PPT were found between post-capsaicin and post-cooling (27% increase) and between post-capsaicin and 20-minutes post-cooling (20% increase) following Swellaway. No significant differences were found in PPT between any time points following ice. Ice reduced quadriceps strength by 13% immediately post-cooling. Swellaway had a negligible effect on muscle strength immediately post-cooling (+0.3%). The strength deficit post ice was almost double the percentage reduction (6%) associated with clinically important functional deficits in people with knee osteoarthritis. Significant increases were found in range of motion (ROM) in the coronal plane following ice, which indicates increased instability (adduction/abduction). Despite not being statistically significant, a trend of increased instability (14%) in the transverse plane ROM 20-minutes post-cooling was most apparent following the ice (P = 0.053). Conclusion(s): Targeted compressive-cryotherapy has the potential to achieve short-term pain relief, as demonstrated on healthy participants with experimentally induced knee pain. The results suggest a targeted approach can also minimise the negative effects on muscle strength, dynamic stability and knee joint repositioning, which may traditionally have discouraged early optimal loading post cryotherapy. This would allow individuals to return to weight-bearing rehabilitation exercises earlier, at a lower risk of re-injury post-intervention. Impact: Clinicians could consider utilising targeted compressive-cryotherapy to provide a short-term pain relief and minimise the reported adverse effects following cryotherapy, facilitating early weight-bearing rehabilitation. Funding acknowledgements: This research was carried out as part of a Knowledge Transfer Partnership between Manchester Metropolitan University, University of Central Lancashire and Swellaway.

The Effects of Knee Orthosis with Two Degrees of Freedom Joint Design on Gait and Sit-to-Stand Task in Patients with Medial Knee Osteoarthritis.

ObjectivesKnee bracing as a conservative treatment option for patients with medial knee osteoarthritis (KOA) is of great interest to health practitioners and patients alike. Optimal orthotic knee joint structure is essential to achieve biomechanical and clinical effectiveness. Therefore, this study aimed to identify the effects of a knee orthosis with a new two-degrees-of-freedom (DOF) joint design on selected gait parameters and in a sit-to-stand task in patients with mild-to-moderate medial KOA.MethodsThis study was conducted both at the Physical Medicine and Rehabilitation Clinic in Shahid Modarres Academic Hospital and the Biomechanical Laboratory of Rehabilitation Faculty of Iran University of medical Sciences in Tehran, Iran from September 2015 to October 2017. The gait performance of 16 patients was assessed without an orthosis, using a common one-DOF (DOF) knee orthosis and using the same knee orthosis with a two-DOF orthotic joint design. The interactive shearing force between limb and brace in the shell area during a sit-to-stand test was also identified. Repeated measures analysis of variance was used to analyse the data.ResultsCompared with walking with no orthosis, both orthosis conditions reduced the external knee adduction moment significantly (P ≤0.05). A significant increase between the one-DOF and two-DOF conditions in terms of walking speed (P = 0.041 and P = 0.009, respectively) and stride length (P = 0.028 and P = 0.038, respectively) was observed. In a sit-to-stand test, wearing the orthosis significantly decreased knee transverse plane range of motion (P ≤0.05). There was a 41.31 ± 8.34 Newtons reduction in knee flexion constraint force.ConclusionThe two-DOF knee orthosis was more comfortable compared to the one-DOF knee orthosis during deep knee flexion. Otherwise, the one-DOF- and two-DOF-braces performed similarly.

Pelvis and Trunk Motion Comparisons Between Male and Female Soldiers While Walking With Heavy Loads

