Helical axes of skeletal knee joint motion during running.

The purpose of this study was to determine the changes in the axis of rotation of the knee that occur during the stance phase of running. Using intracortical pins, the three-dimensional skeletal kinematics of three subjects were measured during the stance phase of five running trials. The stance phase was divided into equal motion increments for which the position and orientation of the finite helical axes (FHA) were calculated relative to a tibial reference frame. Results were consistent within and between subjects. At the beginning of stance, the FHA was located at the midepicondylar point and during the flexion phase moved 20mm posteriorly and 10mm distally. At the time of peak flexion, the FHA shifted rapidly by about 10-20mm in proximal and posterior direction. The angle between the FHA and the tibial transverse plane increased gradually during flexion, to about 15 degrees of medial inclination, and then returned to zero at the start of the extension phase. These changes in position and orientation of FHA in the knee should be considered in analyses of muscle function during human movement, which require moment arms to be defined relative to a functional rotation axis. The finding that substantial changes in axis of rotation occurred independent of flexion angle suggests that musculoskeletal models must have more than one kinematic degree-of-freedom at the knee. The same applies to the design of knee prostheses, if the goal is to restore normal muscle function.

Effects of shoe sole construction on skeletal motion during running.

PURPOSE: The purpose of this study was to quantify effects of shoe sole modification on skeletal kinematics of the calcaneus and tibia during the stance phase of running. METHODS: Intracortical bone pins with reflective marker triads were inserted under standard local anesthetic into the calcaneus and tibia of five healthy male subjects. The three-dimensional tibiocalcaneal rotations were determined using a joint coordinate system approach. Three shoe sole modifications were tested with different sole geometry: a lateral heel flare of 25 degrees (flared), no flare 0 degrees (straight), and a rounded sole. RESULTS: The results showed that these shoe sole modifications did not change tibiocalcaneal rotations substantially. The shoe sole effects at the bone level were small and unsystematic (mean effects being less than 1 degrees ) compared with the differences between the subjects (up to 7 degrees ). Shoe eversion measured simultaneously with shoe markers showed no systematic shoe sole effects. A comparison of shoe and bone results showed the total shoe eversion and maximum shoe eversion velocity to be approximately twice as large as the respective measurements based on bone markers (correlations being r = 0.79 for maximum eversion velocity; r = 0.88 for total eversion), indicating that there may be a relationship or coupling effect between the shoes and the bone. CONCLUSIONS: It is concluded that the tibiocalcaneal kinematics of running may be individually unique and that shoe sole modifications may not be able to change them substantially.

Current issues in the design of running and court shoes.

This review paper focuses on the three most important functional design factors for sport shoes: injury prevention, performance and comfort. Concepts for these design factors are discussed for running and court shoes. For running shoes, pronation control and cushioning are still considered to be the key concepts for injury prevention despite the fact that conclusive clinical and epidemiological evidence is missing to show the efficacy of these design strategies. Several design features have been proposed to be effective in controlling the amount of pronation. However, the kinematic effects of such features seem to be subject-specific and rather small especially when looking at the actual skeletal motion. Recent running shoe research suggests that cushioning may not or only marginally be related to injuries and that cushioning during the impact phase of running may be more related to aspects such as comfort, muscle tuning or fatigue. For court shoes, lateral stability, torsional flexibility, cushioning and traction control appear to be important design strategies to decrease the risk of injury. With respect to running performance, the shoe concepts of weight reduction, efficiency and energy return are discussed. The concept of energy return does not seem to be a feasible concept whereas concepts which aim to minimize energy loss appear to be more promising and successful, e.g. weight reduction, reduction of muscle energy required for stabilization. For court shoes, optimal traction seems to be the key factor for performance. Research in the area of shoe comfort is still sparse. Cushioning, fitting and climate concepts appear to improve the comfort of both running and court shoes. Many investigations in the area of sport shoe research have shown that subject-specific responses can be expected. Different groups of athletes may require different types of shoes. The definition of these grouping characteristics and their design needs seem to be the most important challenge for the sport shoe researchers and manufacturers for the near future.

Tibiocalcaneal kinematics of barefoot versus shod running.

