Effect of foot orthoses on the kinematics and kinetics of normal walking gait

Despite their wide clinical application and success, our understanding of the biomechanical effects of foot orthoses is relatively limited. The aim of this study was to assess the effect of medially wedged and laterally wedged foot orthoses on the kinematics and joint moments of the rearfoot complex, knee, hip and pelvis and the ground reaction forces. The principal effect of the foot orthoses was on the rearfoot complex, where significant changes in joint rotations and moments were observed. Medially wedged orthoses decreased rearfoot pronation and increased the laterally directed ground reaction force during the contact phase, suggesting reduced shock attenuation. The laterally wedged orthoses increased rearfoot pronation and decreased the laterally directed ground reaction force during the contact phase, suggesting increased shock attenuation. The effects of the orthoses on knee, hip and pelvis kinematics were generally minimal. In view of the minimal effect the orthoses had on joints proximal to the foot, it is suggested that the orthoses may have additional effects on the passive and active soft tissues of the lower limb and it is these changes that result in the documented clinical success.     

Influence of foot posture on immediate biomechanical responses during walking to variable-stiffness supported lateral wedge insole designs

BackgroundNovel designs of lateral wedge insoles with arch support can alter walking biomechanics as a conservative treatment option for knee osteoarthritis. However, variations in foot posture may influence individual responses to insole intervention and these effects are not yet known.Research questionHow does foot posture influence biomechanical responses to novel designs of lateral wedge insoles with arch support?MethodsThis exploratory biomechanical investigation categorized forty healthy volunteers (age 23–34) into pronated (n = 16), neutral (n = 15), and supinated (n = 9) foot posture groups based on the Foot Posture Index. Three-dimensional gait analysis was conducted during walking with six orthotic insole conditions: flat control, lateral wedge, uniform-stiffness arch support, variable-stiffness arch support, and lateral wedge + each arch support. Frontal plane knee and ankle/subtalar joint kinetic and kinematic outcomes were compared among insole conditions and foot posture groups using a repeated measures analysis of variance.ResultsThe lateral wedge alone and lateral wedge + variable-stiffness arch support were the only insole conditions effective at reducing the knee adduction moment. However, the lateral wedge + variable-stiffness arch support had a smaller increase in peak ankle/subtalar eversion moment than the lateral wedge alone. Supinated feet had smaller ankle/subtalar eversion excursion and moment impulse than neutral and pronated feet, across all insole conditions.SignificanceSupinated feet have less mobile ankle/subtalar joints than neutral and pronated feet and, as a result, may be less likely to respond to biomechanical intervention from orthotic insoles. Supported lateral wedge insoles incorporating an arch support design that is variable-stiffness may be better than uniform-stiffness since reductions in the knee adduction moment can be achieved while minimizing increases in the ankle/subtalar eversion moment.     

The effect of changing mediolateral center of pressure on rearfoot eversion during treadmill running

IntroductionAtypical rearfoot eversion is an important kinematic risk factor in running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping, yet a running gait retraining is lacking. Therefore, the aim was to investigate the effects of changing mediolateral center of pressure (COP) on rearfoot eversion, subtalar pronation, medial longitudinal arch angle (MLAA), hip kinematics and vertical ground reaction force (vGRF).MethodsFifteen healthy female runners underwent gait retraining under three conditions. Participants were instructed to run normally, on the lateral (COP lateral) and medial (COP medial) side of the foot. Foot progression angle (FPA) was controlled using real-time visual feedback. 3D measurements of rearfoot eversion, subtalar pronation, MLAA, FPA, hip kinematics, vGRF and COP were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes in outcome between three conditions. Data were also analyzed using statistic parameter mapping.ResultsRunning on the lateral side of the foot compared to normal running and running on the medial side of the foot reduced peak rearfoot eversion (mean difference (MD) with normal 3.3°, p < 0.001, MD with COP medial 6°, p < 0.001), peak pronation (MD with normal 5°, p < 0.001, MD with COP medial 9.6°, p=<0.001), peak MLAA (MD with normal 2.3°, p < 0.001, MD with COP medial 4.1°, p < 0.001), peak hip internal rotation (MD with normal 1.8°, p < 0.001), and peak hip adduction (MD with normal running 1°, p = 0.011). Running on the medial side of the foot significantly increased peak rearfoot eversion, pronation and MLAA compared to normal running.SignificanceThis study demonstrated that COP translation along the mediolateral foot axis significantly influences rearfoot eversion, MLAA, and subtalar pronation during running. Running with either more lateral or medial COP reduced or increased peak rearfoot eversion, peak subtalar pronation, and peak MLAA, respectively, compared to normal running. These results might use as a basis to help clinicians and researchers prescribe running gait retraining by changing mediolateral COP for runners with atypical rearfoot eversion or MLAA.     

