Influence of reduced passive ankle dorsiflexion range of motion on lower limb kinetics and stiffness during gait.

BACKGROUND: The ankle dorsiflexion range of motion (ADF-ROM) during single support phase allows elastic energy storage in the calcaneal tendon, contributing to advance the body forward. Reduced ADF-ROM may influence lower limb kinetics and stiffness. RESEARCH QUESTION: What is the influence of reduced passive ADF-ROM on lower limb internal moments and stiffness during gait? METHODS: Thirty-two participants, classified into two groups according to passive ADF-ROM (smaller than 10° and greater than 15°), were submitted to gait assessment at self-selected speed with a force platform and a three-dimensional motion analysis system. Statistical parametrical mapping (SPM) analyses were used to compare the lower limbs' internal moments between groups. Independent t-tests analyzed the differences between groups on lower limb stiffness during gait. RESULTS: The lower ADF-ROM group had greater knee flexor moment (terminal stance and push-off), greater ankle abductor (i.e., shank internal rotator) moment in terminal stance and greater knee internal rotator moment in mid to terminal stance. The lower ADF-ROM group also had higher lower limb stiffness during gait. SIGNIFICANCE: Individuals with reduced passive ADF-ROM had greater lower limb stiffness and adopted a gait pattern with increased knee and ankle moments, suggesting increased loading at these joints.

Clinimetric Properties of the Applied Kinesiology Manual Muscle Test in Adults With and Without Pain: A Methodological Study.

Objective: The purpose of this study was to determine the intra- and interexaminer reliability, concurrent validity, and responsiveness of the applied kinesiology manual muscle test (AK-MMT) to discriminate gluteus medius muscle strength and latency. Methods: A cross-sectional and methodological study was conducted in 38 participants using electromyography, electrogoniometry, and hand-held dynamometry to measure latency, angular displacement, and muscle force during the assessment of the gluteus medius by AK-MMT. Inter- and intrarater reliability of 2 examiners with different levels of experience were obtained using the intraclass correlation coefficient. Muscle force, latency, and joint angular displacement were compared between groups (facilitated vs inhibited). Latency and angular displacement also were compared within groups by using the Wilcoxon paired test. For the concurrent validity of the AK-MMT in classifying an inhibited muscle as weak, the receiver operating characteristic curve was conducted. Results: Intra- and interexaminer reliability for the facilitated vs inhibited classifications based on AK-MMT presented good results, with intraclass correlation coefficient > 0.86. For the inhibited group, force and peak force were significantly lower and joint displacement significantly greater. The receiver operating characteristic curve showed an area under the curve of 0.743, demonstrating that the test has concurrent validity (P = .001) to discriminate muscle force. The Wilcoxon paired test showed a significant delay in latency of the inhibited gluteus medius group (0.10 s vs 0.18 s, P = .007) when compared with the facilitated one. Conclusion: In this study, we found good intra- and interexaminer reliability and concurrent validity for the AK-MMT to determine differences in gluteus medius muscle force. Although the paired data showed a different latency time between groups, the hypothesis of prolonged latency in muscles classified as inhibited by AK-MMT still needs further investigation.

Spatial-temporal parameters, pelvic and lower limb movements during gait in individuals with reduced passive ankle dorsiflexion.

BACKGROUND: Proper ankle dorsiflexion range of motion (ADF-ROM) allows the anterior roll of the tibia relative to the foot during the midstance phase of gait, which contributes to forward movement of the body. Individuals with reduced passive ADF-ROM may present altered movement patterns during gait due to an inefficient anterior tibial roll over the support foot during the stance phase. RESEARCH QUESTION: What is the influence of reduced passive ADF-ROM on the pelvic and lower limb movements and spatiotemporal parameters during gait? METHOD: Thirty-two participants divided into two groups according to the degree of passive ADF-ROM-less than 10° (lower ADF-ROM group) or greater than 15° (higher ADF-ROM group) -were subjected to gait assessment using a three-dimensional motion analysis system. Independent t-tests were used to compare the pelvic and lower limb movements and spatiotemporal gait parameters between the groups on this cross-sectional study. RESULTS: The lower ADF-ROM group had shorter step length, lower peak of pelvic ipsilateral rotation angle, and lower hip and knee maximum flexion angles in the stance phase (p < 0.05). In addition, the peaks of the ankle and forefoot-rearfoot dorsiflexion angles were smaller in the reduced ADF-ROM group (p < 0.05). The between-group differences presented effect sizes varying from moderate to large. SIGNIFICANCE: Individuals with reduced passive ADF-ROM presented reduced foot and ankle dorsiflexion, knee and hip flexion, and pelvis rotation movements and shorter step length during gait. However, no differences in foot pronation were noted between groups. Therefore, individuals with reduced passive ADF-ROM present alterations in the lower limb and pelvic movements during gait.

