Genetic Variants in WNT16 and PKD2L1 Locus Affect Heel Ultrasound Bone Stiffness: Analyses from the General Population and Patients Evaluated for Osteoporosis.

Osteoporosis, a complex chronic disease with increasing prevalence, is characterised by reduced bone mineral density (BMD) and increased fracture risk. The high heritability of BMD suggests substantial impact of the individual genetic disposition on bone phenotypes and the development of osteoporosis. In the past years, genome-wide association studies (GWAS) identified hundreds of genetic variants associated with BMD or osteoporosis. Here, we analysed 1103 single nucleotide polymorphisms (SNPs), previously identified as associated with estimated BMD (eBMD) in the UK Biobank. We assessed whether these SNPs are related to heel stiffness index obtained by quantitative ultrasound in 5665 adult participants of the Study of Health in Pomerania (SHIP). We confirmed 45 significant associations after correction for multiple testing. Next, we analysed six selected SNPs in 631 patients evaluated for osteoporosis [rs2707518 (CPED1/WNT16), rs3779381 (WNT16), rs115242848 (LOC101927709/EN1), rs10239787 (JAZF1), rs603424 (PKD2L1) and rs6968704 (JAZF1)]. Differences in minor allele frequencies (MAF) of rs2707518 and rs3779381 between SHIP participants (higher MAF) and patients evaluated for osteoporosis (lower MAF) indicated a protective effect of the minor allele on bone integrity. In contrast, differences in MAF of rs603424 indicated a harmful effect. Co-localisation analyses indicated that the rs603424 effect may be mediated via stearoyl-CoA desaturase (SCD) expression, an enzyme highly expressed in adipose tissue with a crucial role in lipogenesis. Taken together, our results support the role of the WNT16 pathway in the regulation of bone properties and indicate a novel causal role of SCD expression in adipose tissue on bone integrity.

On the morphological relations of the Achilles tendon and plantar fascia via the calcaneus: a cadaveric study.

Current treatments of plantar fasciitis are based on the premise that the Achilles tendon (AT) and plantar fascia (PF) are mechanically directly linked, which is an area of debate. The aim of this study was to assess the morphological relationship between the AT and PF. Nineteen cadaveric feet were x-ray imaged, serially sectioned and plastinated for digital image analyses. Measurements of the AT and PF thicknesses and cross-sectional areas (CSA) were performed at their calcaneal insertion. The fiber continuity was histologically assessed in representative subsamples. Strong correlations exist between the CSA of the AT and PF at calcaneal insertion and the CSA of PF's insertional length (r = 0.80), and between the CSAs of AT's and PF's insertional lengths. Further correlations were observed between AT and PF thicknesses (r = 0.62). This close morphological relationship could, however, not be confirmed through x-ray nor complete fiber continuity in histology. This study provides evidence for a morphometric relationship between the AT and PF, which suggests the presence of a functional relationship between these two structures following the biological key idea that the structure determines the function. The observed morphological correlations substantiate the existing mechanical link between the AT and PF via the posterior calcaneus and might explain why calf stretches are a successful treatment option for plantar heel pain.

Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis.

CONTEXT: Plantar fasciitis (PF) is a common condition in active individuals. The lack of agreement on PF etiology makes treatment challenging and highlights the importance of understanding risk factors for preventive efforts. OBJECTIVE: The purpose of this systematic review and meta-analysis was to determine what factors may put physically active individuals at risk of developing PF. DATA SOURCES: CENTRAL, CINAHL, EMBASE, Gray Lit, LILACS, MEDLINE (PubMed), ProQuest, Scopus, SPORTDiscus, and Web of Science were searched through April 2018 and updated in April 2020. STUDY SELECTION: Studies were included if they were original research investigating PF risk factors, compared physically active individuals with and without PF, were written in English, and were accessible as full-length, peer-reviewed articles. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 3, because of inconsistent definitions and blinding used in the included observational studies. DATA EXTRACTION: Data on sample characteristics, study design and duration, groups, PF diagnosis, and risk factors were extracted. The methodological quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement. When means and standard deviations of a particular risk factor were presented 2 or more times, that risk factor was included in the meta-analysis. RESULTS: Sixteen studies were included in the systematic review and 11 risk factors in the meta-analysis. Increased plantarflexion range of motion (weighted mean difference [MD] = 7.04°; 95% CI, 5.88-8.19; P < 0.001), body mass index (MD = 2.13 kg/m2; 95% CI, 1.40-2.86; P < 0.001; I2 = 0.00%), and body mass (MD = 4.52 kg; 95% CI, 0.55-8.49; P = 0.026) were risk factors for PF. CONCLUSION: Interventions focused on addressing a greater degree of plantarflexion range of motion, body mass index, and body mass and their load on the force-absorbing plantar surface structures may be a good starting point in the prevention and treatment of active individuals with PF.

