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Background: For demanding activities in daily life, such as negotiating stairs, ramps and uneven ground, the functionality of conventional prosthetic feet ("Daily Life Feet" - DLF) is often limited. With the introduction of microprocessor-controlled feet (MPF) it was expected that the functional limitations of DLF might be reduced. The purpose of the present study was to investigate biomechanical gait parameters with DLF and MPF when walking on a specifically designed ramp involving abruptly changing inclination angles as a scenario reflecting typical situations related to walking on uneven ground., Research Question: The specific aim of the study was to answer the research question if the advanced adaptability of MPF to different ground slopes would lead to more natural motion patterns and reduced joint loading compared with DLF feet., Methods: A specifically designed ramp was installed within a gait lab. During downward motion on this ramp biomechanical parameters - ground reaction forces, joint moments and joint angles were obtained both with DLF and MPF used by four transtibial amputees. A control group of 10 non-amputees (NA) was measured with for comparison., Results: The NA group managed the ramp element with the abruptly changing inclination with a specific ankle joint adaptation. Compared to DLF the MPF considerably improved the ankle adaptation to the abruptly changing inclination which was reflected by a significantly increased stance phase dorsiflexion which was comparable to the NA group. The peak value of the knee extension moment on the prosthetic side was significantly increased with DLF, whereas it was almost normal with MPF (DLF: 0.71 ± 0.13 Nm/kg, MPF: 0.42 ± 0.12 Nm/kg, NA: 0.36 ± 0.07 Nm/kg, p < 0.05 and p < 0.01). The external knee adduction moment was generally reduced for the transtibial amputees and did not show differences between foot designs., Significance: The adaptable ankle joint motion of the MPF is a crucial requirement for a more natural motion pattern and leads to a reduction of sagittal knee joint loading on the prosthetic side., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Knee osteoarthritis (KOA) is the most common form of arthritis with an estimated lifetime prevalence of 45%. The use of orthotic devices is a generally accepted conservative therapy in KOA. A new conservative treatment is an ankle-foot orthosis (AFO); however, studies on the biomechanical effects are limited. The aim of this study was to examine the acute effects of different orthotic devices (AFO, knee brace and wedged shoes) on (un)loading parameters in subjects with KOA., Methods: Fifty-two medial KOA patients (mean age 59 (standard deviation (SD) 10) years and mean body mass index 27.5 (SD 4.9) kg/m 2 ) were recruited. Three-dimensional gait analysis was undertaken with different interventions in a randomized order: control (own shoes), new AFO, conventional unloader brace and laterally wedged shoes (six degrees)., Results: Significant decreases of 27% and nine percent in first peak knee adduction moment (KAM) were observed for the AFO and wedged shoes, respectively, in comparison with the control. Significant decreases of 21%, seven percent and 18% in the KAM impulse were observed for the AFO, brace and wedged shoes, respectively, compared to the control. The knee flexion moment (KFM) increased compared to the control for all conditions, but only significantly while using the AFO, showing an increase of 26% as compared to the control., Conclusions: The AFO and wedged shoes were more effective in unloading the medial compartment of the knee compared to the unloader brace. However, the effect of an increased KFM on KOA remains unclear and requires further investigation., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Knee osteoarthritis (KOA) is a painful disease commonly caused by high loads on the articular cartilage. Orthotic interventions aim to reduce mechanical loading, thereby alleviating pain. Traditional orthotics appear effective, but high drop-out rates have been reported over prolonged periods., Research Question: The aim of this study was to examine the effect of a novel ankle-foot orthosis (AFO) on gait parameters, physical function and activity of KOA patients., Methods: 29 clinically diagnosed KOA patients with varus malalignment wore an AFO for 6 weeks. Prior to and after the intervention period, 3D gait analysis, physical function tests and the KOOS questionnaire were administered. Physical activity was objectively assessed with accelerometers., Results: The AFO immediately reduced the first peak of the knee adduction moment (KAM) and the KAM impulse by 41% and 19%. The knee flexion moment (KFM) was increased by 48%. After six weeks, the first KAM peak and KAM impulse were decreased by 27% and 19% while using the AFO. The KFM was increased by 71%. Furthermore, patients completed the functional tests faster (1.4-2.6%). The KOOS scores decreased significantly. No significant differences were found in physical activity parameters., Significance: The six-week AFO application significantly reduced the KAM. The patients' physical function appeared improved; yet these improvements were only minor and therefore arguably clinically irrelevant. The KFM appeared to be negatively affected after six weeks, as were the scores on the KOOS subscales. In summary, even though the AFO reduced the KAM and improved physical function, the clinical benefit for KOA patients with varus malalignment after the 6-week AFO application is debatable., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Dynamic intraligamentary stabilization (DIS) has been introduced as a new technique to repair the torn anterior cruciate ligament (ACL) and to restore knee joint kinematics after an acute ACL tear. Aim of the present study was to compare the early post-operative activity, restoration of gait pattern and functional results after DIS in comparison with primary ACL reconstruction (ACLR) for acute ACL tears. It was hypothesized that functional results, post-operative activity and changes in gait pattern after DIS are comparable to those after ACLR., Methods: Sixty patients with acute ACL tears were included in this study and underwent either DIS or ACLR with an anatomic semitendinosus autograft in a randomized manner. Patients were equipped with an accelerometric step counter for the first 6 weeks after surgery in order to monitor their early post-operative activity. 3D gait analysis was performed at 6 weeks and 6 months after surgery. Temporal-spatial, kinematic and kinetic parameters were extracted and averaged for each subject. Functional results were recorded at 6 weeks, 6 months and 12 months after surgery using the Tegner activity scale, International Knee Documentation Committee score and Lysholm score., Results: Patients who underwent DIS showed an increased early post-operative activity with significant differences at week 2 and 3 (p = 0.0241 and 0.0220). No significant differences between groups were found for knee kinematic and kinetic parameters or the functional scores at any time of the follow-up. Furthermore, the difference in anterior tibial translation was not significantly different between the two groups (n.s.)., Conclusion: Early functional results and changes in gait pattern after DIS are comparable to those of primary ACLR. Therefore, ACL repair may be an alternative to ACLR in this cohort of patients., Level of Evidence: I.

