Cutaneous mechanisms of isometric ankle force control

The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased cutaneous sensory function as evidenced by increased touch threshold. Absolute dorsiflexion force error increased without visual feedback during peroneal nerve stimulation. This was not a general effect of stimulation because force error did not increase during plantar nerve stimulation. The effects of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases.     

Distribution and behaviour of glabrous cutaneous receptors in the human foot sole

To document the activity of cutaneous mechanoreceptors in the glabrous skin of the foot sole, tungsten microelectrodes were inserted through the popliteal fossa and into the tibial nerve of thirteen healthy human subjects. A total of 104 cutaneous mechanoreceptors were identified in the glabrous skin of the foot. This sample consisted of 15 slow adapting type I (14 %), 16 slow adapting type II (15 %), 59 fast adapting type I (57 %), and 14 fast adapting type II units (14 %). The location of the receptors and the outline of the receptive fields were determined by using nylon monofilaments perpendicularly applied against the surface of the skin. This revealed that the receptors were widely distributed without an accumulation of receptors in the toes. There were also larger receptive fields predominantly isolated on the plantar surface of the metatarsal-tarsal region of the foot sole. Furthermore, with the foot in an unloaded position, there was no background discharge activity in any of the cutaneous receptors in the absence of intentionally applied stimulation. These findings suggest that skin receptors in the foot sole behave differently from those receptors found on the glabrous skin of the hand. This may reflect the role of foot sole skin receptors in standing balance and movement control.     

Evidence for strong synaptic coupling between single tactile afferents from the sole of the foot and motoneurons supplying leg muscles

It has been known for some time that populations of cutaneous and muscle afferents can provide short-latency facilitation of motoneuron pools. Recently, it has been shown that the input from individual low-threshold mechanoreceptors in the glabrous skin of the hand can modulate ongoing activity in muscles acting on the fingers via spinally mediated pathways. We have extended this work to examine whether such strong synaptic coupling exists between tactile afferents in the sole of the foot and motoneurons supplying muscles that act about the ankle. We recorded from 53 low-threshold mechanoreceptors in the glabrous skin of the foot via microelectrodes inserted percutaneously into the tibial nerve of awake human subjects. Reflex modulation of ongoing whole muscle electromyography (EMG) was observed for each of the four classes of low-threshold cutaneous mechanoreceptors (17 of 21 rapidly adapting type I; 2 of 4 rapidly adapting type II; 7 of 18 slowly adapting type I; and 4 of 10 slowly adapting type II). Reflex modulation of the firing probability in single motor units (5 of 11) was also observed. These results indicate that strong synaptic coupling between tactile afferents and spinal motoneurons is not a specialization of the hand and emphasizes the potential importance of cutaneous inputs from the sole of the foot in the control of gait and posture.     

The innervation of the joints of the foot

The nerve supply of the ankle joint and of the joints of the foot was studied in dissections of fetal and adult feet and in serial sections of fetal feet stained with silver. The ankle joint was supplied by the tibial, sural, deep peroneal, and saphenous nerves, and by the accessory deep peroneal nerve when present. The tarsal joints were supplied on their plantar aspects by the medial or lateral plantar nerves, and on their dorsal aspects chiefly by the deep peroneal nerve. The joint between the lateral and intermediate cuneiform received branches from the intermediate dorsal cutaneous nerve also. The lateral dorsal cutaneous nerve and the accessory deep peroneal nerve when present provided additional branches to the subtalar and calcaneocuboid joints. The tarsometatarsal joints were supplied on their plantar aspects by the medial or lateral plantar nerves. Most of them were supplied on their dorsal aspects by the deep peroneal nerve, but the cuboid-metatarsal joints received their supply from the intermediate dorsal cutaneous nerve. The intermetatarsal joints had a similar but sparser supply. The joint between the fourth and fifth metatarsal received branches from the intermediate dorsal cutaneous nerve. The plantar digital nerves provided the main supply to the metatarsophalangeal joints. The dorsal aspect of the first metatarsophalangeal joint was supplied by the deep peroneal and the medial dorsal cutaneous nerves, of the second metatarsophalangeal joint by the deep peroneal nerve, and of the fourth and fifth metatarsophalangeal joints by the lateral dorsal cutaneous nerve. The interphalangeal joints did not receive articular branches from the dorsal digital nerves, except in the case of the interphalangeal joint of the big toe, which was supplied by the deep peroneal and the medial dorsal cutaneous nerves.     