The Role of Weightbearing Computed Tomography Scan in Hallux Valgus.

BACKGROUND: Hyperpronation of the first metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and to understand its association with other standard measurements. METHODS: Retrospective evaluation of WBCT and weightbearing radiographs (WBXRs) was performed for 20 patients with HV feet and 20 controls with no such deformity. Axial computed tomography images of both groups were compared for the first metatarsal pronation angle (alpha angle) and tibial sesamoid subluxation (TSS) grades. The HV angle (HVA), first-second intermetatarsal angle (IMA), first metatarsal-medial cuneiform angle (MMCA), Meary's angle, and calcaneal pitch (CP) angle of the study and control groups were compared on both WBXR and the corresponding 2-dimensional images of WBCT. All measurements were independently performed by 1 musculoskeletal radiology fellow and 1 foot and ankle surgical fellow. Measurements were averaged and interobserver reliability was calculated. RESULTS: The HV group demonstrated significantly higher values for TSS grade (P < .001) but not for alpha angle (P = .121) compared with controls. Likewise, significantly elevated HVA and IMA were noted in the HV group on both imaging modalities, while no such differences were observed for the CP angle. Higher MMCA and Meary's angle in the HV group were evident only on WBXR (MMCA, P = .039; Meary's, P = .009) but not on WBCT (MMCA, P = .183; Meary's, P = .171).Among all, the receiver operating characteristic (ROC) curves demonstrated the greatest area under the curve (AUC) for HVA, followed by IMA. The alpha angle performed only just outside the range of chance (AUC, 0.65; 95% CI, 0.52-0.69). The Pearson's correlations of the alpha angle, in the HV group, revealed a significant linear relationship with TSS grade and with HVA on WBXR, and only trended toward a weak linear relationship with IMA and with HVA on WBCT. CONCLUSION: The alpha angle, a measure of abnormal hyperpronation of the first metatarsal, was an independent factor that may coexist with other parameters in HV, but in isolation had limited diagnostic utility. "Abnormal" alpha angles were even observed in individuals without HV. Increases in IMA and MMCA were not necessarily associated with similar increases in alpha angle, despite moderate correlations with TSS grade and HVA on WBXR. Nevertheless, the WBCT was a useful method for assessing hyperpronation and guiding surgical management in individual cases. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Using point clouds to investigate the relationship between trabecular bone phenotype and behavior: An example utilizing the human calcaneus.

OBJECTIVES: The objective of this study is to demonstrate a new method for analyzing trabecular bone volume fraction and degree of anisotropy in three dimensions. METHODS: We use a combination of automatic mesh registration, point-cloud correspondence registration, and P-value corrected univariate statistical tests to compare bone volume fraction and degree of anisotropy on a point by point basis across the entire calcaneus of two human groups with different subsistence strategies. RESULTS: We found that the patterns of high and low bone volume fraction and degree of anisotropy distribution between the Black Earth (hunter-gatherers) and Norris Farms (mixed-strategy agriculturalists) are very similar, but differ in magnitude. The hunter-gatherers exhibit higher levels of bone volume fraction and less anisotropic trabecular bone organization. Additionally, patterns of bone volume fraction and degree of anisotropy in the calcaneus correspond well with biomechanical expectations of relative forces experienced during walking and running. CONCLUSIONS: We conclude that comparing site-specific, localized differences in trabecular bone variables such as bone volume fraction and degree of anisotropy in three-dimensions is a powerful analytical tool. This method makes it possible to determine where similarities and differences between groups are located within the whole skeletal element of interest. The visualization of multiple variables also provides a way for researchers to see how the trabecular bone variables interact within the morphology, and allows for a more nuanced understanding of how they relate to one another and the broader mechanical environment.

