A laboratory captured ‘giving way’ episode during a single-leg landing task in an individual with unilateral chronic ankle instability

An episode of ‘giving way’ at the ankle is described as excessive inversion of the rearfoot that does not result in an acute ankle sprain and is a unique feature associated with chronic ankle instability (CAI). Limited data currently exists describing the preparatory movement patterns and those that occur during an episode of ‘giving way. Therefore, this case report describes the movement patterns and the forces generated during an unintentional ‘giving way’ captured while an individual with unilateral CAI was performing a single-leg landing task in a research laboratory. The participant completed five single-leg landing trials for both limbs. 3D lower extremity kinematics and kinetics for the sagittal and frontal plane were extracted from 200 ms before and after initial contact (IC). Relative to the affected and un-affected single-leg landing trials, the ‘giving way’ episode was characterized by an increase in plantarflexion and hip extension moments before and after IC. The plantarflexion deviation dissipated (50 ms post-IC) and was followed by excessive ankle inversion. The ankle began to plantarflex again (150 ms post-IC) and the knee extended (50 ms post-IC) and adducted (100 ms post-IC). As a result, the ankle inversion angle plateaued at 150 ms post-IC. Furthermore, large sagittal plane internal joint moments were observed. In the frontal plane, the ‘giving way’ trial generated a large inversion joint moment which was counteracted by a large internal eversion joint moment. The observed plantarflexion and knee extension and adduction after initial contact likely contributed to preventing the ankle from continuing to invert and avoid an ankle sprain.     

Females and males use different hip and knee mechanics in response to symmetric military-relevant loads

The purpose of this study was to determine if females and males use different hip and knee mechanics when walking with standardized military-relevant symmetric loads. Fifteen females and fifteen males walked on a treadmill for 2-min at a constant speed under three symmetric load conditions (unloaded: 1.71 kg, medium: 15 kg, heavy: 26 kg). Kinematic and kinetics of the hip and knee were calculated in the sagittal and frontal planes of the dominant limb. In females, hip abduction moments (normalized to total mass) and sagittal knee excursion decreased with increased load (p ≤ 0.024). In males, hip frontal excursion and adduction angle increased with load (p ≤ 0.003). Females had greater peak hip adduction angle than males in the unloaded and medium load conditions (p ≤ 0.036). Across sex, sagittal hip and knee excursion, peak knee extension angle, and peak hip and knee flexion angles increased with increased load (p ≤ 0.005). When normalized to body mass, all peak joint moments increased with each load (p ≤ 0.016) except peak hip adduction moment. When normalized to total mass, peak hip adduction moment and knee flexion, extension, and adduction moments decreased with each load (p < 0.001). While hip frontal plane kinetic alterations to load were only noted in females, kinematic changes were noted in males at the hip and females at the knee. Differences in strategies may increase the risk of hip and knee injuries in females compared to males. This study noted load and sex effects that were previously undetected, highlighting the importance of using military-relevant standardized loads and investigating frontal plane adaptations.     

Lower-limb joint work and power are modulated during load carriage based on load configuration and walking speed

Soldiers regularly transport loads weighing >20 kg at slow speeds for long durations. These tasks elicit high energetic costs through increased positive work generated by knee and ankle muscles, which may increase risk of muscular fatigue and decrease combat readiness. This study aimed to determine how modifying where load is borne changes lower-limb joint mechanical work production, and if load magnitude and/or walking speed also affect work production. Twenty Australian soldiers participated, donning a total of 12 body armor variations: six different body armor systems (one standard-issue, two commercially available [cARM1-2], and three prototypes [pARM1-3]), each worn with two different load magnitudes (15 and 30 kg). For each armor variation, participants completed treadmill walking at two speeds (1.51 and 1.83 m/s). Three-dimensional motion capture and force plate data were acquired and used to estimate joint angles and moments from inverse kinematics and dynamics, respectively. Subsequently, hip, knee, and ankle joint work and power were computed and compared between armor types and walking speeds. Positive joint work over the stance phase significantly increased with walking speed and carried load, accompanied by 2.3–2.6% shifts in total positive work production from the ankle to the hip (p < 0.05). Compared to using cARM1 with 15 kg carried load, carrying 30 kg resulted in significantly greater hip contribution to total lower-limb positive work, while knee and ankle work decreased. Substantial increases in hip joint contributions to total lower-limb positive work that occur with increases in walking speed and load magnitude highlight the importance of hip musculature to load carriage walking.     

