Reliability study of tibialis posterior and selected leg muscle EMG and multi-segment foot kinematics in rheumatoid arthritis associated pes planovalgus

Gluteus medius muscle strengthening exercise effects on medial longitudinal arch height in individuals with flexible flatfoot: a randomized controlled trial

This study aimed to compare the effects of 8 weeks of foot plus hip exercise to foot exercise alone on medial longitudinal arch (MLA) parameters; navicular drop (ND), arch height index (AHI), plantar pressure, static balance, and dynamic balance were measured at baseline, 4 weeks, and 8 weeks. A total of 52 healthy participants with bilateral flatfoot were randomly assigned into foot exercise (n=26) and foot plus hip exercise (n=26) group. At 4 weeks, the foot plus hip exercise group showed significantly less ND (P=0.002), plantar pressure at the medial forefoot (P=0.002), and mediolateral displacement (P=0.001) while showing a greater AHI (P=0.019) than the foot exercise group. At 8 weeks, there was also significantly less plantar pressure at the medial hindfoot (P=0.017) and less anteroposterior displacement (P=0.002) in the foot plus hip exercise group than in the foot exercise group. No significant differences between groups were found in dynamic balance. The addition of gluteus medius muscle strengthening exercise to foot exercise was more effective in supporting the MLA than performing foot exercise alone.

Comparison of EMG signal of the flexor hallucis longus recorded using surface and intramuscular electrodes during walking

The purpose of this study was to compare the use of intramuscular (iEMG) and surface (sEMG) electromyography electrodes to record flexor hallucis longus (FHL) muscle activity during walking, and describe the role of the FHL. Muscle activity was recorded in 12 participants using sEMG and iEMG during treadmill and overground walking. Inter-tester reliability for visual detection of onset and offset of muscle activity was high (ICC = 1.00). During the loading period, the number of bursts of muscle activity was statistically significantly greater using iEMG compared to sEMG when treadmill walking (p = 0.016), and the duration of muscle activity was significantly greater for iEMG (p = 0.01) on both walking surfaces. There were no differences for peak and mean root mean squared (p ≥ 0.07). The FHL activity observed during the loading period (heel strike to forefoot strike) supports the function of the FHL to act as a dynamic ankle stabiliser of the rearfoot, as well as contributing to propulsion during the latter part of stance. The choice of electrodes to detect FHL activity should be dependent on whether the loading and propulsive periods are of interest, and whether treadmill or overground walking will be examined.

Evaluation of Optical and Radar Based Motion Capturing Technologies for Characterizing Hand Movement in Rheumatoid Arthritis-A Pilot Study

In light of the state-of-the-art treatment options for patients with rheumatoid arthritis (RA), a detailed and early quantification and detection of impaired hand function is desirable to allow personalized treatment regiments and amend currently used subjective patient reported outcome measures. This is the motivation to apply and adapt modern measurement technologies to quantify, assess and analyze human hand movement using a marker-based optoelectronic measurement system (OMS), which has been widely used to measure human motion. We complement these recordings with data from markerless (Doppler radar) sensors and data from both sensor technologies are integrated with clinical outcomes of hand function. The technologies are leveraged to identify hand movement characteristics in RA affected patients in comparison to healthy control subjects, while performing functional tests, such as the Moberg-Picking-Up Test. The results presented discuss the experimental framework and present the limiting factors imposed by the use of marker-based measurements on hand function. The comparison of simple finger motion data, collected by the OMS, to data recorded by a simple continuous wave radar suggests that radar is a promising option for the objective assessment of hand function. Overall, the broad scope of integrating two measurement technologies with traditional clinical tests shows promising potential for developing new pathways in understanding of the role of functional outcomes for the RA pathology.

A systematic review of the effect of footwear, foot orthoses and taping on lower limb muscle activity during walking and running

BACKGROUND

External devices are used to manage musculoskeletal pathologies by altering loading of the foot, which could result in altered muscle activity that could have therapeutic benefits.

OBJECTIVES

To establish if evidence exists that footwear, foot orthoses and taping alter lower limb muscle activity during walking and running.

