Hip Joint Contact Loading and Muscle Forces During Running With a Transtibial Amputation.

People with unilateral transtibial amputations (TTA) have greater risks of bilateral hip osteoarthritis, related to asymmetric biomechanics compared to people without TTA. Running is beneficial for physical health and is gaining popularity. However, people with TTA may not have access to running-specific prostheses (RSPs), which are designed for running, and may instead run using their daily-use prosthesis (DUP). Differences in joint loading may result from prosthesis choice; thus, it is important to characterize changes in peak and impulsive hip joint contact loading during running. Six people with and without TTA ran at 3.5 m/s while ground reaction forces, kinematics, and electromyography were collected. People with TTA ran using their own RSP and DUP. Musculoskeletal models incorporating prosthesis type of each individual were used to quantify individual muscle forces and hip joint contact forces (HJCFs) during running. People using RSPs had smaller bilateral peak hip joint contact forces compared to when wearing DUPs during stance and swing, and a smaller impulse over the entire gait cycle. Greater amputated leg peak hip joint contact forces for people wearing DUPs compared to RSPs occurred with greater forces from the ipsilateral gluteus maximus during stance. People with TTA also had greater bilateral peak hip joint contact forces during swing compared to people without TTA, which occurred with greater peak gluteus medius forces. Running with more compliant RSPs may be beneficial for long-term joint health by reducing peak and impulsive hip loading compared to DUPs.

Amputee Locomotion: Ground Reaction Forces During Submaximal Running With Running-Specific Prostheses.

Individuals with lower extremity amputation must adapt the mechanical interactions between the feet and ground to account for musculoskeletal function loss. However, it is currently unknown how individuals with amputation modulate three-dimensional ground reaction forces (GRFs) when running. This study aimed to understand how running with running-specific prostheses influences three-dimensional support forces from the ground. Eight individuals with unilateral transtibial amputations and 8 control subjects ran overground at 2.5, 3.0, and 3.5 m/s. Ten force plates measured GRFs at 1000 Hz. Peak and average GRFs and impulses in each plane were compared between limbs and groups. Prosthetic limbs generated reduced vertical impulses, braking forces and impulses, and mediolateral forces while generating similar propulsive impulses compared with intact and control limbs. Intact limbs generated greater peak and average vertical forces and average braking forces than control subjects' limbs. These data indicate that the nonamputated limb experiences elevated mechanical loading compared with prosthetic and control limbs. This may place individuals with amputation at greater risk of acute injury or joint degeneration in their intact limb. Individuals with amputation adapted to running-specific prosthesis force production limitations by generating longer periods of positive impulse thus producing propulsive impulses equivalent to intact and control limbs.

Race and geography impact validity of maximum allowable standing height equations for para-athletes.

World Athletics use maximum allowable standing height (MASH) equations for para-athletes with bilateral lower extremity amputations to estimate stature and limit prosthesis length since longer prostheses can provide running performance advantages. The equations were developed using a white Spanish population; however, validation for other races and geographical groups is limited. This study aimed to determine the validity of the MASH equations for Black and white Americans and whether bias errors between calculated and measured stature were similar between these populations. Sitting height, thigh length, upper arm length, forearm length, and arm span of 1899 male and 1127 female Black and white Americans from the Anthropometric Survey of US Army Personnel database were input into the 6 sex-specific MASH equations to enable comparisons of calculated and measured statures within and between Black and white groups. Two of 12 MASH equations validly calculated stature for Black Americans and 3 of 12 equations were valid for white Americans. Bias errors indicated greater underestimation or lesser overestimation of calculated statures in 10 equations for Black compared to white Americans and in 2 equations for white compared to Black Americans. This study illustrates that race and geography impact the validity of MASH equations.

Amputee locomotion: determining the inertial properties of running-specific prostheses.