Efficacy of motion control shoes for reducing excessive rearfoot motion in fatigued runners

ObjectivesExcessive foot pronation and fatigue in running are possible risk factors for injuries. Motion control footwear was designed to limit excessive foot motion in runners, but its clinical efficacy has not been well reported. This study investigated the rearfoot kinematics in runners when running with different footwear before and after fatigue of the lower leg muscles.DesignWithin subjects repeated measures.SettingUniversity gait laboratory.Participants25 female recreational runners.Main outcome measuresA Vicon three-dimensional motion analysis system was used to capture the rearfoot motions of 25 recreational runners who had excessive foot pronation, when running with motion control shoes and neutral shoes before and after fatigue of the lower leg muscles.ResultsThe findings with neutral shoe testing revealed a significant increase in rearfoot angle of 6.5° (95% CI 4.7–8.2°) (p<0.01) when the muscles were fatigued. However, the findings with motion control shoes revealed that rearfoot angle was marginally insignificant (p=0.06) in subjects before and after muscle fatigue. Moreover, rearfoot motion when running with neutral shoes was higher than that with motion control shoes in both pre- (p<0.01) and post-fatigue states (p<0.01).ConclusionsMotion control shoes can control excessive rearfoot movements in runners with over-pronation regardless of the state of leg muscle fatigue.     

An exploration of the effects of prefabricated and customized insoles on lower limb kinetics and kinematics during walking,stepping up and down tasks: A time series analysis

BackgroundPrefabricated and customized insoles are used in clinical practice to reduce foot pronation. Although data exist on the effects at key points within the stance phase, exploring the impact of different insoles using time series analysis may reveal more detail about their efficacy.Research questionWhat are the effects revealed by a time series analysis of arch-supported prefabricated insoles (PREFABRICATED) versus arch-supported prefabricated insoles customized with a 6º medial wedge (CUSTOMIZED) on the lower limb biomechanics during walking, stepping up and down tasks in individuals with pronated feet?MethodsNineteen individuals with excessive foot pronation performed walking, stepping up and down tasks using three insoles: CONTROL (flat insole), CUSTOMIZED, and PREFABRICATED. Angles and moments of ankle and knee coronal and hip transverse planes were compared between conditions using statistical parametric mapping (SPM).ResultsFor walking, CUSTOMIZED reduced ankle eversion moment compared to CONTROL during midstance and PREFABRICATED during propulsion. CUSTOMIZED decreased KAM during midstance and propulsion compared to PREFABRICATED. Compared to CONTROL, CUSTOMIZED and PREFABRICATED reduced hip internal rotation during propulsion and loading response, respectively. CUSTOMIZED decreased eversion movement during midstance and propulsion for the stepping up task. PREFABRICATED reduced eversion movement during midstance in comparison to CONTROL. For the stepping down task, CUSTOMIZED increased eversion movement during propulsion compared to PREFABRICATED. CUSTOMIZED reduced hip internal rotation angle for stepping up task during propulsion, decreased medial rotation movement during midstance compared to CONTROL, and reduced medial rotation during midstance compared to PREFABRICATED. CUSTOMIZED increased KAM for stepping up and down tasks during propulsion.SignificanceThese findings suggest that both CUSTOMIZED and PREFABRICATED reduce foot pronation. However, non-local effects, such as changes in KAM and hip internal rotation, were seen only in the CUSTOMIZED. Therefore, CUSTOMIZED may be preferable if the objective is to modify the knee and hip mechanics.     