Objective: The aim of the study was to investigate the effects of a 4-wk inpatient rehabilitation program on postural control and gait in pediatric patients with cancer., Design: Eighty-eight patients with brain tumors (n = 59) and bone/soft tissue sarcomas (n = 29) were evaluated. Postural control was assessed examining the velocity of the center of pressure and single-leg stance time on a pressure distribution platform. Walk ratio, a measure of neuromotor control, was used to evaluate intervention effects on gait., Results: Repeated measures analysis of variance showed improvements in postural control measures, indicated by a decrease in velocity of center of pressure of -0.4 cm/sec (F1,80 = 7.175, P = 0.009, ηp = 0.082) and increase in single-leg stance time (mean [median] = 1.1 [2.6] sec, respectively; F1,80 = 12.617, P = 0.001, ηp = 0.136). Walk ratio increased by 0.2 mm/steps per min (F1,82 = 3.766, P = 0.056, ηp = 0.044). Mean changes in dependent variables did not differ between both patient groups (P > 0.05)., Conclusions: The results indicate benefits of an inpatient rehabilitation program comprising standard physical therapy as well as aquatic and hippo therapy on postural control and gait after treatment of pediatric patients with cancer.

Gait initiation is the task commonly used to investigate the anticipatory postural adjustments necessary to begin a new gait cycle from the standing position. In this study, we analyzed whether and how foot-floor interface characteristics influence the gait initiation process. For this purpose, 25 undergraduate students were evaluated while performing a gait initiation task in three experimental conditions: barefoot on a hard surface (barefoot condition), barefoot on a soft surface (foam condition), and shod on a hard surface (shod condition). Two force plates were used to acquire ground reaction forces and moments for each foot separately. A statistical parametric mapping (SPM) analysis was performed in COP time series. We compared the anterior-posterior (AP) and medial-lateral (ML) resultant center of pressure (COP) paths and average velocities, the force peaks under the right and left foot, and the COP integral x force impulse for three different phases: the anticipatory postural adjustment (APA) phase (Phase 1), the swing-foot unloading phase (Phase 2), and the support-foot unloading phase (Phase 3). In Phase 1, significantly smaller ML COP paths and velocities were found for the shod condition compared to the barefoot and foam conditions. Significantly smaller ML COP paths were also found in Phase 2 for the shod condition compared to the barefoot and foam conditions. In Phase 3, increased AP COP velocities were found for the shod condition compared to the barefoot and foam conditions. SPM analysis revealed significant differences for vector COP time series in the shod condition compared to the barefoot and foam conditions. The foam condition limited the impulse-generating capacity of COP shift and produced smaller ML force peaks, resulting in limitations to body-weight transfer from the swing to the support foot. The results suggest that footwear and a soft surface affect COP and impose certain features of gait initiation, especially in the ML direction of Phase 1.