The effects of walking speed on obstacle crossing in healthy young and healthy older adults

The effects of walking speed and age on the peak external moments generated about the joints of the trailing limb during stance just prior to stepping over an obstacle and on the kinematics of the trailing limb when crossing the obstacle were investigated in 10 healthy young adults (YA) and 10 healthy older adults (OA). The peak hip and knee adduction moments in OA were 21-43% greater than those in YA (p相似文献   

Soldier-relevant loads impact lower limb biomechanics during anticipated and unanticipated single-leg cutting movements

This study quantified how body borne load impacts hip and knee biomechanics during anticipated and unanticipated single-leg cutting maneuvers. Fifteen male military personnel performed a series of single-leg cutting maneuvers with three different load configurations (light, ~6 kg, medium, ~20 kg, and heavy, ~40 kg). Subject-based means of the specific lower limb biomechanical variables were submitted to repeated measures ANOVA to test the main and interaction effects of body borne load and movement type. With body borne load, stance time (P<0.001) increased, while larger hip (P=0.027) and knee flexion (P=0.004), and hip adduction (P<0.001) moments, and decreased hip (P=0.002) and knee flexion (P<0.001), and hip adduction (P=0.003) postures were evident. Further, the hip (P<0.001) and ankle (P=0.024) increased energy absorption, while the knee (P=0.020) increased energy generation with body borne load. During the unanticipated maneuvers, the hip (P=0.009) and knee (P=0.032) increased energy generation, and peak hip flexion moment (P=0.002) increased relative to the anticipated movements. With the body borne load, participants adopted biomechanical patterns that decreased their locomotive ability including larger moments and reduced flexion postures of the lower limb. During the single-leg cut, participants used greater energy absorption from the large, proximal muscles of the hip and greater energy generation from the knee with the addition of load. Participant?s performance when carrying a range of loads was not compromised by anticipation, as they did not exhibit the hip and knee kinetic and kinematic adaptations previously demonstrated when reacting to an unplanned stimulus.     

A model-based study of passive joint properties on muscle effort during static stance

This study examined the impact of lower extremity joint stiffnesses and simulated joint contractures on the muscle effort required to maintain static standing postures after a spinal cord injury (SCI). Static inverse computer simulations were performed with a three-dimensional 15 degree of freedom musculoskeletal model placed in 1600 different standing postures. The required lower extremity muscle forces were calculated through an optimization routine that minimized the sum of the muscle stresses squared, which was used as an index of the muscle effort required for each standing posture. Joint stiffnesses were increased and decreased by 100 percent of their nominal values, and contractures were simulated to determine their effects on the muscle effort for each posture. Nominal muscle and passive properties for an individual with a SCI determined the baseline muscle effort for comparisons. Stiffness changes for the ankle plantar flexion/dorsiflexion, hip flexion/extension, and hip abduction/adduction directions had the largest effect on reducing muscle effort by more than 5 percent, while changes in ankle inversion/eversion and knee flexion/extension had the least effect. For erect standing, muscle effort was reduced by more than 5 percent when stiffness was decreased at the ankle plantar flexion/dorsiflexion joint or hip flexion/extension joint. With simulated joint contractures, the postural workspace area decreased and muscle effort was not reduced by more than 5 percent for any posture. Using this knowledge, methods can be developed through the use of orthoses, physical therapy, surgery or other means to appropriately augment or diminish these passive moments during standing with a neuroprosthesis.     

Predicting changes in knee adduction moment due to load-altering interventions from pressure distribution at the foot in healthy subjects

The purpose of this pilot study of healthy subjects was to determine if changes in foot pressure patterns associated with a lateral wedge can predict the changes in the knee adduction moment. We tested two hypotheses: (1) increases or decreases in the knee adduction moment and ankle eversion moment due to load-altering footwear interventions can be predicted from foot pressure distribution and (2) changes in magnitude of the knee adduction moment and ankle eversion moment due to lateral wedges can be predicted from pressure distribution at the foot during walking. Fifteen healthy adults performed walking trials in three shoes: 0 degrees , 4 degrees , and 8 degrees laterally wedged. Maximum heel pressure ratio, first peak knee adduction moment, and peak ankle eversion moment were assessed using a pressure mat, motion capture system, and force plate. Increases or decreases in the knee adduction moment and ankle eversion moment were predicted well from foot pressure distribution. However, the magnitude of the pressure change did not predict the magnitude of the peak knee adduction moment change or peak ankle eversion moment change. Factors such as limb alignment or trunk motion may affect the knee adduction moment and override a direct relationship between the pressure distribution at the shoe-ground interface and the load distribution at the knee. However, changes (increases or decreases) in the peak knee adduction moment due to load-altering footwear interventions predicted from pressure distribution during walking can be important when evaluating these types of interventions from a clinical perspective.     