Classification of medial longitudinal arch kinematics during running and characteristics of foot muscle morphology in novice runners with pronated foot

BackgroundNovice runners with pronated feet are at an increased risk of running-related injuries. However, not all runners with pronated feet have increased foot pronation during running. Moreover, although foot muscle morphology is related to static foot alignment, the relationship between foot muscle morphology and foot kinematics during running remains unclear. We aimed to determine foot kinematic patterns during running among novice runners with pronated feet and the presence of a relationship between these foot kinematic patterns and foot muscle morphology.MethodsTwenty-one novice runners with pronated feet participated in this study, and data on 39 lower limbs were collected. Data on foot kinematics during running (rearfoot strike) were collected using a three-dimensional motion capture system in terms of navicular height (NH) at initial contact and dynamic navicular drop (DND). A hierarchical cluster analysis method was used to identify the optimal number of clusters based on these two foot-related kinematic variables. Following identification of the clusters, differences in cluster variables and cross-sectional areas of selected foot muscles assessed using ultrasonography in each cluster were examined. The muscles of interest included the abductor hallucis, flexor hallucis brevis and longus, flexor digitorum brevis and longus, and peroneus longus.ResultsThree subgroups were identified based on foot kinematics during running: cluster 1, lowest NH at initial contact and larger DND; cluster 2, moderate NH at initial contact and smaller DND; and cluster 3, highest NH at initial contact and larger DND. Clusters 1 and 3 had a larger abductor hallucis compared with cluster 2, and cluster 3 had a larger flexor hallucis brevis compared with cluster 2.SignificanceThese subgroups may differ in terms of resistance to and type of running-related injury. Moreover, foot kinematics during running is possibly impacted by the morphology and function of medial intrinsic foot muscles.     

The effect of wedged insoles on the lateral thrust of anterior cruciate ligament-insufficient knees

BACKGROUND: Patients with untreated anterior cruciate ligament insufficiency often develop osteoarthritis. In Japan, laterally or medially elevated insoles have been widely used for the relief of symptoms associated with unicompartmental osteoarthritis of the knee. HYPOTHESIS: The use of a valgus wedge in the shoe of a patient with anterior cruciate ligament insufficiency will decrease lateral thrust. STUDY DESIGN: Controlled laboratory study. METHODS: An accelerometer was used to measure thrust force in 60 control knees and 35 knees with anterior cruciate ligament insufficiency. The sensor was attached to the affected and the control anterior tibial tubercles to record motion in the medial-lateral and perpendicular directions. The lateral thrust immediately after heel strike was measured continuously by a telemeter under stabilized walking conditions. Measurements were made both with and without wedged insoles. RESULTS: When compared with the control knee, the peak value of lateral acceleration immediately after heel strike was significantly greater in the anterior cruciate ligament-insufficient knees. However, lateral thrust decreased significantly in the anterior cruciate ligament-insufficient knees when a wedged insole was used. CONCLUSIONS: Use of an insole resulted in a significant decrease in lateral thrust, even in anterior cruciate ligament-insufficient knees. Clinical Relevance: Use of an insole is one possible prophylaxis for osteoarthritis for an anterior cruciate ligament-insufficient knee.     