With the recent decision permitting female soldiers to enter Combat Arms roles, knowledge of sex differences in military load carriage is more operationally relevant. Limited work comparing the effect of heavy carried loads (>30 kg) in men and women has attributed differences in gait mechanics to sex without matching for anthropometrics that may contribute to differences. PURPOSE: To examine the effect of carrying light to heavy loads on pelvis and trunk range of motion (ROM) between anthropometrically matched male and female soldiers. METHODS: Four male and 4 female Soldiers were matched on height and body weight (differences < 2.54 cm and 4.54 kg). All participants walked unloaded (BW), and with vest-borne loads of 15, 35 and 55 kg. Each load was carried for 10 min while walking on a level treadmill at 1.3 m∙s-1, with pelvis and trunk segmental angles collected after 5 min. Four mixed model ANOVAs (sex x load) compared trunk and pelvis frontal and transverse plane ROM. RESULTS: There were sex x load interactions for trunk transverse and frontal plane motion (Table 1). Specifically, as load increased: (A) trunk axial rotation decreased more in females than males (p=0.037), and (B) trunk frontal plane motion increased for males and remained relatively constant for females (p=0.034). Pelvis frontal plane ROM also increased at 55 kg in both sexes relative to carrying no additional load. CONCLUSIONS: Despite anthropometric matching, preliminary results suggest sex-related differences in trunk frontal plane motion while carrying loads ≥ 35 kg and no sex-related differences in pelvis motion. DISCLAIMER: The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government.Table 1: Pelvis and Trunk Frontal (Y) and Transverse (Z) plane ranges of motion for different loads among male and female soldier

Multi-segment spine range of motion in dancers with and without recent low back pain

BackgroundAltered spine kinematics are a common in people with LBP. This may be especially true for populations such as dancers, who are required to perform repetitive movements of the spine, although this remains unclear. Research questionDo dancers with recent LBP display altered spine kinematics compared to their asymptomatic counterparts? MethodsA cross-sectional study of multi-segment spine kinematics was performed. Forty-seven pre-professional and professional female dancers either with LBP in the past two months (n = 26) or no LBP in the past 12 months (n = 21) participated. Range of motion (ROM) during standing side bending, seated rotation, and walking gait were compared. ResultsFemale dancers with LBP displayed reduced upper lumbar transverse plane ROM in seated rotation (Effect Size (ES)= −0.61, 95% Confidence Interval (CI): −1.20, 0.02, p = 0.04), as well as reduced lower lumbar transverse plane ROM (ES=−0.65, 95% CI: −1.24, −0.06, p = 0.03) in gait. However, there was increased lower thoracic transverse plane ROM (ES = 0.62, 95% CI: 0.04, 1.21, p = 0.04) during gait. No differences in the frontal plane were observed. SignificanceAltered transverse plane spine kinematics were evident in dancers with recent LBP for select segments and tasks. This may reflect a protective movement strategy. However, as the effect sizes of observed differences were moderate, and the total number of differences between groups was small, collectively, it seems only subtle differences in spine kinematics differentiate dancers with LBP to dancers without.

Self-reported sinus headaches are associated with neck pain and cervical musculoskeletal dysfunction: a preliminary observational case control study

ABSTRACTObjectives: Headaches can be associated with rhinosinusitis and may present a diagnostic challenge because of symptomatic overlap with other recurring headaches. Neck pain has received extensive attention in migraine, tension-type and cervicogenic headache but not as a comorbid feature of headache in those with rhinosinusitis. This study investigated the occurrence of neck pain and cervical musculoskeletal dysfunction in individuals with self-reported sinus headaches (SRSH).Methods: Participants with and without SRSH attended a single data collection session. Participants completed the Headache Impact Test (HIT)-6 and the Sino-Nasal Outcome Test (SNOT)-22. Cervical range of motion (ROM), segmental examination, muscle endurance and pressure-pain threshold (PPT) were measured .Results: Participants included 31 with SRSH (77.4% female; age 43.7 (9.9) years) and 30 without headache. Average symptom duration was 89.7 (±85.6) months. Mean SNOT-22 and HIT-6 scores were 36.2 (15.3) and 56.7 (7.1), respectively. In the SRSH group, 83.9% (n = 26) reported neck pain. There was a significant difference between groups for cervical sagittal (14.3° [5.3°, 23.3°], p = 0.002) and transverse plane ROM (21.5° [12.4°, 30.6°], p < 0.001), but no difference in frontal plane motion (p = 0.017). There were significant between groups difference in neck flexor endurance (19.5 s [10.1 s, 28.9 s], <0.001), segmental dysfunction O-C4 (p < 0.001) but not in PPT (p = 0.04).Discussion: Neck pain and cervical musculoskeletal dysfunction are common among persons with SRSH and may be a comorbid feature or contributing factor to headaches attributed to rhinosinusitis. Further research is needed to understand these associations.

