Test-retest reliability of a clinical foot assessment device for measuring first metatarsophalangeal joint quasi-stiffness

Effect of using a kinetic wedge during the hallux dorsiflexion resistance test in asymptomatic individuals

BACKGROUND

The hallux dorsiflexion resistance test is a frequently employed clinical maneuver for assessing the initiation of the windlass mechanism This maneuver involves dorsiflexion of the phalanx of the hallux, thereby evaluating plantarflexion of the first metatarsal, elevation of the medial longitudinal arch, and supination of the rearfoot. The windlass mechanism plays a crucial role in gait, and orthopedic devices, such as a kinetic wedge, which aims to facilitate its activation by increasing the hallux dorsiflexion. Although it is believed that facilitating the windlass mechanism with the kinetic wedge should be directly correlated with a decrease in hallux dorsiflexion resistance, its effects have yet to be characterized. Thus, this study aimed to determine the influence of a kinetic wedge on hallux dorsiflexion resistance in asymptomatic individuals.

METHODS

The sample comprised thirty participants (14 women and 16 men). A digital force gauge measured the force required to perform the hallux dorsiflexion resistance test during two conditions: barefoot and with a kinetic wedge. The Wilcoxon signed-rank test was used to compare the hallux dorsiflexion resistance between conditions.

RESULTS

A statistically significant reduction in force (10.54 ± 3.16N vs. 19.62 ± 5.18N, p < 0.001) was observed when using the kinetic wedge compared to the barefoot condition during the hallux dorsiflexion resistance test.

CONCLUSION

The use of a kinetic wedge reduces the required force for performing the passive hallux dorsiflexion resistance test in asymptomatic individuals. Future studies should determine to what extent the kinetic wedge can attenuate the required force to dorsiflex the hallux in individuals with musculoskeletal disorders such as plantar fasciopathy and functional hallux limitus.

The effect of varus rearfoot wedges on hallux dorsiflexion resistance

BACKGROUND

The first metatarsophalangeal joint (MTPJ), which includes the first metatarsal and proximal phalanx, plays a crucial role in gait and impacts the windlass mechanism. Disruptions to this mechanism are implicated in various foot pathologies. Jack's Test serves as a valuable tool for clinicians to assess the functionality of the MTPJ. Varus rearfoot wedges (VRFWs) are a common treatment employed in the management of lower limb pathologies. The impact of VRFWs on the resistance of the first MTPJ during Jack´s Test is currently unknown. This study aimed to measure the influence of VRFWs on the resistance of the first MTPJ during Jack´s Test. The secondary objective was to validate a new measurement method using a digital force gauge.

METHODS

Thirty participants (17 women and 13 men) were enrolled. A digital force gauge measured the weight-bearing force needed for Jack's Test, thereby evaluating the effects of VRFWs of different angulations. The Kolmogorov-Smirnov test confirmed that the data followed a normal distribution (p > 0.05). The nonparametric Friedman test (p < 0.001) showed that there were significant differences among all VRFWs, while the Wilcoxon test (p < 0.001) showed that there were differences between barefoot conditions and 3°, 5°, and 8° VRFWs.

RESULTS

The use of 8° VRFWs yielded a statistically significant reduction in the passive dorsiflexion force of hallux during Jack's Test (12.51 N ± 4.12, p < 0.001).

CONCLUSIONS

The use of VRFWs has been observed to reduce dorsiflexion resistance in the proximal phalanx of the first MTPJ during Jack's Test. Additionally, the digital force gauge was proven to be a valid tool for conducting Jack's Test, thus offering a reliable measurement method.

Effects of Walking Speed and Added Mass on Hip Joint Quasi-Stiffness in Healthy Young and Middle-Aged Adults

Joint quasi-stiffness has been often used to inform exoskeleton design. Further understanding of hip quasi-stiffness is needed to design hip exoskeletons. Of interest are wearer responses to walking speed changes with added mass of the exoskeleton. This study analyzed hip quasi-stiffness at 3 walking speed levels and 9 added mass distributions among 13 young and 16 middle-aged adults during mid-stance hip extension and late-stance hip flexion. Compared to young adults, middle-aged adults maintained a higher quasi-stiffness with a smaller range. For a faster walking speed, both age groups increased extension and flexion quasi-stiffness. With mass evenly distributed on the pelvis and thighs or biased to the pelvis, both groups maintained or increased extension quasi-stiffness. With mass biased to the thighs, middle-aged adults maintained or decreased extension quasi-stiffness while young adults increased it. Young adults decreased flexion quasi-stiffness with added mass but not in any generalizable pattern with mass amounts or distributions. Conversely, middle-aged adults maintained or decreased flexion quasi-stiffness with even distribution on the pelvis and thighs or biased to the pelvis, while no change occurred if biased to the thighs. In conclusion, these results can guide the design of a hip exoskeleton's size and mass distribution according to the intended user's age.

Intrarater and interrater reliability of the first metatarsophalangeal joint dorsiflexion resistance test

BACKGROUND

The first metatarsophalangeal joint plays a fundamental role during the gait cycle. The Hubscher manoeuvre, which consists of passively dorsiflexing the first metatarsophalangeal joint of an individual in relaxed stance and observing the raising of the medial longitudinal arch, is a clinical test thought to examine the function of the first metatarsophalangeal joint. However, the hallux dorsiflexion achieved during this test is not related to hallux dorsiflexion during gait. On the other hand, unlike kinematic tests, results from kinetic tests have been shown to be strongly correlated with dynamic joint biomechanics. Thus, given the need for valid and reliable tests to evaluate the function of the first metatarsophalangeal joint, this study aimed to assess the reliability of a new kinetic test, namely, the first metatarsophalangeal joint dorsiflexion resistance test.

