How boots affect the kinematics and kinetics of lower limb joints during walking compared to casual footwear.

Boots are widely used by many people for various purposes, but their impact on gait biomechanics and injury risk is not well understood. This study investigated the effects of boots on walking biomechanics, compared to casual footwear. The lower limb joint kinematics and kinetics of 20 healthy male participants aged 20 to 30 years old were compared during self-paced walking with boots and shoes. The results showed that walking with boots is associated with greater hip extensor (P = 0.009) and ankle dorsiflexor (P < 0.001) moments in early stance, hip power generation (P < 0.001) and knee power absorption (P < 0.001) in early swing phase, hip abductor (P < 0.001) and knee adduction (P < 0.001) moments in the entire stance, net concentric work for the hip joint in sagittal (13.9%, P = 0.001) and frontal (21.7%, P = 0.002) planes. In contrast, the subtalar supinator moment in the entire stance (P < 0.001), ankle angular velocity in late stance (P < 0.001), and net concentric (- 42.7%, P < 0.001) and eccentric (- 44.6%, P = 0.004) works of subtalar joint were significantly lower in the boot condition. The compensatory adjustments in the hip and knee joints may result from ankle restrictions. While boots may aid those with ankle disorders, lower limb loading and the risk of musculoskeletal injuries and osteoarthritis could be increased. This study offers new perspectives on the biomechanical impact of boots on gait, potential prevention and treatment strategies of related injuries, and advancing footwear design.

The effects of fatigue on the relationship between ankle angle at initial contact and the knee and hip joints in landing: Assessing the risk of ACL injury.

BACKGROUND: Anterior cruciate ligament (ACL) injuries may correlate with lower limb angles and biomechanical factors in both dominant and non-dominant legs at initial contact (IC) post-landing. This study aims to investigate the correlation between ankle angles in three axes at IC and knee and hip joint angles during post-spike landings in professional volleyball players, both pre- and post-fatigue induction. RESEARCH QUESTION: To what extent does fatigue influence lower limb joint angles, and what is the relationship between ankle joint angles and hip and knee angles at IC during the landing phase following a volleyball spike? METHODS: Under conditions involving the peripheral fatiguing protocol, the lower limb joint angles at IC following post-spike landings were measured in 28 professional male volleyball players aged between 19 and 28 years, who executed the Bosco fatigue protocol both before and after inducing fatigue. A paired t-test was utilized to compare the joint angles pre- and post-fatigue in both dominant and non-dominant legs. Furthermore, Pearson's correlation test was conducted to explore the relationship between ankle angles at IC and the corresponding knee and hip joint angles. RESULTS: The findings of the study revealed that fatigue significantly increased hip external rotation and decreased knee joint flexion and external rotation in both the dominant and non-dominant legs (p < 0.05). Additionally, correlation analysis demonstrated that the ankle joint's positioning in the frontal and horizontal planes was significantly associated with hip flexion and external rotation at the IC, as well as with knee flexion and rotation (0.40 < r < 0.80). CONCLUSION: Fatigue increased hip external rotation and ankle internal rotation, weakening the correlation between these joints while strengthening the ankle-knee relationship, indicating a reduced hip control in jumps. This suggests a heightened ACL injury risk in the dominant leg due to the weakened ankle-hip connection, contrasting with the non-dominant leg.

The effects of cognitive intervention on inter-joint coordination during walking in the older adults with balance impairment.

BACKGROUND: Cognitive interventions are among the effective training-on-gait parameters; however, the effects of such trainings on inter-joints coordination has not been much considered. RESEARCH QUESTION: Can dual task and executive function training affect inter-joint coordination during walking in elderly with poor balance? METHODS: Thirty elderly men were purposefully divided into three groups: 1) dual-task training group (DTG), 2) executive function training group (EFG) and 3) control group. After the pre-test, the experimental groups participated in 24 training sessions while the control group were required to do their normal daily tasks. VICON three-dimensional motion analysis system with four T20 series cameras was used to evaluate inter-joints coordination during the experiment. Participants had to walk a 12-meter path while kinematics of their joints was recorded. The inter-joint coordination at the sagittal plane and in four phases were assessed using the vector coding technique. RESULTS: The findings of this study showed that the greatest effect of the intervention on the coordination between the joints was in the loading and mid-stance phases (p < 0.05). Also, the variability in the coupling angle showed a significant decrease in most phases (p < 0.05). SIGNIFICANCE: Based on the obtained results, it can be argued that the loading and mid-stance are more involved in postural control and balance because the center of gravity is transferred between the legs and the person is normally on single-leg stance in these phases.