Multi-segment spine kinematics: Relationship with dance training and low back pain

BackgroundSpine posture, range of motion (ROM) and movement asymmetry can contribute to low back pain (LBP). These variables may have greater impact in populations required to perform repetitive spine movements, such as dancers; however, there is limited evidence to support this. Research questionWhat is the influence of dance and LBP on spinal kinematics? MethodsIn this cross-sectional study, multi-segment spinal kinematics were examined in 60 female participants, including dancers (n = 21) and non-dancers (n = 39) with LBP (n = 33) and without LBP (n = 27). A nine-camera motion analysis system sampling at 100 Hz was used to assess standing posture, as well as ROM and movement asymmetry for side bend and trunk rotation tasks. A two-way ANOVA was performed for each of the outcome variables to detect any differences between dancers and non-dancers, or individuals with and without LBP. ResultsCompared to non-dancers, dancers displayed a flatter upper lumbar angle when standing (p < 0.01, ηp2 = 0.15), and achieved greater frontal plane ROM for the upper lumbar (p = 0.04, ηp2 = 0.08) and lower thoracic (p = 0.02, ηp2 = 0.09) segments. There were no differences between dancers and non-dancers for transverse plane ROM (p > 0.05) or movement asymmetry (p > 0.05). There was no main effect for LBP symptoms on any kinematic measures, and no interaction effect for dance group and LBP on spinal kinematics (p > 0.05). SignificanceFemale dancers displayed a flatter spine posture and increased spine ROM compared to non-dancers for a select number of spine segments and movement tasks. However, the overall number of differences was small, and no relationship was observed between LBP and spinal kinematics. This suggests that these simple, static posture, ROM, and asymmetry measures often used in clinical practice can provide only limited generalisable information about the impact of dance or LBP on spinal kinematics.

P 170– Effect of sensorimotor foot orthoses on kinematics of knee

1. Introduction Sensorimotor foot orthoses (FO) is concept that is reported to deliver both mechanical effect and influence muscle function [1]. This concept has not yet been fully scientifically explored. In this study we focused on the effect of two types of FO on knee kinematics. 2. Research question What are the effects of sensorimotor FO on knee kinematics? 3. Methods Eleven healthy subjects (7 males, 4 females, mean age 23.0 ± 3.3) were tested under three conditions: a) no FO, b) FO with retrocapital pad attached behind second to fifth metatarsal with elevation to medial side (RM), c) FO with an elevation to lateral side (RL). All measurements were conducted whilst wearing the same type of shoes (ProTouch Drop Shot). Eight trials were recorded for each condition using a Vicon MX system (200 Hz), with a 5 min initial familiarization and “wash out” period between conditions. A Repeated Measures ANOVA with post hoc pairwise comparison using the least significance difference method was used to explore the differences between conditions, with the significance level 0.05. The dependent variables were knee flexion at heel strike (HS), the first peak of knee flexion and sagittal plane range of motion (ROM), transverse plane knee rotation at (HS), peak knee internal rotation during midstance and ROM in transverse plane. 4. Results In sagittal plane, there was a significant difference at the first peak knee flexion (p = 0.03; ηp² = 0.297). Further pairwise comparisons revealed that both RM and RL increased flexion, RL significantly (p = 0.11) by 0.936 degrees (std. error = 0.302). In the transverse plane there were significant differences in peak knee internal rotation (p = 0.037; ηp² = 0.280) and ROM between HS and peak knee internal rotation during midstance (p = 0.004; ηp² = 0.427). Further pairwise comparisons revealed that both RL and RM increased the peak internal rotation, RL significantly by 3.1 degrees (p = 0.041), and both RL and RM significantly increased transverse plane ROM, with RM increasing ROM by 1.7 degrees and RL increasing ROM by 2.57 degrees (p = 0.01). 5. Discussion The results of this study correspond with current knowledge that links knee flexion and internal rotation, as flexion increases so does internal rotation. Our findings show that both FO affected knee rotation in the same way albeit by different amounts. This is not in agreement with their perceive function, with RL theoretically promoting external rotation and RM theoretically promoting internal rotation.

Does Total Ankle Arthroplasty Preserve Midfoot Function and Mitigate Excessive Adjacent Joint Loading?

