6,578 research outputs found

    Comparison of Gait with Ankle Foot Orthosis (AFO) and Functional Electrical Stimulation (FES) in patients following Stroke

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    BACKGROUND: Evidence supports peroneal nerve functional electrical stimulation (FES) as an effective alternative to ankle-foot-orthosis (AFO) for treatment of foot-drop post-stroke, but no conclusive evidence to suggest that FES is superior to AFO for correction of foot drop (Hemiplegic foot). AIM OF THE STUDY: To determine whether FES has any added benefits as compared to ankle foot orthosis (AFO) in post stroke patients, by measuring gait parameters. OBJECTIVES: 1. To compare spatiotemporal parameters between AFO and FES. 2. To evaluate ankle-foot kinematics in patient with stroke. METHOD: The study was a non-randomized cross over trial. Twenty patients with history of cerebrovascular accidents, of at least 3 months duration, were enrolled. Patients were divided in two groups (group A and B) consisting of 10 patients in each group. Patients of group A were trained with Ankle-Foot-Orthosis (AFO) followed by Functional electrical stimulation (FES). Patients of group B were trained first with Functional electrical stimulation (FES) followed by Ankle-Foot-Orthosis (AFO). Primary outcomes - 10 meter walk test, 6 minute walk test, physiological cost index. Secondary outcomes - step length, stride length, stance-swing ratio, single limb support, timed up and go test, Ankle kinematics, feedback for satisfaction level. RESULTS: Peroneal nerve functional electrical stimulation (FES) improved the walking speed (p value-0.0001) and endurance (Six minute walk test, p value-0.004) in both the groups when compared to ankle-foot-orthosis (AFO). Physiological cost index (PCI) was reduced with both AFO and FES as compared to baseline, however there was no statistical difference between AFO and FES. (p value- 0.46). CONCLUSION: FES has positive orthotic effect on walking speed and endurance. FES was found to be effective to minimize ankle plantar-flexion during swing phase thus helps to restore normal ankle kinematics. Satisfaction level was higher with FES users

    3D photogrammetric images to evaluate foot morphology and ankle kinematics during gait of Middle Eastern adults

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    To prevent high fall rates, foot injury and ankle sprain during daily activities and sport, footwear should be designed based on foot shape and ankle kinematics. The purpose of this thesis is to develop an accurate3D photogrammetric images captured by smartphone cameras technique that is non-invasive, low-cost and high-quality to analyse the morphology of the foot surface, investigate the foot shape characteristics of both genders, and evaluate the medial longitudinal arch (MLA) in static and dynamic conditions. Furthermore, the validation and investigation of ankle kinematics during gait according to gender is undertaken, as is an assessment of ankle kinematics in normal and unsteady gait. The photogrammetry technique utilises images of objects captured by multiple cameras from differing viewpoints to produce a digital 3D model of objects. In photogrammetry, camera calibration is an important step to improve the accuracy of measured imaged coordinates (x, y). This system calibration process involves individual calibrations of 7-Galaxy smartphones and the internal accuracy is 0.36 pixels. In this study, 33 healthy voluntary participants (18 males and 15 females, aged between 25and 47years), all of whom were Middle Eastern postgraduate students at the University of Southern Queensland (USQ) were recruited. In clinical settings, a number of landmarks were mounted on foot skin to measure the angles and the distances between anatomical bone locations. The results indicated that there were significant differences in some morphological characteristics of the feet of each gender. For example, the mean value of the foot length of males (26.01cm) was larger than females (22.39cm), and the mean values of arch length, ankle height and Chippaux-Smirak ratio for males was higher than for females. An accurate geometrical 3D close-range photogrammetry (CRP) method was used to evaluate the MLA in static (50% weight-bearing (WB), 10% WB, 90% WB standing and sitting non-WB) and dynamic motion during gait. MLA angle differences between males and females in static and dynamic conditions were also measured. In the static condition, the observation of the MLA angle was lower at about (137°)when sitting, indicating that the MLA was higher in non-WB. In the dynamic condition during walking, the higher mean value was found in the mid-stance phase (150.57°) when the foot tended to flatten. The results of ankle kinematics during walking refer to significant differences between females and males for the transverse plane of range of motion of the ankle (F=12.21, Sig=0.013) however no significant differences of coronal and sagittal planes were found between genders. The CRP technique was also used to measure ankle kinematics during normal gait and three unsteady gait trials ((1) eyes closed,(2) on single beam, and (3) dragging ankle weights) in four phases of stance. We found that the eyes closed gait had higher ankle kinematic values than other gait conditions in the heel strike phase(3.38°, 11.72° and 8.48°) of the coronal, sagittal and transverse planes, respectively. Overall, the study was appropriate because it used a novel precise 3D images technique to evaluate foot morphology and ankle kinematics during gait