STUDY DESIGN

Systematic literature review.

METHODS

CINAHL, MEDLINE, ScienceDirect, SPORTDiscus and Web of Science databases were searched. Quality assessment was performed using guidelines for assessing healthcare interventions and electromyography methodology.

RESULTS

Thirty-one studies were included: 22 related to footwear, eight foot orthoses and one taping. In walking, (1) rocker footwear apparently decreases tibialis anterior activity and increases triceps surae activity, (2) orthoses could decrease activity of tibialis posterior and increase activity of peroneus longus and (3) other footwear and taping effects are unclear.

CONCLUSION

Modifications in shoe or orthosis design in the sagittal or frontal plane can alter activation in walking of muscles acting primarily in these planes. Adequately powered research with kinematic and kinetic data is needed to explain the presence/absence of changes in muscle activation with external devices.

CLINICAL RELEVANCE

This review provides some evidence that foot orthoses can reduce tibialis posterior activity, potentially benefitting specific musculoskeletal pathologies.

Multisegment Foot Models and Clinical Application After Foot and Ankle Trauma: A Review

Since the end of the 1990s, several multisegment foot models (MSFMs) have been developed. Several models were used to describe foot and ankle kinematics in patients with foot and ankle pathologies; however, the diagnostic value for clinical practice of these models is not known. This review searched in the literature for studies describing kinematics in patients after foot and ankle trauma using an MSFM. The diagnostic value of the MSFMs in patients after foot and ankle trauma was also investigated. A search was performed on the databases PubMed/MEDLINE, Embase, and Cochrane Library. To investigate the diagnostic value of MSFMs in patients after foot and ankle trauma, studies were classified and analyzed following the diagnostic research questions formulated by Knottnerus and Buntinx. This review was based on 7 articles. All studies were published between 2010 and 2015. Five studies were retrospective studies, and 2 used an intervention. Three studies described foot and ankle kinematics in patients after fractures. Four studies described foot and ankle kinematics in patients after ankle sprain. In all included studies, altered foot and ankle kinematics were found compared with healthy subjects. No results on patient outcome using MSFMs and costs were found. Seven studies were found reporting foot and ankle kinematics in patients after foot and ankle trauma using an MSFM. Results show altered kinematics compared with healthy subjects, which cannot be seen by other diagnostic tests and add valuable data to the present literature; therefore, MSFMs seem to be promising diagnostic tools for evaluating foot and ankle kinematics. More research is needed to find the additional value for MSFMs regarding patient outcome and costs.

The between-day reliability of peroneus longus EMG during walking

The peroneus longus (PL) is a rearfoot evertor, important in frontal plane foot motion. Studying PL function has been limited by previous electromyography (EMG) studies reporting poor between-day reliability. Due to its close proximity to adjacent muscles, EMG measures of PL may be susceptible to crosstalk, thus correct electrode placement is vital. The aim of this study was to use ultrasound to aid placement of small surface EMG electrodes and determine the between-day reliability of PL EMG in healthy participants' walking. Ten participants walked barefoot and shod at a controlled, self-selected speed. Six trials per condition, per session, were recorded over two days (mean (SD): 5 (3) days apart). The muscle belly was located using ultrasound. EMG was recorded with surface electrodes (Trigno™ Mini, Delsys, Inc.) at 2000 Hz. Amplitude was normalized to the peak per gait cycle and time normalized to the gait cycle. Reliability of discrete variables were primarily assessed with the standard error of measurement (SEM), plus the coefficient of multiple correlation (CMC), the coefficient of variation (CV) and the intra-class correlation coefficient (ICC). The pattern of the EMG profile was consistent. The SEM of peak amplitude was 4% (3-8%) and 3% (2-5%) for barefoot and shod respectively. For timing of the peak the SEM was 2% (1-3%) and 1% (1-2%) for barefoot and shod respectively. Low SEM of discrete variables suggests good reliability of PL EMG during walking supporting the future use of this protocol. Therefore activation of PL can be confidently studied in repeated-measures study designs.

