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Biomechanical consequences of gait impairment at the ankle and foot: Injury, malalignment, and co-contraction
KTH, School of Engineering Sciences (SCI), Mechanics, Structural Mechanics.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The human foot contributes significantly to the function of the whole lower extremity during standing and locomotion. Nevertheless, the foot and ankle often suffer injuries and are affected by many musculoskeletal and neurological pathologies. The overall aim of this thesis was to evaluate gait parameters and muscle function change due to foot and ankle injury, malalignment and co-contraction. Using 3D gait analysis, analytical analyses and computational simulations, biomechanical consequences of gait impairment at the ankle and foot were explored in ablebodied persons and in patient groups with disorders affecting walking.

We have characterized gait patterns of subjects with ankle fractures with a modified multi-segment foot model. The inter-segmental foot kinematics were determined during gait in 18 subjects one year after surgically-treated ankle fractures. Gait data were compared to an age- and gender-matched control group and the correlations between functional ankle score and gait parameters were determined. It was observed that even with fairly good clinical results, restricted range of motion and malalignment at and around the injured area were found in the injured limb.

Moment-angle relationship (dynamic joint stiffness) - the relationship between changes in joint moment and changes in joint angle - is useful for demonstrating interaction of kinematics and kinetics during gait. Ankle dynamic joint stiffness during the stance phase of gait was analyzed and decomposed into three components in thirty able-bodied children, eight children with juvenile idiopathic arthritis and eight children with idiopathic toe-walking. Compared to controls, the component associated with changes of ground reaction moment was the source of highest deviation in both pathological groups. Specifically, ankle dynamic joint stiffness differences can be further identified via two subcomponents of this component which are based on magnitudes and rates of change of the ground reaction force and of its moment arm. And differences between the two patient groups and controls were most evident and interpretable here.

Computational simulations using 3D musculoskeltal models can be powerful in investigating movement mechanisms, which are not otherwise possible or ethical to measure experimentally. We have quantified the effect of subtalar malalignment on the potential dynamic function of the main ankle dorsiflexors and plantarflexors: the gastrocnemius, soleus and tibialis anterior. Induced acceleration analysis was used to compute muscle-induced joint angular and body center of mass accelerations. A three-dimensional subject-specific linkage model was configured by gait data and driven by 1 Newton of individual muscle force. The excessive subtalar inversion or eversion was modified by offsetting up to ±20˚ from the normal subtalar angle while other configurations remain unaltered. We confirmed that in normal gait, muscles generally acted as their anatomical definitions, and that muscles can create motion in many joints, even those not spanned by the muscles. Excessive subtalar eversion was found to enlarge the plantarflexors’ and tibialis anterior’s function.

In order to ascertain the reliability of muscle function computed from simulations, we have also performed a parametric study on eight healthy adults to evaluate how sensitive the muscle-induced joints’ accelerations are to the parameters of rigid foot-ground contact model. We quantified accelerations induced by the gastrocnemius, soleus and tibialis anterior on the lower limb joints. Two types of models, a ‘fixed joint’ model with three fixed joints under the foot and a ‘moving joint’ model with one joint located along the moving center of pressure were evaluated. The influences of different foot-ground contact joint constraints and locations of center of pressure were also investigated. Our findings indicate that both joint locations and prescribed degrees-of-freedom of models affect the predicted potential muscle function, wherein the joint locations are most influential. The pronounced influences can be observed in the non-sagittal plane.

Excessive muscle co-contraction is a cause of inefficient or abnormal movement in some neuromuscular pathologies. We have identified the necessary compensation strategies to overcome excessive antagonistic muscle cocontraction at the ankle joint and retain a normal walking pattern. Muscle-actuated simulation of normal walking and induced acceleration analysis were performed to quantify compensatory mechanisms of the primary ankle and knee muscles in the presence of normal, medium and high levels of co-contraction of two antagonistic pairs (gastrocnemiustibialis anterior and soleus-tibialis anterior). The study showed that if the co-contraction level increases, the nearby synergistic muscles can contribute most to compensation in the gastrocnemius-tibialis anterior pair. In contrast, with the soleus-tibialis anterior co-contraction, the sartorius and hamstrings can provide important compensatory roles in knee accelerations.

