The effects of wearing textured versus smooth shoe insoles for 4-weeks in people with diabetic peripheral neuropathy: a randomised controlled trial.

PURPOSE: To determine whether short-term wear of textured insoles alters balance, gait, foot sensation, physical activity, or patient-reported outcomes, in people with diabetic neuropathy. MATERIALS AND METHODS: 53 adults with diabetic neuropathy were randomised to wear textured or smooth insoles for 4-weeks. At baseline and post-intervention, balance (foam/firm surface; eyes open/closed) and walking were assessed whilst barefoot, wearing shoes only, and two insoles (textured/smooth). The primary outcome was center of pressure (CoP) total sway velocity. Secondary outcomes included other CoP measures, spatiotemporal gait measures, foot sensation, physical activity, and patient-reported outcomes (foot health, falls efficacy). RESULTS: Wearing textured insoles led to improvements in CoP measures when standing on foam with eyes open, relative to smooth insoles (p ≤ 0.04). The intervention group demonstrated a 5% reduction in total sway velocity, indicative of greater balance. The intervention group also showed a 9-point improvement in self-perceived vigour (p = 0.03). Adjustments for multiple comparisons were not applied. CONCLUSIONS: This study provides weak statistical evidence in favour of textured insoles. Wearing textured insoles may alter measures of balance, suggestive of greater stability, in people with diabetic neuropathy. Plantar stimulation, through textured insoles, may have the capacity to modulate the perception of foot pain, leading to improved well-being.IMPLICATIONS FOR REHABILITATIONShort-term wear of textured insoles can lead to improvements in centre of pressure sway measures when standing on a compliant supporting surface.Wearing textured insoles may have the capacity to help relieve foot pain leading to enhanced self-perceived vitality in people with diabetic peripheral neuropathy.

Sagittal plane knee kinematics can be measured during activities of daily living following total knee arthroplasty with two IMU.

Knee function is rarely measured objectively during functional tasks following total knee arthroplasty. Inertial measurement units (IMU) can measure knee kinematics and range of motion (ROM) during dynamic activities and offer an easy-to-use system for knee function assessment post total knee arthroplasty. However, IMU must be validated against gold standard three-dimensional optical motion capture systems (OMC) across a range of tasks if they are to see widespread uptake. We computed knee rotations and ROM from commercial IMU sensor measurements during walking, squatting, sit-to-stand, stair ascent, and stair descent in 21 patients one-year post total knee arthroplasty using two methods: direct computation using segment orientations (r_IMU), and an IMU-driven iCloud-based interactive lower limb model (m_IMU). This cross-sectional study compared computed knee angles and ROM to a gold-standard OMC and inverse kinematics method using Pearson's correlation coefficient (R) and root-mean-square-differences (RMSD). The r_IMU and m_IMU methods estimated sagittal plane knee angles with excellent correlation (>0.95) compared to OMC for walking, squatting, sit-to-stand, and stair-ascent, and very good correlation (>0.90) for stair descent. For squatting, sit-to-stand, and walking, the mean RMSD for r_IMU and m_IMU compared to OMC were <4 degrees, < 5 degrees, and <6 degrees, respectively but higher for stair ascent and descent (~12 degrees). Frontal and transverse plane knee kinematics estimated using r_IMU and m_IMU showed poor to moderate correlation compared to OMC. There were no differences in ROM measurements during squatting, sit-to-stand, and walking across the two methods. Thus, IMUs can measure sagittal plane knee angles and ROM with high accuracy for a variety of tasks and may be a useful in-clinic tool for objective assessment of knee function following total knee arthroplasty.

Flexible Iron-On Sensor Embedded in Smart Sock for Gait Event Detection.