Gorilla calcaneal morphological variation and ecological divergence.

OBJECTIVES: The primate foot has been extensively investigated because of its role in weight-bearing; however, the calcaneus has been relatively understudied. Here we examine entire gorilla calcaneal external shape to understand its relationship with locomotor behavior. MATERIALS AND METHODS: Calcanei of Gorilla gorilla gorilla (n = 43), Gorilla beringei graueri (n = 20), and Gorilla beringei beringei (n = 15) were surface or micro-CT scanned. External shape was analyzed through a three-dimensional geometric morphometric sliding semilandmark analysis. Semilandmarks were slid relative to an updated Procrustes average in order to minimize the bending energy of the thin plate spline interpolation function. Shape variation was summarized using principal components analysis of shape coordinates. Procrustes distances between taxa averages were calculated and resampling statistics run to test pairwise differences. Linear measures were collected and regressed against estimated body mass. RESULTS: All three taxa exhibit statistically different morphologies (p < .001 for pairwise comparisons). G. g. gorilla demonstrates an anteroposteriorly elongated calcaneus with a deeper cuboid pivot region and mediolaterally flatter posterior talar facet. G. b. beringei possesses the flattest cuboid and most medially-angled posterior talar facets. G. b. graueri demonstrates intermediate articular facet morphology, a medially-angled tuberosity, and an elongated peroneal trochlea. DISCUSSION: Articular facet differences separate gorillas along a locomotor gradient. G. g. gorilla is adapted for arboreality with greater joint mobility, while G. b. beringei is adapted for more stereotypical loads associated with terrestriality. G. b. graueri's unique posterolateral morphology may be due to a secondary transition to greater arboreality from a more terrestrial ancestor.

Calcaneus height is a key morphological factor of sprint performance in sprinters.

This study examined the relationships between the foot bone morphologies and sprint performance in sprinters. Foot images in 56 male sprinters obtained using magnetic resonance imaging. The relative lengths of the forefoot bones of the big and second toes, which were calculated as total lengths of the forefoot bones for each toe normalized to the foot length, correlated significantly with personal best 100-m sprint time (r = - 0.293 and - 0.459, both Ps < 0.05). The relative lengths of the rearfoot talus and calcaneus normalized to the foot length also correlated significantly with the sprint performance (r = - 0.378 and - 0.496, both Ps < 0.05). Furthermore, the relative height of the calcaneus, but not the talus, normalized to body height correlated significantly with sprint performance (r = - 0.690, P < 0.001). Additionally, the relative calcaneus height correlated significantly with the foot arch height index (r = 0.420, P = 0.001), and the foot arch height index correlated significantly with sprint performance (r = - 0.517, P < 0.001). These findings suggest that the taller calcaneus may be a key morphological factor for achieving superior sprint performance, potentially via modeling the longer forefoot and rearfoot bones and functional foot morphology in sprinters.

An ossifying bridge - on the structural continuity between the Achilles tendon and the plantar fascia.