This dissertation documented a broad range of gait mechanisms and muscle functions in the foot and ankle area employing both experiments and computational simulations. The strategies and mechanisms in which altered gait and muscles activation are used to compensate for impairment can be regarded as references for evaluation of future patients and for dynamic muscle functions during gait.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2012. , xiv, 58 p.
Series
Trita-MEK, ISSN 0348-467X ; 2012:02
Keyword [en]
muscle function, gait analysis, induced acceleration, foot kinematics, dynamic joint stiffness
National Category
Applied Mechanics
Identifiers
URN: urn:nbn:se:kth:diva-94886ISBN: 978-91-7501-342-8 (print)OAI: oai:DiVA.org:kth-94886DiVA: diva2:526327
Public defence
2012-05-24, F3, Lindstedsvägen 26, KTH, Stockholm, 10:00 (English)
Opponent
Supervisors
Note
QC 20120514Available from: 2012-05-14 Created: 2012-05-11 Last updated: 2012-05-14Bibliographically approved
List of papers
1. One year follow-up after operative ankle fractures: A prospective gait analysis study with a multi-segment foot model
Open this publication in new window or tab >>One year follow-up after operative ankle fractures: A prospective gait analysis study with a multi-segment foot model
Show others...
2010 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 31, no 2, 234-240 p.Article in journal (Refereed) Published
Abstract [en]

Ankle fractures are one of the most common lower limb traumas. Several studies reported short- and long-term post-operative results, mainly determined by radiographic and subjective functional evaluations. Three-dimensional gait analysis with a multi-segment foot model was used in the current study to quantify the inter-segment foot motions in 18 patients 1 year after surgically treated ankle fractures. Data were compared to that from gender- and age-matched healthy controls. The correlations between Olerud/Molander ankle score and kinematics were also evaluated. Patients with ankle fractures showed less plantarflexion and smaller range of motion in the injured talocrural joint, which were believed to be a sign of residual joint stiffness after surgery and immobilization. Moreover, the forefoot segment had smaller sagittal and transverse ranges of motion, less plantarflexion and the hallux segment had less dorsiflexion and smaller sagittal range of motion. The deviations found in the forefoot segment may contribute to the compensation mechanisms of the injured ankle joint. Findings of our study show that gait analysis with a multi-segment foot model provides a quantitative and objective way to perform the dynamic assessment of post-operative ankle fractures, and makes it possible to better understand not only how the injured joint is affected, but also the surrounding joints.

Keyword
Ankle fractures, Operative treatment, Gait analysis, Multi-segment foot, model, Olerud/Molander ankle score (OMAS), functional outcome analysis, rheumatoid-arthritis, coordinate system, kinematics, joint, kinetics, motion, knee
National Category
Mechanical Engineering
Identifiers
urn:nbn:se:kth:diva-19218 (URN)10.1016/j.gaitpost.2009.10.012 (DOI)000274584800017 ()2-s2.0-74449088350 (Scopus ID)
Note
QC 20110210Available from: 2010-08-05 Created: 2010-08-05 Last updated: 2012-05-14Bibliographically approved
2. Analytical decomposition can help to interpret ankle joint moment-angle relationship
Open this publication in new window or tab >>Analytical decomposition can help to interpret ankle joint moment-angle relationship
2012 (English)In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 22, no 4, 566-574 p.Article in journal (Refereed) Published
Abstract [en]

Moment-angle relationship (dynamic joint stiffness) - the relationship between changes in joint moment and changes in joint angle - is useful for demonstrating interaction of kinematics and kinetics during gait. However, the individual contributors of dynamic joint stiffness are not well studied and understood, which has thus far limited its clinical application. In this study, ankle dynamic joint stiffness was analyzed and decomposed into three components in thirty able-bodied children during the stance phase of the gait. To verify the accuracy of the decomposition, the sum of decomposed components was compared to stiffness computed from experimental data, and good to very good agreement was found. Component 1, the term associated with changes in ground reaction force moment, was the dominant contribution to ankle dynamic joint stiffness. Retrospective data from eight children with juvenile idiopathic arthritis and idiopathic toe-walking was examined to explore the potential utility of analytical decomposition in pathological gait. Compared to controls, component 1 was the source of highest deviation in both pathological groups. Specifically, ankle dynamic joint stiffness differences can be further identified via two sub-components of component 1 which are based on magnitudes and rates of change of the ground reaction force and of its moment arm, and differences between the two patient groups and controls were most evident and interpretable here. Findings of the current study indicate that analytical decomposition can help identify the individual contributors to joint stiffness and clarify the sources of differences in patient groups.

