Does the lower extremity alignment affect the risk of falling?

Portable, automated foot progression angle gait modification via a proof-of-concept haptic feedback-sensorized shoe

Over 50% of women experience musculoskeletal pain in the low back or lower extremity during pregnancy. Further, 31% of these women experience continued pain after giving birth. Many women also report changes in foot length and arch height during pregnancy. The purpose of this study was to determine if changes in foot anthropometry during pregnancy are related to low back and lower extremity pain. A secondary aim was to determine if added weight alone explains changes in lower extremity alignment, or if other factors mediate these changes. Methods: Fifteen primigravid women were recruited to participate, along with thirteen weight-matched nulliparous controls. Several measures of foot and lower extremity alignment were assessed during the 1st, 2nd, and 3rd trimesters, as well as post-partum. These measures included: foot length, foot width, arch index, arch height index, arch rigidity index, arch drop, rearfoot angle and pelvic obliquity. Musculoskeletal pain was assessed using a Visual Analogue Scale. Controls and participants who had not yet reached the full weight of pregnancy repeated measurements weighted with a pack worn over the anterior trunk. Results: Over the course of a first pregnancy, significant changes were seen in foot length, arch index and pelvic obliquity. Added weight alone produced significant changes in arch drop and arch rigidity index only. Changes in foot width, standing arch height index and pelvic obliquity were related to pain at the low back, hip and knee during pregnancy. Conclusion: Pregnant women experience changes in lower extremity anthropometry and alignment that may contribute to musculoskeletal pain.

This study evaluated tibiofemoral loading and medial meniscal stress distribution in individuals with flexible flatfoot (FFF) during walking under different foot progression angle (FPA) conditions. This study analyzed the gait of 28 FFF patients (16 males, 12 females) under three FPA conditions (neutral, toe-in, toe-out). Kinematic (Vicon) and kinetic (Kistler) data were used to estimate tibiofemoral forces in OpenSim. Subsequently, joint angles and muscle forces at peak tibiofemoral forces were used to drive a finite element (FE) model of the knee, enabling the comparison of meniscal von Mises stress, maximum shear stress, and contact pressure across FPA conditions. Tibiofemoral force increased during early stance (9-11%) in the toe-in condition with this increase reaching statistical significance in males (p = 0.008, mean partial within the SPM-identified cluster). FE analysis showed that peak stresses and contact pressure were primarily localized in the anterior region of the medial meniscus. A consistent directional response to FPA was observed with the lowest peak values occurring in the toe-in condition and the highest values in the toe-out condition. Adjusting FPA modulates intra-articular knee loading via the kinetic chain. For FFF patients, neutral FPA provides stable loading. The toe-in condition presents a complex mechanism: despite increasing tibiofemoral force (notably in males), it reduces peak stress by altering contact mechanics and stress distribution. Therefore, FFF gait interventions must be individualized based on factors like foot morphology, sex, and functional goals.

The mechanical loads placed on the knee during gait, in particular the adduction moment (KAM), have been implicated in the progression of knee osteoarthritis (OA). Those presenting with symptomatic medial compartment knee OA tend to adopt a toe out gait pattern reducing the peak KAM during gait, hence unloading the diseased medial compartment. Although this is known, the relationship between the foot progression angle (FPA) and the KAM, along with other knee gait kinetic measures has yet to be determined. PURPOSE To determine the relationship between FPA and 3D knee gait forces and moments. METHODS Gait analysis was performed on 11 healthy subjects (23 +/− 1.7 yrs). Subjects performed five trials in each of three conditions: natural foot position (NFP), approximately 30 degrees internally rotated (IR) and approximately 30 degrees externally rotated (ER) from their natural position. 3D knee joint forces and moments were compared to true FPA (ANOVA) and a regression analysis determined the relationships between normalized (by NFP) values. RESULTS Late stance peak KAM and medial-lateral shear forces (MLF) were significantly different across conditions, (KAM: ER=0.125, NFP=0.267, IR=0.410 Nm/kg; p<0.01 and MLF: ER=−0.980, NFP=−1.248, IR=−1.447 N/kg; p<0.01). See Figure 1 for average gait curves. There were also strong relationships between changes in FPA (actual range of 49.3 ±) and changes in KAM (R2=.97) and MLF (R2=.88).FigureCONCLUSIONS Results suggest that for every 10 degree change in FPA there is a 21.7% change in KAM and a 7.6% change in MLF during late stance. This may have implications in preventing the development and progression of knee OA.

