5,034 research outputs found

    Associations of region-specific foot pain and foot biomechanics: the framingham foot study

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    BACKGROUND. Specific regions of the foot are responsible for the gait tasks of weight acceptance, single-limb support, and forward propulsion. With region foot pain, gait abnormalities may arise and affect the plantar pressure and force pattern utilized. Therefore, this study’s purpose was to evaluate plantar pressure and force pattern differences between adults with and without region-specific foot pain. METHODS. Plantar pressure and force data were collected on Framingham Foot Study members while walking barefoot at a self-selected pace. Foot pain was evaluated by self-report and grouped by foot region (toe, forefoot, midfoot, or rearfoot) or regions (two or three or more regions) of pain. Unadjusted and adjusted linear regression with generalized estimating equations was used to determine associations between feet with and without foot pain. RESULTS. Individuals with distal foot (forefoot or toes) pain had similar maximum vertical forces under the pain region, while those with proximal foot (rearfoot or midfoot) pain had different maximum vertical forces compared to those without regional foot pain (referent). During walking, there were significant differences in plantar loading and propulsion ranging from 2% to 4% between those with and without regional foot pain. Significant differences in normalized maximum vertical force and plantar pressure ranged from 5.3% to 12.4% and 3.4% to 24.1%, respectively, between those with and without regional foot pain. CONCLUSIONS. Associations of regional foot pain with plantar pressure and force were different by regions of pain. Region-specific foot pain was not uniformly associated with an increase or decrease in loading and pressure patterns regions of pain

    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

    Rehearsal Injuries in Soft-Soled Character Shoes: Injury Rate of Female Collegiate Dancers Wearing Soft-Soled Character Shoes with 2.5 or 3.0 Inch Heels in Musical Theatre Rehearsals

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    High-heeled shoes (HHS) have been known to present biomechanical imbalances in lower-leg mechanics at the pedestrian level, but have not been thoroughly studied in the context of highly dynamic movement, such as dance. In order to analyze the effects of 2.5-inch and 3.0-inch soft-soled character shoes (CS) worn by female collegiate musical theatre dancers during rehearsals, selected subjects completed a written questionnaire, the star balance excursion test, and a heel raise test. It was predicted that both heel heights would promote irregularities in subjects’ sense of balance and lower leg stamina, while 3.0 inch CS would cause greater rates of injury overall. The resulting data showed that while there was no difference in the number of reported injuries among subjects wearing either 2.5-inch CS or 3.0-inch CS during rehearsals, there was less range of motion (RoM) and stability observed in 3.0-inch CS. The median number of heel rises from the heel raise test was approximately 10, showing a wide range of strength and stamina among subjects individually. Additionally, only 35% of subjects reported warming up in CS before rehearsals, and 13% reported cooling down after dancing in rehearsal. These results indicate a great need for supplemental strengthening for dancers, as well as the development of a comprehensive warm-up and cool-down aiming to prepare dancers to effectively wear CS for extended periods of time and continue to counter potential injury

    Long-term effects of automated mechanical peripheral stimulation on gait patterns of patients with Parkinson's disease

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    New treatments based on peripheral stimulation of the sensory–motor system have been inspiring new rehabilitation approaches in Parkinson’s disease (PD), especially to reduce gait impairment, levodopa washout effects, and the incidence of falls. The aim of this study was to evaluate the change in gait and the clinical status of PD patients after six sessions of a treatment based on automated mechanical peripheral stimulation (AMPS). Eighteen patients with PD and 15 age-matched healthy individuals (control group) participated in this study. A dedicated medical device delivered the AMPS. PD patients were treated with AMPS six times once every 4 days. All PD patients were treated in the off-levodopa phase and were evaluated with gait analysis before and after the first intervention (acute phase), after the sixth intervention, 48 h after the sixth intervention, and 10 days after the end of the treatment. To compare the differences among the AMPS interventions (pre, 6 AMPS, and 10 days) in terms of clinical scales, a t-test was used (α≤0.05). In addition, to compare the differences among the AMPS interventions (pre, post, 6 AMPS, 48 h and 10 days), the gait spatiotemporal parameters were analyzed using the Friedman test and the Bonferroni post-hoc test (α≤0.05). Also, for comparisons between the PD group and the control group, the gait spatiotemporal parameters were analyzed using the Mann–Whitney test and the Bonferroni post-hoc test (α≤0.05). The results of the study indicate that the AMPS treatment has a positive effect on bradykinesia because it improves walking velocity, has a positive effect on the step and stride length, and has a positive effect on walking stability, measured by the increase in stride length. These results are consistent with the improvements measured with clinical scales. These findings indicate that AMPS treatment seems to generate a more stable walking pattern in PD patients, reducing the well-known gait impairment that is typical of PD; regular repetition every 4 days of AMPS treatment appears to be able to improve gait parameters, to restore rhythmicity, and to reduce the risk of falls, with benefits maintained up to 10 days after the last treatment. The trial was registered online at ClinicalTrials.gov (number identifier: NCT0181528)