The influence of hip mobility and quadriceps fatigue on sagittal spinal posture and muscle activation in rugby scrum performance.

Rugby Union scrumming puts the spine under a high degree of loading. The aim of the current study was to determine how sagittal hip range of motion and quadriceps fatigue influence force output, spinal posture, and activation of the trunk and quadriceps muscles in rugby scrumming. Measures of sagittal hip flexion/extension range of motion were collected from 16 male varsity and club first XV level participants. Sagittal spine motion (electromagnetic motion capture), trunk and quadriceps activation (electromyography), and applied horizontal compressive force (force plate) were measured during individual machine scrumming. Participants performed a 5-trial scrum block involving 5 s of contact with 1-2 min recovery between each trial. They then performed a fatiguing protocol (wall sit to failure) and immediately returned to the scrum machine to perform another five trials. Though there was no significant influence of fatigue on the horizontal compressive force applied during contact (P = .83), there was a 52% increase in cervical flexion (P < .001), as well as decreased (18-23% lower) abdominal and erector spinae muscle activation (P < .05). Furthermore, quadriceps activation decreased (12-25% lower) over the course of the initial scrum block but increased (13-15% higher) in the post fatigue block (P < .05). Although athletes were able to maintain force output following the fatiguing wall sit task, there is the potential that they may be at an increased risk of spinal injury due to the combination of increased flexion and high-applied compressive force; a combination which has been shown to increase the likelihood of intervertebral disc herniation.

How symmetric are metal-on-metal hip resurfacing patients during gait? Insights for the rehabilitation.

Metal-on-metal hip resurfacing patients demonstrate hip biomechanics closer to normal in comparison to total hip arthroplasty during gait. However, it is not clear how symmetric is the gait of hip resurfacing patients. Biomechanical data of 12 unilateral metal-on-metal hip resurfacing participants were collected during gait at a mean time of 45months (SD 24) after surgery. Ankle, knee, hip, pelvis and trunk kinematics and kinetics of both sides were measured with a motion and force-capture system. Principal component analysis and mean hypothesis' tests were used to compare the operated and healthy sides. The operated side had prolonged ankle eversion angle during late stance and delayed increased ankle inversion angle during early swing (p=0.008; effect size=0.70), increased ankle inversion moment during late stance (p=0.001; effect size=0.78), increased knee adduction angle during swing (p=0.044; effect size=0.57), decreased knee abduction moment during stance (p=0.05; effect size=0.40), decreased hip range of motion in the sagittal plane (p=0.046; effect size=0.56), decreased range of hip abduction moment during stance (p=0.02; effect size=0.63), increased hip range of motion in the transverse plane (p=0.02; effect size=0.62), decreased hip internal rotation moment during the transition from loading response to midstance (p=0.001; effect size=0.81) and increased trunk ipsilateral lean (p=0.03; effect size=0.60). Therefore, hip resurfacing patients have some degree of asymmetry in long term, which may be related to hip weakness and decreased range of motion, to foot misalignments and to strategies implemented to reduce loading on the operated hip. Interventions such as muscle strengthening and stretching, insoles and gait feedback training may help improving symmetry following hip resurfacing.

Empirical analysis of the International Classification of Functioning, Disability and Health (ICF) using structural equation modeling

