[Clinical gait analysis]

Gait cycle and pressure load values of the foot on different surfaces with Moticon Insole2 in a healthy cohort

BACKGROUND

Pedobarography is a common way to supervise the postoperative treatment following orthopedic and orthopedic trauma surgery. However, there are currently no established reference values and few information on associated factors. The aim of this study was to provide a frame of reference for repeat pedobarographic measurements with the Moticon System on different but standardized surfaces for a healthy population.

METHODS

Pedobarography was performed on 76 participants using pressure-sensitive insoles. All participants had no pathologies of the feet. A standardized parcours on flat ground, stairs, inclined plane and uneven ground was performed, wearing mostly everyday footwear. Differences in pedobarography were determined for age (< 40 years/≥40 years), gender and BMI (≤ 24.9/>24.9 kg/m2).

RESULTS

Over the whole parcours, the mean total pressure was 22 ± 5 kPA with a maximum pressure of 97 ± 12 kPa. The mean step duration was 0.59 ± 0.1 s with a stance duration time of 0.73 ± 0.07 s, swing duration time of 0.46 ± 0.05 s and a resulting mean gait cycle time of 1.17 ± 0.08 s. A reference range of 13.8-36.6 kPa was assessed for the mean forefoot pressure, respectively 7.6-28.4 kPa (hindfoot), 10.1-28.7 kPa (medial column) 13.3-38.3 kPa (lateral column). Except for the mean forefoot pressure (p = 0.072), significantly higher mean and maximum pressures (p < 0.001-0.045) were found for women. Furthermore, significantly longer step duration (p = 0.005), swing duration time (p = 0.013), mean duration of the gait cycle (p = 0.016) and gait line (p = 0.001) were found for men. There were no significant differences for the gait parameters between age - and BMI subgroups.

CONCLUSION

In this pressure load analysis, an association of pedobarographic results with gender has been demonstrated. Gender-adjusted reference values are proposed to enable reliable interpretation of pedobarographic data to guide treatment after orthopedic and trauma surgery.

[Scientific methods for in-vitro investigations in the field of joint kinematics : Cluster experimental joint kinematics]

In vitro studies are an established method to determine joint kinematics for answering preclinical questions regarding the effects of new treatment options, surgical techniques or implant designs. The lack of standardized, interdisciplinary representation in the determination of joint kinematics poses a problem. In addition to representation forms such as the "neutral-zero method" or the description of movements within the three basic planes, there are other mathematical joint-specific representations of individual working groups. The International Society of Biomechanics (ISB) has already made recommendations for standardization, but most of these cannot be implemented in biomechanical in-vitro studies. The cluster has therefore set itself the goal of standardizing in-vitro test methods in order to achieve better comparability of scientific results from different working groups.

[Clinical value of instrumental gait analysis]

BACKGROUND

Instrumental gait analysis is becoming an established addition to conventional diagnostic methods for the clinical assessment of complex movement disorders. It can provide objective and high resolution motion data and contains information that is not observable with conventional clinical methods, such as muscle activation during gait.

UTILISATION

Instrumental gait analysis can add observer independent parameters to the treatment planning of individuals as well as provide insights into pathomechanisms with clinical research studies. Limiting factors for the use of gait analysis technology are currently the time and personnel expenditures for measurements and data processing, as well as the extensive amount of training time required for data interpretation. This article illustrates the clinical value of instrumental gait analysis and specifies its synergies with conventional diagnostic methods.

Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: study protocol for a prospective randomized pilot study

Background

Ankle sprains and fractures are most common injuries in orthopedic and trauma surgery. The concurrent occurrence of syndesmosis ruptures in these injuries represents a more complex problem, as they often remain undetected.

A proper and accurate treatment of injuries of the syndesmosis, both isolated and combined with fractures, is necessary to avoid long-term consequences (chronic instability, cartilage damage, and post-traumatic osteoarthritis). The most popular treatment option is a static screw fixation and the newly developed dynamic TightRope® (Arthrex, Naples, FL, USA).

The aim of this pilot study is to compare monitor ankle range of motion and maximum ankle power in gait as functional outcome parameters of instrumented gait analysis, as well as clinical and radiographic outcome for assessing the stabilization of acute syndesmosis rupture with either a static implant (a 3.5 mm metallic screw) or a dynamic device (TightRope®).