Portable and wearable electronics for biomechanical data collection have become a growing part of everyday life. As smart technology improves and integrates into our lives, some devices remain ineffective, expensive, or difficult to access. We propose a washable iron-on textile pressure sensor for biometric data acquisition. Biometric data, such as human gait, are a powerful tool for the monitoring and diagnosis of ambulance and physical activity. To demonstrate this, our washable iron-on device is embedded into a sock and compared to gold standard force plate data. Biomechanical testing showed that our embedded sensor displayed a high aptitude for gait event detection, successfully identifying over 96% of heel strike and toe-off gait events. Our device demonstrates excellent attributes for further investigations into low-cost, washable, and highly versatile iron-on textiles for specialized biometric analysis.

Maintaining soldier musculoskeletal health using personalised digital humans, wearables and/or computer vision.

OBJECTIVES: The physical demands of military service place soldiers at risk of musculoskeletal injuries and are major concerns for military capability. This paper outlines the development new training technologies to prevent and manage these injuries. DESIGN: Narrative review. METHODS: Technologies suitable for integration into next-generation training devices were examined. We considered the capability of technologies to target tissue level mechanics, provide appropriate real-time feedback, and their useability in-the-field. RESULTS: Musculoskeletal tissues' health depends on their functional mechanical environment experienced in military activities, training and rehabilitation. These environments result from the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing joint tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and strain), which may be enabled by real-time biofeedback. Recent research has shown that these biofeedback technologies are possible by integrating a patient's personalised digital twin and wireless wearable devices. Personalised digital twins are personalised neuromusculoskeletal rigid body and finite element models that work in real-time by code optimisation and artificial intelligence. Model personalisation is crucial in obtaining physically and physiologically valid predictions. CONCLUSIONS: Recent work has shown that laboratory-quality biomechanical measurements and modelling can be performed outside the laboratory with a small number of wearable sensors or computer vision methods. The next stage is to combine these technologies into well-designed easy to use products.

International Women in Biomechanics: Promoting, supporting, and sustaining the careers of women in biomechanics.

Gender biases and inequities are prevalent across many scientific fields and biomechanics is likely no exception. While progress has been made to support women in the field, especially at biomechanics society conferences, the recent COVID-19 pandemic has exacerbated professional isolation. The International Women in Biomechanics (IWB) community started in July 2020 with the mission of fostering an environment for women and other under-represented genders in biomechanics to gain year-round support, visibility, and allyship. Nearly 700 biomechanists have joined the IWB community from over 300 universities/organizations and 33 countries. Our community ranges in career stages and professions and interacts through a forum-style platform, teleconference meetings, and social media. In 2021, we conducted a survey to identify the needs, concerns, and issues faced by individuals in the IWB community. We received 144 responses from members in 16 countries. Our survey revealed three primary needs for women in biomechanics: supportive working environments, career planning support, and addressing workplace gender bias. These results, in conjunction with scientific evidence on workforce gender bias, helped us identify three key areas to meet our mission: Member Support, Community Outreach, and Empowering Allyship. Several levels of support are required in these three areas to ensure a lasting, positive, and sustainable impact on gender equity in biomechanics. We conclude by providing our perspectives on an evidence-based call to action to continue addressing gender bias and inequity at the individual, institutional, and scientific society levels. These actions can collectively enhance our allyship for women in the field of biomechanics.

Immediate effects of wearing textured versus smooth insoles on standing balance and spatiotemporal gait patterns when walking over even and uneven surfaces in people with multiple sclerosis.