Trunk lean and toe out gait strategies impact on lower limb joints

Background: Rotational profiles vary widely among healthy children. Rotation of the long bones refers to the twist of the bone about its long axis. Rotational deformity of the lower limb in the transverse plane is associated with many clinical settings ranging from harmless to excessive intoeing in children. Materials and Methods: This study was conducted at the Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi. Children presenting to the outpatient department during the period of April to September 2013 were followed up. It is a prospective study conducted over 14 months. A total of 27 children (54 lower limbs) were included and followed up. Results: Twenty-seven children were selected as per the inclusion criteria and assessed for the thigh-transmalleolar axis, thigh-foot angle, femoral anteversion (FA), foot progression angles (FPA), and hip rotations at 4-month interval for 2 follow-ups. There were very few studies of such type which have been conducted in India. Conclusions: In our study, there was a definite and significant decrease in FPA and internal tibial torsion with increasing age. The values of clinical anteversion also decreased with age along with a gradual decrease of internal rotation and an increase of external rotation (ER). The decrease of FA with age correlated better with increase of hip ER. FPA was a significant clinical parameter which gave us an objective picture of the change in both femoral and tibial torsions with age.

Stride length (SL), foot clearance (FC), and foot progression angle (FPA) are the key parameters for diagnosing gait disorders. This study used the distance data between two feet measured by ultra-wideband (UWB) sensors installed on shoes and proposed a method for estimating the three gait parameters. Here, a method of compensating the offset of the UWB sensor and estimating the distances between a base sensor installed on one foot during the stance phase and three UWB sensors on the other during the swing phase was applied. Foot trajectory was acquired in a gait experiment with ten healthy adults walking on a treadmill. The results were compared with those obtained using a motion capture system (MCS). The UWBs sensor displayed average errors of 45.84 mm, 7.60 mm, and 2.82° for SL, FC, and FPA, respectively, compared with the MCS. A similar accuracy level was achieved in a previous study that used an inertial measurement unit (IMU). Thus, these results suggest that UWB sensors can be extensively applied to sensor systems used to analyze mobile gait systems.

The determination of rotation of the femur during intramedullary nailing procedures can be difficult, particularly when the fracture pattern does not lend itself to interdigitation. We studied 22 patients who had isolated femur fractures treated by closed intramedullary nailing to determine the degree of malrotation introduced at the time of surgery. Anteversion of the affected and normal femora was determined by a standard computed tomography (CT) torsion study. The range of motion of the hip was measured in the prone position. Foot progression angles (FPAs) were measured in 14 patients who were fully ambulatory for at least 6 months. The average malrotation of the fractured femur was 16 degrees (4 to 61 degrees). The median malrotation was 14 degrees. The differences in CT-measured anteversion (delta A), FPA (delta FPA), internal rotation (delta IR), and external rotation (delta ER) between the affected and normal sides were determined. Linear regression was used to analyze delta A with delta FPA, delta IR, and delta ER. Changes in internal and external rotation as determined by physical exam had a stronger correlation with delta A than did delta FPA. This indicates that malrotation of the femur is accommodated for during gait. Based on this data, we found that anteversion of the normal femur can be determined in the operating room using the image intensifier and can be duplicated on the fractured side using the described technique in cases where comminution prevents fragmentational alignment. This method has been used for 12 patients in a prospective trial, and malrotation has been kept to under 10 degrees in all cases.

BackgroundGait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot–ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot–ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation.MethodsThis was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle–foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle–foot joint, and a clinical motor and balance function assessment based on the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups.ResultsThe FMA-LE and BBS scores improved in both the tPNS groups (p = 0.004 and 0.001, respectively) and CT groups (p = 0.034 and 0.028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including double feet support, stride length, and walking speed of affected side, and the unaffected foot off within a gait cycle after training (p = 0.043, 0.017, 0.001 and 0.010, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = 0.021) and foot progression angle at the frontal plane (p = 0.009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = 0.023) and foot progression angle (FPA) at the frontal and transverse planes (p = 0.032 and 0.046, respectively) during gait cycles after 3 weeks of training.ConclusionsUse of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation.Trial registration Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424

PurposeThe changes in the lower limb alignment were vitally important after high tibial osteotomy (HTO). Therefore, the purpose of present study was to analyze the characteristics of plantar pressure distribution after HTO, and to investigate the effect of plantar pressure distribution on postoperative limb alignment.MethodsBetween May 2020 and April 2021, varus knee patients undergoing HTO were evaluated in the present study. The peak pressure of plantar regions, medial-lateral pressure ratio (MLPR), foot progression angle (FTA), anteroposterior COP (AP-COP), lateral symmetry of COP (LS-COP), and the radiographic parameters were evaluated preoperatively and at the final follow-up. Compared among the slight valgus (SV), moderate valgus (MV) and large valgus (LV) groups at the final follow-up, the peak pressure of HM, HC and M5 regions, and the MLPR were compared; the Knee Injury and Osteoarthritis Outcome Score4 (KOOS4) including four subscales, and the American of orthopedic foot and ankle society (AOFAS) were evaluated.ResultsThe WBL%, HKA and TPI angle changed significantly after HTO (P < 0.001). The preoperative group exhibited a lower peak pressure in the HM region (P < 0.05) and higher peak pressure in the M5 region (P < 0.05); the pre- and postoperative groups exhibited a lower peak pressure in the HC region (P < 0.05); the rearfoot MLPR was significantly lower and LS-COP was significantly higher in the preoperative group (P = 0.017 in MLPR and 0.031 in LS-COP, respectively). Comparison among the SV, MV and LV groups, the SV group indicated a lower peak pressure in the HM region (P = 0.036), and a lower MLPR in the rearfoot (P = 0.033). The KOOS Sport/Re score in the MV and LV groups increased significantly compared with the SV group (P = 0.042).ConclusionPlantar pressure distribution during the stance phase in patients with varus knee OA following HTO exhibited a more medialized rearfoot plantar pressure distribution pattern than that before surgery. Compared with the small valgus alignment, a moderate to large valgus alignment allows patients to walk with a more even medial and lateral plantar pressure distribution, which is more similar to healthy adults.

