The concept of a leaf spring structured midsole shoe (LEAF) is based on shifting the foot anteriorly during the first part of stance phase in heel-toe running. The aim of the current study is to analyze the effects of a LEAF compared to a standard foam midsole shoe (FOAM) on the foot kinematics in overground and treadmill running at two running speeds.
Nine male heel strikers ran on a treadmill with the LEAF and the FOAM at 3 and 4 m/s, each for 5 min. Furthermore, the participants performed with both shoes six runs each on a 40 m indoor track at running speeds of 3 and 4 m/s. For one stance phase the ground reaction forces were measured using a force plate imbedded in the track. Running speed and shoe order were randomized. Kinematics (VICON, 200Hz) and kinetics (AMTI, 1000Hz; only overground) were used to calculate the anterior shift of the foot, the foot ground angle at heel strike (FGA at HS) and the horizontal path of the center of pressure (COP).
The LEAF increases the anterior foot shift in treadmill and overground running at both running speeds compared to the FOAM, without changing the individuals’ strike pattern. Furthermore, the anterior foot shift affects the COP leading to an overall enlarged COP path. These findings indicate a benefit of the structured midsole on performance at least at moderate running speeds
For lower limb amputees graded walking imposes a high level of motor ability, due to the missing proprioceptive feedback of the limb, and the necessary compensation mechanisms. In order to facilitate gait a focus in prosthesis research is the development of the prostheses ankle joints from rigid to moveable. Therefore, the aim of this case study was to analyse the effects of three different prostheses with a rigid and a moveable ankle joint during graded walking of a unilateral amputee.
One male unilateral transfemoral amputee was recruited for this study and a comparison of following three prostheses (endolite, Germany) was performed: Elan (movable ankle joint with flexible resistance), Echelon (movable ankle joint with steady resistance) and Esprit (rigid ankle joint). Kinematic (12 cameras, Vicon, UK, 250 Hz) and kinetic (2 force plates, AMTI, MA, 1000 Hz) data were recorded during self-paced walking on a 6 m ramp, which was set to the inclinations of -12°, -4°, 0°, 4° and 12°. Following gait parameters, ground reaction forces, joint angles and joint moments were calculated.
Gait parameters, ground reaction forces and joint angles were marginally influenced by the different prosthetic designs, but major changes occurred on the joint moment level. The use of the rigid ankle prosthesis Esprit induced up to 10 times higher joint moments compared to the moveable ankle joint prostheses. This case study showed that a moveable ankle joint can reduce the joint moments during graded walking, which might be advantageous to use for transfemoral amputees in graded walking.
Background: Patellofemoral pain (PFP) is a common condition seen in orthopedic practice. A commonly cited hypothesis as to the cause of PFP is increased patellofemoral joint (PFJ) stress secondary to abnormal lower extremity kinematics (ie. excessive hip internal rotation and knee valgus). However, the influence of these motions on PFJ contact mechanics is unknown.
Purpose: To assess the influence of hip rotation and knee valgus on PFJ stress using finite element (FE) analysis.
Methods: Patella cartilage stress profiles for a healthy participant were quantified utilizing a subject-specific FE model. Input parameters included: joint geometry, quadriceps muscle forces, and weight-bearing PFJ kinematics. Using a nonlinear FE solver, quasi-static loading simulations were performed to quantify patella cartilage stress during a static squatting maneuver (45° knee flexion). To simulate hip rotation (0-8°) and knee valgus (0-12°), the femur and tibia were rotated in the transverse and frontal plane respectively in 2° increments.
Results: Increasing hip rotation resulted in a linear increase in patella cartilage stress. In contrast, increasing knee valgus resulted in a decrease in patella cartilage stress. The combination of hip rotation and knee valgus did not result in higher PFJ cartilage stress compared to isolated hip rotation.
Conclusions: Patella cartilage stress appears to be influenced to a greater degree by hip internal rotation as opposed to knee valgus. Surprisingly, higher degrees of knee valgus resulted in decreased cartilage stress (in the absence of hip rotation). Our finding supports the premise that persons exhibiting excessive hip internal rotation may be pre-disposed to elevated patella cartilage stress.