Muscular activity and torque of the foot dorsiflexor muscles during decremental isometric test: A cross-sectional study

PURPOSE

To analyse the torque variation level that could be explained by the muscle activation (EMG) amplitude of the three major foot dorsiflexor muscles (tibialis anterior (TA), extensor digitorum longus (EDL), extensor hallucis longus (EHL)) during isometric foot dorsiflexion at different intensities.

METHODS

In a cross-sectional study, forty-one subjects performed foot dorsiflexion at 100%, 75%, 50% and 25% of maximal voluntary contractions (MVC) with the hip and knee flexed 90° and the ankle in neutral position (90° between leg and foot). Three foot dorsiflexions were performed for each intensity. Outcome variables were: maximum (100% MVC) and relative torque (75%, 50%, 25% MVC), maximum and relative EMG amplitude. A linear regression analysis was calculated for each intensity of the isometric foot dorsiflexion.

RESULTS

The degree of torque variation (dependent variable) from the independent variables explain (EMG amplitude of the three major foot dorsiflexor muscles) the increases when the foot dorsiflexion intensity is increased, with values of R² that range from 0.194 (during 25% MVC) to 0.753 (during 100% MVC). The reliability of the outcome variables was excellent.

CONCLUSION

The EMG amplitude of the three main foot dorsiflexors exhibited more variance in the dependent variable (torque) when foot dorsiflexion intensity increases.

Surface Electromyographic Assessment of Swallowing Function

The reliability of surface electromyographic (sEMG) variables during swallowing determines the potential usefulness of these measures in swallowing assessment and treatment. This study aimed to establish the reliability of the sEMG measures of the swallowing function of muscles during different swallowing conditions in healthy young and old volunteers. Two groups of volunteers (24 older adults, 10 younger adults) participated in this cross-sectional study during 2014. The activity of masseter, submental, and infrahyoid groups were measured using sEMG during three repetitions of different swallowing tasks. Both the relative and absolute reliability (characterized respectively by ICC, SEM%, and SRD%) were calculated for the sEMG indices of muscle activity during swallowing events. Statistical analyses were performed by the SPSS 19.0 and Microsoft Excel 2007 software packages. Statistical significance was set at P≤0.05. The relative reliability calculations showed significant agreements between repetitions for the mean and peak amplitude and the average of median frequency (MDF) of the studied muscles function during most swallowing types in both groups. However, the duration and particularly the time to peak of muscle activity showed significant agreements during fewer swallowing conditions. Excluding MDF, we found high SEM% and SRD% for the studied measures (particularly timing measures) of muscles function during most swallowing types in both groups. The reliability of sEMG measures was influenced by the age and swallowing types. Our findings suggest that the MDF of muscle function during almost all studied swallowing types can be a reliable measure for the sEMG assessment of swallowing function in both younger and older adults.

Neuromuscular Control Mechanisms During Single-Leg Jump Landing in Subacute Ankle Sprain Patients: A Case Control Study

BACKGROUND

Optimal neuromuscular control mechanisms are essential for preparing, maintaining, and restoring functional joint stability during jump landing and to prevent ankle injuries. In subacute ankle sprain patients, neither muscle activity nor kinematics during jump landing has previously been assessed.

OBJECTIVE

To compare neuromuscular control mechanisms and kinematics between subacute ankle sprain patients and healthy persons before and during the initial contact phase of a 25-cm single-leg jump.

DESIGN

Case-control study.

SETTING

University hospital.

PATIENTS

Fifteen patients with grade I or II acute ankle sprains were followed up after 4 weeks of conservative management not involving physical therapy.

METHODS

Subjects performed alternately 3 single-leg forward jumps of 25 cm (toe-to-heel distance) barefoot. Their results were compared with the data of 15 healthy subjects.

MAIN OUTCOME MEASUREMENTS

Electromyographic (EMG) activity of the musculus (m.) gastrocnemius lateralis, m. tibialis anterior, and m. peroneus longus as well as kinematics for ankle, knee, and hip joint were recorded for pre-initial contact (IC) phase, post-initial contact phase, and reflex-induced phase.