PURPOSE: To investigate the immediate effects of wearing novel sensory-stimulating textured insoles on balance and gait in 41 people with multiple sclerosis (pwMS). MATERIALS AND METHODS: Assessments of balance (firm/foam surface; eyes open/closed) and walking (when negotiating even/uneven surfaces) were performed wearing textured insoles, smooth insoles, shoes only, and barefoot. Outcome measures were centre of pressure (CoP) movement during standing (elliptical area, sway path velocity) and spatiotemporal gait patterns (stride/step width, stride time, double-limb support time, stride length, velocity). RESULTS: Wearing textured insoles led to reductions in CoP velocity measures when standing on foam with eyes open and closed when compared to barefoot (p values ≤0.02). Textured insoles did not appear to be consistently superior to smooth insoles or shoes only for improving gait. Relative to the insole/shoe conditions, walking barefoot led to poorer gait performance for the even and uneven surface tasks (p values ≤0.03). CONCLUSIONS: For pwMS, stimulating the foot with "texture" appears to provide enhanced sensory input with the capacity to improve CoP movement control during standing; offering a potential new treatment option for balance rehabilitation. Further research is needed to identify which individuals may benefit most from textured insoles.Implications for rehabilitationTextured shoe insoles, designed to stimulate plantar mechanoreceptors, are a novel approach to improve standing balance and walking patterns in people with multiple sclerosis (pwMS).Wearing textured insoles for the first time can lead to improvements in centre of pressure movement control when standing on an unstable compliant supporting surface.Textured insoles offer a potential new treatment technique for balance rehabilitation in pwMS who show early signs of diminished foot sensation.

Effects of wearing textured versus smooth shoe insoles for 12 weeks on gait, foot sensation and patient-reported outcomes, in people with multiple sclerosis: a randomised controlled trial.

BACKGROUND: Innovative shoe insoles, designed to enhance sensory information on the plantar surface of the feet, could help to improve walking in people with Multiple Sclerosis. OBJECTIVE: To compare the effects of wearing textured versus smooth insoles, on measures of gait, foot sensation and patient-reported outcomes, in people with Multiple Sclerosis. METHODS: A prospective, randomised controlled trial was conducted with concealed allocation, assessor blinding and intention-to-treat analysis. Thirty ambulant men and women with multiple sclerosis (MS) (Disease Steps rating 1-4) were randomly allocated to wear textured or smooth insoles for 12 weeks. Self-reported insole wear and falls diaries were completed over the intervention period. Laboratory assessments of spatiotemporal gait patterns, foot sensation and proprioception, and patient-reported outcomes, were performed at Weeks 0 (Baseline 1), 4 (Baseline 2) and 16 (Post-Intervention). The primary outcome was the size of the mediolateral base of support (stride/step width) when walking over even and uneven surfaces. Independent t-tests were performed on change from baseline (average of baseline measures) to post-intervention. RESULTS: There were no differences in stride width between groups, when walking over the even or uneven surfaces (P ≥ 0.20) at post-intervention. There were no between-group differences for any secondary outcomes including gait (all P values > 0.23), foot sensory function (all P values ≥ 0.08) and patient-reported outcomes (all P values ≥ 0.23). CONCLUSIONS: In our small trial, prolonged wear of textured insoles did not appear to alter walking or foot sensation in people with MS who have limited foot sensory loss. Further investigation is needed to explore optimal insole design. CLINICAL TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ACTRN12615000421538).

Development of predictive statistical shape models for paediatric lower limb bones.