Ankylosing Spondylitis (AS) is an inflammatory chronic disease that causes postural changes. As a result of these changes decreased hip flexion, increased knee flexion and plantar flexion of ankle are developed. The aim of the study is to compare plantar pressure distribution results in patients with AS and healthy individuals and to determine the relationship between clinical and functional parameters in patients with AS. Twenty-five patients (median age = 42.2 ± 2.1years) with AS and 25 healthy individuals (median age = 44.4 ± 1.7years) were included in the study. The maximum foot pressure (FPmax), average pressure, center of pressure angle (CoP),forefoot load (FFL), rearfoot load (RFL), foot progression angle (FPA) and foot angle (FA) weredetermined by pedobarographic analysis. Spinal mobility was assessed with lumbar flexion, lateral flexion, and tragus-wall distance. Functional status and disease-related symptoms were assessed with BASDAI, BASFI and ASQoL. There were no differences between static and dynamic pedobarographic analysis parameters between the AS group and the control group (p > 0.05). Self-rated functional levels parameters, pain, and stiffness were higher in the AS group (p < 0.05). Lumbar flexion (p = 0.187) and tragus-to-wall distance (p = 0.196) were similar in two groups. Self-rated parameters were correlated with pain, stiffness, and lateral flexion (p < 0.05). Lateral flexion correlated with FA and FFL; tragus to wall distance correlated with FPmax and CoP and RFL; lumbar flexion correlated with FA (p < 0.05). The results showed that there was no difference plantar pressure distribution but there was a difference in spinal mobility in AS group compared healthy individuals.

A cost-effective gait analysis system without attachments and specialized large environments can provide useful information to determine effective treatment in clinical sites. This study investigates the capability of a single camera-based pose estimation system using OpenPose (OP) to measure the temporo-spatial and joint kinematics parameters during gait with orthosis. Eleven healthy adult males walked under different conditions of speed and foot progression angle (FPA). Temporo-spatial and joint kinematics parameters were measured using a single camera-based system with OP and a three-dimensional motion capture system. The limit of agreement, mean absolute error, absolute agreement (ICC2, 1), and relative consistency (ICC3, 1) between the systems under each condition were assessed for reliability and validity. The results demonstrated that most of the ICC for temporo-spatial parameters and hip and knee kinematics parameters were good to excellent (0.60 - 0.98). Conversely, most of the ICC for ankle kinematics in all conditions were poor to fair (< 0.60). Thus, the gait analysis using OP can be used as a clinical assessment tool for determining the temporo-spatial, hip, and knee sagittal plane angles during gait.

BackgroundIdiopathic flexible flatfoot is a common condition in children which typically improves with age and remains asymptomatic. However, the condition can sometimes be more severe, and cause mechanical impairment or pain. The aim of the study was to perform a prospective clinical, radiological, podoscopic and pedobarographic assessment (static and dynamic) of subtalar titanium screw arthroereisis for the treatment of symptomatic, idiopathic, flexible flatfeet.MethodsA prospective, consecutive, non-controlled, cohort, clinical follow-up study was performed. In total, 30 patients (41 feet), mean age 10 (6 to 16 years), were evaluated. Clinical and standing radiological assessments, static and dynamic pedobarography, as well as podoscopy, were performed before surgery and at final follow-up.ResultsTreatment was associated with significant improvements in heel valgus angle, radiographic parameters (lateral and dorso-planar talo-first metatarsal angle, calcaneal inclination angle, talar declination angle, longitudinal arch angle) and podoscopic parameters (Clark’s angle, Staheli’s arch index and Chippaux-Smirak index). Significant increases were noted for lateral loading, forefoot contact phase and double support / swing phase, and reduced medial loading (dynamic pedobarography), as well as lateral midfoot area and loading, but decreased were observed for medial forefoot loading (static pedobarography). Four patients reported persistent pain in the sinus tarsi region (six feet), and in one case, the implant was replaced for a larger one due to undercorrection. No overcorrections or infection complications were noted in the study group.ConclusionsSubtalar arthroereisis is a minimally-invasive and effective surgical method for treating symptomatic, idiopathic, flexible flatfeet; it has an acceptable complication rate with good early clinical results.Level of evidenceII b.

The Reliability of the Associate Platinum Digital Foot Scanner in Measuring Previously Developed Footprint Characteristics: A Technical Note

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