Category: Ankle Arthritis Introduction/Purpose: The progressive decline of ankle motion secondary to ankle arthritis increases midfoot joint loading during forward propulsive activities. Preservation or improvement of ankle motion following total ankle arthroplasty (TAA) is theorized to preserve adjacent joint function and potentially mitigate the cumulative effect of midfoot joint loading. If this theory were sound, the biomechanical profile of midfoot function would not change following TAA. Examination of this theory may inform TAA operative care and will directly impact postoperative rehabilitation paradigms. The purpose of this ongoing study was to be the first to prospectively evaluate the effect of TAA on midfoot function during walking, as measured by midfoot range of motion and power, at six month follow up. Methods: Nine adults [Mean (SD): Age 60.2 (3.5) years; BMI 30.4 (1.4) Kg/m2; 100% male] who received a TAA for end-stage ankle arthritis walked barefoot on level ground preoperatively and six months postoperatively. Three dimensional motion analysis was used to record three-segment foot motion (forefoot, rearfoot, tibia) and ground reaction forces. Midfoot (forefoot with respect to rearfoot) sagittal and transverse plane range of motion were measured. Inverse dynamic calculations were used to obtain midfoot negative (absorption) and positive (generation) peak power (joint torque x segmental velocity), since these metrics are biomechanical correlates of midfoot instability and stability, respectively. Accordingly, greater midfoot joint loading would be characterized by increased power absorption. Greater power generation would indicate an increased midfoot contribution to forward propulsion. Paired t-tests were used to evaluate differences across time in the involved limb and between limbs postoperatively for power variables. Results: Midfoot dorsiflexion / plantarflexion and abduction / adduction range of motion were not significantly different pre to postoperatively (mean differences &lt; 0.4 degrees; both p &gt; 0.7). Similarly, involved limb midfoot negative and positive power did not change (mean differences &lt; 0.1 W/Kg; negative power p = 0.1; positive power p = 1.0). Postoperatively, negative power was minimally different between sides (mean difference 0.1 W/Kg; p = 0.4). However, involved limb midfoot positive power was 44% less than the uninvolved limb postoperatively (mean difference 0.3 W/Kg; p = 0.1) (Figure 1). Conclusion: Study findings provide preliminary substantiation to the theory that midfoot function is preserved following TAA. At six months, the biomechanical profile of individuals receiving TAA for end-stage ankle arthritis was not different from preoperative measures. Further, since postoperative power absorption was similar between limbs, the current TAA operative approach may help mitigate midfoot joint loading. However, the asymmetrical power generation (44% less on the involved limb) suggests the midfoot is unprepared to respond to anticipated ankle power improvements as patients advance to higher level activities. Accordingly, rehabilitation targeting midfoot stability through strengthening is recommended to complement current postoperative efforts.

Asymmetrical trunk movement during walking improved to normal range at 3months after corrective posterior spinal fusion in adolescent idiopathic scoliosis.

To investigate the effects of posterior spinal fusion (PSF) and curve type on upper body movements in Adolescent Idiopathic Scoliosis (AIS) patients during gait. Twenty-four girls (12-18years) with AIS underwent PSF. 3D-Gait-analyses were performed preoperatively, at 3months and 1year postoperatively. Mean position (0° represents symmetry) and range of motion (ROM) of the trunk (thorax-relative-to-pelvis) in all planes were assessed. Lower body kinematics and spatiotemporal parameters were also evaluated. Mean trunk position improved from 7.0° to 2.9° in transversal plane and from 5.0° to - 0.8° in frontal plane at 3months postoperative (p<0.001), and was maintained at 1year. Trunk ROM in transverse plane decreased from 9.6° to 7.5° (p<0.001) after surgery. No effects of PSF were observed on the lower body kinematics during the gait cycle. Patients with a double curve had a more axial rotated trunk before and after surgery (p=0.013). In AIS patients, during gait an evident asymmetrical position of the trunk improved to an almost symmetric situation already 3months after PSF and was maintained at 1year. Despite a reduction of trunk ROM, patients were able to maintain the same walking pattern in the lower extremities after surgery. This improvement of symmetry and maintenance of normal gait can explain the rapid recovery and well functioning in daily life of AIS patients, despite undergoing a fusion of large parts of their spine.

