Analysing gait using a force-measuring walkway: intrasession repeatability in healthy children and adolescents

The goal of this study was to determine the repeatability of gait parameters measured by a force plate gait analysis system (Leonardo Mechanograph^® GW) in healthy children. Nineteen healthy children and adolescents (age range: 7–17 years) walked at a self-selected speed on an 11-m-long walkway. Vertical ground reaction forces were measured in the central 6 m of the walkway. Each participant performed three blocks of three trials while walking barefoot and three blocks of three trials while wearing shoes. There were no differences between trials within each condition. All force and spatiotemporal parameters had intraclass correlation coefficients above 0.87 and coefficients of variation in the order of 1–6%. In this group of healthy children and adolescents, gait analysis with a force plate system produced repeatable intra-day results.     

Gait biomechanics in individuals with patellar tendon and hamstring tendon anterior cruciate ligament reconstruction grafts

Anterior cruciate ligament reconstruction (ACLR) restores joint stability following ACL injury but does not attenuate the heightened risk of developing knee osteoarthritis. Additionally, patellar tendon (PT) grafts incur a greater risk of osteoarthritis compared to hamstring grafts (HT). Aberrant gait biomechanics, including greater loading rates (i.e. impulsive loading), are linked to the development of knee osteoarthritis. However, the role of graft selection on walking gait biomechanics linked to osteoarthritis is poorly understood, thus the purpose of this study was to compare walking gait biomechanics between individuals with HT and PT grafts. Ninety-eight (74 PT; 24 HT) subjects with a history of ACLR performed walking gait at a self-selected speed from which the peak vertical ground reaction force (vGRF) during the first 50% of the stance phase and its instantaneous loading rate, peak internal knee extension and valgus moments, and peak knee flexion and varus angles were obtained. When controlling for time since ACLR and quadriceps strength, there were no differences in any kinetic or kinematic variables between graft types. While not significant, 44% of the PT cohort were identified as impulsive loaders (displaying a heelstrike transient in the majority of walking trials) compared to only 25% of the HT cohort (odds ratio = 2.3). This more frequent observation of impulsive loading may contribute to the greater risk of osteoarthritis with PT grafts. Future research is necessary to determine if impulsive loading and small magnitude differences between graft types contribute to osteoarthritis risk when extrapolated over thousands of steps per day.     

Effect of chronic idiopathic low back pain on the kinetic gait characteristics in different foot masks

Identification of kinetic variables in different masks of foot is important for the evaluation and treatment of chronic low back pain. The aim of this study was to investigate the effect of chronic idiopathic low back pain on kinetic variables of gait in different foot masks. 11 idiopathic chronic low back pain patients and 13 healthy matched controls participated in this study. Using Emed foot-scanner system, the ground reaction force and impulse were measured during barefoot normal walking. Then, the average footprints were divided into 10 masks using the Automask program and the data were extracted using Multimask Evaluation programs. The low back pain disability was measured by Quebec questionnaire. Our results revealed that the ground reaction force and impulse in medial and lateral midfoot and hallux masks of patients were significantly lower than controls. Furthermore, these patients demonstrated greater ground reaction force and impulse in 3–5th metatarsals mask than control group. There was a significant interaction between the low back pain and the foot masks factors. In conclusion, the ground reaction forces and impulses in different areas of foot are affected by low back pain. Therefore, the kinetic gait analysis should be considered as an appropriate tool in evaluation and prescribing proper treatment program in low back pain patients.     

The influence of different playing surfaces on the biomechanics of a tennis running forehand foot plant

Research suggests that heightened impacts, altered joint movement patterns, and changes in friction coefficient from the use of artificial surfaces in sport increase the prevalence of overuse injuries. The purposes of this study were to (a) develop procedures to assess a tennis-specific movement, (b) characterize the ground reaction force (GRF) impact phases of the movement, and (c) assess human response during impact with changes in common playing surfaces. In relation to the third purpose it was hypothesized that surfaces with greatest mechanical cushioning would yield lower impact forces (PkFz) and rates of loading. Six shod volunteers performed 8 running forehand trials on each surface condition: baseline, carpet, acrylic, and artificial turf. Force plate (960 Hz) and kinematic data (120 Hz) were collected simultaneously for each trial. Running forehand foot plants are typically characterized by 3 peaks in vertical GRF prior to a foot-off peak. Group mean PkFz was significantly lower and peak braking force was significantly higher on the baseline surface compared with the other three test surfaces (p<0.05). No significant changes in initial kinematics were found to explain unexpected PkFz results. The baseline surface yielded a significantly higher coefficient of friction compared with the other three test surfaces (p<0.05). While the hypothesis is rejected, biomechanical analysis has revealed changes in surface type with regard to GRF variables.     