OBJECTIVES: (1) To test the validity of a trifilar pendulum in estimating moments of inertia (MOIs) for running-specific prostheses (RSPs), (2) to measure inertial properties (mass, center of mass [CM] position, and MOIs) for 4 RSPs, (3) to verify the influence of the stiffness on the inertial properties of RSPs, and (4) to develop a predictive equation to estimate RSP CM positions. DESIGN: An aluminum block with known MOIs was used for verifying the accuracy of the trifilar pendulum MOI measurements. MOI errors were investigated by systematically misaligning the block and pendulum principal axes across a range of 1 to 10cm. Mass, CM position, and MOI were tested across 4 RSP designs with 3 stiffness categories each. SETTING: University biomechanics laboratory. SPECIMENS: Four different RSP designs and 3 stiffness categories per design were examined. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: MOI errors from known values and principal axis misalignments between RSPs and pendulum; mass, CM positions, and RSP principal axis MOIs; and predictive equation CM position errors. RESULTS: The trifilar pendulum estimated MOIs within -6.21×10(-5)kg/m(2) (≤1% error) for a block with known MOIs. Misalignments of 1 to 5cm between the RSPs' and pendulum's CM yielded errors from .00002 to .00113 kg/m(2) (0.3%-59.2%). Each RSP's inertial properties are presented. MOIs about any axis varied <.004kg/m(2) across stiffness categories; MOIs differed up to .013kg/m(2) between different designs. The predictive CM equation erred between .010 and .028m when using average input values across an RSP design. CONCLUSIONS: Trifilar pendulums can accurately measure RSP MOI. The RSP inertial properties differed slightly across stiffness categories within each design, but differed more substantially across different RSP designs. Using a predictive equation to estimate RSP CM positions can provide adequate data, but directly measuring CM positions is preferable.

Prehension synergy: use of mechanical advantage during multifinger torque production on mechanically fixed and free objects.

The aim of this study was to test the mechanical advantage (MA) hypothesis in multifinger torque production tasks in humans: fingers with longer moment arms produce greater force magnitudes during torque production tasks. There were eight experimental conditions: two prehension types determined by different mechanical constraints (i.e., fixed- and free-object prehension) with two torque directions (supination and pronation) and two torque magnitudes (0.24 and 0.48 N·m). The subjects were asked to produce prescribed torques during the fixed-object prehension or to maintain constant position of the free hand-held object against external torques. The index of MA was calculated for agonist and antagonist fingers, which produce torques in the same and opposite directions to the target torques, respectively. Within agonist fingers, the fingers with longer moment arms produced greater grasping forces while within antagonist fingers, the fingers with shorter moment arms produced greater forces. The MA index was greater in the fixed-object condition as compared with the free-object condition. The MA index was greater in the pronation condition than in the supination condition. This study supports the idea that the CNS utilizes the MA of agonist fingers, but not of antagonist fingers, during torque production in both fixed- and free-object conditions.

Users Maintain Task Accuracy and Gait Characteristics During Missed Exoskeleton Actuations Through Adaptations In Joint Kinematics.

In operational settings, lower-limb active exoskeletons may experience errors, where an actuation that should be present is missed. These missed actuations may impact users' trust in the system and the adapted human-exoskeleton coordination strategies. In this study, we introduced pseudorandom catch trials, in which an assistive exoskeleton torque was not applied, to understand the immediate responses to missed actuations and how users' internal models to an exoskeleton adapt upon repeated exposure to missed actuations. Participants (N = 15) were instructed to complete a stepping task while wearing a bilateral powered ankle exoskeleton. Human-exoskeleton coordination and trust were inferred from task performance (step accuracy), step characteristics (step length and width), and joint kinematics at selected peak locations of the lower limb. Step characteristics and task accuracy were not impacted by the loss of exoskeleton torque as hip flexion was modulated to support completing the stepping task during catch trials, which supports an impacted human-exoskeleton coordination. Reductions in ankle plantarflexion during catch trials suggest user adaptation to the exoskeleton. Trust was not impacted by catch trials, as there were no significant differences in task performance or gait characteristics between earlier and later strides. Understanding the interactions between human-exoskeleton coordination, task accuracy, and step characteristics will support development of exoskeleton controllers for non-ideal operational settings.

Varying alignment affects lower extremity joint and limb loading during yoga's triangle (Trikonasana) pose.

BACKGROUND: Limited biomechanical data exist describing how yoga asanas (postures) load the limbs and joints, and little evidence-based recommendations for yoga injury prevention are available. This study aimed to establish joint loading metrics for an injury-prone, yet common yoga pose, the Triangle asana (Trikonasana) by identifying how stance width adjustments alter lower extremity loading. METHODS: Eighteen yoga practitioners underwent 3D motion analysis while performing Trikonasana with self-selected (SS) stance width and -30, -20, -10, +10, +20, and +30% of SS stance width. Ground reaction forces (GRFs), joint forces, and joint moments were calculated for the leading and trailing limb ankle, knee, and hip. One-way repeated-measures analysis of variance determined differences in loading due to stance width. RESULTS: GRFs, net joint forces, and net joint moments were significantly affected by stance width where increasing stance width increased leading limb loading but decreased trailing limb loading. CONCLUSIONS: Altering stance width of Trikonasana influences lower extremity limb loading, and these loading responses were limb-dependent. Yoga practitioners and instructors can use this information to objectively support increasing or decreasing stance width to reduce or increase limb loading according to their goals or to make accommodations to groups such as beginners or at-risk populations for safer, more accessible yoga practices. Cuing a wider or narrower stance width will not have the same effect on both limbs.