Location specificity of plantar cutaneous reflexes involving lower limb muscles in humans

It is known that cutaneous reflexes in human hand muscles show strong location-specificity dependent on the digit stimulated. We hypothesized that in lower leg muscles the cutaneous reflex following tactile sensation of the plantar surface of the foot is also organized in a location-specific manner. The purpose of the present study was to test this hypothesis. Middle latency reflexes (∼70–110 ms, MLR) following non-noxious electrical stimulation to different locations on the plantar foot were recorded from 16 neurologically intact volunteers (15 males, 1 female). Electrical stimulation was given to the fore-medial (f-M), fore-lateral (f-L) and heel (HL) regions of the plantar surface of the right foot while the subjects performed isometric dorsiflexion (tibialis anterior, TA), plantarflexion (soleus, Sol and medial gastrocnemius, MG), eversion (peroneus longus, PL) and knee extension (vastus lateralis, VL) while sitting and standing. In the Sol and MG, an excitatory response was observed following HL stimulation, which was switched to an inhibitory response following f-M or f-L stimulation (P < 0.001). A reciprocal pattern in contrast to Sol was observed in the TA. In the PL, MLR exhibited significant excitation following both f-L and HL stimulation, which, however, was switched to an inhibitory response following f-M stimulation (P < 0.001). Moderate inhibition of the MLR was seen in the VL for all stimulated positions. Systematic stimulation along the lateral side of the plantar foot demonstrated that the reflex reversal occurred around the middle of the plantar foot in the Sol and TA. In all muscles tested, the slope of the regression line between the magnitude of the MLR and background electromyographic activity significantly decreased during standing compared with sitting except for the PL following f-L simulation. These results suggest that reflex effects from cutaneous nerves in the plantar foot onto the motoneurons innervating the lower leg muscles are organized in a highly topographic manner in humans. The organization of these reflexes may play an important role in the alteration of limb loading and/or ground contact in response to tactile sensation of the plantar foot while sitting and standing.     

Coordination of two-joint rectus femoris and hamstrings during the swing phase of human walking and running

It has been hypothesized previously that because a strong correlation was found between the difference in electromyographic activity (EMG) of rectus femoris (RF) and hamstrings (HA; EMG_RF–EMG_HA) and the difference in the resultant moments at the knee and hip (M_k–M_h) during exertion of external forces on the ground by the leg, input from skin receptors of the foot may play an important role in the control of the distribution of the resultant moments between the knee and hip by modulating activation of the two-joint RF and HA. In the present study, we examined the coordination of RF and HA during the swing phase of walking and running at different speeds, where activity of foot mechanoreceptors is not modulated by an external force. Four subjects walked at speeds of 1.8 m/s and 2.7 m/s and ran at speeds of 2.7 m/s and 3.6 m/s on a motor-driven treadmill. Surface EMG of RF, semimembranosus (SM), and long head of biceps femoris (BF) and coordinates of the four leg joints were recorded. An inverse dynamics analysis was used to calculate the resultant moments at the ankle, knee, and hip during the swing phase. EMG signals were rectified and low-pass filtered to obtain linear envelopes and then shifted in time to account for electromechanical delay between EMG and joint moments. During walking and running at all studied speeds, mean EMG envelope values of RF were statistically (P<0.05) higher in the first half of the swing (or at hip flexion/knee extension combinations of joint moments) than in the second half (or at hip extension/knee flexion combinations of joint moments). Mean EMG values of BF and SM were higher (P<0.05) in the second half of the swing than in the first half. EMG and joint moment peaks were substantially higher (P<0.05) in the swing phase of walking at 2.7 m/s than during the swing phase of running at the same speed. Correlation coefficients calculated between the differences (EMG_RF–EMG_HA) and (M_k–M_h), taken every 1% of the swing phase, were higher than 0.90 for all speeds of walking and running. Since the close relationship between EMG and joint moments was obtained in the absence of an external force applied to the foot, it was suggested that the observed coordination of RF and HA can be regulated without a stance-specific modulation of cutaneous afferent input from the foot. The functional role of the observed coordination of RF and HA was suggested to reduce muscle fatigue. Received: 7 August 1997 / Accepted: 9 February 1998     

Movement-induced gain modulation of somatosensory potentials and soleus H-reflexes evoked from the leg I. Kinaesthetic task demands