Assessment of gait and function might be as sensitive tool to monitor the progress of fracture healing. Currently available assessment tools for function use instrumented three dimensional gait analysis or pedobarography. The analysis is focused on gait or movement parameters and seeks to identify abnormalities or asymmetries between legs or arms. The additional inclusion of muscle function by electromyography can further elucidate functional performance and its temporal development. Alternative approaches abstain from directly assessing function in the laboratory but rather determine the amount of activities of daily living or the mere ability to perform defined tasks such as walking, stair climbing or running. Some of these methods have been applied to determine recovery after orthopaedic interventions including fracture repair. The combination of lab-based functional measurements and assessment of physical activities in daily live may offer a valuable level of information about the gait quality and quantity of individual patients which sheds light on functional limitations or rehabilitation of gait and mobility after a disease or injury and the respective conservative, medical or surgical treatment., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The present study shows how foot loading patterns may be deliberately altered by either in-toeing or out-toeing gait during barefoot walking. The results indicate that in-toeing increasingly loads the lateral aspects of the midfoot and forefoot by as much as 61% and 49%, respectively, whereas out-toeing intensifies the load on the medial aspect, i.e. predominantly the medial midfoot and medial forefoot by as much as 72% and 52%. These findings are being discussed with respect to the potential benefits of consciously altering the gait pattern in order to off-load certain plantar regions., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Gait speed has been shown to influence foot loading patterns in adults but the mechanism has not been investigated in children. The present study investigated the effects of changes in gait speed on foot loading characteristics in 20 typically developing children who participated in plantar pressure measurements at normal, slow and fast walking speeds. In spite of shorter contact times in the fast walking speed condition, significantly increased foot loading was seen in the hindfoot, medial and central forefoot and toes while it slightly decreased in the lateral midfoot and forefoot. The results generally confirm the findings in adults that gait speed does not uniformly affect foot loading characteristics and that these effects should be kept in mind when comparing different subject groups or children at repeated measurement occasions., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: While research on exercise interventions during anticancer treatment is well-established in adults, only very few studies exist in children. However, pediatric patients experience great limitations to being physically active, and appropriate interventions are desired., Procedure: The present study aimed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor. The parameter of interest was physical activity (PA). Patients' PA during home stays was assessed 6 weeks as well as 3, 6, 12, and 18 months post-surgery. Patients were distinguished into an intervention group and a control group. All patients received endoprosthetic replacement of the affected bone in the same institution., Results: A constant increase in all PA parameters was observed during follow-up. Exercise interventions were possible and appeared worthwhile. The intervention group showed better PA results at all measurements; however, no significant differences between groups were found. Furthermore, differences decreased especially after the cessation of the intervention. General problems in reaching appropriate power and compliance were observed., Conclusions: Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial. Such interventions should be implemented in adjuvant care; however, future research is needed to understand more about the effects of different interventions.

Everyone's walking style is unique, and it has been shown that both humans and computers are very good at recognizing known gait patterns. It is therefore unsurprising that dynamic foot pressure patterns, which indirectly reflect the accelerations of all body parts, are also unique, and that previous studies have achieved moderate-to-high classification rates (CRs) using foot pressure variables. However, these studies are limited by small sample sizes (n < 30), moderate CRs (CR ≃ 90%), or both. Here we show, using relatively simple image processing and feature extraction, that dynamic foot pressures can be used to identify n = 104 subjects with a CR of 99.6 per cent. Our key innovation was improved and automated spatial alignment which, by itself, improved CR to over 98 per cent, a finding that pointedly emphasizes inter-subject pressure pattern uniqueness. We also found that automated dimensionality reduction invariably improved CRs. As dynamic pressure data are immediately usable, with little or no pre-processing required, and as they may be collected discreetly during uninterrupted gait using in-floor systems, foot pressure-based identification appears to have wide potential for both the security and health industries.

Purpose: The theoretical superiority of mobile-bearing total knee arthroplasties (TKAs) has not yet been proven in clinical studies. The aim of the current study was to compare and to analyse in a patient population that had received either a fixed or a mobile TKA differences in gait analysis electromyography and clinical scores., Methods: In a prospective, randomized, patient- and observer-blinded clinical study, 33 patients with primary osteoarthritis of the knee were included. All patients received a Genesis II total knee replacement. Sixteen patients received a mobile and 17 a fixed-bearing cruciate retaining Genesis II TKA. Clinical and quality-of-life scores, electromyography and gait analysis were applied preoperatively and postoperatively with a follow-up of 24 months., Results: In both groups, improvements from pre- to postoperative were detected. whereas the results of gait analysis and electromyography did not show any differences. The results from the clinical and the quality-of-life scores improved from pre- to postoperative, while the Knee Society Score showed a superiority of the mobile-bearing group (mean 159 ± 28) over the fixed-bearing group (mean 134 ± 41)., Conclusion: No functional advantage of mobile over fixed-bearing TKA was detected, although the mobile-bearing group had better clinical results for which a reason could not be found. These results only apply to cruciate retaining mobile-bearing TKA with a bearing which allows both rotation and anteroposterior translation.