Effects of hip joint transverse plane range of motion with a modeled effusion and capsular tear: A cadaveric study

BackgroundMultiple factors contribute to range of motion of the hip joint in the transverse plane: bony anatomy, hip capsule, corresponding ligaments, articular labrum, ligamentum teres, and negative intra-articular pressure. We hypothesized that violation of the negative pressure of the hip and simulation of an effusion would increase range of motion in the transverse plane in a cadaver model. MethodsTen hip specimens were obtained and dissected with the femur and iliac wing mounted in a custom joint-testing rig in neutral position. Specimens were tested at 0 and at 90° of flexion with 1.5Nm internal and external rotational torque. Three conditions were assessed: (1) intact specimen, (2) an effusion modeled by a 10ml saline infusion, and (3) a capsular tear. FindingsThe modeled effusion decreased rotational range of motion limits in both 0 and 90° of flexion, with a greater effect on the specimens at 0° flexion in external rotation with 4.1° less external rotation (p=0.009). A modeled capsular tear increased rotational motion limits in 0° of flexion in both internal and external rotation and in 90° flexion in internal rotation only (p<0.025). InterpretationAn effusion may decrease the rotation of the hip, and a capsular tear may increase its rotation. This should be considered in hips with traumatic capsular tears or arthroscopic portals.

Report on the frontal and transverse plane range of motion of the hip during the “en dehors pirouette” in pre-professional dancers

Report on the frontal and transverse plane range of motion of the hip during the “en dehors pirouette” in pre-professional dancers

Hip joint motion and gluteal muscle activation differences between healthy controls and those with varying degrees of hip osteoarthritis during walking

Purpose: Compare gluteal muscle activation patterns and three-dimensional hip joint movements among those with severe hip osteoarthritis (OA), moderate OA and a healthy group during walking. Scope: 20 individuals with severe OA, 20 with moderate OA and 20 healthy individuals were recruited. Three-dimensional hip motion and surface electromyograms from gluteus maximus and medius were collected during treadmill walking at a self-selected speed. Angular displacement characteristics were calculated for three-dimensional hip motions. Principal component analysis extracted amplitude and temporal features from electromyographic waveforms. Analysis of Variance models and student t-tests using Bonferroni corrections determined between group differences in these gait features (α=0.05). Conclusions: Sagittal plane hip range of motion was significantly reduced with increasing severity of OA (p<0.05) where as frontal and transverse plane range of motion was reduced in the severe OA group only (p<0.05). Activation patterns of gluteus medius and maximus did not differ between the healthy group and those with moderate hip OA (p>0.05). Individuals with severe OA walking with more prolonged gluteus maximus activation and prolonged and less dynamic gluteus medius activation compared to the other two groups (p<0.05). This study highlights the changing function of the hip joint during walking with increasing hip OA severity.

Differences in the Association of Hip Cartilage Lesions and Cam-Type Femoroacetabular Impingement With Movement Patterns: A Preliminary Study

To investigate the differences in hip movement patterns during different daily and athletic activities in persons with cam-type femoroacetabular impingement (FAI) with and without cartilage lesions compared with control subjects in a preliminary study. Controlled laboratory study using a cross-sectional design. Research institution with a tertiary care medical center. Fifteen subjects [M:F, 13:2; age, 31.6 ± 9.7 years (range, 22-52 years); body mass index, 24.9 ± 4.6 (range, 18.8-38.4); FAI:control, 7:8]. All subjects had 3-Tesla magnetic resonance imaging of the hip and also underwent 3-dimensional motion capture during walking, deep-squat, and drop-landing tasks. Experienced radiologists graded cartilage lesions on clinical magnetic resonance images. Peak kinematic and kinetic variables were compared between subjects who did and did not have FAI, and subjects who had FAI and cartilage lesions were compared with subjects who did not have cartilage lesions. Subjects who had FAI demonstrated no significant differences for walking or drop landing compared with control subjects. However, during the deep-squat task, subjects with FAI adducted more and had a greater internal rotation moment. Subjects who had cartilage lesions in the presence of a cam lesion demonstrated (1) no difference for walking; (2) greater adduction, greater internal rotation moment, and lower transverse plane range of motion during the deep-squat task; and (3) greater adduction and lower internal rotation during the drop-landing task compared with subjects who did not have cartilage lesions. We observed differences in movement patterns between subjects who had FAI compared with control subjects. However, the differences were more pronounced between subjects with FAI who had cartilage lesions compared with subjects who did not have cartilage lesions. These findings highlight the importance of understanding the complex interplay between bony morphologic features, cartilage lesions, and movement patterns in persons with cam-type FAI.