Addition of an arch support improves the biomechanical effect of a laterally wedged insole

In order to examine if the addition of an arch support could improve the biomechanical effect of the laterally wedged insole, three-dimensional gait analysis was performed on 20 healthy volunteers. Kinetic and kinematic parameters at the knee and subtalar joints were compared among the following four types of insoles; a 5-mm thick flat insole, a flat insole with an arch support (AS), a 6 degrees inclined laterally wedged insole (LW), and a laterally wedged insole with an arch support (LWAS). The knee adduction moment averaged for the entire stance phase was reduced by the use of LW and LWAS by 7.7% and 13.3%, respectively, from that with FLAT. The difference in knee adduction moment between LW and LWAS was most obvious in the late stance, which was ascribed to the difference in the progression angle between those insoles. The analyses also revealed that LW tended to increase step width, and that such an increase was completely eliminated by the addition of an arch support to LW. This reduction of step width could be another mechanism for the further reduction of the moment with LWAS. The analyses of biomechanical parameters at the subtalar joints suggested that LWAS allowed the subject to walk in a more natural manner, while exerting greater biomechanical effects than LW. Thus, the addition of an arch support to the laterally wedged insole reduced knee adduction moment more efficiently, possibly through the elimination of potential negative effects of the laterally wedged insole.     

An individually moulded insole with 5-mm medial arch support reduces peak impact and loading at the heel after a one-hour treadmill run

BackgroundFoot pain experienced by long-distance runners could be relieved by functional insoles which aim at evenly distributing the plantar pressure.Research questionWe hypothesised that an individually moulded insole with medial arch support would reduce the impact and loading under the heel and metatarsal regions.MethodsTwelve male recreational runners ran on a treadmill at 10 km/h for 1 hour with flat insoles and medial arch supported insoles. A pressure insole system (Novel Pedar, Germany) was used to obtain the peak pressure, peak force, time normalised pressure-time integrals, and the percentage of the total force-time integrals under 10 regions.ResultsMedial arch supported insoles reduced the peak force under the heel (medial: -15.3%, p = 0.001; lateral: -19.2%, p = 0.037) during the initial run, and reduced peak pressure under the heel (medial: -13.3%, p = 0.005; lateral: -9.9%, p = 0.006), and peak force under the medial heel (-17.8%, p = 0.006) after the run. The percentage of the total force-time integrals under the heel was reduced (medial: -23.8%, p = 0.004; lateral: -13.6%, p = 0.022) after the run. No significant difference was found under the metatarsal regions. There is shift of load from the metatarsal regions to the medial mid-foot as indicated by the change of the percentage of total force-time integrals.SignificanceMedial arch supported insoles were effective in reducing the impact and loading under the heel region in prolonged running on a treadmill.Level of evidenceControlled laboratory study, Level V     

Immediate and 1 week effects of laterally wedge insoles on gait biomechanics in healthy females

It is estimated that approximately 45% of the U.S. population will develop knee osteoarthritis, a disease that creates significant economic burdens in both direct and indirect costs. Laterally wedged insoles have been frequently recommended to reduce knee abduction moments and to manage knee osteoarthritis. However, it remains unknown whether the lateral wedge will reduce knee abduction moments over a prolonged period of time. Thus, the purposes of this study were to (1) examine the immediate effects of a laterally wedged insole in individuals normally aligned knees and (2) determine prolonged effects after the insole was worn for 1 week. Gait analysis was performed on ten women with and without a laterally wedged insole. After participants wore the wedges for a week, a second gait analysis was performed with and without the insole. The wedged insole did not affect peak knee abduction moment, although there was a significant increase in knee abduction angular impulse after wearing the insoles for 1 week. Furthermore, there was a significant increase in vertical ground reaction force at the instance of peak knee abduction moment with the wedges. While the laterally wedged insole used in the current study did not alter knee abduction moments as expected, other studies have shown alterations. Future studies should also examine a longer acclimation period, the influence of gait speed, and the effect of different shoe types with the insole.     