The foot sole is loaded during stance and gait and plantar cutaneous mechanoreceptors sense the local stress distribution. It is not clear whether the perception thresholds of these mechanoreceptors change during the day and how they respond to walking activities. The primary aim of the present study was to investigate diurnal changes of plantar sensitivity. Furthermore, the aim was to find out whether daily changes depend on the individual level of step activity. Twenty-six healthy subjects, 17 women and 9 men, aged 28.6±6.7 years participated in the study. Detection thresholds to light touch were measured in six plantar regions with Semmes-Weinstein monofilaments in the morning, noon and afternoon. Step activity was recorded with a StepWatch™ Activity Monitor and analyzed for three periods (8 a.m.-4 p.m., 8 a.m.-12 p.m., 12 p.m.-4 p.m.). The hallux, the 3rd metatarsal head and the heel showed significantly decreased detection thresholds from 8 a.m. to 4 p.m. (p≤0.05). A fair correlation between the decrease of detection threshold and the total number of steps was found for the 3rd metatarsal head and the heel (p≤0.05). Foot sole sensation appears to improve during the day and seems to be associated with the step activity. This may reflect an improving transfer of afferent information to the central nervous system during the day as well as an adaptation of receptors to gait activity., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: After foot surgery or in diseases such as diabetes, orthopaedic shoes with an elevated sole construction are used to off-load the affected foot. The height difference between the shoes results in a leg length discrepancy and an abnormal gait pattern arises which can cause long-term discomfort in the joints of the lower extremity and the lower back. To compensate for this discrepancy and to ensure a symmetrical gait pattern a Twin Shoe (Darco) has been designed., Aim: To investigate the effect of wearing orthopaedic shoes in combination with the Twin Shoe on normal gait biomechanics., Study Design: Cross-sectional study in a laboratory setting., Methods: Normal gait was recorded in 15 healthy subjects with a gait analysis system. Four different shoe conditions were measured. Selected biomechanical parameters were calculated and compared between the shoe conditions., Results: Walking in orthopaedic shoes with an elevated sole without compensation on the contralateral side leads to significant asymmetrical joint movements and higher loads in feet, knees, hips and the lower back during gait. By using the Twin Shoe these abnormal patterns were improved but not entirely compensated., Conclusions: Using the Twin Shoe as a partner to orthopaedic shoes with an elevated sole construction improves gait asymmetry and increased loading of joints induced by functional leg length discrepancy., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and Roland-Morris score were used to assess the patients' clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm(2). The radiographic results did not correlate either with objective SAM results or with clinical outcome parameters. In conclusion, this study is the first to present objective data on continuous activity monitoring/measurements in patients with central LSS. The SAM could be an adequate tool for performing these measurements in spine patients. Except for leg pain, the objective SAM results did not correlate with the clinical results or with the radiographic extent of central LSS.

Children under 10 years of age are less efficient than adults regarding their dynamic balance control. The development of the somatosensory system is necessary for the control of posture and balance. The foot, as the final link between body and ground, transfers internal forces during gait. The coordination of force transfer needs to be balanced between both feet thus leading to a potential asymmetry of foot loading. The magnitude of asymmetry in infants' gait has been previously studied. However, the individual development and improvement of gait symmetry should also be considered. Therefore, the aim of this study was to retrospectively evaluate the longitudinal development of foot loading symmetries from the onset of independent walking. Sixty-two healthy infants were followed over the course of 4 years by means of plantar pressure distribution measurements (mean age of 15 months at study start and 63 months at the end). The subjects attended a total of nine measurements scheduled every 6 months. Foot loading data was recorded during walking with the emed(®) pressure platform to evaluate contact area, peak pressure, force-time integral, relative maximum force and contact time. An absolute symmetry index was calculated for all parameters. Furthermore, the infants' data were compared to the data of 26 healthy adults. The adults were measured once and the data acquisition followed exactly the same procedures as the infants' data. In conclusion, foot loading is asymmetric with the onset of independent walking and shows improved symmetry with increasing age dependent on the foot loading parameters., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Evaluation of gait performance and muscle activity patterns as well as clinical efficacy and safety after intraarticular injections with hyaluronan (Ostenil) compared with triamcinolone (Volon A10) injections in patients with knee osteoarthritis. This was a prospective, randomised, double-blind clinical trial evaluating the influence of five injections of hyaluronan or triamcinolone on gait pattern and muscle activity. For the clinical evaluation visual analogue scale, Lequesne index, and Knee Society Score were used. Quality of life was estimated with the SF-36. The definitive analysis was performed on the population who received all five injections and were examined in the two follow-up visits. Fifteen patients were treated with triamcinolone and 20 with hyaluronan. Significant improvement could be demonstrated for pain scale and clinical scores in both groups. Gait patterns showed significant differences only for Knee Abduction Moment (p=0.007) in the hyaluronan group and for Maximum Vertical Force 1 and 2 between the both groups in the follow up visit (p=0.018) (p=0.019). In both groups there was no significant difference regarding to muscle activity. Quality of life showed no changes in all visits between the groups. Hyaluronan was not superior to triamcinolone. The results suggest that treatment with hyaluronan can reduce pain and improve knee function. A significant short term improvement in gait and muscle activity patterns, however, was not observed, in either hyaluronan or triamcinolone.