Barefoot running kinematics has been described to vary considerably from shod running. However, previous investigations were typically based on externally mounted shoe and/or skin markers, which have been shown to overestimate skeletal movements. Thus, the purpose of this study was to compare calcaneal and tibial movements of barefoot versus shod running using skeletal markers. Intracortical bone pins with reflective marker triads were inserted under standard local anesthetic into the calcaneus and tibia of five healthy male subjects. The subjects ran barefoot, with a normal shoe, with three shoe soles and two orthotic modifications. The three-dimensional tibiocalcaneal rotations were determined using a joint coordinate system approach. Test variables were defined for eversion and tibial rotation. The results showed that the differences in bone movements between barefoot and shod running were small and unsystematic (mean effects being less than 2 degrees ) compared with the differences between the subjects (up to 10 degrees ). However, differences may occur during midstance when extreme shoe modifications (i.e. posterior orthosis) are used. It is concluded that calcaneal and tibial movement patterns do not differ substantially between barefoot and shod running, and that the effects of these interventions are subject specific. The result of this in vivo study contrasts with previous investigations using skin and shoe mounted markers and suggests that these discrepancies may be the result of the overestimation with externally mounted markers.

Movement coupling at the ankle during the stance phase of running.

The purpose of this study was to quantify movement coupling at the ankle during the stance phase of running using bone-mounted markers. Intracortical bone pins with reflective marker triads were inserted under standard local anaesthesia into the calcaneus and the tibia of five healthy male subjects. The three-dimensional rotations were determined using a joint coordinate system approach. Movement coupling was observed in all test subjects and occurred in phases with considerable individual differences. Between the shoe and the calcaneus coupling increased after midstance which suggested that the test shoes provided more coupling for inversion than for eversion. Movement coupling between calcaneus and tibia was higher in the first phase (from heel strike to midstance) compared with the second phase (from midstance to take-off). This finding is in contrast to previous in-vitro studies but may be explained by the higher vertical loads of the present in-vivo study. Thus, movement coupling measured at the bone level changed throughout the stance phase of running and was found to be far more complex than a simple mitered joint or universal joint model.

Effects of foot orthoses on skeletal motion during running.

OBJECTIVE: To quantify the effects of medial foot orthoses on skeletal movements of the calcaneus and tibia during the stance phase in running. DESIGN: Kinematic effects of medial foot orthoses (anterior, posterior, no support) were tested using skeletal (and shoe) markers at the calcaneus and tibia. BACKGROUND: Previous studies using shoe and skin markers concluded that medially placed orthoses control/reduce foot eversion and tibial rotation. However, it is currently unknown if such orthoses also affect skeletal motion at the lower extremities. METHODS: Intracortical Hofman pins with reflective marker triads were inserted under standard local anesthetic into the calcaneus and tibia of five healthy male subjects. The three-dimensional tibiocalcaneal rotations were determined using a joint coordinate system approach. Eversion (skeletal and shoe) and tibial rotation were calculated to study the foot orthoses effects. RESULTS: Orthotic effects on eversion and tibial rotations were found to be small and unsystematic over all subjects. Differences between the subjects were significantly larger (p<0.01; up to 10 degrees ) than between the orthotic conditions (1-4 degrees ). Significant orthotic effects across subjects were found only for total internal tibial rotation; p<0.05). CONCLUSIONS: This in vivo study showed that medially placed foot orthoses did not change tibiocalcaneal movement patterns substantially during the stance phase of running. RELEVANCE: Orthoses may have only small kinematic effects on the calcaneus and tibia (measured with bone pins) as well as on the shoes (measured with shoe markers) during running of normal subjects. Present results showed that orthotic effects were subject specific and unsystematic across conditions. It is speculated that orthotic effects during the stance phase of running may be mechanical as well as proprioceptive.

Effect of skin movement on the analysis of skeletal knee joint motion during running.

It is not known how well skin markers represent the skeletal knee joint motion during running. Hence the purpose of this investigation was to compare the skin marker derived tibiofemoral motion with the skeletal tibiofemoral motion during running. In addition to skin markers attached to the shank and thigh, triads of reflective markers were attached to bone pins inserted into the tibia and femur. Three-dimensional kinematics of the stance phase of five running trials were recorded for three subjects using high-speed cine cameras (200 Hz). The knee motion was expressed in terms of Cardan angles calculated from both the external and skeletal markers. Good agreement was present between the skin and bone marker based knee flexion/extension. For abduction/adduction and internal/external knee rotation, the difference between skeletal and external motion was large compared to the amplitude of these motions. Average errors relative to the range of motion during running stance were 21% for flexion/extension, 63% for internal/external rotation, and 70% for abduction/adduction. The errors were highly subject dependent preventing the realization of a successful correction algorithm. It was concluded that knee rotations other than flexion/extension may be affected with substantial errors when using skin markers.

