Tibialis posterior muscle pain effects on hip, knee and ankle gait mechanics

The impact of prolonged experimental neck pain on walking stability and gait kinematics - A parallel-group study

BACKGROUND

Neck pain is a common problem in the general population, and movement adaptations are a natural response to pain. Previous studies have reported reduced trunk rotation during walking in those suffering from clinical neck pain. However, it is unknown how soon after the onset of pain, movement adaptations are adopted. This study investigated the effect of prolonged experimental neck pain four days after pain onset on gait kinematics during walking.

METHODS

Forty healthy participants were randomized to receive injections of nerve-growth-factor or a control injection of isotonic saline into the right splenius capitis muscle at the end of days 0 and 2. Participants performed two walking tasks, walking and walking while reading on a smartphone, on days 0, 4, and 15. Gait kinematics, spatiotemporal parameters, and gait stability were measured using Xsens Awinda.

FINDINGS

The nerve-growth-factor group reported increased neck pain intensity (median VAS 17.5 [IQR: 2.75-25.75]) on day 4 compared to day 0 and day 15. No pain intensity changes between days were reported for the isotonic-group. For gait kinematics, a main effect of the task was identified, showing that during the smartphone condition, participants had shorter stride lengths and reduced RoM for the trunk, hip, knee, and ankle compared to normal waking (P < 0.006).

INTERPRETATION

Walking while reading on a smartphone, but not mild neck muscle pain, caused changes in the gait kinematics compared to normal walking without neck pain. This finding suggests that movement alterations during walking are not an early feature of prolonged experimental neck pain.

A 3-Dimensional Gait Analysis of the Effects of Fatigue-Induced Reduced Foot Adductor Muscle Strength on the Walking of Healthy Subjects

Dysfunction of the tibialis posterior muscle is the most common cause of adult acquired flat foot. Tibialis posterior muscle weakness has been observed in several patient populations, including those in the early stages of rheumatoid arthritis. However, the influence of tibialis posterior weakness on gait mechanics is not fully understood, although gait instability has been reported. In 24 healthy participants, 3-dimension lower limb kinematics and kinetics during walking were evaluated bilaterally, before and after, a muscle fatigue protocol aiming to decrease the right foot adductor muscles strength, including the tibialis posterior muscle. The 3-dimension gait kinematics and kinetics were analyzed with statistical parametric mapping. The stance phase duration was increased for the right side. The right ankle external rotation moment decreased, and the left hip extension moment increased with reduced muscle strength compared with normal strength conditions. These changes are similar in patients with dysfunction in the tibialis posterior muscle, indicating that compensatory strategies observed in these patients might be related to the loss of tibialis posterior muscle strength. Such strategies may involve the unaffected side.

The effect of foot orthoses on gait biomechanics and pain among people with rheumatoid arthritis: A quasi-experimental study

BACKGROUND

Foot pain is frequent among people with rheumatoid arthritis (RA). Foot orthoses (FO) are commonly prescribed with the intention to reduce pain symptoms and improve function.

RESEARCH QUESTION

How do a custom-made FO affect pain, gait biomechanics and daily activity among people with RA?

METHODS

Twenty-five participants with RA and foot pain completed this quasi-experimental study using a control insole for four weeks and then a custom-made FO in the following four weeks. The foot orthoses were customized by plantar foot shape targeting optimal restoration of normal arch height. A visual analog scale was used to monitor changes in ankle/foot, knee, hip joints, and global arthritis pain. In addition, the perceived pain area was measured using a body chart analysis. Kinematics and kinetics of the hip, knee and ankle joints during gait were analyzed using 3D-motion capture. Daily steps were measured with a wrist-based activity tracker for both the control insole and custom-made FO period, respectively.

RESULTS

In comparison to the control insole, the custom-made FO reduced ankle/foot pain intensity (p < 0.001) in addition to a reduction of the perceived pain areas in the feet (p < 0.001), legs (p = 0.012), as well as the arms and hands (p = 0.014). Ankle plantar flexion and eversion moments were also reduced (p < 0.001). No difference in daily steps was observed between the two periods (p = 0.657).