BACKGROUND AND OBJECTIVE: Accurate representation of bone shape is important for subject-specific musculoskeletal models as it may influence modelling of joint kinematics, kinetics, and muscle dynamics. Statistical shape modelling is a method to estimate bone shape from minimal information, such as anatomical landmarks, and to avoid the time and cost associated with reconstructing bone shapes from comprehensive medical imaging. Statistical shape models (SSM) of lower limb bones have been developed and validated for adult populations but are not applicable to paediatric populations. This study aimed to develop SSM for paediatric lower limb bones and evaluate their reconstruction accuracy using sparse anatomical landmarks. METHODS: We created three-dimensional models of 56 femurs, 29 pelves, 56 tibias, 56 fibulas, and 56 patellae through segmentation of magnetic resonance images taken from 29 typically developing children (15 females; 13 ± 3.5 years). The SSM for femur, pelvis, tibia, fibula, patella, haunch (i.e., combined femur and pelvis), and shank (i.e., combined tibia and fibula) were generated from manual segmentation of comprehensive magnetic resonance images to describe the shape variance of the cohort. We implemented a leave-one-out cross-validation method wherein SSM were used to reconstruct novel bones (i.e., those not included in SSM generation) using full- (i.e., full segmentation) and sparse- (i.e., anatomical landmarks) input, and then compared these reconstructions against bones segmented from magnetic resonance imaging. Reconstruction performance was evaluated using root mean squared errors (RMSE, mm), Jaccard index (0-1), Dice similarity coefficient (DSC) (0-1), and Hausdorff distance (mm). All results reported in this abstract are mean ± standard deviation. RESULTS: Femurs, pelves, tibias, fibulas, and patellae reconstructed via SSM using full-input had RMSE between 0.89 ± 0.10 mm (patella) and 1.98 ± 0.38 mm (pelvis), Jaccard indices between 0.77 ± 0.03 (pelvis) and 0.90 ± 0.02 (tibia), DSC between 0.87 ± 0.02 (pelvis) and 0.95 ± 0.01 (tibia), and Hausdorff distances between 2.45 ± 0.57 mm (patella) and 9.01 ± 2.36 mm (pelvis). Reconstruction using sparse-input had RMSE ranging from 1.33 ± 0.61 mm (patella) to 3.60 ± 1.05 mm (pelvis), Jaccard indices ranging from 0.59 ± 0.10 (pelvis) to 0.83 ± 0.03 (tibia), DSC ranging from 0.74 ± 0.08 (pelvis) to 0.90 ± 0.02 (tibia), and Hausdorff distances ranging from 3.21 ± 1.19 mm (patella) to 12.85 ± 3.24 mm (pelvis). CONCLUSIONS: The SSM of paediatric lower limb bones showed reconstruction accuracy consistent with previously developed SSM and outperformed adult-based SSM when used to reconstruct paediatric bones.

2021 ISB World Athletics Award for Biomechanics: The Subtalar Joint Maintains "Spring-Like" Function While Running in Footwear That Perturbs Foot Pronation.

Humans have the remarkable ability to run over variable terrains. During locomotion, however, humans are unstable in the mediolateral direction and this instability must be controlled actively-a goal that could be achieved in more ways than one. Walking research indicates that the subtalar joint absorbs energy in early stance and returns it in late stance, an attribute that is credited to the tibialis posterior muscle-tendon unit. The purpose of this study was to determine how humans (n = 11) adapt to mediolateral perturbations induced by custom-made 3D-printed "footwear" that either enhanced or reduced pronation of the subtalar joint (modeled as motion in 3 planes) while running (3 m/s). In all conditions, the subtalar joint absorbed energy (ie, negative mechanical work) in early stance followed by an immediate return of energy (ie, positive mechanical work) in late stance, demonstrating a "spring-like" behavior. These effects increased and decreased in footwear conditions that enhanced or reduced pronation (P ≤ .05), respectively. Of the recorded muscles, the tibialis posterior (P ≤ .05) appeared to actively change its activation in concert with the changes in joint energetics. We suggest that the "spring-like" behavior of the subtalar joint may be an inherent function that enables the lower limb to respond to mediolateral instabilities during running.

Modelling the complexity of the foot and ankle during human locomotion: the development and validation of a multi-segment foot model using biplanar videoradiography.

We developed and validated a multi-segment foot and ankle model for human walking and running. The model has 6-segments, and 7 degrees of freedom; motion between foot segments were constrained with a single oblique axis to enable triplanar motion [Joint Constrained (JC) model]. The accuracy of the JC model and that of a conventional model using a 6 degrees of freedom approach were assessed by comparison to segment motion determined with biplanar videoradiography. Compared to the 6-DoF model, our JC model demonstrated significantly smaller RMS differences [JC: 2.19° (1.43-2.73); 6-DoF: 3.25° (1.37-5.89)] across walking and running. The JC model is thus capable of more accurate musculoskeletal analyses and is also well suited for predictive simulations.

Finite element analysis of the performance of additively manufactured scaffolds for scapholunate ligament reconstruction.

