Retention of improvement in gait stability over 14 weeks due to trip-perturbation training is dependent on perturbation dose

Perturbation training is an emerging approach to reduce fall risk in the elderly. This study examined potential differences in retention of improvements in reactive gait stability over 14 weeks resulting from unexpected trip-like gait perturbations. Twenty-four healthy middle-aged adults (41–62 years) were assigned randomly to either a single perturbation group (SINGLE, n = 9) or a group subjected to eight trip-like gait perturbations (MULTIPLE, n = 15). While participants walked on a treadmill a custom-built brake-and-release system was used to unexpectedly apply resistance during swing phase to the lower right limb via an ankle strap. The anteroposterior margin of stability (MoS) was calculated as the difference between the anterior boundary of the base of support and the extrapolated centre of mass at foot touchdown for the perturbed step and the first recovery step during the first and second (MULTIPLE group only) perturbation trials for the initial walking session and retention-test walking 14 weeks later. Group MULTIPLE retained the improvements in reactive gait stability to the perturbations (increased MoS at touchdown for perturbed and first recovery steps; p < 0.01). However, in group SINGLE no differences in MoS were detected after 14 weeks compared to the initial walking session. These findings provide evidence for the requirement of a threshold trip-perturbation dose if adaptive changes in the human neuromotor system over several months, aimed at the improvement in fall-resisting skills, are to occur.     

Influence of gait speed on free vertical moment during walking

Free vertical moment (FVM) of ground reaction is recognized to be a meaningful indicator of torsional stress on the lower limbs when walking. The purpose of this study was to examine whether and how gait speed influences the FVM when walking. Fourteen young healthy adults performed a series of overground walking trials at three different speeds: low, preferred and fast. FVM was measured during the stance phase of the dominant leg using a force platform embedded in a 10 m-long walkway. Transverse plane kinematic parameters of the foot and pelvis were measured using a motion capture system. Results showed a significant decrease in peak abduction FVM (i.e., resisting internal foot rotation) and an increase in peak adduction FVM (i.e., resisting external foot rotation), together with an increase in gait speed. Concomitantly, we observed a decrease in the foot progression angle and an increase in the peak pelvis rotation velocity in the transverse plane with an increase in gait speed. A significant positive correlation was found between the pelvis rotation velocity and the peak adduction moment, suggesting that pelvis rotation influences the magnitude of adduction FVM. Furthermore, we also found significant correlations between the peak adduction FVM and both the step length and frequency, indicating that the alterations in FVM may be ascribed to changes in these two key variables of gait speed. These speed-related changes in FVM should be considered when this parameter is used in gait assessment, particularly when used as an index for rehabilitation and injury prevention.     

A multi-segment kinematic model of the foot with a novel definition of forefoot motion for use in clinical gait analysis during walking

A multi-segment kinematic model of the foot was developed for use in a gait analysis laboratory. The foot was divided into hindfoot, talus, midfoot and medial and lateral forefoot segments. Six functional joints were defined: ankle and subtalar joints, frontal and transverse plane motions of the hindfoot relative to midfoot, supination/pronation twist of the forefoot relative to midfoot and medial longitudinal arch height-to-length ratio. Twelve asymptomatic subjects were tested during barefoot walking with a six-camera optical stereometric system and auto-reflective markers organized in triads. Repeatability of the joint motions was tested using coefficients of multiple correlation. Ankle and subtalar joint motions and twisting of the forefoot were most repeatable. Hindfoot motions were least repeatable both within-subjects and between-subjects. Hindfoot and forefoot pronation in the frontal plane was found to coincide with dropping of the medial longitudinal arch between early to mid-stance, followed by supination and rising of the arch in late stance and swing phase. This multi-segment foot model addresses an unfortunate shortcoming in current gait analysis practice-the inability to measure motion within the foot. Such measurements are crucial if gait analysis is to remain relevant in the orthopaedic and rehabilitative treatment of the foot and ankle.     

Stance phase control of above-knee prostheses: knee control versus SACH foot design

The mobility of above-knee amputees (A/K) is limited, in part, due to the performance of A/K prostheses during the stance phase. Currently stance phase control of most conventional A/K prostheses can only be achieved through leg alignment and choice of the SACH (Solid Ankle Cushioned Heel) foot. This paper examines the role of the knee controller in relation to a SACH foot during the stance phase of level walking. The three-dimensional gait mechanics were measured under two stance phase conditions. In the first set of trials, the amputee used a prosthesis with a conventional knee controller that allowed the amputee to maintain the knee joint in full extension during the stance phase. In the second set of trials, the prosthetic knee, during stance, echoed the modified kinematics of the amputee's sound (intact) knee that had been recorded during the previous sound stance phase. Analysis and interpretation of the data indicate the following: (1) SACH foot design can strongly influence the walking mechanics independent of the knee controller; (2) knee controller design and SACH foot design are mutually interdependent; and (3) normal kinematics imposed on the prosthetic knee does not necessarily produce normal hip kinematics (e.g. reduce the abnormal rise in the prosthetic side hip trajectory). Future research is necessary to explore and exploit the interdependency of prosthetic knee control and foot design.     

Hip recovery strategy used by below-knee amputees following mediolateral foot perturbations

Lower-limb amputees have a higher risk of falling compared to non-amputees. Proper regulation of whole-body angular momentum is necessary to prevent falls, particularly in the frontal plane where individuals are most unstable. However, the balance recovery mechanisms used by lower-limb amputees when recovering from a perturbation are not well-understood. This study sought to understand the balance recovery mechanisms used by lower-limb amputees in response to mediolateral foot perturbations by examining changes to frontal plane whole-body angular momentum and hip joint work. These metrics provide a quantitative measure of frontal plane dynamic balance and associated joint contributions required to maintain balance during gait. Nine amputees and 11 non-amputees participated in this study where an unexpected medial or lateral foot placement perturbation occurred immediately prior to heel strike on the residual, sound or non-amputee limbs. Lateral perturbations of all limbs resulted in a reduced range of whole-body angular momentum and increased positive frontal plane hip work in the first half of single limb support. Medial perturbations for all limbs resulted in increased range of whole-body angular momentum and decreased positive frontal plane hip work, also in the first half of single limb support. These results suggest that medial foot placement perturbations are particularly challenging and that hip strategies play an important role in balance recovery. Thus, rehabilitation interventions that focus on hip muscles that regulate mediolateral balance, particularly the hip abductors, and the use of prostheses with active ankle control, may reduce the risk of falls.     

Effects of reduced plantar cutaneous afferent feedback on locomotor adjustments in dynamic stability during perturbed walking

This study examined the effects of reduced plantar cutaneous afferent feedback on predictive and feedback adaptive locomotor adjustments in dynamic stability during perturbed walking. Twenty-two matched participants divided between an experimental-group and a control-group performed a gait protocol, which included surface alterations to one covered exchangeable gangway-element (hard/soft). In the experimental-group, cutaneous sensation in both foot soles was reduced to the level of sensory peripheral neuropathy by means of intradermal injections of an anaesthetic solution, without affecting foot proprioception or muscles. The gait protocol consisted of baseline trials on a uniformly hard surface and an adaptation phase consisting of nineteen trials incorporating a soft gangway-element, interspersed with three trials using the hard surface-element (2nd, 8th and 19th). Dynamic stability was assessed by quantifying the margin of stability (MS), which was calculated as the difference between the base of support (BS) and the extrapolated centre of mass (CM). The horizontal velocity of the CM and its vertical projection in the anterior-posterior direction and the eigenfrequency of an inverted pendulum determine the extrapolated-CM. Both groups increased the BS at the recovery step in response to the first unexpected perturbation. These feedback corrections were used more extensively in the experimental-group, which led to a higher MS compared to the control-group, i.e. a more stable body-position. In the adaptation phase the MS returned to baseline similarly in both groups. In the trial on the hard surface directly after the first perturbation, both groups increased the MS at touchdown of the disturbed leg compared to baseline trials, indicating rapid predictive adjustments irrespective of plantar cutaneous input. Our findings demonstrate that the locomotor adaptational potential does not decrease due to the loss of plantar sensation.     

Tibiofemoral kinematics and condylar motion during the stance phase of gait

Accurate knowledge of the dynamic knee motion in-vivo is instrumental for understanding normal and pathological function of the knee joint. However, interpreting motion of the knee joint during gait in other than the sagittal plane remains controversial. In this study, we utilized the dual fluoroscopic imaging technique to investigate the six-degree-of-freedom kinematics and condylar motion of the knee during the stance phase of treadmill gait in eight healthy volunteers at a speed of 0.67 m/s. We hypothesized that the 6DOF knee kinematics measured during gait will be different from those reported for non-weightbearing activities, especially with regards to the phenomenon of femoral rollback. In addition, we hypothesized that motion of the medial femoral condyle in the transverse plane is greater than that of the lateral femoral condyle during the stance phase of treadmill gait. The rotational motion and the anterior–posterior translation of the femur with respect to the tibia showed a clear relationship with the flexion–extension path of the knee during the stance phase. Additionally, we observed that the phenomenon of femoral rollback was reversed, with the femur noted to move posteriorly with extension and anteriorly with flexion. Furthermore, we noted that motion of the medial femoral condyle in the transverse plane was greater than that of the lateral femoral condyle during the stance phase of gait (17.4±2.0 mm vs. 7.4±6.1 mm, respectively; p<0.01). The trend was opposite to what has been observed during non-weightbearing flexion or single-leg lunge in previous studies. These data provide baseline knowledge for the understanding of normal physiology and for the analysis of pathological function of the knee joint during walking. These findings further demonstrate that knee kinematics is activity-dependent and motion patterns of one activity (non-weightbearing flexion or lunge) cannot be generalized to interpret a different one (gait).     

A Dynamic Finite Element Analysis of Human Foot Complex in the Sagittal Plane during Level Walking

The objective of this study is to develop a computational framework for investigating the dynamic behavior and the internal loading conditions of the human foot complex during locomotion. A subject-specific dynamic finite element model in the sagittal plane was constructed based on anatomical structures segmented from medical CT scan images. Three-dimensional gait measurements were conducted to support and validate the model. Ankle joint forces and moment derived from gait measurements were used to drive the model. Explicit finite element simulations were conducted, covering the entire stance phase from heel-strike impact to toe-off. The predicted ground reaction forces, center of pressure, foot bone motions and plantar surface pressure showed reasonably good agreement with the gait measurement data over most of the stance phase. The prediction discrepancies can be explained by the assumptions and limitations of the model. Our analysis showed that a dynamic FE simulation can improve the prediction accuracy in the peak plantar pressures at some parts of the foot complex by 10%–33% compared to a quasi-static FE simulation. However, to simplify the costly explicit FE simulation, the proposed model is confined only to the sagittal plane and has a simplified representation of foot structure. The dynamic finite element foot model proposed in this study would provide a useful tool for future extension to a fully muscle-driven dynamic three-dimensional model with detailed representation of all major anatomical structures, in order to investigate the structural dynamics of the human foot musculoskeletal system during normal or even pathological functioning.     

Postural control during lifting

Any voluntary motion of the body causes an internal perturbation of balance. Load transfer during manual material handling may increase these perturbations. This study investigates effects of stance condition on postural control during lifting. Nineteen healthy subjects repeatedly lifted and lowered a load between a desk and a shelf. The base of support was varied between parallel and step stance. Ground reaction force and segmental kinematics were measured. Load transfer during lifting perturbed balance. In parallel stance postural response consisted of axial movements in the sagittal plane. Such strategy was accompanied by increased posterior shear forces after lift-off. Lifting in step stance provided extended support in anterior/posterior direction. The postural control mechanisms in the sagittal plane are less complex as compared to parallel stance. However, lifting in step stance was asymmetrical and thus accompanied by distinct lateral transfer of the body. Lateral shear forces were larger as compared to parallel stance. Both lifting techniques exhibit positive and negative aspects. We cannot recommend either one as being better in terms of postural control.     

Estimation of stride length in level walking using an inertial measurement unit attached to the foot: a validation of the zero velocity assumption during stance

In a variety of applications, inertial sensors are used to estimate spatial parameters by double integrating over time their coordinate acceleration components. In human movement applications, the drift inherent to the accelerometer signals is often reduced by exploiting the cyclical nature of gait and under the hypothesis that the velocity of the sensor is zero at some point in stance. In this study, the validity of the latter hypothesis was investigated by determining the minimum velocity of progression of selected points of the foot and shank during the stance phase of the gait cycle while walking at three different speeds on level ground. The errors affecting the accuracy of the stride length estimation resulting from assuming a zero velocity at the beginning of the integration interval were evaluated on twenty healthy subjects. Results showed that the minimum velocity of the selected points on the foot and shank increased as gait speed increased. Whereas the average minimum velocity of the foot locations was lower than 0.011 m/s, the velocity of the shank locations were up to 0.049 m/s corresponding to a percent error of the stride length equal to 3.3%. The preferable foot locations for an inertial sensor resulted to be the calcaneus and the lateral aspect of the rearfoot. In estimating the stride length, the hypothesis that the velocity of the sensor can be set to zero sometimes during stance is acceptable only if the sensor is attached to the foot.     

Alteration in community-dwelling older adults' level walking following perturbation training

While perturbation training is promising in reducing fall-risk among older adults, its impact on altering their spontaneous gait pattern has not been investigated. The purpose of this study was to determine to what extent older adults' gait pattern would be affected by exposure to repeated slips. Seventy-three community-dwelling older adults (age: 72.6±5.4 years) underwent 24 repeated-slip exposure induced by unannounced unlocking and relocking of low-friction sections of a 7-m pathway upon which they walked. Full body kinematics and kinetics were recorded during the training. The gait parameters and the center of mass (COM) stability against backward balance loss were compared before and after the training. The results revealed that the training reduced fall incidence from 43.8% upon the novel slip to 0 at the end of training. After the training, subjects significantly improved gait stability by forward positioning of their COM relative to the base of support without altering gait speed. This forward COM shift resulted from a shortened step at the end of single stance and forward trunk leaning during double stance. They also adopted flat foot landing with knee flexed at touchdown (with an average change of 6.9 and 4.1 degrees, respectively). The perturbation training did alter community-dwelling older adults' spontaneous gait pattern. These changes enabled them to improve their volitional control of stability and their resistance to unpredictable and unpreventable slip-related postural disturbance.     

Ankle extensor proprioceptors contribute to the enhancement of the soleus EMG during the stance phase of human walking

A rapid plantar flexion perturbation applied to the ankle during the stance phase of the step cycle during human walking unloads the ankle extensors and produces a marked decline in the soleus EMG. This demonstrates that sensory activity contributes importantly to the enhancement of the ankle extensor muscle activation during human walking. On average, the EMG begins to decline approximately 52 ms after the perturbation. In contrast, a rapid dorsi flex ion perturbation produces a group Ia mediated short-latency stretch reflex burst with an onset latency of approximately 36 ms. The transmission of sensory traffic from the foot and ankle was suppressed in 10 subjects by an anaesthetic nerve block produced with local injections of lidocaine hydrochloride. The anaesthetic block had no effect on the stance phase soleus EMG, the latencies of the EMG responses, or the magnitude of the EMG decline following the plantar flexion perturbation. Therefore, it is more likely that proprioceptive afferents, rather than cutaneous afferents, contribute to the background soleus EMG during the late stance phase of the step cycle. The large difference in onset latencies between the short-latency reflex and unload responses suggests that the largest of the active group Ia afferents might not contribute strongly to the background soleus EMG, although it remains to be determined which of the proprioceptive pathways provide the more important contributions.     

Sex-Specific associations between hip muscle strength and foot progression angle

The foot progression angle (FPA) influences knee loading during gait, but its determinants are unclear. The purpose of this study was to compare FPA between males and females and also examine the association between lower extremity kinematics during gait, hip strength, and the FPA. 25 males and 25 females completed 5 gait trials while FPA and frontal and transverse plane hip and knee angles were calculated from the dominant limb during the foot flat portion of stance. Hip extensor/flexor, abductor/adductor, and internal/external rotator strength were evaluated using maximum voluntary isometric contractions. One-way MANOVAs compared gait and strength outcomes. Stepwise regression assessed the association between FPA, and MVIC and kinematics after accounting for speed in males and females. There was no difference in FPA between sexes (p > 0.05), but females had greater frontal and transverse plane hip angles compared with males (all p < 0.05). Greater hip abduction (p = 0.02) strength was associated with greater FPA, but only in males. In males, greater hip abductor strength may contribute to a more neutral position of the foot during gait, which could help maintain an equal knee loading distribution. Our results suggest that there are sex specific control strategies to achieve a similar FPA during gait.     

Adaptational responses in dynamic stability during disturbed walking in the elderly

The purpose of this study was to examine the age-related predictive and feedback adaptive locomotor improvements in the components of dynamic stability control during disturbed walking. Thirteen old (62–74 yrs) and ten young (23–30 yrs) male subjects performed a gait protocol on a gangway, which included one covered element. By exchanging this element, the subjects walked either solely over hard surface or experienced a perturbation of the gait on the soft surface element. The gait protocol consisted of a baseline on hard surface and an adaptation phase with 19 trials on soft or hard (2nd, 8th and 19th) surface. The investigation of dynamic stability was made by using the margin of stability (MS), which was calculated as the difference between the base of support and the extrapolated center of mass (CM). Horizontal velocity of CM and its vertical projection in anterior–posterior direction as well as the eigenfrequency of an inverted pendulum generate the extrapolated CM. As a result of the first unexpected disturbance, MS was decreased in the step following the perturbation compared to baselines in both age-groups. This decrease was higher for the old participants compared to the young ones, indicating a more unstable position in the step after the perturbation for the elderly. In the following adaptation phase, MS returned to baseline values in both age-groups. In the hard trial after the first unexpected perturbation, both age-groups increased MS at touchdown of the disturbed leg compared to baseline, reflecting fast predictive adjustments. Our findings show that the well-known age-related biological impairments did not inhibit the adaptive improvements in the components of dynamic stability in the elderly. However, the feedback corrections after the first unexpected perturbation were less effective for the elderly. This may increase the risk of falling.     

Biomechanical mechanism of lateral trunk lean gait for knee osteoarthritis patients

The biomechanical mechanism of lateral trunk lean gait employed to reduce external knee adduction moment (KAM) for knee osteoarthritis (OA) patients is not well known. This mechanism may relate to the center of mass (COM) motion. Moreover, lateral trunk lean gait may affect motor control of the COM displacement. Uncontrolled manifold (UCM) analysis is an evaluation index used to understand motor control and variability of the motor task. Here we aimed to clarify the biomechanical mechanism to reduce KAM during lateral trunk lean gait and how motor variability controls the COM displacement. Twenty knee OA patients walked under two conditions: normal and lateral trunk lean gait conditions. UCM analysis was performed with respect to the COM displacement in the frontal plane. We also determined how the variability is structured with regards to the COM displacement as a performance variable. The peak KAM under lateral trunk lean gait was lower than that under normal gait. The reduced peak KAM observed was accompanied by medially shifted knee joint center, shortened distance of the center of pressure to knee joint center, and shortened distance of the knee–ground reaction force lever arm during the stance phase. Knee OA patients with lateral trunk lean gait could maintain kinematic synergy by utilizing greater segmental configuration variance to the performance variable. However, the COM displacement variability of lateral trunk lean gait was larger than that of normal gait. Our findings may provide clinical insights to effectively evaluate and prescribe gait modification training for knee OA patients.     

Ultrasonic motion analysis system--measurement of temporal and spatial gait parameters

The duration of stance and swing phase and step and stride length are important parameters in human gait. In this technical note a low-cost ultrasonic motion analysis system is described that is capable of measuring these temporal and spatial parameters while subjects walk on the floor. By using the propagation delay of sound when transmitted in air, this system is able to record the position of the subjects' feet. A small ultrasonic receiver is attached to both shoes of the subject while a transmitter is placed stationary on the floor. Four healthy subjects were used to test the device. Subtracting positions of the foot with zero velocity yielded step and stride length. The duration of stance and swing phase was calculated from heel-strike and toe-off. Comparison with data obtained from foot contact switches showed that applying two relative thresholds to the speed graph of the foot could reliably generate heel-strike and toe-off. Although the device is tested on healthy subjects in this study, it promises to be extremely valuable in examining pathological gait. When gait is asymmetrical, walking speed is not constant or when patients do not completely lift their feet, most existing devices will fail to correctly assess the proper gait parameters. Our device does not have this shortcoming and it will accurately demonstrate asymmetries and variations in the patient's gait. As an example, the recording of a left hemiplegic patient is presented in the discussion.     

Adaptive feedback potential in dynamic stability during disturbed walking in the elderly

After perturbation of the gait, feedback information may help regaining balance adequately, but it remains unknown whether adaptive feedback responses are possible after repetitive and unexpected perturbations during gait and if there are age-related differences. Prior experience may contribute to improved reactive behavior. Fourteen old (59-73 yrs) and fourteen young (22-31 yrs) males walked on a walkway which included one covered element. By exchanging this element participants either stepped on hard surface or unexpectedly on soft surface which caused a perturbation in gait. The gait protocol contained 5 unexpected soft trials to quantify the reactive adaptation. Each soft trial was followed by 4-8 hard trials to generate a wash-out effect. The dynamic stability was investigated by using the margin of stability (MoS), which was calculated as the difference between the anterior boundary of the base of support and the extrapolated position of the center of mass in the anterior-posterior direction. MoS at recovery leg touchdown were significantly lower in the unexpected soft trials compared to the baseline, indicating a less stable posture. However, MoS increased (p<0.05) in both groups within the disturbed trials, indicating feedback adaptive improvements. Young and old participants showed differences in the handling of the perturbation in the course of several trials. The magnitude of the reactive adaptation after the fifth unexpected perturbation was significantly different compared to the first unexpected perturbation (old: 49±30%; young: 77±40%), showing a tendency (p=0.065) for higher values in the young participants. Old individuals maintain the ability to adapt to feedback controlled perturbations. However, the locomotor behavior is more conservative compared to the young ones, leading to disadvantages in the reactive adaptation during disturbed walking.     

A robotic cadaveric flatfoot analysis of stance phase

The symptomatic flatfoot deformity (pes planus with peri-talar subluxation) can be a debilitating condition. Cadaveric flatfoot models have been employed to study the etiology of the deformity, as well as invasive and noninvasive surgical treatment strategies, by evaluating bone positions. Prior cadaveric flatfoot simulators, however, have not leveraged industrial robotic technologies, which provide several advantages as compared with the previously developed custom fabricated devices. Utilizing a robotic device allows the researcher to experimentally evaluate the flatfoot model at many static instants in the gait cycle, compared with most studies, which model only one to a maximum of three instances. Furthermore, the cadaveric tibia can be statically positioned with more degrees of freedom and with a greater accuracy, and then a custom device typically allows. We created a six degree of freedom robotic cadaveric simulator and used it with a flatfoot model to quantify static bone positions at ten discrete instants over the stance phase of gait. In vivo tibial gait kinematics and ground reaction forces were averaged from ten flatfoot subjects. A fresh frozen cadaveric lower limb was dissected and mounted in the robotic gait simulator (RGS). Biomechanically realistic extrinsic tendon forces, tibial kinematics, and vertical ground reaction forces were applied to the limb. In vitro bone angular position of the tibia, calcaneus, talus, navicular, medial cuneiform, and first metatarsal were recorded between 0% and 90% of stance phase at discrete 10% increments using a retroreflective six-camera motion analysis system. The foot was conditioned flat through ligament attenuation and axial cyclic loading. Post-flat testing was repeated to study the pes planus deformity. Comparison was then made between the pre-flat and post-flat conditions. The RGS was able to recreate ten gait positions of the in vivo pes planus subjects in static increments. The in vitro vertical ground reaction force was within ± 1 standard deviation (SD) of the in vivo data. The in vitro sagittal, coronal, and transverse plane tibial kinematics were almost entirely within ± 1 SD of the in vivo data. The model showed changes consistent with the flexible flatfoot pathology including the collapse of the medial arch and abduction of the forefoot, despite unexpected hindfoot inversion. Unlike previous static flatfoot models that use simplified tibial degrees of freedom to characterize only the midpoint of the stance phase or at most three gait positions, our simulator represented the stance phase of gait with ten discrete positions and with six tibial degrees of freedom. This system has the potential to replicate foot function to permit both noninvasive and surgical treatment evaluations throughout the stance phase of gait, perhaps eliciting unknown advantages or disadvantages of these treatments at other points in the gait cycle.     

In vivo tibiofemoral cartilage deformation during the stance phase of gait

The knowledge of articular cartilage contact biomechanics in the knee joint is important for understanding the joint function and cartilage pathology. However, the in vivo tibiofemoral articular cartilage contact biomechanics during gait remains unknown. The objective of this study was to determine the in vivo tibiofemoral cartilage contact biomechanics during the stance phase of treadmill gait. Eight healthy knees were magnetic resonance (MR) scanned and imaged with a dual fluoroscopic system during gait on a treadmill. The tibia, femur and associated cartilage were constructed from the MR images and combined with the dual fluoroscopic images to determine in vivo cartilage contact deformation during the stance phase of gait. Throughout the stance phase of gait, the magnitude of peak compartmental contact deformation ranged between 7% and 23% of the resting cartilage thickness and occurred at regions with thicker cartilage. Its excursions in the anteroposterior direction were greater in the medial tibiofemoral compartment as compared to those in the lateral compartment. The contact areas throughout the stance phase were greater in the medial compartment than in the lateral compartment. The information on in vivo tibiofemoral cartilage contact biomechanics during gait could be used to provide physiological boundaries for in vitro testing of cartilage. Also, the data on location and magnitude of deformation among non-diseased knees during gait could identify where loading and later injury might occur in diseased knees.