    Lessons from dynamic cadaver and invasive bone pin studies: do we know how the foot really moves during gait?

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    Background: This paper provides a summary of a Keynote lecture delivered at the 2009 Australasian Podiatry Conference. The aim of the paper is to review recent research that has adopted dynamic cadaver and invasive kinematics research approaches to better understand foot and ankle kinematics during gait. It is not intended to systematically cover all literature related to foot and ankle kinematics (such as research using surface mounted markers). Since the paper is based on a keynote presentation its focuses on the authors own experiences and work in the main, drawing on the work of others where appropriate Methods: Two approaches to the problem of accessing and measuring the kinematics of individual anatomical structures in the foot have been taken, (i) static and dynamic cadaver models, and (ii) invasive in-vivo research. Cadaver models offer the advantage that there is complete access to all the tissues of the foot, but the cadaver must be manipulated and loaded in a manner which replicates how the foot would have performed when in-vivo. The key value of invasive in-vivo foot kinematics research is the validity of the description of foot kinematics, but the key difficulty is how generalisable this data is to the wider population. Results: Through these techniques a great deal has been learnt. We better understand the valuable contribution mid and forefoot joints make to foot biomechanics, and how the ankle and subtalar joints can have almost comparable roles. Variation between people in foot kinematics is high and normal. This includes variation in how specific joints move and how combinations of joints move. The foot continues to demonstrate its flexibility in enabling us to get from A to B via a large number of different kinematic solutions. Conclusion: Rather than continue to apply a poorly founded model of foot type whose basis is to make all feet meet criteria for the mechanical 'ideal' or 'normal' foot, we should embrace variation between feet and identify it as an opportunity to develop patient-specific clinical models of foot function

    Sagittal Subtalar and Talocrural Joint Assessment During Ambulation With Controlled Ankle Movement (CAM) Boots

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    Background: The purpose of the current study was to determine sagittal plane talocrural and subtalar kinematic differences between barefoot and controlled ankle movement (CAM) boot walking. This study used fluoroscopic images to determine talar motion relative to tibia and calcaneal motion relative to talus. Methods: Fourteen male subjects (mean age 24.1 ± 3.5 years) screened for normal gait were tested. A fluoroscopy unit was used to collect images at 200 Hz during stance. Sagittal motion of the talocrural and subtalar joints were analyzed barefoot and within short and tall CAM boots. Results: Barefoot talocrural mean maximum plantar and dorsiflexion were 9.2 ± 5.4 degrees and −7.5 ± 7.4 degrees, respectively; short CAM boot mean maximum plantar and dorsiflexion were 3.2 ± 4.0 degrees and −4.8 ± 10.2 degrees, respectively; and tall CAM boot mean maximum plantar and dorsiflexion were −0.2 ± 3.5 degrees and −2.4 ± 5.1 degrees, respectively. Talocrural mean range of motion (ROM) decreased from barefoot (16.7 ± 5.1 degrees) to short CAM boot (8.0 ± 4.9 degrees) to tall CAM boot (2.2 ± 2.5 degrees). Subtalar mean maximum plantarflexion angles were 5.3 ± 5.6 degrees for barefoot walking, 4.1 ± 5.9 degrees for short CAM boot walking, and 3.0 ± 4.7 degrees for tall CAM boot walking. Mean minimum subtalar plantarflexion angles were 0.7 ± 3.2 degrees for barefoot walking, 0.7 ± 2.9 degrees for short CAM boot walking, and 0.1 ± 4.8 degrees for tall CAM boot walking. Subtalar mean ROM decreased from barefoot (4.6 ± 3.9 degrees) to short CAM boot (3.4 ± 3.8 degrees) to tall CAM boot (2.9 ± 2.6 degrees). Conclusion: Tall and short CAM boot intervention was shown to limit both talocrural and subtalar motion in the sagittal plane during ambulation. The greatest reductions were seen with the tall CAM boot, which limited talocrural motion by 86.8% and subtalar motion by 37.0% compared to barefoot. Short CAM boot intervention reduced talocrural motion by 52.1% and subtalar motion by 26.1% compared to barefoot. Clinical Relevance: Both short and tall CAM boots reduced talocrural and subtalar motion during gait. The short CAM boot was more convenient to use, whereas the tall CAM boot more effectively reduced motion. In treatments requiring greater immobilization of the talocrural and subtalar joints, the tall CAM boot should be considered