SIGNIFICANCE

This study has demonstrated an ankle/foot pain-relieving effect in conjunction with alterations of the ankle joint moments in people with RA using custom-made FO. The pain relief is plausibly attributed to alterations of the ankle joint moments when using the custom-made FO. However, future studies are needed to explore further into therapeutic implication of custom-made FO in pain management of people with RA.

Foot and Ankle Problems in Patients With Rheumatoid Arthritis in 2019: Still an Important Issue

Objective

To study the prevalence of foot pain in patients with rheumatoid arthritis (RA) and whether including a 12‐joint foot count in addition to the 28‐joint count (from the Disease Activity Score 28 [DAS28]) improved detection of foot or ankle pain. In addition, the association between the self‐reported foot and ankle score (SEFAS), patient‐reported function, and disease‐specific factors was studied.

Methods

Physician‐reported data (swollen/tender 12‐joint foot count, DAS28, and medication) and patient‐reported data (foot/ankle pain, physical function, global health, and SEFAS) were assessed during a clinical visit. Data were analyzed with t test, χ² tests, and regression analysis.

Results

A total of 320 patients with RA were included (mean age 63 years, SD 13 years; 73% women), of whom 69% reported foot or ankle pain. Patients who reported foot or ankle pain had a lower mean age and worse disease activity, general pain, function, and global health (P ≤ 0.016), and fewer were in remission (50% versus 75%; P < 0.001) compared with patients without foot pain. The 12‐joint foot count identified 3.2% and 9.5% additional patients with swollen and tender joints, respectively, compared with the 28‐joint count. The SEFAS was associated with walking problems (β = −2.733; 95% confidence interval [CI] = −3.963 to −1.503) and worse function (β = −3.634; 95% CI = −5.681 to −1.587) but not with joint inflammation severity.

Conclusion

The prevalence of foot or ankle pain in patients with RA is high. The 12‐joint foot count had minor effects on detecting patients with foot pain. However, the SEFAS contributed additional information on foot problems that was not identified by joint examinations alone.

Different types of foot orthoses effect on gait mechanics in patients with rheumatoid arthritis

Foot orthoses are a first line conservative treatment for foot impairments in patients with rheumatoid arthritis (RA), however their effect on gait mechanics is poorly understood. We aimed to compare changes in lower limb and foot mechanics between two types of commonly used foot orthoses (FO) with a control. Twenty-seven patients with rheumatoid arthritis participated in this crossover study. Two different types of FO (a medially wedged custom-made FO and a prefabricated FO with a metatarsal dome, respectively), were compared against a control insole. During gait, lower limb mechanics were analyzed using 3D motion capture, force plates, and an in-shoe pressure system. Inverse dynamics models were created in the Anybody Modeling System to calculate joint angles and joint moments during gait. Gait variables were analyzed using statistical parametric mapping. Compared to the control, the prefabricated FO had limited effect on gait mechanics. Compared to the control the custom-made FO reduced ankle plantarflexion moment with 0.4 %body weight * body height (BW * BH) between 66 and 76% of stance and ankle eversion moment was reduced 0.16% BW*BH between 3 and 40% of stance. Furthermore, it also reduced the average forefoot plantar pressure by 9 kPa between 20 and 62% of stance compared to the control. Changes in foot pressure distribution, joint moments and angles were most pronounced for custom-made FO compared to the prefabricated FO. The findings suggest that patients with RA and foot impairments may benefit more from an individualized FO strategy, if the aim of the treatment is to alter gait mechanics. (NCT03561688).

Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review

OBJECTIVES

Experimental pain is a commonly used method to draw conclusions about the motor response to clinical musculoskeletal pain. A systematic review was performed to determine if current models of acute experimental pain validly replicate the clinical experience of appendicular musculoskeletal pain with respect to the distribution and quality of pain and the pain response to provocation testing.