Comparison of 2-D and 3-D Analysis of Running Kinematics and Actual Versus Predicted Running Kinetics.

Background: Providing clinicians with an accurate method to predict kinetic measurements using 2D kinematic motion analysis is crucial to the management of distance runners. Evidence is needed to compare the accuracy of 2D and 3D kinematic measurements as well as measured and estimated kinetic variables. Purposes: The objectives of this study were to (1) compare 2D video analysis of running kinematics with gold standard 3D motion capture and, (2) to evaluate published equations which estimate running kinetics using 2D kinematic and spatiotemporal values and modify these equations based on study findings. Design: Controlled laboratory study, cross-sectional design. Methods: Runners who averaged at least 20 miles per week were invited to participate. Athletes ran on an instrumented treadmill at their preferred training pace for a 6-minute warm-up. Markers were placed over designated anatomical landmarks on both sides of the pelvis as well as the left lower extremity. Subjects then ran at their preferred speed and kinematic data were recorded using both the 2D and 3D camera systems at 240 frames/second. Additionally, ground reaction forces were recorded at 1200Hz. 2D and 3D kinematic values were compared and published kinetic prediction formulas were tested. Linear regression was used to develop new prediction equations for average loading rate (AVG_LR), peak vertical ground reaction force (VERT_GRF), and peak braking force (PK_BRK). Paired t-tests were used to assess differences between the 2D and 3D kinematic variables and the measured (MEAS) and calculated (CALC) kinetic variables. Results: Thirty runners (13 men and 17 women) voluntarily consented to participate in this study and the mean age of the participants was 31.8 years (range 20 to 48 years). Although significant differences existed, all 2D kinematic measures were within 2°-5° of 3D kinematic measures. Published prediction equations for AVG_LR and VERT_GRF were supported, but new prediction equations showed higher R2 for AVG_LR (0.52) and VERT_GRF (0.75) compared to previous work. A new prediction equation for PK_BRK was developed. No significant differences were found between the MEAS and CALC kinetic variables using the new equations. Conclusion: Accurate predictions of kinetic variables can be made using spatiotemporal and 2D kinematic variables. Level of Evidence: Level 2.

Detection of COVID-19 using multimodal data from a wearable device: results from the first TemPredict Study.

Early detection of diseases such as COVID-19 could be a critical tool in reducing disease transmission by helping individuals recognize when they should self-isolate, seek testing, and obtain early medical intervention. Consumer wearable devices that continuously measure physiological metrics hold promise as tools for early illness detection. We gathered daily questionnaire data and physiological data using a consumer wearable (Oura Ring) from 63,153 participants, of whom 704 self-reported possible COVID-19 disease. We selected 73 of these 704 participants with reliable confirmation of COVID-19 by PCR testing and high-quality physiological data for algorithm training to identify onset of COVID-19 using machine learning classification. The algorithm identified COVID-19 an average of 2.75 days before participants sought diagnostic testing with a sensitivity of 82% and specificity of 63%. The receiving operating characteristic (ROC) area under the curve (AUC) was 0.819 (95% CI [0.809, 0.830]). Including continuous temperature yielded an AUC 4.9% higher than without this feature. For further validation, we obtained SARS CoV-2 antibody in a subset of participants and identified 10 additional participants who self-reported COVID-19 disease with antibody confirmation. The algorithm had an overall ROC AUC of 0.819 (95% CI [0.809, 0.830]), with a sensitivity of 90% and specificity of 80% in these additional participants. Finally, we observed substantial variation in accuracy based on age and biological sex. Findings highlight the importance of including temperature assessment, using continuous physiological features for alignment, and including diverse populations in algorithm development to optimize accuracy in COVID-19 detection from wearables.

Running-specific prostheses reduce lower-limb muscle activity compared to daily-use prostheses in people with unilateral transtibial amputations.