Measuring the Effect of Vision on the Synergy of Lower Extremity Muscles during Walking using Nonnegative Matrix Factorization (NNMF) Algorithm Method.

Introduction: Lack of visual information in blind people during walking can affect the choice of muscle synergy from among the many incoming messages that reach the central nervous system (CNS). This study aimed to determine the effect of vision on the synergy of lower limb muscles during walking using the nonnegative matrix factorization algorithm (NNMF). Methods: Ten blind people and 10 people with normal vision participated in this study. Activities of involved muscles were recorded during walking. Muscle synergy matrix and synergy activation coefficient were calculated using the NNMF algorithm, while the variance accounted for criterion was used to determine the number of synergies required during walking. In order to assess the similarity of muscle synergy pattern and the relative weight of each muscle in each synergy in each group, Pearson correlation and independent samples t-test at a significance level of α ≤ 0.05 were used. Results: Four muscle synergies were extracted from EMG data during walking. The first (r = 0.431) and the second (r = 0.457) synergy patterns showed a moderate correlation between the two groups. However, the third (r = 0.302) and the fourth (r = 0.329) synergy patterns showed a weak correlation between the two groups. In the blind group, the relative weight of the muscles in the first synergy was significant for the external extensor muscle (P = 0.023), and in the second synergy for the biceps femoris. Also, in the third synergy, the relative weight was found to be significant in none of the muscles. In the fourth synergy, however, the relative weight of external extensor muscle in the blind group showed a significant decrease, as compared to the group with normal vision. Conclusions: These changes can be the strategy of the CNS to preserve the optimal functioning in the motor system of blind people.

Ground reaction forces during stair ascending and descending in congenitally blind and sighted individuals.

BACKGROUND: Stair ascending and descending are common in daily life activities which are challenging for blind individuals. Visual information plays an important role in controlling an individual's movements. However, the relationship between visual information and stair ascending and descending is poorly understood. OBJECTIVE: The aim of this study was to investigate how blindness alters the ground reaction force (GRF) components during ascending and descending the stairs. METHODS: Ten individuals with congenital blindness and 10 able-bodied sighted individuals were served as experimental (EG) and control groups (CG), respectively. The GRFs were recorded during stair ascending and descending tasks using a portable 40 × 40 cm Kistler force plate which was placed on a firm stair. CG repeated the ascending/descending tasks in both open and closed-eyes conditions. For within and between groups comparisons the repeated measure ANOVA and MANOVA tests were used, respectively. The significance level was set at p < 0.05 for all comparisons. RESULTS: In ascending task, there was not any significant between group differences on GRF components. However, closing the eyes in CG resulted in a significant decrease in some GRF components in the stair descending (p < 0.05). The GRF components of the stair descending in CG with open and closed-eyes were significantly different from those in the blind group; however, the differences were less in closed-eyes. SIGNIFICANCE: The GRF in the stair descent was similar in both blind and sighted individuals with closed-eyes condition, that it can increase the risk of falling in blind people. As a result, the provision of tools and equipment for the blind in descent conditions is essential.

The impact of hearing loss on three-dimensional lower limb joint torques during walking in prepubertal boys.

INTRODUCTION: In children, the impact of hearing loss on biomechanical gait parameters is not well understood. Thus, the objectives of this study were to examine three-dimensional lower limb joint torques in deaf compared to age-matched healthy (hearing) children while walking at preferred gait speed. METHODS: Thirty prepubertal boys aged 8-14 were enrolled in this study and divided into a group with hearing loss (deaf group) and an age-matched healthy control. Three-dimensional joint torques were analyzed during barefoot walking at preferred speed using Kistler force plates and a Vicon motion capture system. RESULTS: Findings revealed that boys with hearing loss showed lower joint torques in ankle evertors, knee flexors, abductors and internal rotators as well as in hip internal rotators in both, the dominant and non-dominant lower limbs (all p < 0.05; d = 1.23-7.00; 14-79%). Further, in the dominant limb, larger peak ankle dorsiflexor (p < 0.001; d = 1.83; 129%), knee adductor (p < 0.001; d = 3.20; 800%), and hip adductor torques (p < 0.001; d = 2.62; 350%) were found in deaf participants compared with controls. CONCLUSION: The observed altered lower limb torques during walking are indicative of unstable gait in children with hearing loss. More research is needed to elucidate whether physical training (e.g., balance and/or gait training) has the potential to improve walking performance in this patient group.