METHODS

A structured search of Medline, Scopus and Embase databases was conducted from database inception to August 2020 using the following key terms: "experimental muscle pain" OR "experimental pain" OR "pain induced" OR "induced pain" OR "muscle hyperalgesia" OR ("Pain model" AND "muscle"). Studies in English were included if investigators induced experimental musculoskeletal pain into a limb (including the sacroiliac joint) in humans, and if they measured and reported the distribution of pain, quality of pain or response to a provocation manoeuvre performed passively or actively. Studies were excluded if they involved prolonged or delayed experimental pain, if temporomandibular, orofacial, lumbar, thoracic or cervical spine pain were investigated, if a full text of the study was not available or if they were systematic reviews. Two investigators independently screened each title and abstract and each full text paper to determine inclusion in the review. Disagreements were resolved by consensus with a third investigator.

RESULTS

Data from 57 experimental pain studies were included in this review. Forty-six of these studies reported pain distribution, 41 reported pain quality and six detailed the pain response to provocation testing. Hypertonic saline injection was the most common mechanism used to induce pain with 43 studies employing this method. The next most common methods were capsaicin injection (5 studies) and electrical stimulation, injection of acidic solution and ischaemia with three studies each. The distribution of experimental pain was similar to the area of pain reported in clinical appendicular musculoskeletal conditions. The quality of appendicular musculoskeletal pain was not replicated with the affective component of the McGill Pain Questionnaire consistently lower than that typically reported by musculoskeletal pain patients. The response to provocation testing was rarely investigated following experimental pain induction. Based on the limited available data, the increase in pain experienced in clinical populations during provocative maneuvers was not consistently replicated.

CONCLUSIONS

Current acute experimental pain models replicate the distribution but not the quality of chronic clinical appendicular musculoskeletal pain. Limited evidence also indicates that experimentally induced acute pain does not consistently increase with tests known to provoke pain in patients with appendicular musculoskeletal pain. The results of this review question the validity of conclusions drawn from acute experimental pain studies regarding changes in muscle behaviour in response to pain in the clinical setting.

A parametric study of effect of experimental tibialis posterior muscle pain on joint loading and muscle forces-Implications for patients with rheumatoid arthritis?

BACKGROUND

Foot pain and deformities are commonly encountered in patients with rheumatoid arthritis (RA). Likewise, Posterior tibial tendon dysfunction (PTTD) is commonly involved in development of foot and ankle abnormalities and has been reported with a prevalence in two-thirds of the RA patients.

RESEARCH QUESTION

Redundancy in the physiological function between different muscles provides the central nervous system multiple options to perform the same movement but which muscles compensate for the impairment of the tibialis posterior (TP) muscle? And how does these changes affect ankle joint loading?

METHODS

Experimental and computational disciplines were applied to investigate changes in muscle forces as result of induced pain in the right TP muscle. Twelve healthy subjects were enrolled in the study. Experimental pain was induced in the TP by a single ultrasound graphically guided injection of 1 mL hypertonic saline (5.0% Sodium Chloride). The participants' gait was assessed by skin marker-based motion capture and force plates. Musculoskeletal models were used to investigate compensation mechanisms systematically in the lower under extremity when TP muscle was recruited less as a consequence of the induced pain.

RESULTS

Experimental TP muscle pain and simulated reduced strength caused altered muscle recruitment and made the flexor digitorum longus and flexor hallucis longus muscles compensated for the impairment of the TP muscle. Further, the resultant ankle joint force was increased as the strength of the TP muscle was reduced.

SIGNIFICANCE

The compensation mechanism observed in the present study indicate that alterations in muscle recruitment and muscle force distribution as a result of the underlying disease inflammation itself may contribute to development of chronic foot pain and deformities in patients with RA. Further studies are required to understand the role of PTTD in occurrence of those late adverse musculoskeletal manifestations aiming at search for early preventive strategies.