The purpose of this study was to assess the foot loading characteristics and foot function of patients after operative correction of a tarsal coalition. Ten patients who had undergone operative treatment of a tarsal coalition were included in this study. One foot was affected in five patients and both feet in the other five. A calcaneonavicular coalition was present in 12 feet and a talocalcaneal coalition in three feet. Mean follow-up was 11.3 years. Clinical evaluation was based on a standardized questionnaire, a visual analogue scale for pain (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Score and radiographic evaluation of the last radiographs. An objective analysis of foot loading characteristics was carried out with instrumented gait analysis and pedobarography. The clinical results were overall fair for pain, range of motion and walking distance. The AOFAS also showed fair results (mean: 78.1) at follow-up. Gait analysis revealed alterations in kinematic and kinetic parameters for the operated foot. Pedobarographic analysis showed altered loadings for heel and forefoot. In this study, operative treatment of tarsal coalition achieved fair clinical and radiographic results and did not restore physiologic gait and foot loading.

Background: The human foot has to bear loads during all kinds of bipedal locomotion throughout the whole life. Rapid developmental changes of foot morphology and foot function occur during the first years of walking. Furthermore, disease dependent modifications can also have an influence on plantar loading. Therefore, it is reasonable to assume that foot function will undergo changes in life. However, the main differences between the pressure patterns in young and elderly have not been well described. The aim of the study was to evaluate age-dependent pressure patterns in different age-related stages., Methods: Hundred and four healthy humans of four different age groups were retrospectively analysed by means of plantar pressure measurements (toddlers: mean age 1.0 (SD 0.2) year; 7-year olds: 7.0 (SD 0.4) years; adults: 31.9 (SD 2.1) years; seniors: 68.7 (SD 3.2) years). The emed pressure platform was used to evaluate peak pressure, maximum force, contact time, contact area and arch index., Findings: Significant differences were found for each parameter between almost every age group. The highest peak pressure values were observed for the seniors' (P<0.001). Peak pressures are low in toddlers (145 kPa), high in 7-year olds and adults (400-600 kPa) and even higher in elderly (> or =800 kPa)., Interpretation: Elderly adults can still be functionally mobile even if pressures are high. The results for the investigated age groups can be used as normative foot loading data to compare to pathological foot function.

Background: Diabetes mellitus is one of the most common diseases worldwide and the number of patients is expected to increase dramatically in future. Plantar ulceration is partly caused by high plantar pressures and a major complication in diabetic patients., Purpose: The aim of this study was to investigate the pressure-relieving effects of two vacuum orthoses in patients with diabetes mellitus., Methods: Twenty patients with diabetes mellitus were included. They presented with plantar callosities but no ulceration. Exclusion criteria included the use of walking aids and other systemic diseases. Plantar pressure distribution was measured with sensor insoles (Pedar-X, Novel GmbH) during walking in two vacuum orthoses, a post-operative shoe and an off-the-shelf shoe as reference condition. Statistical analysis was conducted using Friedman and Wilcoxon signed-rank tests., Results: Significant differences in plantar pressure distribution were found between the four walking conditions. The contact area increased in the midfoot with the vacuum orthoses. Maximum force and peak pressures showed a significant decrease under the rearfoot and forefoot and increased in the midfoot area during walking with both vacuum orthoses. The high-cut vacuum orthosis revealed equal pressure relief under the forefoot and significantly lower rearfoot pressures compared to the post-operative shoe., Conclusions: The vacuum orthoses demonstrated a comparable pressure-relieving efficacy under the forefoot to post-operative shoes. Using vacuum orthosis significantly benefited re-distribution of plantar pressure and the roll-over process. Clinical significance of the pressure-relieving efficacy could not be confirmed in this investigation and has to be addressed in further studies.