RESULTS

The results showed that EMG activity of the 3 muscles did not differ between ankle sprain patients (n = 15) and healthy persons (n = 15) for any of the analyzed time intervals (all P > .05). However, during the pre-IC phase, ankle sprain patients presented less plantar flexion, as well as during the post-IC phase after jump landing, compared to healthy persons (P < .05).

CONCLUSION

Taken together, these kinematic alterations of the ankle joint can lead to neuromuscular control mechanism disturbances through which functional instability might arise.

LEVEL OF EVIDENCE

III.

Use of a temporary supramalleolar orthosis to manage foot pain in a patient with rheumatoid arthritis: A case report

BACKGROUND

Rheumatoid arthritis is a chronic inflammatory condition characterized by joint pain, stiffness, and functional disability. Approximately 90% of patients will report symptoms in the foot or ankle during the course of their disease.

CASE DESCRIPTION

A case of a 40-year-old woman with a 12-year history of rheumatoid arthritis referred to outpatient physical therapy with a chief complaint of pain in the lateral rearfoot and forefoot is presented. At the time of the initial examination, the patient reported persistent pain ranging from 3 to 9/10, aggravated when standing and walking during activities of daily living. Treatment consisted of the fabrication of a supramalleolar orthosis that incorporated an in-shoe foot orthosis to address functional limitations and abnormal foot and ankle posture. A home exercise program was prescribed to address potential balance deficits and strength loss following the application of the orthosis.

OUTCOMES

Clinically significant improvements were seen in pain, gait speed, and on the Foot Function Index following the implementation of the orthotic device. The patient returned to standing and walking with minimal symptom limitations.

DISCUSSION

This case report highlights the short-term clinical outcomes when using a supramalleolar orthosis in conjunction with an in-shoe foot orthosis to manage lateral rearfoot and forefoot pain in a patient with rheumatoid arthritis.

The feasibility of a modified shoe for multi-segment foot motion analysis: a preliminary study

Background

The majority of multi-segment kinematic foot studies have been limited to barefoot conditions, because shod conditions have the potential for confounding surface-mounted markers. The aim of this study was to investigate whether a shoe modified with a webbed upper can accommodate multi-segment foot marker sets without compromising kinematic measurements under barefoot and shod conditions.

Methods

Thirty participants (15 controls and 15 participants with midfoot pain) underwent gait analysis in two conditions; barefoot and wearing a shoe (shod) in a random order. The shod condition employed a modified shoe (rubber plimsoll) with a webbed upper, allowing skin mounted reflective markers to be visualised through slits in the webbed material. Three dimensional foot kinematics were captured using the Oxford multi-segment foot model whilst participants walked at a self-selected speed.

Results

The foot pain group showed greater hindfoot eversion and less hindfoot dorsiflexion than controls in the barefoot condition and these differences were maintained when measured in the shod condition. Differences between the foot pain and control participants were also observed for walking speed in the barefoot and in the shod conditions. No significant differences between foot pain and control groups were demonstrated at the forefoot in either condition.

Conclusions

Subtle differences between pain and control groups, which were found during barefoot walking are retained when wearing the modified shoe. The novel properties of the modified shoe offers a potential solution for the use of passive infrared based motion analysis for shod applications, for instance to investigate the kinematic effect of foot orthoses.

Between-day reliability of a cluster-based method for multisegment kinematic analysis of the foot-ankle complex

BACKGROUND

Detailed description of foot pronation-supination requires multisegment evaluation of the kinematics of the foot-ankle complex. There are noninvasive methods with independent (single) tracking markers attached directly to the skin. However, these methods are inconsistent with the usual rigid segments assumption. In contrast, using clustered markers is compatible with this assumption and is necessary for analyses that need tracking markers to be distant from the foot (eg, shod walking). This study investigated the between-day reliability of a cluster-based method for multisegment analysis of foot-ankle angles related to pronation-supination.