Postural Response Latencies Are Related to Balance Control During Standing and Walking in Patients With Multiple Sclerosis

ObjectiveTo understand and examine the relation between postural response latencies obtained during postural perturbations and representative measures of balance during standing (sway variables) and walking (trunk motion). DesignCross-sectional. SettingUniversity medical center. ParticipantsPersons with multiple sclerosis (MS) (n=40) were compared with similar aged control subjects (n=20). There were 20 subjects with MS in the normal walking velocity group and 20 subjects with MS who had slow walking velocity based on a timed 25-foot walk (T25FW) of <5 seconds. InterventionsNone. Main Outcome MeasuresPostural response latency, sway variables, trunk motion variables. ResultsWe found that subjects with MS with both slow or normal walking velocities had significantly longer postural response latencies than the healthy control group. Postural response latency was not correlated with the T25FW. Postural response latency was significantly correlated with center of pressure sway variables during quiet standing (root mean square: ρ=.334, P=.04; range: ρ=.385, P=.017; mean velocity: ρ=.337, P=.038; total sway area: ρ=.393, P=.015). Postural response latency was also significantly correlated with motion of the trunk during walking (sagittal plane range of motion: ρ=.316, P=.05; SD of transverse plane range of motion: ρ=−.43, P=.006). ConclusionsThese findings clearly indicate that slow postural responses to external perturbations in patients with MS contribute to disturbances in balance control during both standing and walking.

Hindfoot Motion Following STAR Total Ankle Arthroplasty

One of the rationales for total ankle arthroplasty (TAA) is that it may retard the changes of hypermobility and accelerated arthritis in the hindfoot after ankle arthrodesis. Until recently, it has not been possible to quantify or even objectively demonstrate biomechanical findings to substantiate the theory that postsurgical biomechanical changes in the ankle produce changes in the kinematics of the hindfoot. Standard gait analysis has treated the foot as a single biomechanical unit. This study was undertaken to describe the hindfoot motion following Scandinavian Total Ankle Replacement (STAR) TAA by using multisegment foot model gait analysis. Forty-six patients with a mean age of 66 years underwent a 3D gait analysis following TAR. Mean interval between surgery and gait analysis was 4.9 years (range 2 to 9). The contralateral limb was used as control for each patient. Temporospatial variables and kinematic parameters were studied. Temporospatial results showed statistically significant differences. Stance time on the affected side was 61.1% ± 2.2% of the gait cycle compared to 63.2% ± 2.1% for the unaffected side. Step length was 55.6 cm ± 10 on the affected side compared to 53.9 cm ± 10 for the unaffected side. Kinematics results were statistically significant: Ankle range of motion (ROM) on the arthroplasty side was 16.8 ± 4.5 degrees compared to 23.6 ± 5.0 on the unaffected side. Sagittal plane ROM was 12.7 ± 4.2 degrees on the arthroplasty side and 17.3 ± 3.5 degrees on the unaffected side. Coronal plane ROM was 4.7 ± 2.4 degrees on the arthroplasty side and 7.5 ± 2.4 degrees on the unaffected side. Transverse plane ROM on the arthroplasty side was 4.1 ± 1.5 degrees and 4.9 ± 1.6 on the unaffected side. This study showed that, in addition to previously documented diminution in sagittal plane motion and gait velocity, some of the residual abnormalities of gait following TAR were comprised of differences in hindfoot function. These results relate to the growing recognition of the importance of understanding hindfoot mechanics apart from those of the tibiotalar joint. Level III, comparative case series.

Differences in tibiocalcaneal kinematics measured with skin- and shoe-mounted markers

PurposeThe aim of the current investigation was to compare the 3-D tibiocalcaneal kinematics between skin- and shoe-mounted markers.MethodsEleven male participants ran at 4.0m/s ± 5% along a 22 m runway. Tibiocalcaneal kinematics were captured simultaneously using markers placed externally on the shoe and on the skin through windows cut in the shoe. Paired t-tests were used to compare the 3-D kinematic parameters, and intraclass correlations were employed to contrast the kinematic waveforms.ResultsStrong correlations were observed between the waveforms at &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; 0.85. However, foot movements such as eversion range of motion, peak eversion, peak transverse plane range of motion, velocity of external rotation and peak eversion velocity were all significantly underestimated using shoe-mounted markers.ConclusionsThe results indicate that shoe-mounted markers do not fully represent true foot movement.