Keyword
Gait analysis, Idiopathic toe walking, Inverse dynamics, Juvenile idiopathic arthritis, Stiffness
National Category
Applied Mechanics
Identifiers
urn:nbn:se:kth:diva-94866 (URN)10.1016/j.jelekin.2012.04.005 (DOI)000306377900010 ()22572108 (PubMedID)2-s2.0-84863883709 (Scopus ID)
Note
QC 20120807Available from: 2012-05-11 Created: 2012-05-11 Last updated: 2017-12-07Bibliographically approved
3. The effect of subtalar inversion/eversion on the dynamic function of the tibialis anterior, soleus, and gastrocnemius during the stance phase of gait
Open this publication in new window or tab >>The effect of subtalar inversion/eversion on the dynamic function of the tibialis anterior, soleus, and gastrocnemius during the stance phase of gait
2011 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 34, no 1, 29-35 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to determine how gait deviation in one plane (i.e. excessive subtalar inversion/eversion) can affect the dynamic function of the tibialis anterior, gastrocnemius, and soleus to accelerate the subtalar, ankle, knee and hip joints, as well as the body center of mass. Induced acceleration analysis was performed based on a subject-specific three-dimensional linkage model configured by stance phase gait data and driven by one unit of muscle force. Eight healthy adult subjects were examined in gait analysis. The subtalar inversion/eversion was modeled by offsetting up to 20 from the normal subtalar angle while other configurations remained unaltered. This study showed that the gastrocnemius, soleus and tibialis anterior generally functioned as their anatomical definition in normal gait, but counterintuitive function was occasionally found in the bi-articular gastrocnemius. The plantarflexors play important roles in the body support and forward progression. Excessive subtalar eversion was found to enlarge the plantarflexors and tibialis anterior's function. Induced acceleration analysis demonstrated its ability to isolate the contributions of individual muscle to a given factor, and as a means of studying effect of pathological gait on the dynamic muscle functions.

Keyword
Induced acceleration analysis, Subtalar joint, Excessive inversion/eversion, Gastrocnemius, Soleus, Tibialis anterior
National Category
Mechanical Engineering
Identifiers
urn:nbn:se:kth:diva-36880 (URN)10.1016/j.gaitpost.2011.03.003 (DOI)000292237200006 ()2-s2.0-79957523392 (Scopus ID)
Funder
Swedish Research Council
Note
QC 20110720Available from: 2011-07-20 Created: 2011-07-18 Last updated: 2017-12-08Bibliographically approved
4. A parametric study of the rigid foot-ground contact model: effects on induced angular accelerations of the lower limb joints in the stance-phase
Open this publication in new window or tab >>A parametric study of the rigid foot-ground contact model: effects on induced angular accelerations of the lower limb joints in the stance-phase
(English)Manuscript (preprint) (Other academic)
National Category
Applied Mechanics
Identifiers
urn:nbn:se:kth:diva-94870 (URN)
Note

QS 2012

Available from: 2012-05-11 Created: 2012-05-11 Last updated: 2017-08-15Bibliographically approved
5. Compensatory strategies in response to excessive muscle co-contraction at the ankle joint during walking
Open this publication in new window or tab >>Compensatory strategies in response to excessive muscle co-contraction at the ankle joint during walking
(English)Manuscript (preprint) (Other academic)
National Category
Applied Mechanics
Identifiers
urn:nbn:se:kth:diva-94872 (URN)
Note
QS 2012Available from: 2012-05-11 Created: 2012-05-11 Last updated: 2012-05-14Bibliographically approved

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Citation style
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Output format
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