Dual-task and anticipation impact lower limb biomechanics during a single-leg cut with body borne load

This study quantified how a dual cognitive task impacts lower limb biomechanics during anticipated and unanticipated single-leg cuts with body borne load. Twenty-four males performed anticipated and unanticipated cuts with and without a dual cognitive task with three load conditions: no load (∼6 kg), medium load (15% of BW), and heavy load (30% of BW). Lower limb biomechanics were submitted to a repeated measures linear mixed model to test the main and interaction effects of load, anticipation, and dual task. With body borne load, participants increased peak stance (PS) hip flexion (p = .004) and hip internal rotation (p = .001) angle, and PS hip flexion (p = .001) and internal rotation (p = .018), and knee flexion (p = .016) and abduction (p = .001) moments. With the dual task, participants decreased PS knee flexion angle (p < .001) and hip flexion moment (p = .027), and increased PS knee external rotation angle (p = .034). During the unanticipated cut, participants increased PS hip (p = .040) and knee flexion angle (p < .001), and decreased PS hip adduction (p = .001), and knee abduction (p = .005) and external rotation (p = .026) moments. Adding body borne load produces lower limb biomechanical adaptations thought to increase risk of musculoskeletal injury, but neither anticipation nor dual task exaggerated those biomechanical adaptations. With a dual task, participants adopted biomechanics known to increase injury risk; whereas, participants used lower limb biomechanics thought to decrease injury risk during unanticipated cuts.     

Orthoses posted in both the forefoot and rearfoot reduce moments and angular impulses on lower extremity joints during walking

The purpose of the present study was to determine the effects of orthoses designed to support the forefoot and rearfoot on the kinematics and kinetics of the lower extremity joints during walking. Fifteen participants volunteered for this study. Kinematic and kinetic variables during overground walking were compared with the participants wearing sandals without orthoses or sandals with orthoses. Orthoses increased knee internal abduction moment during late stance and knee abduction angular impulse, and reduced the medial ground reaction force during late stance, adduction free moment, forefoot eversion angle, ankle inversion moment and angular impulse, hip adduction angle, hip abduction moment, and hip external rotation moment and angular impulse (p<0.05). Orthoses decreased the torsional forces on the lower extremity and reduced the loading at the hip during walking. These findings combined with our previous studies and those of others suggest that forefoot abnormalities are critically important in influencing lower extremity kinematics and kinetics, and may underlie some non-traumatic lower extremity injuries.     

Biomechanical strategies for successful obstacle crossing with the trailing limb in older adults with medial compartment knee osteoarthritis

To investigate the biomechanical strategy adopted by older adults with medial compartment knee osteoarthritis (OA) for successful obstacle crossing with the trailing limb, and to discuss its implications for fall-prevention, 15 older adults with bilateral medial compartment knee OA and 15 healthy controls were recruited to walk and cross obstacles of heights of 10%, 20%, and 30% of their leg lengths. Kinematic and kinetic data were obtained using a three-dimensional (3D) motion analysis system and forceplates. The OA group had higher trailing toe clearance than the controls. When the trailing toe was above the obstacle, the OA group showed greater swing hip abduction, yet smaller stance hip adduction, knee flexion, and ankle eversion. They showed greater pelvic anterior tilt and toe-out angle. They also exhibited greater peak knee abductor moments during early stance and at the instant when the swing toe was above the obstacle, while a greater peak hip abductor moment was found during late stance. Smaller knee extensor, yet greater hip extensor moments, were found in the OA group throughout the stance phase. In order to achieve higher toe clearance with knee OA, particular joint kinematic and kinetic strategies have been adopted by the OA group. Weakness in the hip abductors and extensors in individuals with OA may be risk factors for tripping owing to the greater demands on these muscle groups during obstacle crossing by these individuals.     