The effect of modifying foot progression angle on the knee loading parameters in healthy participants with different static foot postures

BackgroundStudies have found that toe-in gait reduced the peak knee adduction moment (KAM) during early stance, while toe-out gait reduced the peak KAM during late stance. However, some other studies found that toe-in or toe-out gait could reduce the KAM throughout stance phase. There is still a divergence of opinion on the use of toe-in or toe-out gait for reducing the KAM.Research questionThis study aimed to investigate whether static foot posture affected participants’ biomechanical responses to three self-selected foot progression angles (FPA): neutral, toe-out and toe-in.MethodsTwenty-seven healthy participants were recruited for this FPA gait modification experiment and classified into three groups: neutral (n = 8), supination (n = 9) and pronation (n = 10), based on the Foot Posture Index (FPI). The kinematic and kinetic data were recorded with Vicon motion capture system and three force plates. The knee adduction moment and ankle eversion moment were calculated using an inverse dynamics model. The effect of the FPA modification on the knee loading parameters was analysed by the Friedman non-parametric test.ResultsThe KAM results in the neutral group showed that the toe-in gait modification reduced the first peak of the KAM (KAM1), while the KAM1 was increased in the supination group. The effect of the FPA modification on the KAM1 did not reach significance in the pronation group. The toe-out gait modification reduced the second peak (KAM2) regardless of the static posture.SignificanceDifferent static foot postures were correlated with different peak KAM during the early stance phase due to FPA modification. These data suggest that the assessment of static foot posture provides a reference on how to offer adequate FPA modification for knee OA patients with different foot postures.     

The relationship between transverse plane leg rotation and transverse plane motion at the knee and hip during normal walking

The purpose of this study was to test the clinical hypothesis that the magnitude and temporal characteristics of rearfoot complex motion are closely correlated with those of the transverse plane motion at the knee and hip. Twenty subjects underwent kinematic assessment during walking at 108 steps/minute. The transverse plane rotation of the leg relative to the foot was used to indicate rearfoot complex pronation and supination. Taking into account errors inherent in kinematic assessment involving skin mounted markers, it is unlikely that a correlation exists between the range of internal leg rotation during the contact phase and the total range of transverse plane leg rotation during gait and the corresponding values for the transverse plane motion at the knee and hip. Correlation tests were performed to assess the temporal characteristics of the motions at the joints that showed that there was no correlation between the transverse plane motion in the rearfoot complex, knee and hip. Thus the hypothesis that the magnitude and temporal characteristics of rearfoot complex motion are closely correlated with the transverse plane motion at the knee and hip was rejected.     

Analysis of foot motion during running using a joint co-ordinate system

The amount and rate of pronation and supination have been the subject of interest to runners for some time. Exact determination of the motions has been hampered by their complexities and use of a two-dimensional data collection protocol. "Rearfoot motion," measured by determining the projection of the angle between a line on the posterior of the shank and a line on the heel, has been a common approach. This projection measures a rotation about a laboratory axis and not a body segment axis and has a potential of error due to projection onto a plane. The angle measured in rearfoot motion is not the true angle between these lines in space and has projection distortion errors which are compounded during plantar and dorsiflexion and medial and lateral foot rotations. The rearfoot motion angle, however, does approximate foot inversion-eversion during much of stance phase. The proposed change in research protocol allows analysis of the three-dimensional position data of targets to construct a "joint coordinate system" which gives more accurate data on inversion-eversion and data on plantar-dorsiflexion and medial-lateral rotation of the foot. This analysis may allow the examination of measurable differences between individuals and running shoes of various design.     

The effects of shoes on the torsion and rearfoot motion in running.

Excessive pronation is accepted as a good indicator for various running injuries. The least amount of pronation takes place when running barefoot. The latest investigations show that this is connected to a large torsional movement between forefoot and rearfoot which can be influenced by the shoe sole construction. The shoes which are in use among runners in track and field are basically of two types, running shoes (in general torsionally stiff) and spikes (torsionally flexible). The possibly varying effect of these shoes on the shoe/foot motion in running is not known. The purpose of this investigation was therefore to show whether the pronation angle and the torsion angle differ when running barefoot, with spikes, and with running shoes (forefoot touchdown, N = 9 left and right). A film analysis provided the angular movements of the lower leg, rearfoot, and forefoot as well as pronation and torsion in the frontal plane. The results show that at touchdown the torsional movements with both shoe types are quite different from those of running barefoot. With shoes, the torsion angle is reduced back to zero--with running shoes more than with spikes--and the pronation angle is increased beyond the barefoot values (P less than 0.01). In order to reduce the risk of injury, both shoe types should be improved--the running shoes with respect to torsion and the spikes with respect to pronation.     

