Investigation of Spatiotemporal Gait Characteristics, Balance, and Pain in Forefoot and Rearfoot Problems: Preliminary Results.

BACKGROUND: Foot problems are common in the general adult population. Whereas older people experience foot problems because of multiple chronic diseases, younger people often have musculoskeletal foot problems related to overuse. Symptoms and severity may differ depending on the anatomical location of the problem, such as forefoot and rearfoot problems. We aimed to compare the differences in spatiotemporal gait characteristics, balance, and pain in musculoskeletal forefoot and rearfoot problems. METHODS: Twenty-six patients with forefoot (14 participants) and rearfoot (12 participants) problems participated in this prospective study. Spatiotemporal gait characteristics (velocity, cadence, step time, step length, step-extremity ratio, stride length, base support, percentage of swing phase, percentage of stance phase, swing time, and stance time) were evaluated using an electronic walkway, and balance assessment was made using a balance check screener and trainer. The visual analog scale foot and ankle was used to determine patient pain levels. The Mann-Whitney U test was used to determine differences between groups. RESULTS: There were no significant differences between groups regarding spatiotemporal gait characteristics (P > .05). The eyes closed normal stability and eyes open perturbed stability scores were lower in patients with rearfoot problems (P < .05). Pain intensity evaluated with the visual analog scale foot and ankle was higher in patients with rearfoot problems (P < .05). CONCLUSIONS: Pain levels and balance deficits in this study were higher in patients with rearfoot problems. The balance evaluation and possible effects of pain management on balance should be considered, especially in patients with rearfoot problems, in aspects of treatment.

Do Children with Attention Deficit and Hyperactivity Disorder Present with Different Spatio-Temporal Gait Parameters? An Evaluation of the Relationship Between Gait and Gross Motor Skills.

Objective: The aim of the current study was to compare the spatio-temporal parameters of gait and gross motor skills in children with attention deficit hyperactivity disorder-combined type with those of typically developing children and to search the effect of motor skills on gait parameters in children with attention deficit hyperactivity disorder-combined type. Methods: A total of 50 children (n = 25 attention deficit hyperactivity disorder-combined type, n = 25 typically developing children) aged 5-12 years were included. Gross motor skills were evaluated using the Bruininks-Oseretsky Test Second Edition-Short Form. Spatio-temporal parameters of gait were assessed with a GAITRite® computer-based system. Results: In the subtests of Bruininks-Oseretsky Test Second Edition-Short Form (bilateral coordination (P < .001), balance (P = .013), running speed and agility (P = .003)), lower scores were obtained by the children with attention deficit hyperactivity disorder-combined type. The swing phase of gait was found to be longer in children with attention deficit hyperactivity disorder-combined type (P = .01). Conclusion: The current study results show that gross motor skills are affected negatively and the swing phase is prolonged in children with attention deficit hyperactivity disorder-combined type. Upper limb coordination and balance were also seen to have an effect on the velocity, step, and stride length. It is important to include an objective gait assessment as well as gross motor skills in the comprehensive clinical evaluation of children with attention deficit hyperactivity disorder-combined type.

Reliability and validity of the Turkish version of the Kyphosis specific spinal appearance questionnaire in adolescents with moderate hyperkyphosis.

BACKGROUND: Hyperkyphosis cause poor posture, self-image, clinical or cosmetic deformity and well-being. Therefore, it is important to evaluate patients' perception of appearance in the rehabilitation process of individuals with hyperkyphosis. Recently Kyphosis Specific Spinal Appearance Questionnaire (KSAQ) has been developed for the assessment of appearance in hyperkyphosis patients. OBJECTIVE: To test validity and reliability of the Turkish version of the KSAQ. METHODS: Sixty-two patients with hyperkyphosis (curve above 50º), ranging in age between 12 and 22 years, was included in this study. Turkish translation/back-translation of the KSAQ was done by an expert committee. Internal consistency was analyzed using Cronbach's alpha. Validity was assessed by correlating the KSAQ with the Scoliosis Research Society-22 (SRS-22) Questionnaire. Its reliability was assessed using the test-retest method with two-week interval (Pearson's correlation coefficient) on 44 of these patients. RESULTS: Mean kyphosis angle was 60º ± 8.9º. KSAQ total scores showed excellent internal consistency (Cronbach's α = 0.944) and test-retest reliability (ICC = 0.890). Moderate to strong associations were found between KSAQ total score, each item scores and self-image domain of SRS-22 (r -0.299 to -0.730, p < 0.05). KSAQ total score had moderate correlation with SRS-22 total score (r 0.423, p 0.001). Overall, the KSAQ scale showed good validity. CONCLUSION: The Turkish version of the KSAQ is a reliable and valid patient reported outcome measure of kyphosis-specific aspects of appearance in patients with moderate hyperkyphosis.