Unlabelled: Current methods of treating congenital clubfeet provide high rates of functional outcomes. Despite the clinical outcomes, radiographic assessment suggests residual equinus deformity of the hindfoot. It is unclear whether these deformities result in abnormal foot-floor pressures and whether they correlate with clinical outcome. We evaluated 28 feet in 20 patients following Ponseti treatment for clubfoot by clinical and pedobarographic examination a mean of 33 months after removal of the last cast. The data were compared to age- and weight-matched normal subjects and to the unaffected foot in the unilaterally affected patients. Despite ankle range of motion of 30 degrees and a physiologic hindfoot valgus alignment in 19 cases, pedobarography suggested differences in maximum force, impulse, contact area, and peak pressure compared to normal subjects. Compared to the unaffected foot the only difference was reduced peak pressure over the medial hindfoot and forefoot with increased pressure over the lateral midfoot. Similar to radiographic abnormalities in studies on treated clubfeet with good functional outcome, pedobarographic analyses show differences compared to a control group. The value of pedobarographic analysis for predicting successful treatment of congenital clubfoot is questionable since it does not correlate with the clinical outcome in patients treated with the Ponseti method., Level of Evidence: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Objective: To detect gait alterations in rheumatoid arthritis (RA) patients using peak pressure curves (PPC) and normalized force curves (NFC) instead of clinical classification based on the health assessment questionnaire (HAQ)., Methods: Three RA groups--30 patients each--were classified according to their HAQ score. Cluster analysis based on a k-means algorithm was applied to PPCs and NFCs in order to classify RA patients with respect to amplitude and shapes of such gait parameters., Results: The best gait pattern identification was obtained by clustering PPCs into three clusters. Peak pressures of the three identified patterns were 1169.5+/-99.4 kPa for cluster 1, 885.8+/-165.2 kPa for cluster 2 and 402.0+/-128.5 kPa for cluster 3 (statistically different, Student's t-test, p<0.001). 41 patients were included in cluster 3, 31 in cluster 2 and only 18 patients in cluster 1. Most RA3 patients--17 out of 30--showed low peak pressures and almost normal PPCs (cluster 3). Cluster 2, which incorporated altered PPCs, was mainly formed by RA1 and RA2 patients., Conclusions: PPC appears as a reliable gait parameter for a shape-based clustering algorithm. The proposed cluster analysis was proved to be reliable and the delivered classifications stable. The distribution of RA patients among the three identified PPC clusters showed only a partial agreement between clinical and functional classification, thus revealing the development of specific gait strategies related to the pathology more than to its clinical level of severity. This finding may be clinically relevant and support effective treatment of RA gait related pathologies.

Objective: To compose an inventory of instruments that have been described to measure foot function (i.e., pressure and/or gait parameters), foot pain, and foot-related disability in rheumatoid arthritis (RA), and to investigate the clinimetric quality of these measures., Methods: A systematic search was conducted in Medline, CINAHL, EMBase, and Sportdiscus. Standardized criteria, extended with levels of evidence, were applied to assess the quality of the clinimetric studies and the properties (i.e., reliability, validity, and responsiveness) of the described instruments., Results: A variety of measurement instruments were identified. Only 16 instruments have been studied for their measurement properties in RA patients: 7 for assessing foot function, 3 for measuring foot-related disability, and 6 for measuring both foot pain and foot-related disability. Thirteen instruments were rated for reliability, of which 10 were rated positively on different levels of evidence. No positive rating for absolute measurement error was applicable for any of the tests. Internal consistency was reported for 7 instruments; 3 assigned a positive rating. For 2 instruments, Rasch analysis was used to assess the methodologic quality. A positive rating was reported for goodness-of-fit only, not for item calibration. Seven instruments were rated for construct validity, and 3 assigned a positive rating. Only 2 instruments were rated positively for responsiveness., Conclusion: This review offers a basis for choosing the most appropriate instruments for measuring foot function, foot pain, and foot-related disability in RA patients, both for clinical practice and for research. Further research on the quality of these measures is urgently needed.

Purpose: This study investigated the relationship between the quality of life, quality of gait and the quantity of gait in patients with impairments in the lower extremities., Methods: Twenty-six subjects (age 58.6+/-13.4 years) suffering from knee or hip osteoarthritis were investigated before implantation of an endoprosthesis. Quality of life was assessed using the SF-36 survey. The quality of gait was assessed with a six camera motion analysis system in combination with two force plates. For evaluation of the quantity of gait, two monitors were applied: (a) the accelerometer-based DynaPort activity monitor measured locomotion and posture for 1 day and (b) The Step-Activity-Monitor, a small microprocessor-operated acceleration sensor, measured the number of gait cycles in 1-min intervals for 1 week. Spearman correlation coefficients were calculated between quantity of gait, quality of gait and quality of life., Results: The patients showed typical gait impairments caused by osteoarthritis. Locomotion accounted for 10.5+/-5% of the daily recorded time, 4782+/-2116 gait cycles were counted per day. The sub-categories of the SF-36 showed limited physical functioning and general health with 38 and 56 out of 100 points, respectively. Computation of Spearman-rho revealed no relevant correlations between quality and quantity of gait but moderate correlations between quality of life and quantity of gait., Conclusion: The findings underline that a patient's level of mobility cannot be reliably estimated from quality of gait or from quality of life. Instead, adequate methods should be chosen to measure the quantity of gait in daily life.