We investigated the production of free radicals on a poly(ether-ether-ketone) (PEEK) substrate under ultraviolet (UV) irradiation. The amount of the ketyl radicals produced from the benzophenone (BP) units in the PEEK molecular structure initially increased rapidly and then became almost constant. Our observations revealed that the BP units in PEEK acted as photoinitiators, and that it was possible to use them to control the graft polymerization of poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC). This “self-initiated surface graft polymerization” method is very convenient in the absence of external photoinitiator. We also investigated the effects of the monomer concentration and UV irradiation time on the extent of the grafted PMPC layer. Furthermore, as an application to improving the durability of artificial hips, we demonstrated the nanometer-scale photoinduced grafting of PMPC onto PEEK and carbon fiber-reinforced PEEK (CFR-PEEK) orthopedic bearing surfaces and interfaces. A variety of test revealed significant improvements in the water wettability, frictional properties, and wear resistance of the surfaces and interfaces.
INTRODUCTION: Workers in industry wear steel toe boots; however, these boots are inflexible and may restrict foot movement. Occupational kneeling is also associated with an increased risk of knee osteoarthritis. Examination of the effects of work boots in kneeling is needed to better understand potential injury risk. Therefore, the purpose of this study was to analyze the center of pressure (COP) at the knee during kneeling when shod and barefoot.
METHODS: Fifteen, young, healthy males completed five 10-second static kneeling trials in each condition. Lower body kinematics were obtained using the Optotrak system (Certus and 3020, NDI, Waterloo, ON, CA). Force data were measured from a force plate under the knee of the dominant leg (OR6-7, AMTI, Watertown, MA, USA).
The mean COP location was determined with respect to the medial tibial plateau (normalized to tibial width) and the tibial tuberosity (normalized to tibial length) for the medial/lateral and longitudinal directions, respectively.
RESULTS: COP was located more medially in the shod condition (34% (±10.6%) tibial width) compared to the barefoot condition (40% (±11.9%) tibial width) (p=0.0485). COP was located above the tibial tuberosity, with no difference between conditions (shod 11% (±3.2%) tibial length, barefoot: (7%) (±8.8%) tibial length) (p=0.97).
DISCUSSION: There is a difference in COP location in shod compared to barefoot kneeling. A COP location farther from the joint center of rotation, as occurred in the frontal plane of the shod condition, would increase the moment arm of the ground reaction force and thus the moment at the knee.
We investigated whether stability affects the learning and/or transfer of human postural control strategies. Subjects learned novel postural control strategies in a more stable standing configuration and then transferred to a less stable configuration, or vice versa. Initial learning was not affected by stability. However, transfer of learned control from one context to another was affected by the change in stability between contexts. These results suggest that in rehabilitation it is important to consider the context in which task learning occurs, as well as the context in which the task will be performed in the future.
Following amputation, an amputee must learn to walk again using a prosthesis. A goal of prosthetic rehabilitation is to reduce and eliminate asymmetries between the prosthetic leg and sound leg which may decrease the negative effects of long term force and work demands on the sound leg. An amputee-specific physical therapy program provides structured motor learning to aid in developing proper gait mechanics. However, physical therapy is not standard of care for all individuals receiving their first prosthesis due to limited evidence showing improved gait. Thus, the purpose of this study was to determine whether amputees receiving physical therapy have better gait mechanics than those that do not. It was hypothesized that those who underwent an amputee-specific physical therapy program would display a more symmetrical gait pattern. Transtibial amputees walked overground at self-selected pace while kinetic (600Hz) and kinematic (60Hz) data were collected. The therapy group had previously received 2-3 therapy sessions per week for 3 months. Asymmetries were determined through dependent t-tests (α=0.05) comparing sound leg and prosthetic leg kinetic variables. Of the 23 kinetic variables tested, 17 variables showed significant difference between the sound leg and prosthetic leg for the group that did not receive the amputee-specific physical therapy. For the group that had previously received the therapy, only 4 variables showed differences between the sound and prosthetic leg. Thus, we showed that individuals partaking in amputee-specific physical therapy have a more symmetrical gait which results on less force and energy demands on the sound leg.
Pain, tingling, or numbness in the calves, thighs, and/or buttocks brought on by physical activity is called intermittent claudication (IC). IC is the primary symptom of peripheral arterial disease (PAD) that occurs because blockages in the lower extremity arteries hinder blood flow to the legs. Current conservative treatment for patients with PAD consists of supervised treadmill walking exercise (STW). After STW, patients with PAD exhibit improvement in maximum walking distances(1), but little is known regarding gait biomechanics. This study was conducted to determine the effectiveness of the current conservative treatment on gait biomechanics and lower extremity strength in patients with PAD.