METHODS

Ten healthy adults participated in the study. An anatomically based, three-dimensional model comprising the shank, calcaneus, and forefoot was created. Rigid clusters of tracking markers were used to determine the relative positions and motions of the segments. Mean positions were measured with the subtalar joint in neutral position during standing. Furthermore, mean angles, peaks, and timings of peaks were measured during the stance phase of walking. All of the variables were measured twice, with a 1-week interval. To evaluate reliability, intraclass correlation coefficients were calculated for discrete variables and coefficients of multiple correlation for entire gait curves.

RESULTS

Intraclass correlation coefficients varied from 0.8 to 0.93 for the angles obtained when the subtalar joint was in neutral and from 0.76 to 0.9 for walking variables. Coefficients of multiple correlation varied from 0.93 to 0.97 for walking curves.

CONCLUSIONS

The method described has good to high reliability and provides a systematic method for multisegment kinematic evaluation of foot-ankle pronation-supination.

Differences in muscle activity during hand-dexterity tasks between women with arthritis and a healthy reference group

BACKGROUND

Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group.

METHODS

Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC.

RESULTS

The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and-for the EDC-also when writing with a pen and using a key (p < 0.02). The exercise "rolling dough with flat hands" required the lowest %MVIC and may be less effective in improving muscle strength.

CONCLUSIONS

Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength.

Kinematic, kinetic and electromyographic response to customized foot orthoses in patients with tibialis posterior tenosynovitis, pes plano valgus and rheumatoid arthritis

Objective. To describe the effect of customized foot orthoses (FOs) on the kinematic, kinetic and EMG features in patients with RA, tibialis posterior (TP) tenosynovitis and associated pes plano valgus.

Methods. Patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including three-dimensional (3D) kinematics, kinetics, intramuscular EMG of TP and surface EMG of tibialis anterior, peroneus longus, soleus and medial gastrocnemius. Findings were compared between barefoot and shod with customized FO conditions.

Results. Ten patients with RA with a median (range) disease duration of 3 (1–18) years were recruited. Moderate levels of foot pain and foot-related impairment and disability were present with moderately active disease states. Altered timing of the soleus (P = 0.05) and medial gastrocnemius (P = 0.02) and increased magnitude of tibialis anterior (P = 0.03) were noted when barefoot was compared with shod with FO. Trends were noted for reduced TP activity in the contact period (P = 0.09), but this did not achieve statistical significance. Differences in foot motion characteristics were recorded for peak rearfoot eversion (P = 0.01), peak rearfoot plantarflexion (P < 0.001) and peak forefoot abduction (P = 0.02) in the shod with FOs compared with barefoot conditions. No differences in kinetic variables were recorded.

Conclusion. This study has demonstrated, for the first time, alterations in muscle activation profiles and foot motion characteristics in patients with RA, pes plano valgus and US-confirmed TP tenosynovitis in response to customized FOs. Complex adaptations were evident in this cohort and further work is required to determine whether these functional alterations lead to improvements in patient symptoms.

Assessment of foot and ankle muscle strength using hand held dynamometry in patients with established rheumatoid arthritis

Background

The foot and ankle are frequently affected in patients with rheumatoid arthritis (RA). One of the negative consequences of RA on the physical function of patients is a decrease in muscle strength. However, little is known about foot and muscle strength in this population. The aim of the study was to evaluate significant differences in foot and ankle muscle strength between patients with established RA against age and sex-matched controls using hand-held dynamometry.

Methods

The maximal muscle strength of ankle plantarflexion, dorsiflexion, eversion and inversion was assessed in 14 patients with RA, mean (SD) disease duration of 22 (14.1) years, and 20 age and sex-matched control participants using hand-held dynamometry.

Results

Significant differences were observed in muscle strength between the two groups in plantarflexion (p = 0.00), eversion (p = 0.04) and inversion (p = 0.01). No significant difference was found in dorsiflexion (p > 0.05). The patients with RA displayed a significantly lower plantarflexion-dorsiflexion ratio than the control participants (p = 0.03).

Conclusions

The results from this study showed that the RA patients displayed a significant decrease in ankle dorsiflexion, eversion and inversion when compared to the non-RA control group suggesting that foot and ankle muscle strength may be affected by the pathological processes in RA. This study is a preliminary step for the measurement of muscle impairments within the RA population.