The objective of this study was to determine the reliability of repeated plantar pressure distribution measurements during normal gait across multiple testing sessions. Testing sessions were conducted on 5 separate days at approximately the same time of day. Nine subjects (five males, four females, age 26+/-8.4 years) who were free of any musculoskeletal injury were recruited. A capacitive pressure distribution platform (EMED AT, Novel GmbH, Munich, Germany), sampling at 50Hz was used to collect plantar pressure patterns during barefoot walking at a self-selected speed. Four parameters were investigated: peak pressure, maximum force, impulse, and contact time, and these were investigated in 10 areas of the foot after using the PRC mask method of subdividing the foot into ten anatomical areas of interest. Individual means of all the five repeated trials for each foot were calculated, and these values were used to calculate intraclass correlation coefficients (ICC) and coefficients of variation (CoV) for all parameters. The results of this investigation show a generally good level of reliability, the quality of which is dependent on the region of the foot and the parameter investigated. Areas with typically high loading characteristics, such as the central forefoot showed a higher level of reliability in the ICC's (>0.9) than less loaded areas such as the medial midfoot (<0.8). The conclusion of this study is that plantar pressure distribution measurements can be used in comparative evaluations since the measures of repeatability are satisfactory for the parameters and foot regions usually used in the investigation of clinical populations such as neuropathic diabetics.

The purpose of the present study was to provide normative data for foot loading patterns and foot shape parameters in order to support decisions about the normal or abnormal development of the growing foot during childhood. In a longitudinal design, 90 healthy German children were followed over the course of 6-48 months. The children had a mean age of 15 months at the first appointment and 63 months at the last appointment. The children participated in 11 measurement appointments every 3 months or 6 months. Dynamic foot loading was evaluated with plantar pressure measurements during walking and static footprints were taken to determine changes in foot shape. During the investigation period a significant increase of peak pressure in almost every foot region was observed. Peak pressure of the total foot increased by 92%. Only for the midfoot region a significantly decreased impulse by about 15% per year and a significant decrease of the contact area by 9% per year could be observed. A significant influence of gender was observed for peak pressures and impulses in some foot regions as well as for the midfoot width and the foot shape index. The established database can be used as comparative values for clinical decisions about the normal development.

The objective of this study was to examine if spatio-temporal gait parameters in healthy children can be determined from accelerations measured at the lower trunk as has been demonstrated in adults, previously. Twenty children aged 3-16 years, participated in a protocol that involved repeated walks of different distances in an indoor environment. During walking, accelerations were measured by three orthogonally mounted acceleration sensors in a small wireless device (DynaPort MiniMod) that was attached to the lower back. Based on an inverted pendulum approach, spatio-temporal gait parameters and walking distances were computed from the acceleration signals. Results were compared to video observations and known walking distances and durations. Steps were successfully detected in 99.6+/-0.6% of all observed steps (n=5554). On average, walking distance was accurately estimated (100.6+/-3.3%, range 93-106.7%). No correlation was found between the number of miscounted steps and the total number of steps or the age of the subject. It can be concluded that the use of an inverted pendulum model provides the possibility to estimate spatio-temporal gait parameters in children as well as in adults. The method allows an inexpensive and comfortable assessment of gait parameters in children, is applicable in controlled, indoor environments and could be tested for applicability under free living conditions.

Evaluation of the clinical and functional results of a new prosthetic knee design with conservation of the physiologic properties of the patellofemoral joint. After total knee arthroplasty there are often patella problems. Some of them may be a result of excessive retropatellar pressure caused by the prosthetic design. Twelve patients with an average age of 68.6 years were evaluated after a follow-up of 16.4 months after implantation of a new prosthetic design. The clinical results were evaluated with the Hospital for Special Surgery Scores (HSS) and the Knee Society Clinical Rating Systems (KSS). Pain was rated on a Visual Analog Scale (VAS). Quality of life was determined with the SF-36 questionnaire. Furthermore, clinical gait analysis was performed with a 3D motion analysis system and force plates as well as surface electromyography of seven lower extremity muscles. The HSS-Score reached a mean value of 79.3 points. The KSS reached 82.3 points for the knee score and 75 points for the functional score. The VAS for pain revealed an average value of 1.7. For the gait analysis only three parameters indicated significant differences between the affected and the contralateral leg. The mean EMG amplitude revealed a significant difference only for the biceps femoris. The clinical and functional outcome of a new prosthesis design show satisfactory results. Even if the presented results appear promising, a further application and long term results are needed.