Tibiocalcaneal motion during running, measured with external and bone markers.

OBJECTIVE: The purpose of this study was to compare tibiocalcaneal motion during running based on skeletal markers with tibiocalcaneal motion based on external markers. DESIGN. IN VIVO: measurements of external and skeletal tibiocalcaneal kinematics. BACKGROUND: External (shoe, skin) markers are typically used to determine rearfoot kinematics. However, it is not known if such markers are able to provide a good representation of the skeletal (tibiocalcaneal) kinematics. METHODS: Bone pins were inserted into the tibia and calcaneus of five subjects. The 3-D motion of markers attached to bone pins as well as of external markers attached to the shank and shoe were determined during the stance phase of five running trials. Intersegmental motion was expressed in terms of Cardan angles (plantarflexion/dorsiflexion, abduction/adduction, inversion/eversion). RESULTS: It was found that the skeletal inversion/eversion, abduction/adduction, and plantarflexion/dorsiflexion motions were similar across the subjects. The shape of the tibiocalcaneal rotation curves based on external markers were similar to those based on bone markers. However, the rotations were generally overestimated when using external markers, e.g. the average maximal eversion motion calculated from external markers was 16.0 degrees whereas the skeletal maximal eversion motion was only 8.6 degrees. These discrepancies were mainly due to the relative movement between shoe markers and underlying calcaneus. CONCLUSIONS: External markers are only gross indicators of the skeletal tibiocalcaneal motion. The rotations derived from external shoe and shank markers typically overestimate the skeletal tibiocalcaneal kinematics. RELEVANCE: Quantitative results determined from external markers have to be used with caution. For tibiocalcaneal rotations, external markers may be used to show trends, but absolute values cannot be trusted.

Optimal trajectory for the basketball free throw.

Using a theoretical approach, we studied the basketball free throw as a function of angle, speed and spin at release. The ball was constrained to the sagittal plane bisecting the hoop and normal to the backboard, and was permitted to bounce and change spin on both backboard and hoop. Combinations of angle, speed and spin resulting in a successful shot were calculated analytically. Standard deviations for a shooter's angle and speed were used to predict the optimal trajectory for a specific position of release. An optimal trajectory was predicted which had an initial angle and speed of approximately 60 degrees and 7.3 m s(-1) respectively over the domain of spins (-2 to +2 m s(-1) surface speed; -16 to +16 rad s[1]). The effect of air resistance and the sagittal plane constraint on the predicted optimal trajectory were discussed and quantified. The optimal trajectory depended on both the anthropometric characteristics and accuracy of the shooter, but generally a high backspin with an angle and speed combination which sent the ball closer to the far rim of the basket than the near rim was advantageous. We provide recommendations for shooters as a function of the height of ball release.

Lateral stability in sideward cutting movements.

Sideward cutting movements occur frequently in sports activities, such as basketball, soccer, and tennis. These activities show a high incidence of injuries to the lateral aspect of the ankle. Consequently, the lateral stability of sport shoes seems important. The purpose of this study was to show the effect of different shoe sole properties (hardness, thickness, torsional stiffness) and designs on the lateral stability during sideward cutting movements. A film analysis was conducted including 12 subjects performing a cutting movement barefoot and with five different pairs of shoes each filmed in the frontal plane. A standard film analysis was conducted; for the statistical analysis, various parameters such as the range of motion in inversion and the angular velocity of the rearfoot were used. The results showed a large difference between the barefoot and shod conditions with respect to the lateral stability. Two shoes performed significantly better (P < 0.05) than the others with a decreased inversion movement and less slipping inside the shoe. The two shoes differed mainly in the shoe sole design (hollow inner core) and the upper (high-cut). It is concluded that lateral stability may be improved by altering the properties and design of the shoe sole as well as the upper.

Reliability and validity of active, passive and dynamic range of motion tests.

The purposes of this project were to determine (a) the reliability of ROM and POM assessment methods for tests where an ankle joint brace was used and (b) the relationship between active and passive ROM and POM inversion measurements. The range of motion of the ankle joint complex for inversion was quantified using a range of motion apparatus. The inversion path of motion for the foot and the shoe was quantified using a high speed video system. The results of this study indicated: (a) Comprehensive functional tests of ankle joint braces using ROM and POM measurements showed maximal group differences of less than 1 degree between days for ROM (rAROM = 0.96 and rPROM = 0.93) and less than 1.5 degrees for POM measurements (rPOM = 0.88). (b) PROM measurements showed a consistent "creep" effect of about 2 degrees with increasing trial number during the first ten trials which must be taken into consideration for the design of the appropriate test protocol. (c) The correlation coefficient between AROM and POM was 0.37 and 0.44 between PROM and POM, suggesting that AROM and PROM measurements do not predict inversion during actual movement.