People with unilateral transtibial amputation (TTA) have biomechanical differences between the amputated and intact legs and compared to people without TTA during running. Additional biomechanical differences emerge between running with running-specific (RSPs) and daily-use prostheses (DUPs), but the associated underlying muscle activity is unclear. We collected surface electromyography from the biceps femoris long head, rectus femoris, vastus lateralis, and gastrocnemius as well as body kinematics and ground reaction forces in six people with and six people without TTA. We compared stance phase muscle activity and peak activation timing in people with and without TTA and between people using RSPs compared to DUPs during running at 3.5 m/s. Peak amputated leg hamstring activity occurred 34% (RSP) and 31% (DUP) earlier in stance phase compared to the intact leg. Peak amputated leg rectus femoris activity of people wearing DUPs occurred 8% and 9% later in stance phase than the intact leg of people wearing DUPs and amputated leg of people wearing RSPs, respectively. People with TTA had 45% (DUP) and 61% (RSP) smaller peak amputated leg knee extension moments compared to people without TTA, consistent with observations of quadriceps muscle activity. Using RSPs decreased overall muscle activity compared to DUPs.

Joint work and ground reaction forces during running with daily-use and running-specific prostheses.

Some individuals with a transtibial amputation (TTA) may not have access to running-specific prostheses and therefore choose to run using their daily-use prosthesis. Unlike running-specific prostheses, daily-use prostheses are not designed for running and may result in biomechanical differences that influence injury risk. To investigate these potential differences, we assessed the effect of amputation, prosthesis type, and running speed on joint work and ground reaction forces. 13 people with and without a unilateral TTA ran at speeds ranging from 2.5 m/s to 5.0 m/s. People with TTA ran using their own daily-use and running-specific prostheses. Body kinematics and ground reaction forces were collected and used to compute joint work. People with TTA had smaller peak braking, propulsive and medial/lateral ground reaction forces from the amputated leg compared to people without TTA. People wearing running-specific prostheses had smaller peak amputated leg vertical ground reaction forces compared to daily-use prostheses at speeds above 3.5 m/s. Medial/lateral forces were also smaller in running-specific prostheses, which may present balance challenges when running on varied terrain. Running-specific prostheses stored and returned more energy and provided greater propulsion, resulting in more similar positive hip work between legs compared to daily-use prostheses. Increases in positive hip work, but not device work, highlight the importance of the hip in increasing running speed. Running-specific devices may be beneficial for joint health at running-speeds above 3.5 m/s and provide advantages in propulsion and energy return at all speeds compared to daily-use prostheses, helping people with TTA achieve faster running speeds.

Loading rates in unilateral transfemoral amputees with running-specific prostheses across a range of speeds.

BACKGROUND: Understanding the potential risks of running-related injuries in unilateral transfemoral amputees contributes to the development and implementation of the injury prevention programme in running gait rehabilitation. We investigated the vertical ground reaction force loading in unilateral transfemoral amputees who used running-specific prostheses across a range of running speeds. METHODS: Ten unilateral transfemoral amputees and ten non-amputees performed running trials on an instrumented treadmill at the incremental speeds of 30, 40, 50, and 60% of their maximum acquired speeds. Per-step and cumulative vertical instantaneous loading rates were calculated from the vertical ground reaction force in the affected, unaffected, and non-amputated control limbs. FINDINGS: Both the per-step and cumulative vertical instantaneous loading rates of the unaffected limbs in runners with unilateral transfemoral amputation were significantly greater than the affected and non-amputated control limbs at all speeds. INTERPRETATION: The results of the present study suggest that runners with unilateral transfemoral amputation may be exposed to a greater risk of running-related injuries in their unaffected limbs compared to the affected and non-amputated control limbs.

Dynamic balance during running using running-specific prostheses.

Running is beneficial for physical, social, and emotional health, and participating in physical activity, including running, is becoming more popular for people with an amputation. However, this population has a greater risk of falling relative to people without an amputation, which may be a barrier to running. Understanding how dynamic balance is maintained during running is important for removing this barrier. To investigate dynamic balance, we quantified whole-body angular momentum in eight people with a unilateral transtibial amputation (TTA) using running-specific prostheses (RSPs) compared to eight people without TTA during running at 2.5, 3.0, and 3.5 m/s. People with TTA had greater ranges of whole-body angular momentum compared to people without TTA in the frontal and sagittal planes (p < 0.01). These greater ranges resulted from smaller peak medial, lateral, and braking ground reaction forces from the amputated leg compared to the intact leg and people without TTA. Reduced RSP mass relative to the biological leg also influenced whole-body angular momentum as evidenced by smaller ranges of amputated leg angular momentum compared to the intact leg in the frontal and sagittal planes. Smaller amputated leg angular momentum corresponded with smaller contralateral arm angular momentum in the sagittal plane (p < 0.01). People with TTA maintain balance during running with altered muscle coordination and prosthesis characteristics. Restoring mediolateral force generation through prosthetic design advances may help in regulating the frontal plane component of whole-body angular momentum for people with TTA, with potential to improve their ability to maintain balance during running.