New Insight into Hallux Valgus: Body Awareness in Patients with Hallux Valgus.

BACKGROUND: Body awareness is an expression of the extent of sensitivity and attentiveness to internal bodily signals and sensations. The foot has a critical function in providing interoceptive and exteroceptive information. The purposes of this study were to 1) compare body awareness in individuals with and without hallux valgus (HV) deformity, and 2) investigate the relationship between body awareness and HV-related parameters. METHODS: A total of 129 participants completed the assessments. The severity of the HV was evaluated using the Manchester Scale; pain severity was evaluated using the numeric pain rating scale; and the functional status was evaluated using the Manchester-Oxford Foot Questionnaire. The patients were divided into two groups according to the Manchester Scale scores as the presence or absence of HV. The body awareness of the individuals with HV was assessed using the Body Awareness Questionnaire. RESULTS: Included in this study were 69 participants with HV and 60 healthy participants. There was no difference between groups in terms of demographic properties. Two groups were found different only in pain severity (P < .01). The correlation analysis showed that there was a low correlation between the body awareness score and pain severity in both feet (right foot, r = 0.306, P = .011; left foot, r = 0.320, P = .007) in individuals with HV. CONCLUSIONS: Participants with HV had higher pain severity and the pain severity was associated with the body awareness. The level of body awareness should be assessed and taken into consideration in the management of pain in patients with HV.

Comparison of the lower extremity function of patients with foot problems according to the level of kinesiophobia.

PURPOSE: The presence of kinesiophobia was identified in patients with foot problems. There was no finding of foot functionality according to the level of kinesiophobia in lower extremity problems. The aim of this study was to compare the lower extremity functional status in foot problems with a low or high level of kinesiophobia. MATERIALS AND METHODS: Evaluated herein were 37 patients with foot problems (plantar fasciitis, hallux valgus, flat foot). Physical and demographic characteristics were recorded. Patients were divided into two groups based on if they had a high or low level of kinesiophobia using the Tampa kinesiophobia scale. Ankle plantar flexor and knee flexor muscles tightness were recorded. The foot posture was evaluated using the Foot Posture Index. Foot-related pain was measured using the Visual Analog Scale Foot & Ankle. The Foot Function Index and the American Orthopaedics Foot and Ankle Foundation Ankle-Hindfoot Scale and Hallux Metatarsophalangeal-Interphalangeal Scale were used to assess the foot function. The general functional status of the lower extremities was evaluated using the Lower Extremity Functional Scale. RESULTS: Foot function was better in patients with a low level of kinesiophobia (p < 0.05). Pain was higher in patients with high level of kinesiophobia than in patients with a low level of kinesiophobia (p < 0.05). There was no difference between the groups in terms of foot posture index and muscle tightness (p > 0.05). The general lower extremity function was more negatively affected in patients with a high level of kinesiophobia (p < 0.05). CONCLUSIONS: Patients with a high level of kinesiophobia presented with more functional problems in the foot and whole lower extremity; hence, function-based rehabilitation and pain coping strategies should be a crucial part of the rehabilitation program at the earliest opportunity.

Comparison of gait variability and symmetry in trained individuals with transtibial and transfemoral limb loss.