Highly regular aligned trabeculae are found in the superficial posterior and inferior calcaneus appearing to connect the Achilles tendon (AT) to the plantar fascia (PF) in a bridge-like manner. This provides a morphological basis for the stretching-based heel pain treatment. However, the continuity of collagen fibres between the AT and the PF remains debated controversially to date. The given study morphologically investigated the AT-calcaneus-PF complex using histology and plastination. Moreover, the AT-calcaneus-PF complex was biomechanically mapped based on 13 sub-regions with a total of 76 tested samples. Regular calcaneal trabeculae were surrounded by tendon-like collagen fibre bundles and adipocytes. The orientation of calcaneal trabeculae was further closely related to the course of the PF collagen fibre bundles. The pooled biomechanical analysis revealed low elastic moduli (minimum = 4 MPa) and ultimate tensile strengths of the decalcified calcaneal samples (minimum = 0.4 MPa) and the calcaneal periostea (minimum = 2 MPa) and high respective values (elastic modulus maximum of 144 MPa; ultimate tensile strength maximum of 29 MPa) for the PF samples compared to the other sub-regions. This study provides structural evidence for a morphological connection between the AT and PF via the highly aligned calcaneal trabeculae of the posterior calcaneus. The AT-calcaneus-PF complex was biomechanically mapped to allow for an assessment of its site-dependent mechanical characteristics.

Cross-sectional and longitudinal associations between physical activity, sedentary behaviour and bone stiffness index across weight status in European children and adolescents.

BACKGROUND: The associations between physical activity (PA), sedentary behaviour (SB) and bone health may be differentially affected by weight status during growth. This study aims to assess the cross-sectional and longitudinal associations between PA, SB and bone stiffness index (SI) in European children and adolescents, taking the weight status into consideration. METHODS: Calcaneus SI was first measured by quantitative ultrasound among children aged 2-9 years old in 2007/08. It was measured again after 2 years in the IDEFICS study and after 6 years in the I. Family study. A sample of 2008 participants with time spent at sports clubs, watching TV and playing computer/games self-reported by questionnaire, and a subsample of 1037 participants with SB, light PA (LPA) and moderate-to-vigorous PA (MVPA) objectively measured using Actigraph accelerometers were included in the analyses. Weight status was defined as thin/normal and overweight/obese according to the extended International Obesity Task Force criteria. Linear mixed-effects models were used to estimate the cross-sectional and longitudinal associations between PA, SB and SI percentiles, stratified by weight status. RESULTS: The cross-sectional association between weekly duration of watching TV and SI percentiles was negative in thin/normal weight group (ß = - 0.35, p = 0.008). However, baseline weekly duration of watching TV (ß = - 0.63, p = 0.021) and change after 2 years (ß = - 0.63, p = 0.022) as well as the change in weekly duration of playing computer/games after 6 years (ß = - 0.75, p = 0.019) were inversely associated with corresponding changes in SI percentiles in overweight/obese group. Change in time spent at sports clubs was positively associated with change in SI percentiles after 2 years (ß = 1.28, p = 0.001), with comparable effect sizes across weight status. In the subsample with accelerometer data, we found a positive cross-sectional association between MVPA and SI percentiles in thin/normal weight group. Baseline MVPA predicted changes in SI percentiles after 2 and 6 years in all groups. CONCLUSIONS: Our results suggested the beneficial effect of PA on SI. However, the increasing durations of screen-based SB might be risk factors for SI development, especially in overweight/obese children and adolescents.

Knee Osteoarthritis Grade does not Correlate with Quadriceps Muscle Strength or Bone Properties of the Calcaneus in Men Aged 80 Years or More who Can Walk independently.

Purpose: Muscle weakness and bone deterioration in the elderly are related to falls and fractures, resulting in decreased mobility. Knee osteoarthritis also may contribute to falls and fractures and thereby affect mortality rates. The Kellgren-Lawrence (KL) classification is widely used in the radiographic evaluation of knee osteoarthritis. Aims: This study aimed to evaluate the quadriceps strength and bone properties of the calcaneus for each KL grade, and to clarify the impact of knee osteoarthritis grade on quadriceps strength and bone properties. Methods: This prospective cross-sectional study included data on 108 male patients (213 knees), aged ≥80 years, who could walk independently. A handheld dynamometer was used to measure quadriceps strength. Bone properties were evaluated using broadband ultrasound attenuation with a portable bone densitometer. Weight-bearing standing knee radiographs were evaluated using KL classification. Quadriceps strength and bone properties were evaluated for each KL grade and the correlations between the grade and quadriceps strength and bone properties were assessed simultaneously. Results: The numbers of participants in KL grades I-IV were 46, 102, 45, and 20, respectively. There were no differences among grades for either quadriceps strength or bone properties. Conclusions: Participants exhibited good quadriceps strength and bone properties regardless of their KL grade. Relatively high mechanical loading of muscle and bone incurred while walking independently, likely explaining this result. Clinically, this study demonstrated the absence of correlations between KL grade and quadriceps strength and bone properties, as was previously reported in studies showing the absence of a correlation between KL grade and pain.