USE OF 2-DIMENSIONAL SAGITTAL KINEMATIC VARIABLES TO ESTIMATE GROUND REACTION FORCE DURING RUNNING.

BACKGROUND: Variations in vertical loading rates have been associated with overuse injuries of the lower extremity; however, they are typically collected using 3-dimensional motion capture systems and in-ground force plates not available to most clinicians because of cost and space constraints. PURPOSE: The purpose of this study was to determine if kinetic measures commonly used to describe lower extremity loading characteristics could be estimated from step rate and specific sagittal plane kinematic variables captured using 2-dimensional motion analysis during treadmill running. STUDY DESIGN: Observational Study. METHODS: Ten high school cross-country runners (4 men and 6 women) voluntarily consented to participate in this study. Reflective markers were placed on each lower extremity over multiple anatomical landmarks. Participants were then asked to run on the instrumented treadmill at their preferred running speed. When the participants indicated they were in their typical running pattern, they continued to run at their preferred speed for a minimum of five minutes. After three minutes of running at their preferred running speed, the participant's step rate was counted and after running for four minutes, video and ground reaction force data were recorded for 60 sec. All running motion data were recorded using a single high-speed camera at 240 frames per second and ground reaction force data were sampled at 1000 Hz. RESULTS: Mean kinematic values between the left and right extremities for all 10 participants were not significantly different. Consequently, data for the left and right extremities were grouped for all further analyses. The stepwise forward regression to predict vertical ground reaction force resulted in a five-variable model (step rate and four kinematic variables) with R2 = 0.56. The stepwise forward regression to predict average loading rate also resulted in a five kinematic variable model with R2 = 0.51. CONCLUSIONS: Step rate and sagittal plane kinematic variables measured using a simplified 2-dimensional motion analysis approach with a single high-speed camera can provide the clinician with a reasonable estimate of ground reaction force kinetics during treadmill running. LEVEL OF EVIDENCE: 4, Controlled laboratory study.

Amputee Locomotion: Joint Moment Adaptations to Running Speed Using Running-Specific Prostheses after Unilateral Transtibial Amputation.

OBJECTIVE: The objective of this study was to investigate three-dimensional lower extremity joint moment differences between limbs and speed influences on these differences in individuals with lower extremity amputations using running-specific prostheses. DESIGN: Eight individuals with unilateral transtibial amputations and 8 control subjects with no amputations ran overground at three constant velocities (2.5, 3.0, and 3.5 m/sec). A 2 × 2 × 3 (group × leg × speed) repeated-measures analysis of variance with Bonferroni adjustments determined statistical significance. RESULTS: The prosthetic limb generated significantly greater peak ankle plantarflexion moments and smaller peak ankle varus, knee stance extension, knee swing flexion, knee internal rotation, hip stance flexion, hip swing flexion, hip swing extension, hip valgus, and hip external rotation moments than the intact limb did. The intact limb had greater peak hip external rotation moments than control limbs did, but all other peak moments were similar between these limbs. Increases in peak hip stance and knee swing flexion moments associated with speed were greater in the intact limb than in the prosthetic limb. CONCLUSION: Individuals with amputation relied on the intact limb more than the prosthetic limb to run at a particular speed when wearing running-specific prostheses, but the intact joints were not overloaded relative to the control limbs.

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

OBJECTIVE: To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke. DESIGN: Parallel group, posttest only. SETTING: Inpatient rehabilitation center. PARTICIPANTS: Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7). INTERVENTIONS: Locomotor treadmill training with partial BWS or traditional gait training methods. MAIN OUTCOME MEASURES: Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult. RESULTS: Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group. CONCLUSIONS: Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.

Physical properties, durability, and energy-dissipation function of dual-density orthotic materials used in insoles for diabetic patients.