Influence of heel height on ankle joint moments in running.

Clinically, heel lifting or heel wedging in running shoes has been proposed as a prevention and treatment of Achilles tendinitis. It has been speculated that heel lifting decreases the Achilles tendon forces. The purpose of this study was to determine the effect of heel height on resultant ankle flexion moments during running. It was assumed that plantarflexion moments at the ankle joint would indicate Achilles tendon loading. Each of the five subjects performed five running trials (4.6 m.s-1) for each of the five shoes, differing only in heel height (2.1-3.3 cm). Resultant plantar-/dorsiflexion moments were calculated using a standard three-dimensional inverse dynamics analysis. The results showed that, typically, a small initial dorsiflexion moment took place changing into a larger plantarflexion moment before 20% of stance phase. The magnitude and time of occurrence of the initial dorsiflexion moment were significantly affected by heel height changes, but the maximum plantarflexion moment and its time of occurrence were not significantly affected. The results did not support the speculation that a heel lift generally decreases the Achilles tendon loading during running. However, single subject analyses indicated that for two subjects the plantarflexion moments decreased with increasing heel height.

Influence of activity on plantar force distribution.

The purpose of the study was to quantify the influence of physical activity on force distribution on the plantar surface of the foot. Eleven healthy subjects each performed 10 walking trials over a force distribution platform: five trials before and five trials after a 30-min run. For the analysis the foot was divided into three different regions (rearfoot, midfoot, forefoot), and maximal and average forces were determined for each region. The only statistically significant difference was found in the maximal force in the forefoot, but the difference was relatively small (<3%). The results suggested that the half-hour run did not have a large effect on the plantar force distribution. Differences between subjects were significant for all variables, indicating that relevant information on individual foot structure and/or gait may be obtained from the plantar force distribution.

Heel movement within a court shoe.

Lateral movements of the leg and foot were filmed from behind to evaluate court shoes. Inversion/eversion may be an indicator of potential injuries, but estimates of actual inversion/eversion have typically been measured as the angular displacement of marker pairs on the lower leg and on the shoe. The purpose of this study was to measure the shoe movement versus the heel movement inside the shoe in order to determine the appropriateness of using shoe markers to represent the heel position. Two windows were cut into the heel counter of the shoe to show the heel position in addition to shoe position. The subjects were filmed from behind during a lateral side-stepping movement. The difference between the shoe and heel position was [corrected] statistically significant. The average maximum change in heel inversion inside the shoe was 13.3 +/- 3.8 degrees, compared with 30.7 +/- 6.2 degrees for the shoe. In addition, the maximum change in heel inversion in a barefoot movement was 10.1 +/- 3.1 degrees. The results suggest that for a lateral movement shoe markers do not accurately represent the position of the heel, and heel movement inside a shoe is similar to a barefoot movement. Skin markers on the heel as observed through windows in the shoe give a better indication of the actual position of the calcaneus than do markers placed directly on the shoe.

The movement of the heel within a running shoe.

Most running shoe investigations have used the same standard procedure for the evaluation of the shoes: the runners are filmed from behind and a film analysis is carried out digitizing markers at the heel counter of the shoe and on the lower leg. The angular displacement of these markers relative to the horizontal or the vertical is assumed to be an indicator for various sports injuries. The goal of this investigation was to measure the movement of the heel counter as well as the movement of the heel inside the shoe. First, the influence of the size of different heel counter windows was controlled and found negligible for the test conditions of this study. Second, 15 subjects performed the following procedure: running (a) barefoot, (b) with shoes with windows, and (c) without windows. Overall, the heel was found to move similarly but not identically to the heel counter. The maximum change of pronation was (a) 13.7 +/- 3.7 degrees, barefoot; (b) 14.1 +/- 3.8 degrees for the shoe with windows and 12.1 +/- 3.7 degrees for the heel inside these shoes; and 14.9 +/- 4.2 degrees for the shoes with no windows. To achieve a general impression of a shoe in the sense of a qualitative description, the previous method without heel counter windows still seems adequate. However, for a detailed analysis of quantitative nature, it is important to use the method with heel counter windows.