Experimentally reduced hip abductor function during walking: Implications for knee joint loads

Hip and knee functions are intimately connected and reduced hip abductor function might play a role in development of knee osteoarthritis (OA) by increasing the external knee adduction moment during walking. The purpose of this study was to test the hypothesis that reduced function of the gluteus medius (GM) muscle would lead to increased external knee adduction moment during level walking in healthy subjects. Reduced GM muscle function was induced experimentally, by means of intramuscular injections of hypertonic saline that produced an intense short-term muscle pain and reduced muscle function. Isotonic saline injections were used as non-painful control. Fifteen healthy subjects performed walking trials at their self-selected walking speed before and immediately after injections, and again after 20 min of rest, to ensure pain recovery. Standard gait analyses were used to calculate three-dimensional trunk and lower extremity joint kinematics and kinetics. Surface electromyography (EMG) of the glutei, quadriceps, and hamstring muscles were also measured. The peak GM EMG activity had temporal concurrence with peaks in frontal plane moments at both hip and knee joints. The EMG activity in the GM muscle was significantly reduced by pain (?39.6%). All other muscles were unaffected. Peaks in the frontal plane hip and knee joint moments were significantly reduced during pain (?6.4% and ?4.2%, respectively). Lateral trunk lean angles and midstance hip joint adduction and knee joint extension angles were reduced by ?1°. Thus, the gait changes were primarily caused by reduced GM function. Walking with impaired GM muscle function due to pain significantly reduced the external knee adduction moment. This study challenge the notion that reduced GM function due to pain would lead to increased loads at the knee joint during level walking.     

Individuals with varus thrust do not increase knee adduction when running with body borne load

Osteoarthritis (OA) is a common occupational hazard for service members. This study quantified how body borne load impacts knee biomechanics for participants who do and do not present varus thrust (range of knee adduction motion exhibited from heel strike to mid-stance (0–51%)) during over-ground running. Eighteen (9 varus thrust and 9 control) military personnel had knee biomechanics recorded when running with three load conditions (light, ∼6 kg, medium, 15% BW, and heavy, 30% BW). Subject-based means for knee biomechanics were calculated and submitted to a RM ANOVA to test the main effects and possible interactions between load and varus thrust group. The varus thrust group exhibited greater varus thrust (p = .001) and peak stance (PS, 0–100%) knee adduction (p = .009) posture compared to the control group with the light load, but not for the medium (p = .741 and p = .825) or heavy loads (p = .142 and p = .429). With the heavy load, varus thrust group reduced varus thrust (p = .023), whereas, the control group increased varus thrust (p = .037) compared to the light load, and increased PS knee adduction moment compared to light (p = .006) and medium loads (p = .031). The varus thrust group, however, exhibited no significant difference in knee adduction moment between any load (p = .174). With the addition of body borne load, varus thrust participants exhibited a significant reduction in knee biomechanics related to OA; whereas, control participants adopted knee biomechanics, including greater varus thrust and knee adduction moment, related to the development of OA.     

Loading of the knee joint during activities of daily living measured in vivo in five subjects

Detailed knowledge about loading of the knee joint is essential for preclinical testing of implants, validation of musculoskeletal models and biomechanical understanding of the knee joint. The contact forces and moments acting on the tibial component were therefore measured in 5 subjects in vivo by an instrumented knee implant during various activities of daily living.Average peak resultant forces, in percent of body weight, were highest during stair descending (346% BW), followed by stair ascending (316% BW), level walking (261% BW), one legged stance (259% BW), knee bending (253% BW), standing up (246% BW), sitting down (225% BW) and two legged stance (107% BW). Peak shear forces were about 10–20 times smaller than the axial force. Resultant forces acted almost vertically on the tibial plateau even during high flexion. Highest moments acted in the frontal plane with a typical peak to peak range ?2.91% BWm (adduction moment) to 1.61% BWm (abduction moment) throughout all activities. Peak flexion/extension moments ranged between ?0.44% BWm (extension moment) and 3.16% BWm (flexion moment). Peak external/internal torques lay between ?1.1% BWm (internal torque) and 0.53% BWm (external torque).The knee joint is highly loaded during daily life. In general, resultant contact forces during dynamic activities were lower than the ones predicted by many mathematical models, but lay in a similar range as measured in vivo by others. Some of the observed load components were much higher than those currently applied when testing knee implants.     