BACKGROUND: Patients with neuropathic conditions may develop plantar bony deformities through neuropathic collapse, frequently placing the skin and soft tissues at risk. Orthoses have been used to accommodate and distribute plantar pressures over a large surface area, thereby minimizing peak loading pressures in small regions and reducing the risk of ulceration. METHODS: A previously described bony prominence model (Brodsky et al.) was used to test the pressure-absorbing and force-transmission properties of various orthotic material combinations used in our outpatient clinic. Six materials were tested in five combinations of materials for their compressive properties: [MS]: medium plastazote (M) + soft plastazote (S); [MN]: medium plastazote (M) + nickelplast (N); [NP] nickelplast (N) + Poron (P); [MO] medium plastazote (M) + Spenco (O); and [MC] medium plastazote (M) + P-cell (C). Materials were tested for 100,000 cycles using a materials-testing system (MTS) apparatus (MTS Systems Corporation, Cary, NC) and software. Stress-strain curves comparing the measured peak pressure to the elastic deformation, or the percentage of compression a material experiences with respect to its original thickness, were plotted for each orthotic combination. RESULTS: For MS, MN, MO, and to a lesser extent, MC, a trend was noted for decreased elastic deformation with increased testing. Additionally, the peak pressures before and after testing for each 10,000 testing cycle for each of the orthotic combinations were plotted. For both MN and NP, no demonstrable difference was noted in the peak pressures in the pretesting and post-testing for the 100,000 cycles. The MO showed a trend for increased peak pressures after each testing cycle. Both the MC and MS peak pressures markedly increased with respect to pretesting value. Also, the MN, MO, and MS all showed an overall trend for increased load cell values with increasing cycles at fast loading. CONCLUSIONS: These data showed that some orthotic combinations are more effective than others at reducing peak pressures during compression testing using our bony prominence model. Further studies are needed to test the orthotic combinations for shear and combined shear and compression modes.

Prospective gait analysis in patients with first metatarsophalangeal joint arthrodesis for hallux rigidus.

BACKGROUND: Arthrodesis of the first metatarsophalangeal (MTP) joint is a common procedure with a proven long-term success rate. However, there is limited scientific information on its functional results. There is little data in the literature about changes in gait parameters after first MTP joint arthrodesis. The purpose of this study was to objectively evaluate the effects of first MTP joint arthrodesis on gait. METHODS: Twenty-three patients with symptomatic hallux rigidus refractory to nonoperative treatment were treated with first MTP joint arthrodesis. A prospective gait analysis study was performed on all patients at an average of 8.6 days before surgery and then again at least 1 year postoperatively. Preoperative and postoperative data from the patients were compared to determine differences in clinically relevant temporal-spatial, kinematic, and kinetic parameters of gait. RESULTS: There were three statistically significant changes in gait: increases in maximal ankle push-off power and single-limb support time on the involved extremity, and a decrease in step width. CONCLUSIONS: First MTP joint arthrodesis produces objective improvement in propulsive power, weightbearing function of the foot, and stability during gait.

Amputee locomotion: Frequency content of prosthetic vs. intact limb vertical ground reaction forces during running and the effects of filter cut-off frequency.

Compared to intact limbs, running-specific prostheses have high resonance non-biologic materials and lack active tissues to damp high frequencies. These differences may lead to ground reaction forces (GRFs) with high frequency content. If so, ubiquitously applying low-pass filters to prosthetic and intact limb GRFs may attenuate veridical high frequency content and mask important and ecologically valid data from prostheses. To explore differences in frequency content between prosthetic and intact limbs we divided signal power from transtibial unilateral amputees and controls running at 2.5, 3.0, and 3.5m/s into Low (<10Hz), High (10-25Hz), and Non-biologic (>25Hz) frequency bandwidths. Faster speeds tended to reduce the proportion of signal power in the Low bandwidth while increasing it in the High and Non-biologic bandwidths. Further, prostheses had lower proportions of signal power at the High frequency bandwidth but greater proportions at the Non-biologic bandwidth. To evaluate whether these differences in frequency content interact with filter cut-offs and alter results, we filtered GRFs with cut-offs from 1 to 100Hz and calculated vertical impact peak (VIP). Changing cut-off had inconsistent effects on VIP across speeds and limbs: Faster speeds had significantly larger changes in VIP per change in cut-off while, compared to controls, prosthetic limbs had significantly smaller changes in VIP per change in cut-off. These findings reveal differences in GRF frequency content between prosthetic and intact limbs and suggest that a cut-off frequency that is appropriate for one limb or speed may be inappropriate for another.