 Movement-related gating of cerebral somatosensory evoked potentials (SEPs) occurs during active and passive movements of both the upper and the lower limbs. The general hypothesis was tested that the brain participates in setting the gain of the ascending path from somatosensory receptors of the human leg to the somatosensory cortex. In experiment 1, SEPs from Cz’ and soleus H-reflexes were evoked by electrical stimulation of the tibial nerve in the popliteal fossa during passive movement about the right ankle. Early SEPs and H-reflexes sampled during simple passive movement were significantly attenuated when compared with stationary controls (P<0.05). The additional requirement of tracking the passive ankle movement with the other foot led to a significant relative facilitation of mean SEP, but not H-reflex amplitude, compared with means from passive movement alone (P<0.05). In experiment 2, SEPs were evoked in the active (tracking) leg during a forewarned reaction-time task. Subjects were required to move in a preferred direction or to track the passive movement of their right foot with their left. Significant attenuation of early SEP components occurred 100 ms prior to EMG onset (P<0.05), with no apparent effect due to tracking. In the 3rd experiment, SEPs and H-reflexes were evoked in the passively moved leg (the target for active movement of the left leg) during the same forewarned reaction-time task. During the warning period, SEPs were significantly attenuated compared with stationary controls for non-tracking movements, but not for movements involving tracking (P<0.05). It is concluded that centrifugal factors are important in modulating SEP gain required by the kinaesthetic demands of the task. Received: 8 April 1996 / Accepted: 14 November 1996     

Differential regulation of cutaneous and H-reflexes during leg cycling in humans

Reflexes undergo modulation according to task and timing during standing, walking, running, and leg cycling in humans. Both cutaneous and Hoffman (H-) reflexes are modulated by movement and task. However, recent evidence suggests that the modulation pattern for cutaneous and H-reflexes may be different. We sought to clarify this issue by reducing the effect of movement phase and altering the level of background muscle activation (low and high) in static and dynamic (leg cycling) conditions. Electromyography was recorded from the ankle extensors soleus and medial gastrocnemius (MG) and the knee extensor vastus lateralis (VL). Reflexes were evoked during the downstroke of stationary leg cycling. Cutaneous reflexes were evoked with trains of 5 x 1.0 ms pulses at 300 Hz delivered to the distal tibial nerve, whereas H-reflexes were evoked in soleus by stimulation with single 1.0-ms pulses. There were two main observations in this study: 1) middle latency cutaneous reflexes were facilitatory during static contraction but were dramatically attenuated or reversed to suppressive responses during cycling (task-dependent modulation); 2) soleus H-reflexes were larger in the high muscle activation condition but were unaffected by task (no task-dependent modulation). Thus opposite results were obtained in the two reflex pathways. It is concluded that cutaneous and H-reflexes are modulated by different mechanisms during active locomotor-like movements.     

Influence of plantar cutaneous afferents on early compensatory reactions to forward fall

Summary The influence of cutaneous afferents in the compensatory reactions to a forward fall was investigated. Modification of cutaneous afferent activity was obtained in two different ways: first, by varying the initial pedal support conditions, secondly by anesthetizing the plantar foot sole. The initial pedal support conditions were: 1) bipedal posture, 2) unipedal posture, with contact and 3) unipedal posture, without contact. Nine healthy subjects participated in the control (without anesthesia) experimental session, of which three subjects participated in a session where the plantar sole was anesthetized. The compensatory reactions to a perturbation of balance of a subject initially with a bipedal stance, showed synchronized EMG activity in both Soleus muscles, starting on average at 59 ms, and a burst of EMG activity in the Tibialis Anterior of the starting foot after 200 ms. When the subject was in unipedal posture, the EMG responses on the side which was without support, showed several modifications: the EMG burst in Soleus was strikingly depressed, the response in Tibialis Anterior appeared earlier (mean latency 90 ms) and its magnitude was enhanced. When this foot was in contact with a rigid support, the Soleus showed a short burst of activity and the activity in Tibialis Anterior started at a mean latency of 150 ms. The results of the anesthesia session showed that: in the bipedal posture, the Soleus response was depressed and its duration shortened, the Tibialis Anterior response increased in magnitude and the onset was earlier; in the unipedal posture with contact, the magnitude of Soleus response was lower than the control value; in unipedal posture, the motor pattern was similar to that observed in the control unipedal condition. The plantar cutaneous afferents play a marked role in postural control regulation, as is evidenced by the comparison between the EMG responses in control situations and in sessions with anesthesia of the foot sole.     