The rocker sole and solid-ankle cushion-heel (SACH) heels are the most commonly prescribed external shoe modification. Only a limited number of scientific evidence exists to support these interventions in clinical practice. The objective of this study was to determine the effects of rocker soles and SACH heels on kinematics during gait. In this study, we investigated the gait parameters during level walking, stair climbing and stair descending in healthy volunteers and assessed the effects of the modified shoes on the motion of the forefoot and hindfoot compared with the traditional shoes. Eleven normal subjects participated in this study. A six-camera motion analysis system was used to capture motion trajectories. The three-dimensional (3D) coordinates of the markers were used to calculate the angles of flexion-extension, valgus-varus, and internal-external rotation at the hindfoot and forefoot joints in a gait cycle by the custom software for foot kinematic analysis. The results showed that the rocker soles offer several advantages from the viewpoint of gait kinematics. The forefoot joint excursion in sagittal plane while wearing rocker shoes was significantly less than that while wearing traditional shoes during level walking, stair climbing and stair descending. It means that they could mimic the action of the forefoot joint, aid in roll off, and simulate forefoot dorsiflexion. Since the bony structures mechanically link the forefoot joint and hindfoot joint to a triplanar axis of motion, they could be used whenever there is minimal or no motion at the forefoot joint or hindfoot joint, because of, for example, fusion, fracture, cast immobilization, orthosis design, pain, or arthritis.

The aim of this study was to investigate the influence of reduced plantar sensation on gait patterns during walking in 20 healthy subjects (25.9 +/- years, 61.6 +/- 11.5 kg, 178 +/- 9.5 cm) with no history of sensory disorders. Force plate measurements, electromyography (EMG) measurements and a three-dimensional movement analysis were performed simultaneously during barefoot walking before and after reduction of plantar sensation using an ice immersion technique. The results show that reduced plantar sensation leads to significant changes in gait patterns that are present at the ankle, knee and hip joint and indicate a more cautious ground contact and push-off with modified EMG and motion patterns., (Copyright 2003 Elsevier B.V.)

This study evaluated developmental changes of foot and gait during the first year of independent walking. In a longitudinal design, plantar pressure distribution patterns were measured with a capacitive platform every 3 months in a group of 42 normal children. The first significant changes were already found after a few weeks of independent walking. The development of the longitudinal arch correlated with significantly reduced midfoot loading parameters even though the changes showed a wide interindividual variation. This study illustrates that a child's foot goes through significant changes in shape and loading characteristics once the child starts to stand and walk. Some children showed a fairly mature appearance of the plantar pressure pattern after 1 year while others retained a more immature loading pattern., (Copyright 2003 Elsevier B.V.)

The aim of the present study was to investigate the influence of reduced plantar sensation on pressure distribution patterns during gait of 40 healthy subjects (25.3+/-3.3 yr, 70.8+/-10.6 kg and 176.5+/-7.8 cm) with no history of sensory disorders. Plantar sensation in the subjects was reduced by using an ice immersion approach, and reduced sensitivity was tested with Semmes-Weinstein monofilaments. All subjects performed six trials of barefoot walking over a pressure distribution platform under normal as well as iced conditions. Plantar cutaneous sensation was significantly reduced after the cooling procedure (p<0.0001). Pressure distribution analysis showed substantially modified plantar pressure distribution patterns during the roll-over process (ROP) under iced conditions. Analysis of peak pressures revealed significant reductions under the toes and under the heel (p<0.001). The contact time and the relative impulse for the whole foot did not change significantly between the two conditions. For the different areas, a significant load shift from the heel and toes towards the central and lateral forefoot and the lateral midfoot was observed. The results indicate the strong influence of reduced afferent information of the sole of the foot on the ROP in walking.

Background: Deficits in motor control can be observed with a decrease in plantar sensation. There is evidence that changing the plantar feedback leads to kinematic, kinetic and neuromuscular adaptations in static as well as dynamic conditions. The effect of changes in plantar feedback on the modulation of gait has not been clarified conclusively. Objectives: The purpose of this paper was to provide a review of studies reporting the effects of changes in plantar feedback on human gait characteristics. Method: The databases Medline (PubMed), Cochrane Central Register of Controlled Trials and PEDro (Physiotherapy Evidence Database) were searched for clinical (CTs) and randomized controlled trials (RCTs) concerning foot sensation and gait. Results: Twenty-three studies were included in the evaluation. Several methods were used to affect the sensitivity of the foot sole. After cooling or sedating the foot sole, predominant changes occur in decreased peak pressures, muscle activities and joint angles, and relocation of the centre of pressure under the foot was found. Walking on uneven surfaces results in a decrease in gait velocity, cadence and step length and also an increase in step variability. The use of textured insoles during walking leads to increased knee, hip and ankle angles, forces and moments in neurological patients with decreased foot sensation. In particular, individuals with sensory deficits show significant gait improvements when using textured or vibrating insoles. Conclusions: Changes in plantar feedback lead to stimulation-specific adaptations of gait characteristics. Further prospective RCTs should be performed to investigate interventions for enhancing plantar receptor feedback for the prevention of falls and the treatment of injuries and movement disorders. [ABSTRACT FROM AUTHOR]