    Future footwear : the birth of feet, the re-birth of footwear

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    Neuropathy - gait changes in the diabetic foot

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    Motor neuropathy in patients with diabetes can lead to weakness in the muscles of the foot and lower leg, which in turn can lead to characteristic changes to the structure of the foot, such as an altered arch profile. Such structural changes often occur at sites of abnormally high pressure, which can result in tissue breakdown and ulceration particularly in individuals who also have sensory neuropathy

    The influence of peripheral neuropathy on walking kinematics and physical function

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    The 108th Congress (2005) has reported that 20 million U.S. citizens suffer from Peripheral Neuropathy (PN). Characterized by sensory nerve deterioration, PN reduces somatosensation (Padua et al., 2005) and increases the risk of fall-related injury (Richardson et al., 1992). The purpose of this dissertation was to provide insight into 1) the effects of acute loss of foot sole sensation on locomotor system health, 2) the effects of PN on locomotor system health, and 3) the underlying impairments associated with reduced physical function within the older adult and PN populations. Locomotor system health was assessed by the magnitude of stride-to-stride variability and local instability contained in the kinematics of treadmill walking. In healthy young adults, ice-induced reduction of foot sole sensation did not alter the magnitude of stride-to-stride variability during treadmill walking. It did, however, increase lower-extremity joint local instability, or the sensitivity to small scale perturbations. Compared to controls, individuals with PN walked with similar local instability yet increased variability, at relatively slow speeds. When walking at relatively fast speeds, individuals with PN exhibited exaggerated increases in local instability. In healthy older adults, locomotion-based physical function (LBPF), as defined by 6-minute walk and Timed Up-and-Go performance, was correlated to leg strength and measures of locomotor system health. However, only measures of locomotor system health provided independent predictive information of LBPF. The PN group exhibited reduced LBPF. As opposed to healthy old adults, correlates of LBPF were not leg strength but instead standing balance variables. Multiple variables of leg strength, standing balance, and locomotor system health provided independently predictive information regarding each test of LBPF. The opposing effects of ice-induced reduction in foot sole sensation and PN on locomotor system health suggest that the chronic nature of PN allows for the implementation of partially effective compensatory strategies. Yet, the inability to adapt to relatively fast speeds suggests that falls likely occur during challenging situations. The fundamentally different correlates and predictors of LBPF between older adults and those with PN highlight the uniqueness of the movement disorder associated with PN

    THE EFFECTS OF ORTHOTICS AND INCREASED PLANTAR SOLE MECHANORECEPTOR ACTIVATION ON TURNING PERFORMANCE IN INDIVIDUALS WITH PARKINSON’S DISEASE