Repeatability of stance phase kinematics from a multi-segment foot model in people aged 50 years and older

Confidence in 3D multi-segment foot models has been limited by a lack of repeatability data, particularly in older populations that may display unique functional foot characteristics. This study aimed to determine the intra and inter-observer repeatability of stance phase kinematic data from a multi-segment foot model described by Leardini et al. [2] in people aged 50 years or older. Twenty healthy adults participated (mean age 65.4 years SD 8.4). A repeated measures study design was used with data collected from four testing sessions on two days from two observers. Intra (within-day and between-day) and inter-observer coefficient of multiple correlations revealed moderate to excellent similarity of stance phase joint range of motion (0.621–0.975). Relative to the joint range of motion (ROM), mean differences (MD) between sessions were highest for the within-day comparison for all planar ROM at the metatarsus-midfoot articulation (sagittal plane ROM 5.2° vs. 3.9°, MD 3.1°; coronal plane ROM 3.9 vs. 3.1°, MD 2.3°; transverse plane ROM 6.8° vs. 5.16°, MD 3.5°). Consequently, data from the metatarsus-midfoot articulation in the Istituto Ortopedico Rizzoli (IOR) foot model in adults aged over 50 years needs to be considered with respect to the findings of this study.

Dynamic foot function changes following total knee replacement surgery

BackgroundIndividuals with knee osteoarthritis (OA) have flatter/more pronated feet than those without OA, but it is unclear whether altered foot posture and function are a cause or consequence of knee OA. The purpose of this study was to examine whether changes in foot posture and function occur after realignment of the knee following total knee replacement (TKR). Materials and methodsNineteen patients with predominantly medial compartment knee OA were tested prior to and 12months after TKR. The Foot Posture Index (FPI) and Arch Index (AI) were measured as well as motion of the tibia, rearfoot and forefoot using a 3D motion analysis system incorporating a multisegment foot model. ResultsThere were no significant changes in FPI or AI following TKR, however gait analysis revealed significant increases in tibial external rotation (−18.7±7.0° vs −22.5±8.7°, p=0.002), tibial transverse plane range of motion (−9.1±4.6° vs −11.4±6.1°, p=0.0028) and rearfoot range of motion in the frontal plane (8.6±2.6° vs 10.4±2.7°, p=0.002), and a decrease in rearfoot transverse plane range of motion (8.7±5.3° vs 5.9±4.1°, p=0.038) following the procedure. ConclusionsTKR produces no change in static foot posture, but results in significant changes in rearfoot kinematics during gait. These findings suggest that rearfoot motion compensates for changes in the alignment of the knee, highlighting the ability of the foot to accommodate for proximal skeletal malalignment.

Mechanics and control of the flat versus normal foot during the stance phase of walking

Objective. To compare walking stance phase rearfoot and forefoot motion, ankle joint moments and extrinsic foot muscle EMG profiles between normal and pes planus feet. Design. A cross-sectional comparative study. Background. Musculoskeletal conditions are often attributed to pes planus, in which motion is assumed to be excessive and the muscle control inadequate. However, many of the speculated differences in mechanics and control between the normal and the pes planus foot have not been quantified. Methods. Kinematic and kinetic data were obtained from video recordings of skin surface markers and a force plate, and EMG was recorded with surface electrodes. Analysis of variance was carried out to compare the group profiles. Results. In the pes planus group: the forefoot was less adducted ( P<.05) at toe-off, and total transverse plane range of motion, at 8° versus 10°, was less ( P<.01); the peak plantarflexor ankle moment at push-off was greater ( P<.05); the invertor moment was greater at foot flat ( P<.05); for the EMG profiles, activity early in stance, relative to the mean stance phase activity was higher ( P<.01) in tibialis anterior and lower ( P<.05) in the peronei, soleus and medial and lateral gastrocnemius. Conclusions. Despite reaching statistical significance, the group differences were small for the task of laboratory walking at a natural pace. The main implications of the differences were for restraint of motion. The expectations of excessive motion and muscle effort in the pes planus group were therefore not substantiated. Relevance Symptomatic pes planus subjects did not reveal the expected biomechanical differences from normal subjects. The underlying causes of symptoms were not identifiable.