    Full gait cycle analysis of lower limb and trunk kinematics and muscle activations during walking in participants with and without ankle instability

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    This document is the Accepted Manuscript version of the following article: Lynsey Northeast, Charlotte N. Gautrey, Lindsay Bottoms, Gerwyn Hughes, Andrew C. S. Mitchell, and Andrew Greenhalgh, ‘Full gait cycle analysis of lower limb and trunk kinematics and muscle activations during walking in participants with and without ankle instability’, Gait & Posture, Vol. 64: 114-118, July 2018. Under embargo until 7 June 2019. The final, definitive version is available online at doi: https://doi.org/10.1016/j.gaitpost.2018.06.001Background Chronic ankle instability (CAI) has previously been linked to altered lower limb kinematics and muscle activation characteristics during walking, though little research has been performed analysing the full time-series across the stance and swing phases of gait. Research Question The aim of this study was to compare trunk and lower limb kinematics and muscle activity between those with chronic ankle instability and healthy controls. Methods Kinematics and muscle activity were measured in 18 (14 males, 4 females) healthy controls (age 22.4 ± 3.6 years, height 177.8 ± 7.6 cm, mass 70.4 ± 11.9 kg, UK shoe size 8.4 ± 1.6), and 18 (13 males, 5 females) participants with chronic ankle instability (age 22.0 ± 2.7 years, height 176.8 ± 7.9 cm, mass 74.1 ± 9.6 kg, UK shoe size 8.1 ± 1.9) during barefoot walking trials, using a combined Helen Hayes and Oxford foot model. Surface electromyography (sEMG) was recorded for the tibialis anterior and gluteus medius. Full curve statistical parametric mapping was performed using independent and paired-samples T-tests. Results No significant differences were observed in kinematic or sEMG variables between or within groups for the duration of the swing phase of gait. A significantly increased forefoot-tibia inversion was seen in the CAI affected limb when compared to the CAI unaffected limb at 4–16% stance (p = 0.039). No other significant differences were observed. Significance There appears to be no differences in muscle activation and movement between CAI and healthy control groups. However, participants with CAI exhibited increased inversion patterns during the stance phase of gait in their affected limb compared to their unaffected limb. This may predispose those with CAI to episodes of giving way and further ankle sprains.Peer reviewedFinal Accepted Versio

    Foot kinematics in patients with two patterns of pathological plantar hyperkeratosis

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    Background: The Root paradigm of foot function continues to underpin the majority of clinical foot biomechanics practice and foot orthotic therapy. There are great number of assumptions in this popular paradigm, most of which have not been thoroughly tested. One component supposes that patterns of plantar pressure and associated hyperkeratosis lesions should be associated with distinct rearfoot, mid foot, first metatarsal and hallux kinematic patterns. Our aim was to investigate the extent to which this was true. Methods: Twenty-seven subjects with planter pathological hyperkeratosis were recruited into one of two groups. Group 1 displayed pathological plantar hyperkeratosis only under metatarsal heads 2, 3 and 4 (n = 14). Group 2 displayed pathological plantar hyperkeratosis only under the 1st and 5th metatarsal heads (n = 13). Foot kinematics were measured using reflective markers on the leg, heel, midfoot, first metatarsal and hallux. Results: The kinematic data failed to identify distinct differences between these two groups of subjects, however there were several subtle (generally <3°) differences in kinematic data between these groups. Group 1 displayed a less everted heel, a less abducted heel and a more plantarflexed heel compared to group 2, which is contrary to the Root paradigm. Conclusions: There was some evidence of small differences between planter pathological hyperkeratosis groups. Nevertheless, there was too much similarity between the kinematic data displayed in each group to classify them as distinct foot types as the current clinical paradigm proposes