Fifteen patients (total of 26 claudicating limbs; age: 66±1.9 years, height: 1.75±2.24 m, weight: 89.23± 5.01 kg), diagnosed with PAD were recruited from the Omaha Veterans’ Affairs Medical Center. Patients visited the lab prior to and after completing a prescribed 12-week, 3 times/week STW. Five over-ground walking trials for each leg were performed while kinematics (60 Hz; Motion Analysis Corp., USA) and kinetics (600 Hz; Kistler Instruments, USA) were recorded pre and post 12-weeks STW. Absolute claudication distance (max walk distance) was determined through a progressive, graded treadmill protocol (2 miles/hour, 0% grade with 2% increase every 2 minutes) until maximal claudication pain. Inverse dynamics was used to calculate peak joint torques and powers for the ankle, knee, and hip (Visual 3D, C-Motion, Inc., USA). Peak plantar flexor strength was assessed using an isokinetic dynamometer (Biodex Medical Systems, USA). Differences pre to post STW were determined using paired t-tests (α=0.05).
In agreement with the previous literature, absolute claudication distance significantly increased post STW. No significant differences between baseline and post STW were detected for joint torques and powers, or lower extremity strength. Supervised treadmill walking appears to address a cardiovascular mechanism in PAD. STW may only be helping to improve stamina. The lack of any functional training may be reinforcing poor mechanics, which will continue to hinder patient function with a poor chance for long term benefits to be realized. Future investigation should include functional exercises in patients with PAD.
Higher ACL injury frequencies have been reported on synthetic turfs compared to natural turfs. However, assessments of cleat stud type on lower extremity biomechanics worn on these surfaces are limited. The purpose of this study was to examine the knee biomechanics of a non-studded running shoe (RS), a football shoe with natural turf studs (NTS), and with synthetic turf studs (STS) during single-leg land-cut and 180°-cut tasks on synthetic turf. Fourteen recreational football players performed five trials of 180°-cut and land-cut tasks in the three shoe conditions on an infilled synthetic turf. Knee biomechanics were analyzed using a 2x3 (task x shoe) repeated measures ANOVA followed by post-hoc paired samples t-tests (p<0.05). For the 180° cut, 1st peak internal knee adduction moments were increased in RS and STS compared to NTS (Table) and in 1st peak knee extensor moments in RS compared NTS and STS. The peak negative knee extensor power was increased in RS compared to NTS and STS. The land-cut had significantly greater peak extensor moments, sagittal plane powers, and abduction angles, and significantly lower adduction moments compared to the 180°-cut. As expected, the land-cut movement involved increased power absorption, power generation, and extensor moment compared to the 180°-cut. However, shoe effects lie only in the 180°-cut. Decreased medial ground reaction force1, knee adduction and extensor moments in NTS suggest the knee may be in a safer environment using these studs during cutting maneuvers. Reduced knee adduction moments in NTS could have implications in non-contact ACL injury.
Peripheral arterial disease (PAD) is a vascular disease characterized by atherosclerotic blockages restricting blood flow to the lower extremities causing pain and discomfort with physical activity. Several studies have previously found decrements in ambulation associated with PAD, such as decreased joint moments and powers before and after the onset of claudication pain . With decreases in moments and powers, the joint work may also be decremented as well. Thus, the purpose of this study was to investigate the positive and negative work at the ankle, knee and hip of PAD patients in a pain-free condition and compare them to gait-velocity matched controls.
Five patients with PAD and five healthy older controls were consented for participation. Subjects walked along a 10-meter walkway at their own self-selected speed while kinematics and kinetics were recorded. Each subject rested one minute between trials to mitigate fatigue and prevent ischemic pain. The positive and negative joint work for the PAD patients’ affected limb and the right limb of each control were analyzed and compared through independent t-tests (α=0.05).
Five PAD patients (66.6 + 6.2 years; 178.2 + 9.3 cm; 102.6 + 18.5 kg; 1.16 + 0.07 m/s) and five controls (69 + 4.6 years; 174.5 + 1.6 cm; 79.4 + 8.14 kg; 1.30 + 0.09 m/s) were used for analysis.
From this study it was found that patients with PAD exhibit a 26% reduction in positive ankle joint work during stance phase than their healthy counterparts (p=0.012).