Foot pronation during walking is associated to the mechanical resistance of the midfoot joint complex

BackgroundThe demonstration of the relationship between midfoot passive mechanical resistance and foot pronation during gait may guide the development of assessment and intervention methods to modify foot motion during gait and to alter midfoot passive mechanical resistance.Research questionIs foot pronation during the stance phase of gait related to the midfoot passive mechanical resistance to inversion?MethodsThe resistance torque and stiffness provided by midfoot soft tissues of 33 participants (21 females and 12 males) with average of 26.21 years were measured. In addition, the participants’ forefoot and rearfoot kinematic data during the stance phase of gait were collected with the Qualisys System (Oqus 7+). Correlation Coefficients were calculated to test the association between kinematic variables representing pronation (forefoot-rearfoot inversion, forefoot-rearfoot dorsiflexion and rearfoot-shank eversion) and maximum resistance torque and maximum stiffness of the midfoot with α = 0.05.ResultsReduced maximum midfoot resistance torque was moderately associated with increased forefoot-rearfoot inversion peak (p = 0.029; r = 0.38), with forefoot-rearfoot dorsiflexion peak (p = 0.048; r = −0.35) and with rearfoot-shank eversion peak (p = 0.008; r = −0.45). Maximum midfoot stiffness was not associated to foot pronation.SignificanceThe smaller the midfoot resistance torque, the greater the forefoot-rearfoot inversion and dorsiflexion peaks and the rearfoot-shank eversion peak during gait. The findings suggest the existence of a relationship between foot pronation and midfoot passive mechanical resistance. Thus, changes in midfoot passive mechanical resistance may affect foot pronation during gait.     

Is there a dose-response of medial wedge insoles on lower limb biomechanics in people with pronated feet during walking and running?

BackgroundAlthough the effects of medial wedge insoles on lower limb biomechanics have been investigated, information about the effects of different magnitudes of medial posting is still lacking.Research questionWhat are the dose-response effects of medial wedge insoles with postings varying between 0 °, 3 °, 6 °, and 9 ° of inclination on the lower limb biomechanics during walking and running in individuals with pronated feet?MethodsSixteen participants with an FPI ≥ 6 were recruited. Four arch-supported insole conditions with varying degrees of medial heel wedge were tested (0°, 3°, 6°, and 9°). A 3D motion analysis system with force plates was used to obtain the kinetics and kinematics of walking and running at self-selected speeds. To compare the ankle, knee, and hip angles and moments among conditions, a time series analysis was performed using Statistical Parametric Mapping (SPM).ResultsA reduction in ankle eversion angle was observed during walking for all insoles. For running, the 6° and 9° insoles decreased the ankle eversion angle during early stance and increased this angle during the propulsive phase. A decrease in ankle eversion moment was observed in walking and running for 6° and 9° insoles. An increase in knee adduction moment occurred in walking and running for all insoles. For hip, the 6° and 9° insoles showed, during walking, a decrease in hip adduction angle and an increase in hip adduction and external rotation moments. For most variables, statistical differences were found for a greater period across the stance phase as the medial wedge increased, except for ankle eversion moment and hip external rotation moment during walking.SignificanceThe biomechanical effects over the time series for many of the parameters increased with the addition of insole inclination, showing a dose-response effect of medial wedge insoles on the lower limb biomechanics during walking and running in adults with excessive foot pronation.     