踝关节不同应力位的动态足底压力特征

目的探究踝关节不同侧肢体和应力位的足底压力分布特点。方法 23名健康受试者通过简易定制走道和足底压力测试平板进行踝中立位、踝内翻、踝外翻的足底压力测试,测试指标为峰值压强、接触面积、接触时间百分比、足底内侧峰值压强之和与外侧峰值压强之和的比值(M/L)、足趾峰值压强之和与足跟峰值压强的比值(A/P)。结果优势腿在第1跖骨的峰值压强明显大于非优势侧,第5跖骨峰值压强明显小于非优势侧。优势侧M/L显著大于非优势侧。除中足、第1趾,其余区域3种应力位的峰值压强存在显著性差异。内翻时各区域的接触时间百分比均大于中立时,外翻时除第2趾其余区域的接触时间百分比大于中立时。内翻、中立、外翻M/L分别为1.24±0.46、1.06±0.26、0.88±0.25;内翻时优势侧M/L大于非优势侧;内、外翻时A/P均大于中立。结论优势侧踝关节稳定性优于非优势侧。踝关节内翻、外翻时稳定性有所下降。内翻时身体往前、内侧偏移,外翻时则往前、外侧偏移以维持稳定。     

Influences of tendon stiffness,joint stiffness,and electromyographic activity on jump performances using single joint

The present study aimed to examine the influences of tendon stiffness, joint stiffness, and electromyographic activity on jump performances consisting of a single-joint movement. Twenty-four men performed three kinds of unilateral maximal jump using only the ankle joint (squat jump: SJ; countermovement jump: CMJ; drop jump: DJ) on the sledge apparatus. The relative differences in the jump height of CMJ and DJ compared to SJ were defined as pre-stretch augmentation. During jumping exercises, electromyographic activities (mEMG) were recorded from the plantar flexors. Ankle joint stiffness was calculated as the change in the joint torque divided by the change in ankle joint angle during the eccentric phase of DJ. Achilles tendon stiffness was measured using ultrasonography during isometric plantar flexion. No significant correlations were found between joint stiffness and pre-stretch augmentation in both CMJ and DJ. On the contrary, tendon stiffness was significantly correlated with pre-stretch augmentation in both CMJ (r = −0.471) and DJ (r = −0.502). The relative mEMG value of CMJ (to that of SJ) during the concentric phase was significantly correlated with pre-stretch augmentation (r = 0.481), although this relationship was not found in DJ. These results suggested that (1) the greater jump height in CMJ could be explained by both the tendon elasticity and the increased activation level of muscle, (2) tendon elasticity played a more significant role in the enhancement of jump height during DJ, and (3) joint stiffness was not related to either pre-stretch augmentation or tendon stiffness.     

Biomechanical study of tarsometatarsal joint fusion using finite element analysis

Complications of surgeries in foot and ankle bring patients with severe sufferings. Sufficient understanding of the internal biomechanical information such as stress distribution, contact pressure, and deformation is critical to estimate the effectiveness of surgical treatments and avoid complications. Foot and ankle is an intricate and synergetic system, and localized intervention may alter the functions to the adjacent components. The aim of this study was to estimate biomechanical effects of the TMT joint fusion using comprehensive finite element (FE) analysis. A foot and ankle model consists of 28 bones, 72 ligaments, and plantar fascia with soft tissues embracing all the segments. Kinematic information and ground reaction force during gait were obtained from motion analysis. Three gait instants namely the first peak, second peak and mid-stance were simulated in a normal foot and a foot with TMT joint fusion. It was found that contact pressure on plantar foot increased by 0.42%, 19% and 37%, respectively after TMT fusion compared with normal foot walking. Navico-cuneiform and fifth meta-cuboid joints sustained 27% and 40% increase in contact pressure at second peak, implying potential risk of joint problems such as arthritis. Von Mises stress in the second metatarsal bone increased by 22% at midstance, making it susceptible to stress fracture. This study provides biomechanical information for understanding the possible consequences of TMT joint fusion.     

Facilitation of transmission in Ib pathways by cutaneous afferents from the contralateral foot sole in man

Changes in the quadriceps H-reflex were used to study the effect of a weak contralateral cutaneous stimulation upon transmission in Ib pathways from ankle muscles to quadriceps in man. Provided it was applied to the contralateral foot sole, such a stimulation facilitated transmission in Ib pathways to quadriceps (inhibitory from extensors as well as excitatory from flexors). The central latency of this contralateral cutaneous facilitation was 1 msec longer than that of the ipsilateral cutaneous depression of Ib pathways. These findings are discussed with regard to the requirements of bipedal gait.     