    Sagittal Subtalar and Talocrural Joint Assessment With Weight-Bearing Fluoroscopy During Barefoot Ambulation

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    Background: Identifying talar position during ambulation has proved difficult as the talus lacks palpable landmarks for skin marker placement and more invasive methodologies such as bone pins are not practical for most clinical subjects. A fluoroscopic motion system was used to track the talus and calcaneus, allowing kinematic analysis of the talocrural and subtalar joints. Methods: Thirteen male subjects (mean age 22.9 ± 3.0 years) previously screened for normal gait were tested. A fluoroscopy unit was used to collect images at 120 fps during stance. Sagittal motion of the talocrural and subtalar joints were analyzed. Results: The intersubject mean and standard deviation values for all 58 trials of 13 subjects are reported. Maximum talocrural joint plantarflexion of 11.2 degrees (4.3 degrees of standard deviation) occurred at 11% stance and maximum dorsiflexion of −6.9 degrees (5.6 degrees of standard deviation) occurred at 85%. Maximum subtalar joint plantarflexion of 4.8 degrees (1.0 degrees of standard deviation) occurred at 96% stance and maximum dorsiflexion of −3.6 degrees (2.3 degrees of standard deviation) occurred at 30%. Talocrural and subtalar range of motion values during stance were 18.1 and 8.4 degrees, respectively. Conclusion: Existing fluoroscopic technology was capable of defining sagittal plane talocrural and subtalar motion during gait. These kinematic results compare favorably with more invasive techniques. This type of assessment could support more routine analysis of in vivo bony motion during gait. Clinical Relevance: Fluoroscopic technology offers improved sagittal plane motion evaluation during weight-bearing with potential application in patients with end-stage ankle arthritis, postoperative ankle replacements and fusions, and orthotics and braces

    Best practice statement : use of ankle-foot orthoses following stroke

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    NHS Quality Improvement Scotland (NHSQIS) leads the use of knowledge to promote improvement in the quality of health care for the people of Scotland and performs three key functions. It provides advice and guidance on effective clinical practice, including setting standards; drives and supports implementation of improvements in quality, and assessing the performance of the NHS, reporting and publishing findings

    Segmental Kinematic Analysis of Planovalgus Feet during Walking in Children with Cerebral Palsy

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    Pes planovalgus (flatfoot) is a common deformity among children with cerebral palsy. The Milwaukee Foot Model (MFM), a multi-segmental kinematic foot model, which uses radiography to align the underlying bony anatomy with reflective surface markers, was used to evaluate 20 pediatric participants (30 feet) with planovalgus secondary to cerebral palsy prior to surgery. Three-dimensional kinematics of the tibia, hindfoot, forefoot, and hallux segments are reported and compared to an age-matched control set of typically-developing children. Most results were consistent with known characteristics of the deformity and showed decreased plantar flexion of the forefoot relative to hindfoot, increased forefoot abduction, and decreased ranges of motion during push-off in the planovalgus group. Interestingly, while forefoot characteristics were uniformly distributed in a common direction in the transverse plane, there was marked variability of forefoot and hindfoot coronal plane and hindfoot transverse plane positioning. The key finding of these data was the radiographic indexing of the MFM was able to show flat feet in cerebral palsy do not always demonstrate more hindfoot eversion than the typically-developing hindfoot. The coronal plane kinematics of the hindfoot show cases planovalgus feet with the hindfoot in inversion, eversion, and neutral. Along with other metrics, the MFM can be a valuable tool for monitoring kinematic deformity, facilitating clinical decision making, and providing a quantitative analysis of surgical effects on the planovalgus foot
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