Jogging gait kinetics following fatiguing lumbar paraspinal exercise

A relationship exists between lumbar paraspinal muscle fatigue and quadriceps muscle activation. The objective of this study was to determine whether hip and knee joint moments during jogging changed following paraspinal fatiguing exercise. Fifty total subjects (25 with self-reported history of low back pain) performed fatiguing, isometric lumbar extension exercise until a shift in EMG median frequency corresponding to a mild level of muscle fatigue was observed. We compared 3-dimensional external joint moments of the hip and knee during jogging before and after lumbar paraspinal fatigue using a 10-camera motion analysis system. Reduced external knee flexion, knee adduction, knee internal rotation and hip external rotation moments and increased external knee extension moments resulted from repetitive lumbar paraspinal fatiguing exercise. Persons with a self-reported history of LBP had larger knee flexion moments than controls during jogging. Neuromuscular changes in the lower extremity occur while resisting knee and hip joint moments following isolated lumbar paraspinal exercise. Persons with a history of LBP seem to rely more heavily on quadriceps activity while jogging.     

Normalization of joint moments during gait: a comparison of two techniques

Joint moments are commonly used to characterize gait. Factors like height and weight influence these moments. This study determined which of two commonly used normalization methods, body mass or body weight times height, most reduced the effects of height and weight on peak hip, knee, and ankle external moments during walking. The effectiveness of each normalization method in reducing gender differences was then tested. Gait data from 158 normal subjects were analyzed using unnormalized values, body mass normalized values, and body weight times height normalized values. Without normalization, height or weight accounted for 7-82% of the variance in all 10 peak components of the moments. With normalization, height and weight accounted for at most 6% of the variance with the exception of the hip adduction moment normalized by body weight times height and the ankle dorsiflexion moment normalized by body mass. For the hip adduction moment normalized by body weight times height, height still accounted for 13% of the variance (p<0.001) and for the ankle dorsiflexion moment normalized by body mass, 22% of the variance (p<0.001). After normalization, significant differences between males and females remained for only two out of 10 moments with the body weight times height method compared to six out of 10 moments with the body mass method. When compared to the unnormalized data, both normalization methods were highly effective in reducing height and weight differences. Even for the two cases where one normalization method was less effective than the other (hip adduction-body weight times height; ankle dorsiflexion-body mass) the normalization process reduced the variance ascribed to height or weight by 48% and 63%, respectively, as compared to the unnormalized data.     

A comparison of dorsal and heel plate foot tracking methods on lower extremity dynamics

The primary method to model ankle motion during inverse dynamic calculations of the lower limb is through the use of skin-mounted markers, with the foot modeled as a rigid segment. Motion of the foot is often tracked via the use of a marker cluster triad on either the dorsum, or heel, of the foot/shoe. The purpose of this investigation was to evaluate differences in calculated lower extremity dynamics during the stance phase of gait between these two tracking techniques. In an analysis of 7 subjects, it was found that sagittal ankle angles and sagittal ankle, hip and knee moments were strongly correlated between the two conditions, however, there was a significant difference in peak ankle plantar flexion and dorsiflexion angles. Frontal ankle angles were only moderately correlated and there was a significant difference in peak ankle eversion and inversion, resulting in moderate correlations in frontal plane moments and a significant difference in peak hip adductor moments. We demonstrate that the technique used to track the foot is an important consideration in interpreting lower extremity dynamics for clinical and research purposes.     

The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury

This study investigated the mechanical consequences of differences in dynamic frontal plane alignment of the support limb and the influence of anticipatory muscle activation at the hip and ankle on reducing the potential for non-contact ACL injury during single-limb landing. A frontal plane, three-link passive dynamic model was used to estimate an ACL non-contact injury threshold. This threshold was defined as the maximum axial force that the knee could sustain before the joint opened 8 degrees either medially or laterally, which was deemed sufficient to cause injury. The limb alignment and hip and ankle muscle contractions were varied to determine their effects on the ACL injury threshold. Valgus or varus alignment reduced the injury threshold compared to neutral alignment, but increasing the anticipatory contraction of hip abduction and adduction muscle groups increased the injury threshold. Increasing anticipatory ankle inversion/eversion muscle contraction had no effect. This study provides a mechanical rationale for the conclusion that a neutral limb alignment (compared to valgus or varus) during landing and increasing hip muscle contraction (abductors/adductors) prior to landing can reduce the possibility of ACL rupture through a valgus or varus opening mechanism.     