Withdrawal reflex organisation to electrical stimulation of the dorsal foot in humans

The present study investigated excitatory reflex receptive fields for various muscle reflex responses and reflex mediated ankle joint movements using randomised electrical stimulation of the dorsal and plantar surface of the foot in 12 healthy subjects. Eleven electrodes (0.5-cm2 cathodes) were mounted on the dorsal side and three on the plantar side of the foot. A low (1.5 times pain threshold) and a high (2.3 times pain threshold) stimulus intensity were used to elicit the reflexes. EMG signals were recorded from tibialis anterior (TA), gastrocnemius medialis (GM), soleus (SO), biceps femoris (BF), and rectus femoris (RF) muscles together with the ankle movement measured by a goniometer. The withdrawal pattern evoked from the dorsal side consisted of two separate responses with different receptive fields: (1) early EMG responses in GM and BF (50-120 ms) evoking knee flexion, probably of purely spinal origin, and (2) a late response in GM and SO (120-200 ms) that may be under supraspinal control. The ankle flexor TA was significantly activated in both time windows, but in 11 of 12 subjects its contraction was too small to cause significant dorsal flexion. In the ankle joint inversion was the most dominant movement. Stimulation of the plantar side resulted in activation of TA when stimulating the forefoot and in activation of triceps surae when stimulating the heel. These observations show that painful stimuli activate appropriate muscles depending on stimulus location to initiate the adequate withdrawal. For proximal muscles (e.g. knee flexors) the receptive field covers almost the entire foot (dorsal and plantar sides) while more distal muscles have a smaller receptive field covering only a part of the foot. This adequate withdrawal movement suggests a more refined withdrawal reflex organisation than a stereotyped flexion of all joints to avoid tissue damage.     

Anti-opioid effects of neuropeptide FF receptors in the ventral tegmental area

The aim of this study was to establish the modulation pattern of the soleus H-reflex and excitability changes of interneurones mediating presynaptic inhibition from tibialis anterior to soleus Ia afferents when the right foot approached and withdrew from a step in standing humans. The task was conducted at 40 beats per minute, and this tempo corresponded to the rhythm of a half full movement cycle. Each subject was instructed not to load and not to move forward. Soleus H-reflexes were elicited once in every full movement cycle that lasted approximately 3s. The ipsilateral knee joint angle and activity of leg muscles were recorded through a twin-axis goniometer and surface EMG, respectively. In all subjects, the soleus H-reflex was modulated in a phase-dependent pattern. The H-reflex was significantly depressed during the approach phase of the motor task and when the foot was on the step, and facilitated during the withdrawal phase and when the foot was on the ground. The soleus H-reflex conditioned by common peroneal nerve stimulation at tibialis anterior motor threshold at a long conditioning test interval was increased during the withdrawal phase or while the foot was on the ground suggesting that presynaptic inhibition was decreased. In most subjects, knee extensor activity was small, while ankle flexors and extensors were active in a reciprocal pattern. This study provides evidence that the soleus H-reflex is modulated in a phasic pattern during one-legged foot reaching and withdrawal by changes occurring at a premotoneuronal level.     

Neuromuscular and biomechanical coupling in human cycling: modulation of cutaneous reflex responses to sural nerve stimulation

This study tested the hypothesis that the modulation of cutaneous reflexes during human cycling would be dependent on muscle biomechanical function and phase of leg movement. The coupling between neuromuscular (electromyographic, EMG), kinetic and kinematic responses to brief innocuous (75% of the pain threshold PnT) and noxious (125% PnT) sural nerve stimulation were studied. Stimuli were delivered pseudorandomly at eight equidistant (45°) positions of the crank cycle. Peak ipsilateral middle latency EMG reflex responses were calculated between 70 and 130 ms post stimulus in Biceps Femoris (BF), Rectus Femoris (RF), Tibialis Anterior (TA) and Soleus (SOL). Peak torque, knee and ankle joint angle changes were calculated between 140 and 220 ms post stimulus to quantify net kinetic and kinematic reflex modulation. Reflex responses were predominately suppressive during early activation of all muscles and facilitatory during BF and TA muscle inactivation. EMG reflex responses in monoarticular lower leg muscles TA and SOL were well correlated with ankle angle in dorsi/plantaflexion, whereas the correlation between reflex modulation in biarticular upper leg muscles (BF and RF) and knee angle changes in flexion/extension was weaker. Stimulation provoked significant ankle eversion over the whole crank cycle for both stimulus intensities, which was correlated with TA and BF EMG reflex responses. Torque modulation followed EMG and kinematic changes in a movement phase-dependent manner. Reflex magnitude was stimulation intensity-dependent. Supplementary nociceptive activation may contribute for this increase. We conclude that sural nerve stimulation during human cycling evokes distinct reflex responses in muscles operating around the knee (BF and RF) and the ankle (TA and SOL). These reflexes are modulated in a phase-dependent manner depending on muscle biomechanical function to generate energy for limb and crank propulsion during a specific region in the cycle. This modulation contributed to a specific adaptation of joint motion and force production in order to maintain task performance.     