PURPOSE: Gait variability is a determinant of qualified locomotion and is useful for monitoring the effects of therapeutic interventions. The aim of this study was to compare gait variability and symmetry in trained individuals with transtibial (TT) amputation and transfemoral (TF) amputation. METHODS: The design of this study was planned as observational. Eleven individuals with TF amputation, 14 individuals with TT amputation, and 14 healthy individuals (HI) were evaluated with a motorized treadmill. The mean step length, the step length variability, an ambulation index, and the time on each foot (stance phase symmetry) of participants were recorded. RESULTS: There were differences between the three groups in the residual/non-preferred limb (RNp) step length ( p = 0.031), the intact/preferred (IP) limb step length variability ( p = 0.001), the RNp step length variability ( p < 0.001), the time on each foot ( p < 0.001), and the ambulation index score ( p < 0.001). There was a similarity between the groups (TF, TT, HI) in IP limb step lengths ( p = 0.127) and duration of prosthesis usage since amputation in individuals with lower limb loss ( p = 0.224). CONCLUSIONS: This study provided basic data about gait variability and symmetry in individuals with traumatic lower limb loss. The results of the study showed that the variability of gait increased with the level of loss, and individuals with TT amputation showed partially equivalent performance with the healthy group. Similarities in gait characteristics may have resulted from effective prosthetic usage or effective gait rehabilitation.

Effects of arm swing on spatiotemporal characteristics of gait in unilateral transhumeral amputees.

BACKGROUND: Gait is an autonomic process consisting of coordinated movements of the upper extremities, lower extremities, trunk and pelvis. However, researches regarding effects of upper extremity problems on gait parameters are limited. RESEARCH QUESTION: The aim of this study was to investigate the effects of arm swing on spatiotemporal characteristics of gait in individuals with unilateral transhumeral amputations. METHODS: A total of 25 unilateral transhumeral amputees and 25 healthy subjects were included. Information on the demographic features of individuals, amputations, and prosthetic devices were recorded. Spatiotemporal characteristics of gait were obtained using the GAITRite electronic walkway, and the arm swing was evaluated with the two video-cameras and analyzed using the Dartfish Pro Suite 7 software. RESULTS: The groups were similar regarding their age, height and weight. Mean duration from the amputation was 14.91 ± 10.90 years, and the mean weight of the prostheses was 1.44 ± 0.39 kg. Amputees had a less ambulatory arm swing on their amputated sides compared to their intact arms and healthy individuals. When the amputee group was compared to the healthy individuals, their step and stride lengths were shorter and their foot progression angle was higher, their gait velocity and cadence were lower than the healthy group. SIGNIFICANCE: The reduction of arm swing on the amputated side in unilateral transhumeral amputees is thought to be due to (1) use of the contralateral side in functional activities, (2) restriction of shoulder joint movement of socket boundaries and (3) fixed mechanical elbow joint. It has been thought that a decrease in the arm swing during walking may lead to a decrease in step length, stride length, and gait velocity.

Learning effect of dynamic postural stability evaluation system.

BACKGROUND: Repeated exposure to a given perturbation of the postural control system has been shown to cause learning of more efficient postural strategies for maintaining balance both within a session and over time. It is important to show whether outcomes from treatment strategies are related to the effectiveness of training or are the result of the learning of the test process. OBJECTIVE: To investigate the learning effect of the dynamic postural stability evaluation system. METHODS: We studied 20 healthy young subjects (13 females and 7 males), with a mean age of 22.3 ± 1.9 years. Limits of stability and postural sway were assessed. All participants completed the standardized dynamic postural stability evaluation test (Bertec, Bertec Corporation, Columbus, OH, USA) seven times. The test was performed in both eyes open and eyes closed conditions. RESULTS: There were differences in the limits of stability scores for backward (p= 0.042), left side (p= 0.05), and the total score (p= 0.04). There were significant differences in postural sway anteroposterior direction in perturbed surface with eyes closed condition (p= 0.004) and total limits of stability scores of perturbed surface with eyes closed condition (p= 0.046). CONCLUSIONS: The study showed that balance test scores stabilized at different sessions from 1st to 3rd assessment period. Maximum normalized scores were reached at the third trial.