Evidence for an elongated Achilles tendon in Australopithecus.

Modern humans have the longest Achilles tendon (AT) of all the living primates. It has been proposed that this anatomy increases locomotor efficiency and that its elongation may have played a crucial role in the origin and early evolution of the genus Homo. Unfortunately, determining the length of the AT in extinct hominins has been difficult as tendons do not fossilize. Several methods have been proposed for estimating the length of the AT from calcaneal morphology, but the results have been inconclusive. This study tested the relationship between the area of the superior calcaneal facet and AT length in extant primates. The superior facet is instructive because it anchors the retrocalcaneal bursa, a soft tissue structure which helps to reduce friction between the AT and the calcaneus. Calcanei from 145 extant anthropoid primates from 12 genera were photographed in posterior view and the relative superior facet size quantified. AT lengths were obtained from published sources. The relative area of the superior facet is predictive of AT length in primates (R2 = 0.83; p < .001) and differs significantly between the great apes and humans (p < 0.001). When applied to fossil Australopithecus calcanei, our results suggest that australopiths possessed a longer, more human-like, AT than previously thought. These findings have important implications for the locomotor capabilities of Australopithecus, including their capacity for endurance running and climbing.

Microstructural modeling of Achilles Tendon biomechanics focusing on bone insertion site.

The interface between the Achilles Tendon (AT) and calcaneus comprises soft and hard connective tissues. Such interfaces are vulnerable to mechanical damage. Tendon to Bone Insertion Region (TBIR) has unique microstructural characteristics for reinforcement. This region constitutes almost 10% of the AT's distal end. The rest of the tendon (tendon proper) has longitudinal fiber orientation with no mineral content. Although, the TBIR lacks longitudinally organized fibers and at the same time, incorporates mineral molecules. In this study, a 3D computational model of the TBIR proposed to underline several reinforcement mechanisms. The obtained results showed that off-axis alignment of fibers, when coupled with the mineral deposition, shifts the stress concentration region to the tendon proper. In the case of altering each parameter individually, probable failure observed in the bone interface, which causes complications in surgical procedure or during healing. A gradual increase of mineral compensates for the stiffness mismatch between the AT and calcaneus. The proposed computational framework illustrated the complementary roles of fiber orientation and mineral molecules: nearly transverse orientation of fibers alleviated the stress concentration locally, while mineral deposition directly enhanced the TBIR stiffness.

Disparities in bone density across contemporary Amazonian forager-horticulturalists: Cross-population comparison of the Tsimane and Shuar.

OBJECTIVES: This study investigates bone density across the life course among Bolivian Tsimane and Ecuadorian Shuar of Amazonia. Both groups are rural, high-fertility forager-horticulturalists, with high lifetime physical activity levels. We test whether Tsimane and Shuar bone density patterns are different from each other, and if both groups are characterized by lower osteoporosis risk compared to U.S. references. METHODS: Anthropometric and calcaneal bone density data, obtained via quantitative ultrasonometry (QUS), were collected from 678 Tsimane and 235 Shuar (13-92 years old). Population and sex differences in QUS values (estimated bone mineral density, speed of sound, broadband ultrasound attenuation) by age group were assessed using Mann-Whitney U tests. Age-related change and age at peak QUS value were determined using polynomial regressions. One-way analyses of covariance assessed population-level differences in QUS values by age group adjusting for body mass index. Participants aged 50+ years at elevated osteoporosis risk were identified using a T score < -1.8; binomial tests assessed risk compared to U.S. references. RESULTS: Shuar males and females <50 years old have QUS values 3-36% higher than Tsimane, with differences evident in adolescence. Among Tsimane and Shuar, 49 and 23% of participants aged 50+ years old, respectively, are at high risk for osteoporosis, compared to 34% of Americans; Shuar osteoporosis risk is comparable to Americans, while Tsimane risk is elevated. CONCLUSIONS: Disparate patterns in QUS values are documented for Tsimane and Shuar, with pronounced differences early in life. Potential explanations for differences include gene-environment interactions and/or degree of market integration, which influences diet, activity profiles, pathogen exposures, and other lifestyle covariates. As Tsimane osteoporosis risk is greater than in the United States, findings point to alternative risk factors for low bone density that are not readily discernible in industrialized populations.