The effect of working memory intervention on the gait patterns of the elderly.

INTRODUCTION: The purpose of this study was to evaluate the role of working memory (WM) training on walking patterns in elderly people. METHODS: 20 elderly adults were selected and assigned randomly to two groups: WM training group and control group. WM training group received 6 weeks of computerized training on various spatial and verbal WM tasks. The spatial-temporal parameters, the ground reaction force and the timing activity of muscles in pre-posttest and in a follow-up were taken. RESULT: The results indicated that a significant change in gait speed, double support time and stride time (p < 0.05). Alternations in ground reaction force (GRF) components were found significant. Timing of muscle activity also showed non-significant change after WM intervention. CONCLUSION: Based on the results of this study, it can be concluded that WM intervention can be applied to improve gait parameters. The improvements in vertical ground reaction force after training may result in an increase upright stability and a decreased in rate falls.

Effect of kinesio taping on lower limb joint powers in individuals with genu varum.

OBJECTIVE: Therapeutic lateral knee joint muscle taping potentially offers a low-risk, economical and effective alternative for the clinical treatment of light to moderate knee overload, due to misalignment in patients with genu varum. In this study, we aimed at investigating the immediate effect of lateral knee joint muscular kinesio taping on lower limb joint powers, during the stance phase of walking, in individuals with genu varum. METHODS: Fifteen male subjects with genu varum misalignment (age: 24.2±3.7 years) participated in the study. Subjects performed three walking trials without, and three with, biceps femoris and vastus lateralis kinesio taping. The three-dimensional position coordinate data of reflective markers were collected at 100 Hz using a six-cameras Vicon system (Motion Analysis Corp., UK). Additionally, two Kistler force plates (Kistler AG, Winterthur, Switzerland) were used to record the Ground Reaction Forces (GRF) components at 1000 Hz during stance phase of walking. A three-way ANOVA with post-hoc testing (using paired samples Student's t-test with Bonferroni correction) was performed to compare the power values of lower limb joints before and after the use of KT. RESULTS: With kinesio taping, we observed that the average negative power increased at the ankle level in dominant limb, (P<0.05, 10-20% of gait cycle, GC), and at the knee level in both limbs (10-20% and 60-80% GC). Further, average negative power of the non-dominant knee joint (80-100% GC) and positive power of the non-dominant hip joint (60-80% GC) significantly reduced (P<0.05) in kinesio taping condition. CONCLUSION: The biomechanical analysis of joint power during walking using kinesio taping provided essential information about the possible mechanisms involved in gait analysis with this intervention in adults with genu varus.

Rehabilitation improves walking kinematics in children with a knee varus: Randomized controlled trial.

BACKGROUND: Previous studies have demonstrated increased medial stresses in knee varus alignment. Selecting a suitable treatment strategy for individuals with knee malalignment should be a priority. OBJECTIVES: We aimed to investigate the effects of a 16-week corrective exercise continuum (CEC) program on 3-D joint angles of the dominant and non-dominant lower limbs in children with genu varus during walking. METHODS: Overall, 28 male children with genu varus (age range 9-14 years) volunteered to participate in this study. They were randomly divided into 2 equal groups (experimental and control). The participants of the experimental group received CEC for 16 weeks. 3-D gait analysis involved using a Vicon Motion System. Paired and independent sample t-tests were used for within- and between-group comparisons, respectively. RESULTS: For the experimental group, comparison of pre- and post-test joint kinematics of the dominant lower limb revealed that CEC decreased the peak ankle dorsiflexion angle by 26% (P=0.020), peak foot internal rotation angle by 53% (P=0.001), peak knee internal rotation angle by 40% (P=0.011), peak hip abduction by 47% (P=0.010), and peak hip external rotation angle by 60% (P=0.001). In contrast, peak knee external rotation angle of the dominant limb was increased after the training program by 46% (P=0.044). For the non-dominant lower limb, CEC decreased the peak ankle inversion by 63% (P<0.01), peak ankle eversion by 91% (P<0.01), peak foot internal rotation by 50% (P<0.01), peak knee internal rotation by 29%; P=0.042), peak hip abduction angle by 38% (P<0.01), and peak hip external rotation angle by 60% (P<0.01). CONCLUSIONS: CEC therapy reduced excessive foot and knee internal rotations as well as excessive hip external rotation during walking in children with genu varus.