A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis

The purpose of this study was to evaluate the effectiveness of variable-stiffness shoes in lowering the peak external knee adduction moment during walking in subjects with symptomatic medial compartment knee osteoarthritis. The influence on other lower extremity joints was also investigated. The following hypotheses were tested: (1) variable-stiffness shoes will lower the knee adduction moment in the symptomatic knee compared to control shoes; (2) reductions in knee adduction moment will be greater at faster speeds; (3) subjects with higher initial knee adduction moments in control shoes will have greater reductions in knee adduction moment with the intervention shoes; and (4) variable-stiffness shoes will cause secondary changes in the hip and ankle frontal plane moments. Seventy-nine individuals were tested at self-selected slow, normal, and fast speeds with a constant-stiffness control shoe and a variable-stiffness intervention shoe. Peak moments for each condition were assessed using a motion capture system and force plate. The intervention shoes reduced the peak knee adduction moment compared to control at all walking speeds, and reductions increased with increasing walking speed. The magnitude of the knee adduction moment prior to intervention explained only 11.9% of the variance in the absolute change in maximum knee adduction moment. Secondary changes in frontal plane moments showed primarily reductions in other lower extremity joints. This study showed that the variable-stiffness shoe reduced the knee adduction moment in subjects with medial compartment knee osteoarthritis without the discomfort of a fixed wedge or overloading other joints, and thus can potentially slow the progression of knee osteoarthritis.     

Signaling of Ankle Joint Position by Receptors in Different Muscles

Plots were made of multiunit activity versus ankle joint position for receptors in each of the 12 muscles crossing the cat ankle joint, except peroneus tertius, by recording from populations of afferent fibers in muscle nerves. The discharge was measured 15 or 30 sec after terminating the movements that altered the position of the joint. These recordings were dominated by large-spike activity that would be expected to originate mainly from primary spindle endings. Seven of the 12 muscles also cross other joints. Their responses at a given ankle joint position were so altered by changes in the position of the knee or toe joints that they could not reliably signal the position of the ankle joint. As judged from multiunit recording, receptors in each of the five muscles specific to the ankle joint were influenced by more than one axis of ankle joint displacement.

Single-unit recording from dorsal root filaments was used to determine whether primary or secondary spindle receptors in soleus and tibialis anterior could selectively signal one axis of ankle joint rotation. Individual soleus receptors were tested both on the flexion extension axis and with a combined adduction–eversion movement.

For 38 of the 70 soleus receptors examined (54%), firm adduction–eversion produced a level of activity greater than that caused by 10° of flexion, and for 77% the level of activity was greater than that caused by 5° of flexion. For 168 of the 184 tibialis anterior receptors studied (91%), firm abduction inversion produced a level of activity greater than that caused by 10° of extension. Thus few receptors were found that responded exclusively to one axis of rotation.

One way in which the position of the ankle joint could be specified in the face of multiaxial receptor activity is by examining the receptor discharge from more than one muscle. A suggestion for how the nervous system might do this is given in the discussion.     

Kinematic adaptations to a variable stiffness shoe: mechanisms for reducing joint loading

A recently described variable-stiffness shoe has been shown to reduce the adduction moment and pain in patients with medial-compartment knee osteoarthritis. The mechanism associated with how this device modifies overall gait patterns to reduce the adduction moment is not well understood. Yet this information is important for applying load modifying intervention for the treatment of knee osteoarthritis. A principal component analysis (PCA) was used to test the hypothesis that there are differences in the frontal plane kinematics that are correlated with differences in the ground reaction forces (GRFs) and center of pressure (COP) for a variable-stiffness compared to a constant-stiffness control shoe. Eleven healthy adults were tested in a constant-stiffness control shoe and a variable-stiffness shoe while walking at self-selected speeds. The PCA was performed on trial vectors consisting of all kinematic, GRF and COP data. The projection of trial vectors onto the linear combination of four PCs showed there were significant differences between shoes. The interpretation of the PCs indicated an increase in the ankle eversion, knee abduction and adduction, decreases in the hip adduction and pelvic obliquity angles and reduced excursion of both the COP and peak medial-lateral GRFs for the variable-stiffness compared to the control shoe. The variable-stiffness shoe produced a unique dynamic change in the frontal plane motion of the ankle, hip and pelvis that contributed to changes in the GRF and COP and thus reduced the adduction moment at a critical instant during gait suggesting a different mechanism that was seen with fixed interventions (e.g. wedges).