Methods

This prospective, randomized, controlled, clinical trial will be carried out at the Center for Orthopedics, Trauma Surgery and Spinal Cord Injury of the University Hospital Heidelberg. Adult patients, who suffer from an acute syndesmosis rupture, both isolated and in combination with fractures of the lateral malleolus (Weber C and Maisonneuve fractures) and who are undergoing surgery at our trauma center will be included in our study. The patients will be randomized to the different treatment options (screw fixation or “TightRope®”). Subsequent to the surgical treatment, all patients will receive the same standardized follow-up procedures including a gait analysis and MRI of the ankle at 6 months follow-up.

The primary endpoint of the study is the successful healing of the syndesmosis and biomechanical investigation with gait analysis.

Discussion

The results of the gait analysis from the current study will help to impartially and reliably evaluate the clinical and biomechanical outcome of both treatment options of acute syndesmosis ruptures. We hypothesize that the dynamic fixation provides an equivalent or better biomechanical, clinical, and radiographic outcome in comparison to the screw fixation.

Trial registration

German Clinical Trials Register (DRKS) DRKS00013562. Registered on July, 12, 2017.

[Vacuum shoe system vs.forefoot offloading shoe for the management of metatarsal fractures. A prospective, randomized trial]

BACKGROUND

Metatarsal fractures are managed using different types of forefoot offloading orthosis. Theaim of this prospective study was to evaluate the clinical and pedographic results of a vacuum shoe system in comparison to a forefoot unloading shoe.

METHOD

20 patients (14 women/6 men--age: 36.4 +/- 14.1 years) were prospectively included in the study. The patients were followed up at four different time points. Detailed clinical and radiological examinations were carried out, functional scores were measured and a pedographic assessment was performed.

RESULTS

Between the study groups no differences were seen in functional scoring. A complete bony healing was achieved within the 3 months of followup in all patients. The heelstrike to heelstrike time was without significant differences in the pedographic analysis. Adequate forefoot unloading was achieved with both orthosis. The load sharing between fore-, mid- and hindfoot showed no significant differences in the pedographic analysis. Patients' satisfaction was rated with higher values for the vacuum shoe system, but without significance.

CONCLUSION

Both shoe systems show an adequate unloading of the forefoot. Therefore both orthosis may be used for the treatment of metatarsal fractures.

Effects of wearing different personal equipment on force distribution at the plantar surface of the foot

Background. The wearing of personal equipment can cause specific changes in muscle activity and posture. In the present study, we investigated the influence of differences in equipment related weight loading and load distribution on plantar pressure. In addition, we studied functional effects of wearing different equipment with a particular focus on relevant changes in foot shape. Methods. Static and dynamic pedobarography were performed on 31 male soldiers carrying increasing weights consisting of different items of equipment. Results. The pressure acting on the plantar surface of the foot increased with higher loading, both under static and dynamic conditions (p < 0.05). We observed an increase in the contact area (p < 0.05) and an influence of load distribution through different ways to carry the rifle. Conclusions. The wearing of heavier weights leads to an increase in plantar pressure and contact area. This may be caused by flattening of the transverse and longitudinal arches. The effects are more evident in subjects with flat feet deformities which seem to flatten at an earlier load condition with a greater amount compared to subjects with normal arches. Improving load distribution should be a main goal in the development of military equipment in order to prevent injuries or functional disorders of the lower extremity.

[Instrumented gait and movement analysis of musculoskeletal diseases]

Instrumented 3-dimensional gait analysis is increasingly being used for the evaluation of movement disorders in orthopedic and neurological musculoskeletal diseases. Due to the high reliability of the measurements the procedures are appropriate for diagnostic purposes as well as for outcome assessment after conservative or surgical interventions. Contrary to conventional clinical assessments gait analysis parameters are able to demonstrate a normal physiological gait pattern that can be achieved with improved kinematic and kinetic parameters. For a suitable application in clinically relevant problems the limitations of the procedures should be taken into account. Due to the high instrumental involvement combined with time and cost expenditure instrumented gait analysis will probably not develop to a clinical routine procedure. Nevertheless, an excellent set of information for answering clinical questions is provided. The present contribution presents selected measurement procedures and technologies and illustrates the wide variety of possibilities with the use of selected clinical examples.