Rupture of the scapholunate interosseous ligament can cause the dissociation of scaphoid and lunate bones, resulting in impaired wrist function. Current treatments (e.g., tendon-based surgical reconstruction, screw-based fixation, fusion, or carpectomy) may restore wrist stability, but do not address regeneration of the ruptured ligament, and may result in wrist functional limitations and osteoarthritis. Recently a novel multiphasic bone-ligament-bone scaffold was proposed, which aims to reconstruct the ruptured ligament, and which can be 3D-printed using medical-grade polycaprolactone. This scaffold is composed of a central ligament-scaffold section and features a bone attachment terminal at either end. Since the ligament-scaffold is the primary load bearing structure during physiological wrist motion, its geometry, mechanical properties, and the surgical placement of the scaffold are critical for performance optimisation. This study presents a patient-specific computational biomechanical evaluation of the effect of scaffold length, and positioning of the bone attachment sites. Through segmentation and image processing of medical image data for natural wrist motion, detailed 3D geometries as well as patient-specific physiological wrist motion could be derived. This data formed the input for detailed finite element analysis, enabling computational of scaffold stress and strain distributions, which are key predictors of scaffold structural integrity. The computational analysis demonstrated that longer scaffolds present reduced peak scaffold stresses and a more homogeneous stress state compared to shorter scaffolds. Furthermore, it was found that scaffolds attached at proximal sites experience lower stresses than those attached at distal sites. However, scaffold length, rather than bone terminal location, most strongly influences peak stress. For each scaffold terminal placement configuration, a basic metric was computed indicative of bone fracture risk. This metric was the minimum distance from the bone surface to the internal scaffold bone terminal. Analysis of this minimum bone thickness data confirmed further optimisation of terminal locations is warranted.

Development and validation of statistical shape models of the primary functional bone segments of the foot.

INTRODUCTION: Musculoskeletal models are important tools for studying movement patterns, tissue loading, and neuromechanics. Personalising bone anatomy within models improves analysis accuracy. Few studies have focused on personalising foot bone anatomy, potentially incorrectly estimating the foot's contribution to locomotion. Statistical shape models have been created for a subset of foot-ankle bones, but have not been validated. This study aimed to develop and validate statistical shape models of the functional segments in the foot: first metatarsal, midfoot (second-to-fifth metatarsals, cuneiforms, cuboid, and navicular), calcaneus, and talus; then, to assess reconstruction accuracy of these shape models using sparse anatomical data. METHODS: Magnetic resonance images of 24 individuals feet (age = 28 ± 6 years, 52% female, height = 1.73 ± 0.8 m, mass = 66.6 ± 13.8 kg) were manually segmented to generate three-dimensional point clouds. Point clouds were registered and analysed using principal component analysis. For each bone segment, a statistical shape model and principal components were created, describing population shape variation. Statistical shape models were validated by assessing reconstruction accuracy in a leave-one-out cross validation. Statistical shape models were created by excluding a participant's bone segment and used to reconstruct that same excluded bone using full segmentations and sparse anatomical data (i.e. three discrete points on each segment), for all combinations in the dataset. Tali were not reconstructed using sparse anatomical data due to a lack of externally accessible landmarks. Reconstruction accuracy was assessed using Jaccard index, root mean square error (mm), and Hausdorff distance (mm). RESULTS: Reconstructions generated using full segmentations had mean Jaccard indices between 0.77 ± 0.04 and 0.89 ± 0.02, mean root mean square errors between 0.88 ± 0.19 and 1.17 ± 0.18 mm, and mean Hausdorff distances between 2.99 ± 0.98 mm and 6.63 ± 3.68 mm. Reconstructions generated using sparse anatomical data had mean Jaccard indices between 0.67 ± 0.06 and 0.83 ± 0.05, mean root mean square error between 1.21 ± 0.54 mm and 1.66 ± 0.41 mm, and mean Hausdorff distances between 3.21 ± 0.94 mm and 7.19 ± 3.54 mm. Jaccard index was higher (P < 0.01) and root mean square error was lower (P < 0.01) in reconstructions from full segmentations compared to sparse anatomical data. Hausdorff distance was lower (P < 0.01) for midfoot and calcaneus reconstructions using full segmentations compared to sparse anatomical data. CONCLUSION: For the first time, statistical shape models of the primary functional segments of the foot were developed and validated. Foot segments can be reconstructed with minimal error using full segmentations and sparse anatomical landmarks. In future, larger training datasets could increase statistical shape model robustness, extending use to paediatric or pathological populations.