Combined Effect of Osteoporosis and Poor Dynamic Balance on the Incidence of Sarcopenia in Elderly Chinese Community Suburban-Dwelling Individuals.

OBJECTIVES: Given the increasing prevalence of osteoporosis and the important role dynamic balanced plays in the assessment of muscle function, we aimed to examine the joint and separate effects of osteoporosis and poor dynamic balance on the incidence of sarcopenia in Chinese elderly individuals. DESIGN: This study was conducted on 658 (44.4% male) Chinese suburban-dwelling participants with a mean age of 68.42 ± 5.43 years who initially had no sarcopenia and were aged ≥60 years. A quantitative ultrasound scan of each participant's calcaneus with a T score less than -2.5 was used to identify the prevalence of osteoporosis. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria. We assessed dynamic balance using the Timed Up and Go Test (TUGT). Participants who scored in the top 20% on the TUGT were defined as having poor dynamic balance. RESULTS: After a follow-up of three years, the incidence of sarcopenia in the general population was 8.1% (9.6% in males, 6.8% in females). The incidence of sarcopenia was progressively greater in people suffering from both osteoporosis and poor dynamic balance (OR=2.416, 95%CI=1.124-5.195) compared to those who only had osteoporosis (OR=0.797, 95%CI=0.378-1.682) or poor dynamic balance (OR=1.226, 95%CI=0.447-3.363) in models without adjustments. Even after adjusting for potential confounders, the result still held true (OR=2.431, 95%CI=1.053-5.614). CONCLUSIONS: In our study, we found individuals who suffered from both osteoporosis and poor dynamic balance simultaneously had a significantly higher incidence of sarcopenia than those who suffered from either one or the other.

Microwave tomography with phaseless data on the calcaneus by means of artificial neural networks.

The aim of this study is to use a multilayer perceptron (MLP) artificial neural network (ANN) for phaseless imaging the human heel (modeled as a bilayer dielectric media: bone and surrounding tissue) and the calcaneus cross-section size and location using a two-dimensional (2D) microwave tomographic array. Computer simulations were performed over 2D dielectric maps inspired by computed tomography (CT) images of human heels for training and testing the MLP. A morphometric analysis was performed to account for the scatterer shape influence on the results. A robustness analysis was also conducted in order to study the MLP performance in noisy conditions. The standard deviations of the relative percentage errors on estimating the dielectric properties of the calcaneus bone were relatively high. Regarding the calcaneus surrounding tissue, the dielectric parameters estimations are better, with relative percentage error standard deviations up to ≈ 15%. The location and size of the calcaneus are always properly estimated with absolute error standard deviations up to ≈ 3 mm. Microwave tomography of the calcaneus using phaseless data. Simulations were inspired in Computed Tomography images from real heels (above). Inverse problem was solved using Multilayer Perceptron Artificial Neural Network (below).

Onset of neonatal locomotor behavior and the mechanical development of Achilles and tail tendons.