Muscle activity and kinetics of lower limbs during walking in pronated feet individuals with and without low back pain.

The objectives of this study were to investigate whether excessive feet pronation alters the joints' kinematics, kinetics and the activity of involved muscles during gait in low back pain patients. METHODS: The lower limb joints' motion, moment and power, as well as the activity of involved muscles during walking were measured in a control group, and two experimental groups including a group with excessive feet pronation only, and another group of low back pain patients with excessive feet pronation. RESULTS: In both experimental groups, ankle inversion, knee flexion and internal rotation, hip internal rotation, plantar flexors' moment, hip flexors' moment, and peak positive ankle power were lower than those in control group (p < .05). Besides, in patients, higher activity of gastrocnemius medialis, gluteus medius, erector spinae, and internal oblique muscles, and lower negative power at the ankle and peak positive power at the knee were observed (p < .05). In conclusion, pronated feet with low back pain was associated with less ankle inversion and knee flexion, higher knee and hip internal rotation, higher muscle activity, less energy absorption at the ankle, and reduced positive power at the knee. This study reveals that strengthening of the muscles especially knee extensors are of great importance in low back pain patients with feet pronation.

The effects of low arched feet on lower limb joints moment asymmetry during gait in children: A cross sectional study.

BACKGROUND: The prevalence of flexible flat feet in children was reported to be up to 20% in previous studies. However, the role of foot type in the development of musculoskeletal injuries is less clear, particularly in children. The purpose of this study was to investigate the differences in the joint moment asymmetry in children with flexible flat feet and healthy matched control subjects. METHODS: Fourteen male children with flexible flat feet and 15 healthy control subjects served as the sample of the study. Three dimensional kinematics and kinetic data were collected using a Vicon camera system and two Kistler force platforms during walking. Then between-limb asymmetry was examined for each joint moment. RESULTS: Normal individuals experienced higher asymmetry in the ankle eversion and the external rotation moments than the flat feet group. Asymmetry indices in the knee abduction, adduction, and the internal rotation moments in the flat feet group were higher than that in the normal group by 15%, 24% and 13%, respectively. Furthermore, in comparison of the two groups, individuals with flat feet had higher asymmetry in the hip flexion moment as well as the hip abduction moment. CONCLUSIONS: In order to provide appropriate protocols or footwear design for male children with flat feet, clinicians need to understand that flat feet children do not have higher levels of joint moment asymmetry as compared to normal children in all joints and all planes; consequently, they must differentiate their treatments for each specific joint. However, further larger study is warranted.

A comparison of running kinetics in children with and without genu varus: A cross sectional study.

INTRODUCTION: Varus knee alignment has been identified as a risk factor for the progression of medial knee osteoarthritis. However, the underlying mechanisms have not been elucidated yet in children. Thus, the aims of the present study were to examine differences in ground reaction forces, loading rate, impulses, and free moment values during running in children with and without genu varus. METHODS: Thirty-six boys aged 9-14 volunteered to participate in this study. They were divided in two age-matched groups (genu varus versus healthy controls). Body weight adjusted three dimensional kinetic data (Fx, Fy, Fz) were collected during running at preferred speed using two Kistler force plates for the dominant and non-dominant limb. RESULTS: Individuals with knee genu varus produced significantly higher (p = .01; d = 1.09; 95%) body weight adjusted ground reaction forces in the lateral direction (Fx) of the dominant limb compared to controls. On the non-dominant limb, genu varus patients showed significantly higher body weight adjusted ground reaction forces values in the lateral (p = .01; d = 1.08; 86%) and medial (p < .001; d = 1.55; 102%) directions (Fx). Further, genu varus patients demonstrated 55% and 36% greater body weight adjusted loading rates in the dominant (p < .001; d = 2.09) and non-dominant (p < .001; d = 1.02) leg, respectively. No significant between-group differences were observed for adjusted free moment values (p>.05). DISCUSSION: Higher mediolateral ground reaction forces and vertical loading rate amplitudes in boys with genu varus during running at preferred running speed may accelerate the development of progressive joint degeneration in terms of the age at knee osteoarthritis onset. Therefore, practitioners and therapists are advised to conduct balance and strength training programs to improve lower limb alignment and mediolateral control during dynamic movements.

Lower limb muscle activity during gait in individuals with hearing loss.