The Reliability of Foot and Ankle Bone and Joint Kinematics Measured With Biplanar Videoradiography and Manual Scientific Rotoscoping.

The intricate motion of the small bones of the feet are critical for its diverse function. Accurately measuring the 3-dimensional (3D) motion of these bones has attracted much attention over the years and until recently, was limited to invasive techniques or quantification of functional segments using multi-segment foot models. Biplanar videoradiography and model-based scientific rotoscoping offers an exciting alternative that allows us to focus on the intricate motion of individual bones in the foot. However, scientific rotoscoping, the process of rotating and translating a 3D bone model so that it aligns with the captured x-ray images, is either semi- or completely manual and it is unknown how much human error affects tracking results. Thus, the aim of this study was to quantify the inter- and intra-operator reliability of manually rotoscoping in vivo bone motion of the tibia, talus, and calcaneus during running. Three-dimensional CT bone volumes and high-speed biplanar videoradiography images of the foot were acquired on six participants. The six-degree-of-freedom motions of the tibia, talus, and calcaneus were determined using a manual markerless registration algorithm. Two operators performed the tracking, and additionally, the first operator re-tracked all bones, to test for intra-operator effects. Mean RMS errors were 1.86 mm and 1.90° for intra-operator comparisons and 2.30 mm and 2.60° for inter-operator comparisons across all bones and planes. The moderate to strong similarity values indicate that tracking bones and joint kinematics between sessions and operators is reliable for running. These errors are likely acceptable for defining gross joint angles. However, this magnitude of error may limit the capacity to perform advanced analyses of joint interactions, particularly those that require precise (sub-millimeter) estimates of bone position and orientation. Optimizing the view and image quality of the biplanar videoradiography system as well as the automated tracking algorithms for rotoscoping bones in the foot are required to reduce these errors and the time burden associated with the manual processing.

Flip-flops do not alter the neuromuscular function of the gastrocnemius muscle and tendon during walking in children.

INTRODUCTION/AIM: Flip-flops are a popular choice of footwear for children. However, their inherent design provides minimal support to the foot and ankle and has been suggested to increase the work performed by muscle and tendon structures, potentially predisposing them to injury. Therefore, the aim of this study was to compare the length change behaviour of the medial gastrocnemius (MG) muscle fascicles and muscle tendon unit (MTU) and their mechanical function at the ankle and subtalar joints in children during walking with and without flip-flop. METHODS: Eight healthy children walked barefoot and with flip-flops whilst 3D gait analysis and simultaneous B-mode ultrasound images of the MG fascicles during level walking were collected. Joint kinematics, kinetics and MTU lengths were analysed using musculoskeletal modelling and fascicle lengths using a semi-automated tracking algorithm. RESULTS: The muscles and tendons across the ankle absorbed greater amounts of power during barefoot walking compared to flip-flop walking. The muscle activations of the lateral gastrocnemius, soleus and tibialis anterior remained invariant across the conditions as did the activation, and fascicle length change behaviour of the medial gastrocnemius. In the barefoot condition, there was a trend of greater MTU lengthening, to potentially absorb greater amounts of power, although no differences in shortening was observed during late stance. CONCLUSION: Walking with flip-flops does not increase the mechanical work performed by the MG muscle at the ankle and subtalar joints, suggesting that flip-flops do not increase the stresses and strains of the Achilles tendon and hence its predisposition to strain induced injury. Instead, our results suggest that flip-flops, act as a compliant surface and absorb energy during contact and hence the strain experienced by the Achilles tendon.