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    Locomotion and turning are complex movement patterns essential to activities of daily living. Individuals with Parkinson’s disease (PD) report difficulties turning, often coupled with impaired balance and increased fear of falling. The purpose of this within-subject study was to determine if orthotics, with and without a textured top cover, can improve gait stability and turning performance within Parkinson’s participants. Seven participants with a diagnosis of idiopathic Parkinson’s disease, aged 55-80 years old, participated in the study. Participants completed three testing sessions; baseline, 4 weeks post-baseline, and 5 weeks post-baseline. The ‘footwear only’ and ‘footwear + non-textured orthotic’ conditions were tested at baseline, ‘footwear + non-textured orthotic’ and ‘footwear + textured orthotic’ conditions were testing at 4-weeks, and the ‘footwear + textured orthotic’ condition was repeated at 5 weeks. Kinematic, kinetic, electromyographical, and video data was collected during a turning task. The turn task consisted of walking towards a pre-determined turn area, and then completing a 180° to static stance. Variables of interest were categorized into three main areas: dynamic stability (COM/BOS ML maximum, minimum, and range), turning performance (turn strategy, step count, step length, step width, and average walking velocity), and average muscle activity of lower limb musculature (tibialis anterior, medial gastrocnemius, and peroneus longus). Results were further subdivided between acute and long-term changes associated with both non-textured and textured orthotics. Long-term orthotic wear and the addition of texture appears to significantly improve dynamic stability, characterized by an increase in the ML maximum and ML range COM/BOS relationship. Significant increases in averaged muscle activity of the ipsilateral tibialis anterior and medial gastrocnemius were noted in the textured orthotic condition, along with significant decreases in ipsilateral peroneus longus. These study results provide two potential treatment options, foot orthotics and textured orthotics, for rehabilitation professionals treating Parkinson’s disease individuals

    The effects of manipulated somatosensory input on simulated falls during walking

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    Previous research has demonstrated that there is a distinct relationship between aging and instability. The somatosensory system plays a significant role in balance control in conjunction with vision and the vestibular system (Qiu et al., 2012). Evidence has shown that manipulation of the mechanoreceptors on the plantar surface of the foot has a direct effect on balance control. By manipulating these receptors with hypothermic anesthesia and vibration, researchers are capable of simulating the effect of sensory modification on healthy individuals, in order to understand the role that plantar-surface sensation has in adapting to perturbation during gait (Perry et al., 2001; Priplata et al., 2006). This study included 14 healthy young adults (mean age 23.07 (±2.43)). Within this study, participants were asked to walk the length of an 8-meter platform at a comfortable speed. Participants were required to walk with reduced, enhanced and normal levels of somatosensory information of the plantar foot surface. During walking trials the participants travelled along a raised platform that had 4 sections in which removable foam squares were placed to provide either a stable or unstable situation when stepped upon. Located underneath three of these squares were three force plates (OR-6-2000 (AMTI, Waterdown, MA)). In order to prevent learning bias the location of the foam, as well as the direction of the perturbation was randomized. Participants were perturbed in either the anterior or lateral direction based upon the direction in which the removable foam squares within the platform were placed. Moreover, participants experienced three separate conditions (control, vibration, and cooled) on the plantar surface of the foot to manipulate the sensory information received. Electromyography (AMT-8 (Bortec, Calgary, Alberta)) was used to analyze magnitude and onset changes in muscle activity within the Gastrocnemius and Tibialis Anterior of the right lower limb, and the Rectus Femoris, and Biceps Femoris muscles of the left lower limb. Three-dimensional motion analysis was also used to capture observable changes in gait (Optotrak, NDI, Waterloo, Ontario). A main effect of condition was found for the third burst of muscle activity recorded within the Tibialis Anterior (F(2,17)=2.75, p\u3c0.01), with post-hoc analysis between the cooled and vibration conditions. A significant positive correlation was found between Rectus Femoris EMG amplitude and rate of loading (r=0.94,p=0.05). Within the anterior perturbations, a main effect for condition was observed for maximum COM velocity ((F(2,35)=3.71, p=0.05), minimum COP velocity (F(2,35)=4.62, p=0.03), and for the maximum distance between COM and COP (F(2,35)=4.37, p=0.04). A trend was also observed for the maximum distance the COM travelled within the lateral direction in the BOS (F(9,35)=2.61, p=0.06). Within the lateral perturbations, a trending effect for condition was also observed for maximum COM velocity (F(2,55)=3.07, p=0.06), the maximum distance between the COM and COP (F(2,55)=2.98, p=0.06), and a main effect was observed for condition for the rate of loading (F(2,55)=3.86, p=0.03). This study provides evidence of a relationship between the plantar cutaneous mechanoreceptors and gait parameters regarding to balance control as observed by the significant effects on commonly used measurements of balance control (i.e. COP and COM velocity). A relationship between mechanoreceptors and EMG amplitude, as well as foot contact forces and EMG amplitude is also evident. These relationships may be used to further knowledge for balance control during adaptive gait, as well as provide further development of footwear and insoles to improve balance control
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