METHOD

Thirty young adults completed two data collection sessions 1 week apart, during which the first metatarsophalangeal joint dorsiflexion resistance test was performed. Intrarater and interrater reliability were assessed using intraclass correlation coefficients (ICC), minimal detectable difference (MDD), standard error of the mean (SEM) and limits of agreements (LoA).

RESULTS

For the intrarater reliability, the ICC was 0.77 (p < 0.001), the SEM was 6.5 N, the MDD was 18.1 N and the LoA were -7.9 to 26.9 N. For the interrater reliability, the ICC was 0.86 (p < 0.001), the SEM was 6.9 N, the MDD was 19.0 N and the LoA were -6.4 to 21.8 N.

CONCLUSION

The results of this study demonstrate good intra and interrater reliability of the first metatarsophalangeal joint dorsiflexion resistance test, which provides evidence to support its use in clinical and research contexts. Further work is required to establish the test results' relationship with joint kinetics during gait and to provide normative values in individuals with and without musculoskeletal disorders as well as among different age groups and genders to optimise its utilization in clinical and research settings.

Recent advancements of fiber Bragg grating sensors in biomedical application: a review

Due to attractive application in the medical field, fiber Bragg grating sensor has become increasing attractive from past few decades for various strain sensing applications. FBG sensor has been used in many applications such as different surgical devices, vital sign detection devices, invasive surgery, heart rate, dental applications and biosensing application as wearable sensing devices. This paper reviews the 55 recent research articles published on fiber Bragg grating sensor for biomedical application used the qualitative, quantitative and experimental method to identify the recent advancement and challenges. In this study, particular focus is placed on applications for biomechanical devices, temperature monitors, respiratory monitors, and biosensing applications. Critical things, demands, and emerging trends for these sensing devices are also discussed in order to determine what will be needed for the next generation.

Morton’s Extension on Hallux Rigidus Pathology

Study design, case-control study: Background, Morton’s extension (ME) is a kind of orthotic that has been used as a conservative treatment of painful hallux rigidus (HR) osteoarthritis, but only their effects on first metatarsophalangeal joint (MPJ) mobility and position in healthy subjects have been studied, but not on its applied pulled tension forces neither in subjects with HR. Objectives: This study sought to understand how ME’s orthotics with three different thicknesses could influence the kinematic first MPJ by measuring hallux dorsiflexion using Jack’s test and a digital algometer with a rigid strip anchored to the iron hook’s extremity and comparing subjects with healthy first MPJ mobility to those with HR. We aimed to clarify whether tension values were different between healthy and HR subjects. Methods: Fifty-eight subjects were selected, of whom thirty were included in the case group according to HR criteria and twenty-eight were included in the control group. A digital algometer (FPX®® 25, Wagner Instruments®®, Greenwich, CT, USA) was used to assess the pulled tension values (kgf) of the first MPJ during Jack’s test. Results: The pulled tension values were highly reliable (ICC > 0.963). There were no statistically significant differences between the pulled tension values for the different ME conditions in the case (p = 0.969) or control (p = 0.718) groups. However, as it’s expected, there were statistically significant differences comparing all pulled tension values between case and control group subjects (p < 0.001). Conclusions: Different ME’s thicknesses had no influence on the pulled effort applied during the dorsiflexion Jack’s test between the healthy and HR groups; therefore, it can be prescribed without joint-care danger. In addition, it is proven that there is greater resistance to performing Jack’s test in the HR group than in the healthy group, regardless of ME’s orthotics. Furthermore, it is shown that the digital algometer device is a valid tool to detect the first MPJ restriction and is more reliable than other tests.

WITHIN-DAY AND BETWEEN-DAY RELIABILITY OF A FBG-BASED SMART SOCK SYSTEM FOR MEASURING ACTIVE TOE FLEXION DISPLACEMENT OF THE HALLUX

This study examined the test-retest reliability of hallux flexion displacement measured using a smart sock system with embedded fiber Bragg grating (FBG) sensors. Thirty female participants consisting of 15 hallux valgus (HV) patients and 15 control participants were recruited. Maximum active hallux flexion displacement was measured twice on each participant in the first visit; the same procedures were repeated 7 days later. Intraclass correlation coefficients (ICC2,1) and standard error of measurement (SEM) were applied to test within-day and between-day reliability. Paired-samples T-test was performed to compare the displacements between trials. Results showed almost perfect within-day reliability for both HV and control groups ([Formula: see text] and 0.977, respectively) with small SEM (both 0.5[Formula: see text]cm). However, fair to moderate between-day reliability was found (0.323 and 0.438, respectively). Significant differences were found between repeated measurements taken on the same day (mean [Formula: see text][Formula: see text]cm, [Formula: see text]) and on different days (mean [Formula: see text][Formula: see text]cm, [Formula: see text]), though the effect size was small. The poorer between-day reliability is likely due to the inconsistency in fitting the sock onto the foot. Future optimization of the prototype design is called for to improve the fitting consistency of wearable sensors onto patients.