Textured shoe insoles to improve balance performance in adults with diabetic peripheral neuropathy: study protocol for a randomised controlled trial.

INTRODUCTION: Peripheral neuropathy is a major risk factor for falls in adults with diabetes. Innovative footwear devices which artificially manipulate the sensory environment at the feet, such as textured shoe insoles, are emerging as an attractive option to mitigate balance and walking problems in neuropathic populations. This study aims to explore whether wearing textured insoles for 4 weeks alters balance performance in adults with diabetic peripheral neuropathy. METHODS AND ANALYSIS: A prospective, single-blinded randomised controlled trial with parallel groups will be conducted on 70 adults with diabetic peripheral neuropathy. Adults with a diagnosis of peripheral neuropathy (secondary to type 2 diabetes), aged ≥18 years, ambulant over 20 m (with/without an assistive device), will be recruited. Participants will be randomised to receive a textured insole (n=35) or smooth insole (n=35), to be worn for 4 weeks. During baseline and post intervention assessments, standing balance (foam/firm surface; eyes open/closed) and walking tasks will be completed barefoot, wearing standard shoes only, and two different insoles (smooth, textured). The primary outcome measure will be centre of pressure (CoP) velocity, with higher values indicating poorer balance. Secondary outcome measures include walking quality (gait velocity, base of support, stride length and double-limb support time), physical activity levels, foot sensation (light-touch pressure, vibration) and proprioception (ankle joint position sense), and other balance parameters (CoP path length, anteroposterior and mediolateral excursion). Patient-reported outcomes will be completed evaluating foot health, frequency of falls and fear of falling. Data will be analysed using a repeated measures mixed models approach (including covariates) to establish any differences between-groups, for all outcome measures, over the intervention period. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the institutional Human Research Ethics Committee (#2017000098). Findings will be disseminated at national and international conferences, through peer-reviewed journals, workshops and social media. TRIAL REGISTRATION NUMBER: ACTRN12617000543381; Pre-results.

Increasing step width reduces the requirements for subtalar joint moments and powers.

The subtalar joint (STJ) contributes to the absorption and generation of mechanical energy (and power) during walking to maintain frontal plane stability. Previous observational studies have suggested that there may be a relationship between step width and STJ supination moment. This study directly tests the hypothesis that walking with a step width greater than preferred would reduce STJ moments, energy absorption, and power generation requirements, while increasing energy absorption at the hip during initial contact. Participants (n = 12, 7 females) were asked to walk on an instrumented treadmill at a constant velocity and cadence at a range of fixed step widths ranging from 0.1 to 0.4 times leg length (L). Walking at step widths greater than preferred (0.149 ±â€¯0.04 L) reduced peak STJ moments at initial contact and propulsion which subsequently reduced the negative and positive work performed at the STJ. There was a 43% reduction in energy absorption (negative work) and approximately 30% decrease in positive work at the STJ as step width increased from 0.1 L to 0.4 L. An increase in energy absorption at the knee and hip was evident with an increase in step width during initial contact, although minimal mechanical changes were observed at the proximal joints during propulsion. These results suggest an increase in step width reduces the forces generated by muscles at the STJ across stance and is therefore likely to be beneficial in the prevention and treatment of their injuries. In terms of rehabilitation, the increase in mechanical costs occurring due to an increase in energy absorption by the hip and knee is of minimal concern.

Tibialis anterior tendinous tissue plays a key role in energy absorption during human walking.