The immediate effects of sensorimotor foot orthoses on foot kinematics in healthy adults

BackgroundSensorimotor foot orthoses is an alternative concept, which in addition to mechanical effects, are designed to change muscle activation by altering sensory input to the plantar surface of the foot. However, there is little evidence of how these affect the kinematics of the foot during gait.Research questionThe aim of the study was to explore the immediate effect of calcaneal medial heel bars and retrocapital bars on foot kinematics during the stance phase of gait.MethodsKinematic data were collected from 32 healthy individuals using an eight camera motion capture system and a six-degrees-of-freedom multi-segment foot model in three different orthotic conditions; calcaneal medial heel bar, retrocapital bar, and no orthosis. Vector field statistical analysis was performed to explore the effect of the orthotic conditions over the kinematic time series curves during stance phase. Peak median and interquartile ranges were also reported during the different phases of stance.ResultsThe calcaneal medial bar significantly decreased rearfoot eversion for the majority of the stance phase and compensatory increased midfoot eversion during the entire stance phase compared to the no orthosis condition. The retrocapital bar rotated the foot externally significantly abducting the rearfoot for the entire stance phase and the midfoot for the majority of stance phase.SignificanceThe calcaneal medial heel bar and retrocapital bar significantly altered the foot kinematics in a way that may benefit patients with abnormal pronation and intoeing gait.     

Gender differences in frontal and sagittal plane biomechanics during drop landings

PURPOSE: To determine gender differences in lower-extremity joint kinematics and kinetics between age- and skill-matched recreational athletes. METHODS: Inverse dynamic solutions estimated the lower-extremity flexion-extension and varus-valgus kinematics and kinetics for 15 females and 15 males performing a 60-cm drop landing. A mixed model, repeated measures analysis of variance (gender (*) joint) was performed on select kinematic and kinetic variables. RESULTS: Peak hip and knee flexion and ankle dorsiflexion angles were greater in females in the sagittal plane (group effect, P < 0.02). Females exhibited greater frontal plane motion (group (*) joint, P = 0.02). Differences were attributed to greater peak knee valgus and peak ankle pronation angles (post hoc tests, P = 0.00). Females exhibited a greater range of motion (ROM) in the sagittal plane (group main effect, P = 0.02) and the frontal plane (group (*) joint, P = 0.01). Differences were attributed to the greater knee varus-valgus ROM, ankle dorsiflexion, and pronation ROM (post hoc tests). Ground reaction forces were different between groups (group (*) direction, P = 0.05). Females exhibited greater peak vertical and posterior (A/P) force than males (post hoc tests). Females exhibited different knee moment profiles (Group main effect, P = 0.01). These differences were attributed to a reduced varus moment in females (post hoc tests). CONCLUSION: The majority of the differences in kinematic and kinetic variables between male and female recreational athletes during landing were observed in the frontal plane not in the sagittal plane. Specifically, females generated a smaller internal knee varus moment at the time of peak valgus knee angulation.     

Alterations to plantar loading and ankle range of motion of the contralateral foot during assisted walking in patients with Type 2 Diabetes Mellitus

AimsPatients with diabetic foot ulcers are instructed to be non-weight bearing on the affected limb to promote healing. Therefore, the aim of this study was to investigate the effect of different assistive devices on whole foot plantar loading, peak forefoot force, ankle range of motion, and locomotion speed during gait in patients with Type 2 Diabetes Mellitus.MethodsParticipants walked normally, with crutches, a walker, and a wheeled knee walker (WKW) in randomized order. Force sensitive insoles and 3D motion capture were used to record plantar normal force and ankle kinematics. Force sensitive pads were wrapped around handles of the crutches and walker to measure bodyweight offloaded onto the assistive device. An instrumented WKW was used to measure bodyweight offloaded onto the handlebars and knee cushion.ResultsLocomotion with the WKW produced the lowest whole foot plantar loading and peak forefoot force in the propulsive limb, while also producing the greatest ankle range of motion and locomotion speed amongst assistive devices.ConclusionsThis pre-clinical study found that the WKW could be the preferred assistive device for total unilateral offloading of diabetic foot ulcers as it reduced propulsive limb whole foot and forefoot plantar loading while retaining ankle range of motion and locomotion speed.