Tendon tissue engineering approaches are challenged by a limited understanding of the role mechanical loading plays in normal tendon development. We propose that the increased loading that developing postnatal tendons experience with the onset of locomotor behavior impacts tendon formation. The objective of this study was to assess the onset of spontaneous weight-bearing locomotion in postnatal day (P) 1, 5, and 10 rats, and characterize the relationship between locomotion and the mechanical development of weight-bearing and non-weight-bearing tendons. Movement was video recorded and scored to determine non-weight-bearing, partial weight-bearing, and full weight-bearing locomotor behavior at P1, P5, and P10. Achilles tendons, as weight-bearing tendons, and tail tendons, as non-weight-bearing tendons, were mechanically evaluated. We observed a significant increase in locomotor behavior in P10 rats, compared to P1 and P5. We also found corresponding significant differences in the maximum force, stiffness, displacement at maximum force, and cross-sectional area in Achilles tendons, as a function of postnatal age. However, the maximum stress, strain at maximum stress, and elastic modulus remained constant. Tail tendons of P10 rats had significantly higher maximum force, maximum stress, elastic modulus, and stiffness compared to P5. Our results suggest that the onset of locomotor behavior may be providing the mechanical cues regulating postnatal tendon growth, and their mechanical development may proceed differently in weight-bearing and non-weight-bearing tendons. Further analysis of how this loading affects developing tendons in vivo may inform future engineering approaches aiming to apply such mechanical cues to regulate engineered tendon formation in vitro.

The relationship between foot posture index and resting calcaneal stance position in elementary school students.

BACKGROUND: Static foot assessment is commonly performed in clinical practice to classify foot type for prescribing therapeutic interventions. Foot posture index is known to be a reliable indicator for foot position. Resting calcaneal stance position angle is used widely to determine foot posture and manufacture orthoses for pediatric flat foot patients. However, the relationship between foot posture index and resting calcaneal stance position angle in elementary school students is currently unclear. RESEARCH QUESTION: To investigate the relationship between foot posture index and resting calcaneal stance position angle in elementary school students. METHODS: Between January 2016 and December 2017, 208 elementary school students (average age, 10.3 years; range, 8-13 years) were enrolled for this study. All students were examined physically by one practitioner to measure foot posture index and resting calcaneal stance position angle. Age, gender, and body mass index were analyzed for factors associated with flat foot prevalence. This study was conducted as a retrospective comparative study. Associations between foot posture index and resting calcaneal stance position angle were determined by Pearson's correlation analysis. RESULTS AND SIGNIFICANCE: When measured by foot posture index and resting calcaneal stance position angle, the overall prevalence of flatfoot was 29% and 24% in the right foot and 26% and 23% in the left foot, respectively. Resting calcaneal stance position angle and foot posture index score showed moderate correlation in Pearson's correlation analysis (left side foot: kappa value = 0.710; right side foot: kappa value = 0.704). CONCLUSION: There is a moderate correlation between foot posture index and resting calcaneal stance position angle in elementary school students. Thus, both foot posture index with proven validity and reliability and resting calcaneal stance position widely used in the manufacture of insoles can be used as important biomechanical evaluation tools for feet in clinical settings.

Unholey shoes: Experimental considerations when estimating ankle joint complex power during walking and running.

For studies that aim to assess biological ankle function, calculating ankle joint complex (AJC) power between the calcaneus and shank is recommended over conventional inverse dynamics estimates between a rigid-body foot and shank. However, when designing a new experiment, it remains unclear whether holes should be cut in footwear to permit motion tracking via skin-mounted markers, or whether marker placement locations should be tightly controlled across conditions. Here we provide data to assist researchers in answering these questions. We performed a gait analysis study of walking (0.8, 1.2, 1.6 m·s-1) and running (2.6, 2.8, 3.0 m·s-1) while subjects (N = 10) wore custom-modified footwear, which allowed markers to be placed either on the shoe, or on the skin via cut-out windows in the shoes. First, we compared foot markers affixed to the skin vs. on the same locations on the shoe. Using statistical non-parametric mapping techniques, we discovered that skin vs. shoe markers had no statistically significant effect on net AJC power estimates throughout stance phase, for all walking and running speeds. Second, we compared calcaneal markers in the nominal shoe configuration vs. markers in a nearby location (∼27 mm below) on the shoe. We observed significant differences when marker placement on the shoe was varied, which may be relevant to repeated-measures study designs. The results suggest that when computing AJC power for walking and running, you may want to put down the scissors (i.e., forego cutting holes in your footwear), and instead pick up a Sharpie® (pen) or use a template, to maintain consistent marker placement across trials and conditions.