The objective of this study was to investigate the electrical activity of lower limb muscles during gait in an able-bodied control group and in deaf individuals. Thirty male children were equally divided into a control group and a group of deaf children. A portable EMG system was used to record the activity of the bilateral tibialis anterior, gastrocnemius medialis and vastus lateralis muscles during barefoot walking with and without dual task. For EMG analysis, the average root mean square (RMS) values of the five trials were calculated and then normalized based on the peak RMS obtained by the maximum isometric voluntary contraction. MANOVA test was used for between group comparisons. The significance level was set at p < 0.05 for all analyses. The findings indicated that gait speed in children with hearing loss was smaller than that in control group. Dual task resulted in a decreased walking speed of children with hearing loss. The activities of tibialis anterior muscle in terminal stance phase (p = 0.040), medial gastrocnemius muscle in loading response and initial swing phases (p < 0.05), and vastus lateralis muscle in the terminal stance and pre swing phases (p < 0.05) were greater in deaf group. In deaf children the gait speed was reduced and the muscle activity was increased with respect to those in control group. This altered gait speed and muscle activity is suggestive of a lower mechanical efficiency of gait in deaf children.

Effect of foot orthoses on the medial longitudinal arch in children with flexible flatfoot deformity: A three-dimensional moment analysis.

Foot orthoses are often used to correct altered gait patterns. The purpose of this study was to investigate how foot orthoses can modify the magnitude of three dimensional moments of ankle, knee, and hip joints during a stride of gait in children with flexible flat feet. Bilateral gait data were collected from fourteen male children (age 10.2±1.4 years) suffering from flat feet syndrome. In order to obtain the kinematics data, a Vicon system with six cameras (100Hz) was used and two Kistler force plates (1000Hz) to record the kinetics data under each leg. Arc support foot orthoses were used as an intervention. Paired-sample T-test was used for within-group comparisons (α=0.05). The results of data analysis showed that foot orthoses can decrease the ankle evertor moment, knee and hip abductor moments and hip flexor moment in dominant lower limb. In non-dominant lower limb, using the orthoses can decrease evertor and internal rotator moments at the ankle, flexor and internal rotator moments at the knee and extensor moment at the hip, while it can increase dorsiflexor moment at the ankle. The findings imply that effects of orthoses on three dimensional moments differ in dominant and non-dominant lower limbs. Furthermore, results demonstrated that dominant and non-dominant lower limbs would also show different responses to the same intervention.

Gait ground reaction force characteristics in deaf and hearing children.

The link between gait parameters and hearing loss is not well understood. The objective of this study was to investigate the effects of the gait ground reaction forces, their time to peak, vertical loading rate, impulses and free moment during gait in deaf and hearing children. Thirty male children were equally divided into a healthy group and a group with hearing loss problems (Deaf group). Ground reaction forces were analyzed during barefoot walking. MANOVA test was used for between group comparisons. The significance level was set at p<0.05 for all analyses. Hearing loss was associated with increased propulsion lateral-medial ground reaction force (p=0.031), its time to peak (p=0.008), and lateral- medial impulse (p=0.018). Similar vertical reaction forces were observed in both groups (p>0.05). Positive peak of free moments in the healthy group was significantly greater than that in the deaf group (p=0.004). In conclusion, the results reveal that gait ground reaction force components in deaf children may have clinical values for rehabilitation of these subjects.

The effect of interventional proprioceptive training on static balance and gait in deaf children.

Children with hearing impairment have balance and motor deficits primarily due to concomitant damage to the vestibular structures. Although early intervention focused on the development of communication skills, investigations of intervention for the amelioration of balance deficits in children with hearing loss have been minimal and inconclusive. Therefore, using an experimental design, the present study investigated the effect of a 12-session exercise balance program based on proprioception training on balance and gait in deaf as compared with hearing schoolchildren. The subjects, 10 deaf and 10 typically developing children were assigned to an experimental and a control group respectively. Taking up the initial differences between the groups through a pretest under different conditions, the participants in the experimental group went through a 12-session intervention program including static and dynamic training with emphasis on proprioceptive system. After this, the participants were tested again. The data obtained was analyzed using repeated measure. A comparison between the control and experimental groups revealed that the intervention program had not significantly increased gait velocity while it had significantly decreased the amount of sway. Thus, it was concluded that an exercise program that enhances somatosensory ability can result in improved balance in deaf children.