Facilitation of the soleus stretch reflex induced by electrical excitation of plantar cutaneous afferents located around the heel

Previous studies have demonstrated that plantar cutaneous afferents can adjust motoneuronal excitability, which may contribute significantly to the control of human posture and locomotion. However, the role of plantar cutaneous afferents with respect to their location specificity in modulating the mechanically induced stretch reflex still remains unclear. In the present study, it was hypothesized that electrical stimulation of the ipsilateral heel region of the foot is followed by a modulation of spinal excitability, leading to a facilitation of the soleus motor output. The study was performed to investigate the effect of excitation of plantar cutaneous afferents located around the heel on the soleus stretch reflex. The soleus stretch reflex was evoked by rotating the ankle joint in dorsiflexion direction at two different angular velocities of 50 and 200 degrees s(-1). A conditioning pulse train of non-noxious electrical stimulation was delivered to the plantar surface of the heel at different conditioning test intervals ranging from 5 to 100 ms. Excitation of plantar cutaneous afferents around the heel resulted in a pronounced facilitation of the soleus stretch reflex with magnitude and time course comparable for both velocities. This facilitation was manifested by a significant increase of reflex size for conditioning test intervals from 30 to 70 ms. The observed effect implies a potential functional role of cutaneous afferents in balance control conditions where the ankle is naturally disturbed, e.g., during step reactions to external perturbations.     

Influence of plantar cutaneous afferents on early compensatory reactions to forward fall

The influence of cutaneous afferents in the compensatory reactions to a forward fall was investigated. Modification of cutaneous afferent activity was obtained in two different ways: first, by varying the initial pedal support conditions, secondly by anesthetizing the plantar foot sole. The initial pedal support conditions were: 1) bipedal posture, 2) unipedal posture, with contact and 3) unipedal posture, without contact. Nine healthy subjects participated in the control (without anesthesia) experimental session, of which three subjects participated in a session where the plantar sole was anesthetized. The compensatory reactions to a perturbation of balance of a subject initially with a bipedal stance, showed synchronized EMG activity in both Soleus muscles, starting on average at 59 ms, and a burst of EMG activity in the Tibialis Anterior of the starting foot after 200 ms. When the subject was in unipedal posture, the EMG responses on the side which was without support, showed several modifications: the EMG burst in Soleus was strikingly depressed, the response in Tibialis Anterior appeared earlier (mean latency 90 ms) and its magnitude was enhanced. When this foot was in contact with a rigid support, the Soleus showed a short burst of activity and the activity in Tibialis Anterior started at a mean latency of 150 ms.(ABSTRACT TRUNCATED AT 250 WORDS)     

Numerical simulation of the plantar pressure distribution in the diabetic foot during the push-off stance

The primary objective of conservative care for the diabetic foot is to protect the foot from excessive pressures. Pressure reduction and redistribution may be achieved by designing and fabricating orthotic devices based on foot structure, tissue mechanics, and external loads on the diabetic foot. The purpose of this paper is to describe the process used for the development of patient-specific mathematical models of the second and third rays of the foot, their solution by the finite element method, and their sensitivity to model parameters and assumptions. We hypothesized that the least complex model to capture the pressure distribution in the region of the metatarsal heads would include the bony structure segmented as toe, metatarsal and support, with cartilage between the bones, plantar fascia and soft tissue. To check the hypothesis, several models were constructed with different levels of details. The process of numerical simulation is comprised of three constituent parts: model definition, numerical solution and prediction. In this paper the main considerations relating model selection and computation of approximate solutions by the finite element method are considered. The fit of forefoot plantar pressures estimated using the FEA models and those explicitly tested were good as evidenced by high Pearson correlations (r = 0.70–0.98) and small bias and dispersion. We concluded that incorporating bone support, metatarsal and toes with linear material properties, tendon and fascia with linear material properties, soft tissue with nonlinear material properties, is sufficient for the determination of the pressure distribution in the metatarsal head region in the push-off position, both barefoot and with shoe and total contact insert. Patient-specific examples are presented.