ABSTRACT Objective: To empirically test the relationships proposed by the International Classification of Functioning, Disability and Health (ICF) among its domains. Method: The cross-sectional study was completed with 226 adult patients with different health conditions who attended a Brazilian rehabilitation unit. The ICF components were measured with the following instruments: World Health Organization Disability Assessment Instrument II, Functional Independence Measure, Participation Scale, Craig Hospital Inventory of Environmental Factors, and a protocol designed to gather information on body structure and function and personal factors. Results: Structural equation modeling showed good model adjustment, GFI=0.863; AGFI=0.795; RMSEA=0.028 (90% CI=0.014-0.043). Significant relationships were found between activity and both body structure and function (standard coefficient=0.32; p<0.0001) and participation components (standard coefficient=–0.70; p<0.0001). Environmental and personal factors had a significant effect on the three functioning components (standard coefficient =0.39; p<0.0001; standard coefficient =-0.35; p<0.001, respectively). In contrast, body structure and function had no significant effect on participation (standard coefficient=–0.10; p=0.111) and health conditions had no significant effect on any of the functioning components, i.e., body structure and function, activity, and participation (standard coefficient=–0.12; p=0.128). Conclusion: Some of the ICF’s proposed relationships across domains were confirmed, while others were not found to be significant. Our results reinforce the contextual dependency of the functioning and disability processes, in addition to putting into perspective the impact of health conditions.

Mild leg length discrepancy affects lower limbs, pelvis and trunk biomechanics of individuals with knee osteoarthritis during gait.

BACKGROUND: Leg length discrepancy greater than 1cm increases odds of progressive knee osteoarthritis in the shorter limb. METHODS: Biomechanical data of 15 knee osteoarthritis participants were collected while they walked under two conditions: (1) control - wearing thick sandals; (2) short limb - wearing a thin sandal on the osteoarthritic limb and a thick sandal on the contralateral limb. The thick and thin sandals had 1.45cm of thickness difference. The knee osteoarthritis limb was analyzed for both conditions. Ankle, knee, hip, pelvis and trunk kinematics and moments were measured with a motion and force capture system. Principal component analysis and mean hypothesis' tests were used to compare the conditions. FINDINGS: The short limb condition reduced rearfoot plantarflexion in loading response and increased plantarflexion in late stance (p<0.001), increased ankle dorsiflexion moment (p=0.003), increased knee flexion angle in loading response and delayed knee flexion in late stance (p=0.001), increased knee extension moment in loading response and increased knee flexion moment in terminal stance (p=0.023), reduced hip extension moment in early stance and reduced hip flexion moment in late stance (p<0.001), reduced knee adduction moment (p=0.015), reduced hip adduction angle (p=0.001) and moment (p=0.012) and increased pelvic (p=0.023) and trunk (p=0.001) external rotation. INTERPRETATION: Mild leg length discrepancy affects the entire kinetic chain of individuals with knee osteoarthritis during gait, increasing knee sagittal plane loading, which helps to explain why mild leg length discrepancy accelerates knee osteoarthritis progression. Mild leg length discrepancy should not be overlooked in knee osteoarthritis individuals.

Spatiotemporal and variability gait data in community-dwelling elderly women from Brazil.

BACKGROUND: Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. OBJECTIVE: To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. METHOD: 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. RESULTS: 95% CI showed that only three components - rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. CONCLUSION: Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

Spatiotemporal and variability gait data in community-dwelling elderly women from Brazil

ABSTRACT Background Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. Objective To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. Method 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. Results 95% CI showed that only three components – rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. Conclusion Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

Biomechanical strategies implemented to compensate for mild leg length discrepancy during gait.

Although mild leg length discrepancy is related to lower limb injuries, there is no consensus regarding its effects on the biomechanics of the lower limbs during gait. Biomechanical data of 19 healthy participants were collected while they walked under different conditions as described: (1) control condition-wearing flat thick sandals; (2) short limb condition-wearing a flat thick sandal on the left and a flat thin sandal on the right foot; (3) long limb condition: wearing flat thin sandal on the left and flat thick sandal on the right foot. The thick and thin sandals had 1.45cm of mean thickness difference. The right lower limb data were analyzed for all conditions. Ankle, knee, hip and pelvis kinematics and internal moments were measured with a motion capture system and six force platforms. Principal component analysis was used to compare differences between conditions. The scores of the principal components were compared between conditions using one-way repeated measures ANOVA. Twelve gait variables were different between conditions: rearfoot dorsiflexion and inversion (p<0.001); ankle dorsiflexion and inversion moments (p<0.001); knee flexion angle and moment (p<0.001); knee adduction moment (p<0.001); hip flexion angle and moment (p<0.001); hip adduction angle (p=0.001) and moment (p=0.022); and pelvic ipsilateral drop (p<0.001). Mild leg length discrepancy caused compensatory changes during gait, apparently to equalize the functional length of the lower limbs. However, these strategies did not fully succeed, since both short and long limb conditions affected pelvic motion in the frontal plane. These results suggest that mild leg length discrepancy should not be overlooked in clinical settings.

Ipsilateral and contralateral foot pronation affect lower limb and trunk biomechanics of individuals with knee osteoarthritis during gait.

BACKGROUND: Lateral wedges have been suggested for the treatment of individuals with knee osteoarthritis, but it may have undesirable effects on the biomechanics of gait through increased foot pronation. This study investigated the effects of increased unilateral foot pronation on the biomechanics of individuals with knee osteoarthritis during gait. METHODS: Biomechanical data of twenty individuals with knee osteoarthritis were collected while they walked in three conditions: i) flat sandals; ii) wedged sandal on the knee osteoarthritis limb and flat sandal on the healthy limb; and iii) flat sandal on the osteoarthritis and wedged sandal on the healthy limb. Knee pain and comfort were evaluated. Principal Component Analysis followed by ANOVA was implemented to identify differences between conditions. FINDINGS: The wedged sandal on the osteoarthritis limb increased rearfoot eversion (P<0.001; ES=0.79); increased shank rotation range of motion (P<0.001; ES=0.70); reduced knee internal rotation moment (P<0.001; ES=0.83); reduced hip internal rotation moment (P=0.001; ES=0.66); increased ipsilateral trunk lean (P=0.031; ES=0.47); and increased trunk rotation range of motion (P=0.001; ES=0.69). Walking with the wedged sandal on the healthy limb increased hip (P=0.003; ES=0.61) and knee (P=0.002; ES=0.63) adduction moments. Individuals reported greater comfort walking with the flat sandals (P=0.004; ES=0.55). INTERPRETATION: Increased unilateral foot pronation of the knee osteoarthritis and healthy limbs causes lower limb and trunk mechanical changes that may overload the knee and the lower back, such as increased knee adduction moment, shank rotation and trunk lateral lean. Foot motion of both lower limbs should be evaluated and care must be taken when suggesting lateral wedges for individuals with knee osteoarthritis.

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy.

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis. OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP). METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact. CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis.OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP).METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively.RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact.CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Spatiotemporal gait parameters and recurrent falls in community-dwelling elderly women: a prospective study.

BACKGROUND: Falling is a common but devastating and costly problem of aging. There is no consensus in the literature on whether the spatial and temporal gait parameters could identify elderly people at risk of recurrent falls. OBJECTIVE: To determine whether spatiotemporal gait parameters could predict recurrent falls in elderly women. METHOD: One hundred and forty-eight elderly women (65-85 years) participated in this study. Seven spatiotemporal gait parameters were collected with the GAITRite(r) system. Falls were recorded prospectively during 12 months through biweekly phone contacts. Elderly women who reported two or more falls throughout the follow-up period were considered as recurrent fallers. Principal component analysis (PCA) and discriminant analysis followed by biplot graph interpretation were applied to the gait parameters. RESULTS: After 12 months, 23 elderly women fell twice or more and comprised the recurrent fallers group and 110 with one or no falls comprised the non-recurrent fallers group. PCA resulted in three components that explained 88.3% of data variance. Discriminant analysis showed that none of the components could significantly discriminate the groups. However, visual inspection of the biplot showed a trend towards group separation in relation to gait velocity and stance time. PC1 represented gait rhythm and showed that recurrent fallers tend to walk with lower velocity and cadence and increased stance time in relation to non-recurrent fallers. CONCLUSIONS: The analyzed spatiotemporal gait parameters failed to predict recurrent falls in this sample. The PCA-biplot technique highlighted important trends or red flags that should be considered when evaluating recurrent falls in elderly females.

Spatiotemporal gait parameters and recurrent falls in community-dwelling elderly women: a prospective study

BACKGROUND: Falling is a common but devastating and costly problem of aging. There is no consensus in the literature on whether the spatial and temporal gait parameters could identify elderly people at risk of recurrent falls. OBJECTIVE: To determine whether spatiotemporal gait parameters could predict recurrent falls in elderly women. METHOD: One hundred and forty-eight elderly women (65-85 years) participated in this study. Seven spatiotemporal gait parameters were collected with the GAITRite(r) system. Falls were recorded prospectively during 12 months through biweekly phone contacts. Elderly women who reported two or more falls throughout the follow-up period were considered as recurrent fallers. Principal component analysis (PCA) and discriminant analysis followed by biplot graph interpretation were applied to the gait parameters. RESULTS: After 12 months, 23 elderly women fell twice or more and comprised the recurrent fallers group and 110 with one or no falls comprised the non-recurrent fallers group. PCA resulted in three components that explained 88.3% of data variance. Discriminant analysis showed that none of the components could significantly discriminate the groups. However, visual inspection of the biplot showed a trend towards group separation in relation to gait velocity and stance time. PC1 represented gait rhythm and showed that recurrent fallers tend to walk with lower velocity and cadence and increased stance time in relation to non-recurrent fallers. CONCLUSIONS: The analyzed spatiotemporal gait parameters failed to predict recurrent falls in this sample. The PCA-biplot technique highlighted important trends or red flags that should be considered when evaluating recurrent falls in elderly females. .

Is there an association between symptoms of anxiety and depression and quality of life in patients with chronic obstructive pulmonary disease?

BACKGROUND: In addition to symptoms, such as dyspnea and fatigue, patients with chronic obstructive pulmonary disease (COPD) also experience mood disturbances. OBJECTIVE: To explore the relationships between health-related quality of life measures collected from patients with stable COPD and a commonly used measure of depression and anxiety. METHODS: The present analysis was a retrospective study of patients with COPD enrolled in a pulmonary rehabilitation program. Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Disease Questionnaire (CRQ), Medical Research Council dyspnea scale and 6 min walk test data were collected. Statistical analyses were performed using Spearman's correlations, and categorical regression and categorical principal component analysis were interpreted using the biplot methodology. RESULTS: HADS anxiety scores retrieved from 80 patients were grouped as 'no anxiety' (n=43 [54%]), 'probable anxiety' (n=21 [26%]) and 'presence of anxiety' (n=16 [20%]). HADS depression scores were similarly grouped. There was a moderate relationship between the anxiety subscale of the HADS and both the emotional function (r=-0.519; P<0.01) and mastery (r=-0.553; P<0.01) domains of the CRQ. Categorical regression showed that the CRQ-mastery domain explained 40% of the total variation in anxiety. A principal component analysis biplot showed that the highest distance between the groups was along the mastery domain, which separated patients without feelings of anxiety from those with anxiety. However, none of the CRQ domains were able to discriminate the three depression groups. CONCLUSIONS: The CRQ-mastery domain may identify symptoms of anxiety in patients with COPD; however, the relationship is not strong enough to use the CRQ-mastery domain as a surrogate measure. None of the CRQ domains were able to discriminate the three depression groups (no depression, probable and presence); therefore, specific, validated tools to identify symptoms of depression should be used.

Increased unilateral foot pronation affects lower limbs and pelvic biomechanics during walking.

BACKGROUND: Increased unilateral foot pronation may cause biomechanical changes on the lower limbs during gait. We investigated the effects of increased unilateral foot pronation on the biomechanics of lower limbs and pelvis during gait. METHODS: Kinematic and kinetic data of 22 participants were collected while they walked wearing flat and laterally wedged sandals. Principal omponent analysis was used to compare differences between conditions. FINDINGS: Wearing the wedged sandal on the ipsilateral side increased ankle eversion moment (p<0.001; effect size=0.97); rearfoot eversion angle (p<0.001; effect size=0.76); shank internal rotation (p=0.009; effect size=0.53); increased and reduced knee internal rotation angle during early and late stance, respectively (p<0.001; effect size=0.89); increased femur internal rotation (p=0.005; effect size=0.90); reduced hip internal rotation moment during late stance (p=0.001; effect size=0.68); and increased pelvic ipsilateral drop (p=0.02; effect size=0.48) of the ipsilateral side. Wearing the wedged sandal on the contralateral side increased pelvic contralateral drop (p=0.001; effect size=0.63); hip adduction moment throughout stance (p=0.027; effect size=0.46); and increased and reduced the knee adduction moment in early and late stance, respectively (p<0.001; effect size=0.79). INTERPRETATION: The increased lower limb internal rotation caused by the wedged sandal reinforces the assumption that rearfoot eversion is coupled with shank internal rotation. The increased pelvic contralateral drop caused by the wedged sandal on the contralateral side may explain the increased hip and knee adduction moments on the ipsilateral side. Increased unilateral foot pronation causes biomechanical changes on both lower limbs that are associated with the occurrence of injuries.