The elastic tendinous tissues of distal lower limb muscles can improve the economy of walking and running, amplify the power generated by a muscle and absorb energy. This paper explores the behaviour of the tibialis anterior (TA) muscle and its tendinous tissue during gait, as it absorbs energy during contact and controls foot position during swing. Simultaneous measurements of ultrasound, surface electromyography and 3D motion capture with musculoskeletal modelling from 12 healthy participants were recorded as they walked at preferred and fast walking speeds. We quantified the length changes and velocities of the TA muscle-tendon unit (MTU) and its fascicles across the stride at each speed. Fascicle length changes and velocities were relatively consistent across speeds, although the magnitude of fascicle length change differed between the deep and superficial regions. At contact, when the TA is actively generating force, the fascicles remained relatively isometric as the MTU actively lengthened, presumably stretching the TA tendinous tissue and absorbing energy. This potentially protects the muscle fibres from damage during weight acceptance and allows energy to be returned to the system later in the stride. During early swing, the fascicles and MTU both actively shortened to dorsiflex the foot, clearing the toes from the ground; however, at the fast walking velocity, the majority of shortening occurred through tendinous tissue recoil, highlighting its role in accelerating ankle dorsiflexion to power rapid foot clearance in swing.

The Immediate Effect of Foot Orthoses on Subtalar Joint Mechanics and Energetics.

PURPOSE: Foot orthoses maybe used in the management of musculoskeletal disorders related to abnormal subtalar joint (STJ) pronation. However, the precise mechanical benefits of foot orthoses for preventing injuries associated with the STJ are not well understood. The aim of this study was to investigate the immediate effect of foot orthoses on the energy absorption requirements of the STJ and subsequently tibialis posterior (TP) muscle function. METHODS: Eighteen asymptomatic subjects with a pes planus foot posture were prescribed custom-made foot orthoses made from a plaster cast impression. Participants walked at preferred and fast velocities barefoot, with athletic footwear and with athletic footwear plus orthoses, as three-dimensional motion capture, force data, and intramuscular electromyography of the TP muscle were simultaneously collected. Statistical parametric mapping was used to identify time periods across the stride cycle during which footwear with foot orthoses significantly differed to barefoot and footwear only. RESULTS: During early stance, footwear alone and footwear with orthoses significantly reduced TP muscle activation (1%-12%), supination moments (3%-21%), and energy absorption (5%-12%) at the STJ, but had no effect on STJ pronation displacement. CONCLUSIONS: The changes in TP muscle activation and STJ energy absorption were primarily attributed to footwear because the addition of foot orthoses provided little additional effect. We speculate that these results are most likely a result of the compliant material properties of footwear. These results suggest that athletic footwear may be sufficient to absorb energy in the frontal plane and potentially reducing any benefit associated with the addition of foot orthoses.

Subtalar Joint Pronation and Energy Absorption Requirements During Walking are Related to Tibialis Posterior Tendinous Tissue Strain.

During human walking, the tibialis posterior (TP) tendon absorbs energy in early stance as the subtalar joint (STJ) pronates. However, it remains unclear whether an increase in energy absorption between individuals, possibly a result of larger STJ pronation displacement, is fulfilled by greater magnitudes of TP tendon or muscle fascicle strain. By collecting direct measurements of muscle fascicle length (ultrasound), MTU length (3D motion capture and musculoskeletal modelling), and TP muscle activation (intramuscular electromyography) we endeavoured to illustrate that the TP tendinous tissue fulfils the requirements for energy absorption at the STJ as a result of an increase in muscle force production. While a significant relationship between TP tendon strain, energy absorption at the STJ (R2 = 0.53, P = < 0.01) and STJ pronation (R2 = 0.53, P = < 0.01) was evident, we failed to find any significant associations between tendon strain and surrogate measure of TP muscle force (TP muscle activation together with ankle and subtalar joint moments). These results suggest that TP tendon compliance may explain the variance in pronation and energy absorption at the STJ. Therefore, as the tendinous tissue of the TP is accountable for the absorption of energy at the STJ it may be predisposed to strain-induced injury.

Foot structure is significantly associated to subtalar joint kinetics and mechanical energetics.

INTRODUCTION/AIM: Foot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking. METHODS: A total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures. RESULTS: Although no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility. CONCLUSION: The models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence.