Response of able-bodied persons to changes in shoe rocker radius during walking: Changes in ankle kinematics to maintain a consistent roll-over shape

Recent studies have determined a seemingly consistent feature of able-bodied level ground walking, termed the roll-over shape, which is the effective rocker (cam) shape that the lower limb system conforms to between heel contact and contralateral heel contact during walking (first half of the gait cycle). The roll-over shape has been found to be largely unaffected by changes in walking speed, load carriage, and shoe heel height. However, it is unclear from previous studies whether persons are controlling their lower limb systems to maintain a consistent roll-over shape or whether this finding is a byproduct of their attempt to keep ankle kinematic patterns similar during the first half of the gait cycle. We measured the ankle–foot roll-over shapes and ankle kinematics of eleven able-bodied subjects while walking on rocker shoes of different radii. We hypothesized that the ankle flexion patterns during single support would change to maintain a similar roll-over shape. We also hypothesized that with decrease in rocker shoe radii, the difference in ankle flexion between the end and beginning of single support would decrease. Our results supported these hypotheses. Ankle kinematics were changed significantly during walking with the different rocker shoe radii (p<0.001), while ankle–foot roll-over shape radii (p=0.146) and fore–aft position (p=0.132) were not significantly affected. The results of this study have direct implications for designers of ankle–foot prostheses, orthoses, walking casts/boots, and rocker shoes. The results may also be relevant to researchers studying control of human movements.     

Effect of rocker shoes and running speed on lower limb mechanics and soft tissue vibrations

Previous studies have shown a possible effect of running speed and the sole material of footwear on lower-limb mechanics and soft tissue vibrations, while little information has been offered concerning the influence of the shape of the footwear’s sole. The purpose of this study is to assess the effect of running speed and rocker shoes on muscular activity, ground reaction force, and soft tissue vibrations. Twenty participants performed heel-toe running with two shoes, differentiated only by their sole shape (i.e. rocker and non-rocker), at four running speeds. Ground reaction force and electromyograms of the gastrocnemius medialis and vastus lateralis were measured, and soft tissue accelerations of the same muscles were recorded with tri-axial accelerometers. A continuous wavelet transform was applied to the accelerometer’s signals to analyse them in the time-frequency domain. The rocker of the shoes did not change the muscular activations, ground reaction force, nor power of soft tissue vibrations. In opposite, increased running speed led to an augmentation of all of the measured parameters. Interestingly, running speed augmentation led to a greater increase in high frequencies component of soft tissue vibrations (25–50 Hz, 242%) than lower ones (8–25 Hz, 111%). Consequently, we indicated a 10% increase in the relative part of the high frequencies of the total power. In conclusion, although rocker shoes have shown an effect on lower-limb kinetics in some studies, no influence on soft tissue vibration is denoted. By contrast, soft tissue vibrations may be modulated by changing running speed.     

Kinematics and muscle activity when running in partial minimalist,traditional, and maximalist shoes

While several studies have examined kinematic and kinetic differences between maximalist (MAX), traditional (TRAD), or partial minimalist (PMIN) shoes, to date it is unknown how MAX shoes influence muscle activity. This study compared lower extremity kinematics and muscle activity when running in PMIN, TRAD, and MAX shoes. Thirteen participants ran in each shoe while whole body kinematics were recorded using motion capture and electromyography was recorded from seven leg muscles. Differences in kinematics and root mean square amplitudes (RMS) were compared between shoe conditions. There were small differences in sagittal and frontal plane ankle kinematics between shoe conditions, with the MAX shoes resulting in less dorsiflexion at foot strike (p = .002) and less peak dorsiflexion (p < .001), and the PMIN shoes resulting in greater peak eversion (p = .012). Gluteus medius (p.006) and peroneus longus (p = .007) RMS amplitudes were greater in the MAX shoe then the TRAD or PMIN shoes while tibialis anterior RMS amplitudes were higher in the PMIN shoes (p = .005) than either the TRAD or MAX shoes. Consistent with previous findings, these results suggest there are small differences in kinematics when running in these three shoe types. This may partly be explained by the changes in muscle activity, which may be a response in order to maintain a preferred or habitual movement path. Implications for these difference in muscle activity in terms of fatigue or injury remain to be determined.     

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.     

The influence of footwear on foot motion during walking and running

There are evidences to suggest that wearing footwear constrains the natural barefoot motion during locomotion. Unlike prior studies that deduced foot motions from shoe sole displacement parameters, the aim of this study was to examine the effect of footwear motion on forefoot to rearfoot relative motion during walking and running. The use of a multi-segment foot model allowed accurate both shoe sole and foot motions (barefoot and shod) to be quantified. Two pairs of identical sandals with different midsole hardness were used. Ten healthy male subjects walked and ran in each of the shod condition.The results showed that for barefoot locomotion there was more eversion of the forefoot and it occurred faster than for shod locomotion. In this later condition, the range of eversion was reduced by 20% and the rate of eversion in late stance by 60% in comparison to the barefoot condition. The sole constrained both the torsional (eversion/inversion) and adduction range of motion of the foot. Interestingly, during the push-off phase of barefoot locomotion the rate and direction of forefoot torsion varied between individuals. However, most subjects displayed a forefoot inversion direction of motion while shod. Therefore, this experiment showed that the shoes not only restricted the natural motion of the barefoot but also appeared to impose a specific foot motion pattern on individuals during the push-off phase. These findings have implications for the matching of footwear design characteristics to individual natural foot function.     

Method of healing diabetic forefoot ulcers.

Six diabetic patients with neuropathic ulceration of the sole of the foot (seven feet, eight ulcers) were treated by the application of a below knee walking plaster with a rubber rocker. All the ulcers healed with this treatment, greatly reducing the usual period of hospital inpatient stay. After healing, study of the forces acting on the sole of the foot showed that these ulcers occur at the site of maximal horizontal shear force and confirmed that they occur at the site of maximal vertical force. This treatment is highly effective for neuropathic ulcers of the sole not affecting bone or complicated by deep sepsis. There may be a high rate of recurrence, however, reflecting inadequacy of methods of protecting damaged neuropathic feet.     

Mechanics of jazz shoes and their effect on pointing in child dancers

There has been little scientific investigation of the impact of dance shoes on foot motion or dance injuries. The pointed (plantar-flexed) foot is a fundamental component of both the technical requirements and the traditional aesthetic of ballet and jazz dancing. The aims of this study were to quantify the externally observed angle of plantar flexion in various jazz shoes compared with barefoot and to compare the sagittal plane bending stiffness of the various jazz shoes. Sixteen female recreational child dancers were recruited for 3D motion analysis of active plantar flexion. The jazz shoes tested were a split-sole jazz shoe, full-sole jazz shoe, and jazz sneaker. A shoe dynamometer measured the stiffness of the jazz shoes. The shoes had a significant effect on ankle plantar flexion. All jazz shoes significantly restricted the midfoot plantar flexion angle compared with the barefoot condition. The split-sole jazz shoe demonstrated the least restriction, whereas the full-sole jazz shoe the most midfoot restriction. A small restriction in metartarsophalangeal plantar flexion and a greater restriction at the midfoot joint were demonstrated when wearing stiff jazz shoes. These restrictions will decrease the aesthetic of the pointed foot, may encourage incorrect muscle activation, and have an impact on dance performance.     

Kinematic changes using weightlifting shoes on barbell back squat

The purpose of this study was to validate a higher degree of foot segment angle by wearing the weightlifting (WL) shoes and to determine the kinematic differences between WL shoes and running shoes during the barbell back squat. College-aged individuals volunteered to participate in this study (N = 25). After warm-up, subjects performed 60% of 1RM barbell back squat. Reflective markers were placed on lower extremity joints and end of the bar to create segments to analyze kinematics of the barbell back squat from a 2-dimensional view. Three separate repeated measure analyses of variance were used at p = 0.05. Results showed that there was a difference between the footwear conditions; foot segment angle of 3.5° (p < 0.05) and trunk lean of 22 mm (p < 0.05) were captured when wearing WL shoes. However, thigh segment peak flexion angle was not statistically different (p = 0.37). Wearing WL shoes seems to be beneficial in reducing the overall trunk lean, because this position is believed to reduce the amount of shear stress in the lower back area. Back squat with WL shoes also increased foot segment angle and possibly contributes to greater muscle excitation in knee extensors. Weightlifting shoes did not help reach thigh segment closer to horizontal as compared with the running shoe condition. It is recommended that WL shoes be used by those who are prone to displaying a forward trunk lean and who aim to increase knee extensor activation.     

Effect of rocker shoe radius on oxygen consumption rate in young able-bodied persons

We studied oxygen consumption rate of eleven young able-bodied persons walking at self-selected speed with five different pairs of shoes: one regular pair without rocker soles (REG) and four pairs with uniform hardness (35-40 shore A durometer) rocker soles of different radii (25% of leg length (LL) (R25), 40% LL (R40), 55% LL (R55), and infinite radius (FLAT)). Rocker soled shoes in the study were developed to provide similar vertical lift (three inches higher than the REG shoes condition). Oxygen consumption rate was significantly affected by the use of the different shoes (p<0.001) and pairwise comparisons indicated that persons consumed significantly less oxygen (per minute per kilogram of body mass) when walking on the R40 shoes when compared with both the FLAT (p<0.001) and REG (p=0.021) shoe conditions. Oxygen consumption was also significantly less for the R25 shoes compared with the FLAT shoes (p=0.005) and for the R55 shoes compared with FLAT shoes (p=0.027). The three-inch lift on the FLAT shoe did not cause a significant change in oxygen consumption compared to the shoe without the lift (REG).     

Minimum toe clearance adaptations to floor surface irregularity and gait speed

Toe speed during gait generally nears its maximum while its height reaches a local minima approximately halfway through swing phase. Trips are thought to frequently occur at these local minima (minimum toe clearance or MTC events) and trip risk has been quantified using the minimum distance between the toe and ground here (MTC). This study investigated MTC on floor surfaces with and without multiple small obstacles. After shoes and floor surfaces were digitized, 14 unimpaired subjects (half women) each traversed a 4.88 m walkway 4 times at slow, preferred, and fast speeds across surfaces with no obstacles, visible obstacles, and hidden obstacles. Both surfaces with obstacles had the same random obstacle configuration. Shoe and body segment motions were tracked using passive markers and MTC and joint kinematics calculated. All MTC and kinematic variables tested significantly increased with faster instructed gait speed except the likelihood of MTC event occurrence (local minima in minimum toe clearance trajectory when foot is in upper quartile of speed). MTC events were less frequent for swing phases on surfaces with obstacles (80% vs. 98% for no obstacles). MTC values, when present, were doubled by the presence of visible obstacles (22.2 ± 7.3mm vs. 11.1 ± 5.7 mm) and further increased to 26.8 ± 7.1mm when these obstacles were hidden from view (all comparisons p ≤ 0.0003). These substantial floor surface-related changes in MTC event occurrences and values resulted from alterations in toe- and heel-clearance trajectories caused by subtle but significant changes in joint kinematics that did not exceed 10% each joint's swing phase range of motion.     

The effect of stride length on the dynamics of barefoot and shod running

A number of interventions and technique changes have been proposed to attempt to improve performance and reduce the number of running related injuries. Running shoes, barefoot running and alterations in spatio-temporal parameters (stride frequency and stride length) have been associated with significant kinematic and kinetic changes, which may have implications for performance and injury prevention. However, because footwear interventions have been shown to also affect spatio-temporal parameters, there is uncertainty regarding the origin of the kinematic and kinetic alterations. Therefore, the purpose of this study was to independently evaluate the effects of shoes and changes in stride length on lower extremity kinetics. Eleven individuals ran over-ground at stride lengths ±5 and 10% of their preferred stride length, in both the barefoot and shod condition. Three-dimensional motion capture and force plate data were captured synchronously and used to compute lower extremity joint moments. We found a significant main effect of stride length on anterior–posterior and vertical GRFs, and sagittal plane knee and ankle moments in both barefoot and shod running. When subjects ran at identical stride lengths in the barefoot and shod conditions we did not observe differences for any of the kinetic variables that were measured. These findings suggest that barefoot running triggers a decrease in stride length, which could lead to a decrease in GRFs and sagittal plane joint moments. When evaluating barefoot running as a potential option to reduce injury, it is important to consider the associated change in stride length.     

Segmental motion of forefoot and hindfoot as a diagnostic tool

Segmental motions derived from non-invasive motion analysis are being used to investigate the intrinsic functional behavior of the foot and ankle in health and disease. The goal of this research was to examine the ability of a generic segmented model of the foot to capture and differentiate changes in internal skeletal kinematics due to neuromuscular disease and/or trauma. A robotic apparatus that reproduces the kinematics and kinetics of gait in cadaver lower extremities was employed to produce motion under normal and aberrant neuromuscular activation patterns of tibialis posterior and/or tibialis anterior. Stance phase simulations were conducted on 10 donor limbs while recording three-dimensional kinematic trajectories of (1) skin-mounted markers used clinically to construct segmented foot models, and (2) bone-mounted marker clusters to capture actual internal bone motion as the gold standard for comparison. The models constructed from external marker data were able to differentiate the kinematic behaviors elicited by different neuromuscular conditions in a manner similar to that using the bone-derived data. Measurable differences between internal and externally measured kinematics were small, variable and random across the three axes of rotation and neuromuscular conditions, with a tendency toward more differences noted during early and late stance. Albeit slightly different, three-dimensional motion profiles of the hindfoot and forefoot segments correlated well with internal skeletal motion under all neuromuscular conditions, thereby confirming the utility of measuring segmental motions as a valid means of clinical assessment.     

Variation in foot size and shape in some British land snails and its functional significance

Live weight, and the length, breadth and surface area of the extended foot sole were measured in 24 species of British terrestrial snails. Allometric relationships between these variables are described, concentrating on the relationship between foot surface area and weight. Intraspecific foot area/weight relationships deviate from isometric expectation for several species; this may be attributed to density changes, foot-shape variation or the physical constraint imposed by shell aperture size.
The rate of increase of foot sole area with live weight among species is greater than expected under isometry, indicating that larger species partially compensate for the increase in foot loading (weight per unit foot area). The rate of whorl expansion of the shell is related to the deviations from the interspecific foot area/weight relationship, reinforcing the possibility that shell aperture area may limit foot size in some species. Foot ratio (foot length:foot width) is negatively related to live weight and foot loading.
The findings are discussed in relation to the known behaviour and microdistribution patterns of the species.     

Determination of dynamic ankle ligament strains from a computational model driven by motion analysis based kinematic data

External rotation of the foot has been implicated in high ankle sprains. Recent studies by this laboratory, and others, have suggested that torsional traction characteristics of the shoe-surface interface may play a role in ankle injury. While ankle injuries most often involve damage to ligaments due to excessive strains, the studies conducted by this laboratory and others have largely used surrogate models of the lower extremity to determine shoe-surface interface characteristics based on torque measures alone. The objective of this study was to develop a methodology that would integrate a motion analysis-based kinematic foot model with a computational model of the ankle to determine dynamic ankle ligament strains during external foot rotation. Six subjects performed single-legged, internal rotation of the body with a planted foot while a marker-based motion analysis was conducted to track the hindfoot motion relative to the tibia. These kinematic data were used to drive an established computational ankle model. Ankle ligament strains, as a function of time, were determined. The anterior tibiofibular ligament (ATiFL) experienced the highest strain at 9.2±1.1%, followed by the anterior deltoid ligament (ADL) at 7.8±0.7%, averaged over the six subjects. The peak ATiFL strain occurred prior to peak strain in the ADL in all subjects. This novel methodology may provide new insights into mechanisms of high ankle sprains and offer a basis for future evaluations of shoe-surface interface characteristics using human subjects rather than mechanical surrogate devices.     

Kinematic correlates of walking cadence in the foot

Evidence has frequently been reported of modifications in gait patterns within the lower limb related to the cadence of walking. Most reports have concerned relationships between cadence and kinematic and the kinetic changes occurring in the main joints and muscles of the lower limb as a whole. The aim of the present study was to assess whether significant changes are also measurable in kinematics of the foot segments. An existing 15 marker-set protocol allowed a four-segment foot and shank model to be defined for relative rotations between the segments to be calculated. Stereophotogrammetry was employed to record marker position data from ten subjects walking at three cadences. The slow- and normal cadence datasets showed similar profiles of joint rotation in three anatomical planes, but significant differences were found between these and the fast cadence. At all joints, frame-by-frame statistical analysis revealed increased dorsiflexion from heel-strike to midstance (p<0.05) and increased plantarflexion from midstance to toe-off (p<0.05) with increasing cadence. From foot-flat to heel-rise, the fast cadence kinematic data showed a decreased range of motion in the sagittal-plane between forefoot and rearfoot (3.2°±1.2° at slow cadence; 2.0°±0.8° at fast cadence; p<0.05). The cadences imposed and the multisegment protocol revealed significant kinematic changes in the joints of the foot during barefoot walking.     

A generic analytical foot rollover model for predicting translational ankle kinematics in gait simulation studies

The objective of this paper is to develop an analytical framework to representing the ankle–foot kinematics by modelling the foot as a rollover rocker, which cannot only be used as a generic tool for general gait simulation but also allows for case-specific modelling if required. Previously, the rollover models used in gait simulation have often been based on specific functions that have usually been of a simple form. In contrast, the analytical model described here is in a general form that the effective foot rollover shape can be represented by any polar function ρ=ρ(φ). Furthermore, a normalized generic foot rollover model has been established based on a normative foot rollover shape dataset of 12 normal healthy subjects. To evaluate model accuracy, the predicted ankle motions and the centre of pressure (CoP) were compared with measurement data for both subject-specific and general cases. The results demonstrated that the ankle joint motions in both vertical and horizontal directions (relative RMSE ～10%) and CoP (relative RMSE ～15% for most of the subjects) are accurately predicted over most of the stance phase (from 10% to 90% of stance). However, we found that the foot cannot be very accurately represented by a rollover model just after heel strike (HS) and just before toe off (TO), probably due to shear deformation of foot plantar tissues (ankle motion can occur without any foot rotation). The proposed foot rollover model can be used in both inverse and forward dynamics gait simulation studies and may also find applications in rehabilitation engineering.     

A new method to normalize plantar pressure measurements for foot size and foot progression angle

Plantar pressure measurement provides important information about the structure and function of the foot and is a helpful tool to evaluate patients with foot complaints. In general, average and maximum plantar pressure of 6–11 areas under the foot are used to compare groups of subjects. However, masking the foot means a loss of important information about the plantar pressure distribution pattern. Therefore, the purpose of this study was to develop and test a simple method that normalizes the plantar pressure pattern for foot size, foot progression angle, and total plantar pressure. Moreover, scaling the plantar pressure to a standard foot opens the door for more sophisticated analysis techniques such as pattern recognition and machine learning.Twelve subjects walked at preferred and half of the preferred walking speed over a pressure plate. To test the method, subjects walked in a straight line and in an approaching angle of approximately 40°. To calculate the normalized foot, the plantar pressure pattern was rotated over the foot progression angle and normalized for foot size.After normalization, the mean shortest distance between the contour lines of straight walking and walking at an angle had a mean of 0.22 cm (SD: 0.06 cm) for the forefoot and 0.14 cm (SD: 0.06 cm) for the heel. In addition, the contour lines of normalized feet for the various subjects were almost identical.The proposed method appeared to be successful in aligning plantar pressure of various feet without losing information.     

Validation of gait event detection by centre of pressure during target stepping in healthy and paretic gait

BackgroundTarget-stepping paradigms are increasingly used to assess and train gait adaptability. Accurate gait-event detection (GED) is key to locating targets relative to the ongoing step cycle as well as measuring foot-placement error. In the current literature GED is either based on kinematics or centre of pressure (CoP), and both have been previously validated with young healthy individuals. However, CoP based GED has not been validated for stroke survivors who demonstrate altered CoP pattern.MethodsYoung healthy adults and individuals affected by stroke stepped to targets on a treadmill, while gait events were measured using three detection methods; verticies of CoP cyclograms, and two kinematic criteria, (1) vertical velocity and position and of the heel marker, (2) anterior velocity and position of the heel and toe marker, were used. The percentage of unmatched gait events was used to determine the success of the GED method. The difference between CoP and kinematic GED methods were tested with two one sample (two-tailed) t-tests against a reference value of zero. Differences between group and paretic and non-paretic leg were tested with a repeated measures ANOVA.ResultsThe kinematic method based on vertical velocity only detected about 80% of foot contact events on the paretic side in stroke survivors while the method on anterior velocity was more successful in both young healthy adults as stroke survivors (3% young healthy and 7% stroke survivors unmatched). Both kinematic methods detected gait events significantly earlier than CoP GED (p < 0.001) except for foot contact in stroke survivors based on the vertical velocity.ConclusionsCoP GED may be more appropriate for gait analyses of SS than kinematic methods; even when walking and varying steps.     

Comparison of Minimalist Footwear Strategies for Simulating Barefoot Running: A Randomized Crossover Study

Possible benefits of barefoot running have been widely discussed in recent years. Uncertainty exists about which footwear strategy adequately simulates barefoot running kinematics. The objective of this study was to investigate the effects of athletic footwear with different minimalist strategies on running kinematics. Thirty-five distance runners (22 males, 13 females, 27.9 ± 6.2 years, 179.2 ± 8.4 cm, 73.4 ± 12.1 kg, 24.9 ± 10.9 km.week^-1) performed a treadmill protocol at three running velocities (2.22, 2.78 and 3.33 m.s^-1) using four footwear conditions: barefoot, uncushioned minimalist shoes, cushioned minimalist shoes, and standard running shoes. 3D kinematic analysis was performed to determine ankle and knee angles at initial foot-ground contact, rate of rear-foot strikes, stride frequency and step length. Ankle angle at foot strike, step length and stride frequency were significantly influenced by footwear conditions (p<0.001) at all running velocities. Posthoc pairwise comparisons showed significant differences (p<0.001) between running barefoot and all shod situations as well as between the uncushioned minimalistic shoe and both cushioned shoe conditions. The rate of rear-foot strikes was lowest during barefoot running (58.6% at 3.33 m.s^-1), followed by running with uncushioned minimalist shoes (62.9%), cushioned minimalist (88.6%) and standard shoes (94.3%). Aside from showing the influence of shod conditions on running kinematics, this study helps to elucidate differences between footwear marked as minimalist shoes and their ability to mimic barefoot running adequately. These findings have implications on the use of footwear applied in future research debating the topic of barefoot or minimalist shoe running.