Relationship between physical activity, dietary intake and bone parameters in 10-12 years old Hungarian boys and girls.

OBJECTIVES: Physical activity (PA) and adequate macro- and micronutrient intake have favourable influence on the bone status. The aim of this study was to analyse the relationships among PA, anthropometric data, dietary intake and ultrasound bone characteristics in children. METHODS: 10-12 years old Hungarian children (N = 123, 59 girls, 64 boys) provided physical activity, diet, anthropometric and bone data. PA was measured with accelerometer (Actigraph GT3X+). Diet was evaluated with three-day, 24-hour food recall. Calcaneal quantitative ultrasound (QUS) bone parameters were registered with Sonost3000 bone densitometer. RESULTS: Nutrition and anthropometry did not differ by gender. The values of broadband ultrasound attenuation (BUA) were significantly higher in boys. Girls spent significantly more time being sedentary, boys had greater light, moderate, vigorous, and moderate to vigorous physical activity (MVPA) levels. The children accumulated more than twice the suggested amount of public health guidelines for MVPA. QUS parameters correlated significantly with vigorous physical activity in boys, and with age, height, weight, fat percentage, and body mass index (BMI) for both genders. There was no significant relationship between nutrition and QUS; however, inadequate vitamin K intake correlated with less favourable bone parameters. Multiple linear regression analysis confirmed the importance of vigorous PA - speed of sound (SOS): ß = 0.358, p = 0.006; BUA: ß = 0.340, p = 0.007; bone quality index (BQI): ß = 0.377, p = 0.002; vitamin K intake - SOS: ß = 0.256, p = 0.025; BUA: ß = 0.235, p = 0.033; BQI: ß = 0.295, p = 0.007; BMI - SOS: ß = 0.207, p = 0.064; BUA: ß = 0.455, p < 0.001; BQI: ß = 0.284, p = 0.008; and age - SOS: ß = 0.450, p < 0.001; BUA: ß = 0.318, p = 0.004; BQI: ß = 0.444, p < 0.001). CONCLUSIONS: Changes in the characteristics of ultrasound bone parameters among 10-12 years old children mainly depended on the amount of intense PA, adequate vitamin K intake and anthropometric variables related to age.

Meta-Analysis of Genome-Wide Association Studies Identifies Three Loci Associated With Stiffness Index of the Calcaneus.

The stiffness index (SI) from quantitative ultrasound measurements is a good indicator of BMD and may be used to predict the risk of osteoporotic fracture. We conducted a genomewide association study (GWAS) for SI using 7742 individuals from the Taiwan Biobank, followed by a replication study in a Korean population (n = 2955). Approximately 6.1 million SNPs were subjected to association analysis, and SI-associated variants were identified. We further conducted a meta-analysis of Taiwan Biobank significant SNPs with a Korean population-based cohort. Candidate genes were prioritized according to epigenetic annotations, gene ontology, protein-protein interaction, GWAS catalog, and expression quantitative trait loci analyses. Our results revealed seven significant single-nucleotide polymorphisms (SNPs) within three loci: 7q31.31, 17p13.3, and 11q14.2. Conditional analysis showed that three SNPs, rs2536195 (CPED1/WNT16), rs1231207 (SMG6), and rs4944661 (LOC10050636/TMEM135), were the most important signals within these regions. The associations for the three SNPs were confirmed in a UK Biobank estimated BMD GWAS; these three cytobands were replicated successfully after a meta-analysis with a Korean population cohort as well. However, two SNPs were not replicated. After prioritization, we identified two novel genes, RAB15 and FNTB, as strong candidates for association with SI. Our study identified three SI-associated SNPs and two novel SI-related genes. Overall, these results provide further insight into the genetic architecture of osteoporosis. Further studies in larger East Asian populations are needed. © 2019 American Society for Bone and Mineral Research.