Comparison of lower limb kinetics,kinematics and muscle activation during drop jumping under shod and barefoot conditions

This study was to investigate the acute effects of wearing shoes on lower limb kinetics, kinematics and muscle activation during a drop jump. Eighteen healthy men performed a drop jump under barefoot and shod conditions. Vertical ground reaction force (GRF) was measured on a force plate during the contact phase of a drop jump, and GRF valuables were calculated for each condition. The angles of the knee and ankle joints, and the foot strike angle (the angle between the plantar surface of the foot and the ground during ground contact) as well as the electromyography of 7 muscles were measured. The shod condition showed a significant larger first peak GRF, longer time to first peak GRF from the initial ground contact and lower initial loading rate than the barefoot condition. The shod condition showed a significant larger ankle joint angle at initial ground contact, smaller knee joint angle between the second peak GRF and take-off as well as smaller foot strike angle at both initial ground contact and take-off than the barefoot condition. There were significant correlations between relative differences in ankle joint at the initial ground contact and relative differences in the initial loading rate. The muscle activity of all muscles during foot ground contact did not differ between two conditions; however, in the shod condition, muscle activation of 150 ms before foot ground contact was significantly higher in the rectus femoris, whereas it was lower in the biceps femoris and tibialis anterior muscles than the barefoot condition. These results indicate that wearing shoes alternates the GRF variables at initial ground contact, joint kinematics at the ground contact and muscle activation before foot ground contact during a drop jump, suggesting that the effects of wearing shoes on drop jump training differ from being barefoot.     

An MRI-compatible foot-loading device for assessment of internal tissue deformation

It is well known that mechanical forces acting within the soft tissues of the foot can contribute to the formation of neuropathic ulcers in people with diabetes. Presently, only surface measurements of plantar pressure are used clinically to estimate risk status due to mechanical loading. It is currently not known how surface measurements relate to the three-dimensional (3-D) internal stress/strain state of the foot. This article describes the development of a foot-loading device that allows for the direct observation of the internal deformation of foot tissues under known forces. Ground reaction forces and plantar pressure distributions during normal walking were measured in ten healthy young adults. One instant in the gait cycle, when pressure under the metatarsal heads reached a peak, was extracted for simulation in an MR imager. T1-weighted 3-D gradient echo MRI sets were collected as the simulated walking ground reaction force was incrementally applied to the foot by the novel foot-loading device. The sub-metatarsal head soft-tissue thickness decreased rapidly at first and then reached a plateau. Peak plantar pressure measurements collected within the loading device (161+/-75kPa) were lower in magnitude and less focal than pressures measured during walking (492+/-91kPa). This finding implies that although the device successfully applied full peak walking ground reaction forces to the foot, they were not distributed in the same manner as during walking. Although not representative of gait, the data collected from this in vivo mechanical test are suitable for determination of foot tissue material properties or, when combined with finite element modeling, to examine the relationship between surface loading and internal stress.     

Greater toe grip and gentler heel strike are the strategies to adapt to slippery surface

This study investigated the plantar pressure distribution during gait on wooden surface with different slipperiness in the presence of contaminants. Fifteen Chinese males performed 10 walking trials on a 5-m wooden walkway wearing cloth shoe in four contaminated conditions (dry, sand, water, oil). A pressure insole system was employed to record the plantar pressure data at 50Hz. Peak pressure and time-normalized pressure-time integral were evaluated in nine regions. In comparing walking on slippery to non-slippery surfaces, results showed a 30% increase of peak pressure beneath the hallux (from 195.6 to 254.1kPa), with a dramatic 79% increase in the pressure time integral beneath the hallux (from 63.8 to 114.3kPa) and a 34% increase beneath the lateral toes (from 35.1 to 47.2kPa). In addition, the peak pressure beneath the medial and lateral heel showed significant 20-24% reductions, respectively (from 233.6-253.5 to 204.0-219.0kPa). These findings suggested that greater toe grip and gentler heel strike are the strategies to adapt to slippery surface. Such strategies plantarflexed the ankle and the metatarsals to achieve a flat foot contact with the ground, especially at heel strike, in order to shift the ground reaction force to a more vertical direction. As the vertical ground reaction force component increased, the available ground friction increased and the floor became less slippery. Therefore, human could walk without slip on slippery surfaces with greater toe grip and gentler heel strike as adaptation strategies.     

Contributions of muscles to mediolateral ground reaction force over a range of walking speeds

Impaired control of mediolateral body motion during walking is an important health concern. Developing treatments to improve mediolateral control is challenging, partly because the mechanisms by which muscles modulate mediolateral ground reaction force (and thereby modulate mediolateral acceleration of the body mass center) during unimpaired walking are poorly understood. To investigate this, we examined mediolateral ground reaction forces in eight unimpaired subjects walking at four speeds and determined the contributions of muscles, gravity, and velocity-related forces to the mediolateral ground reaction force by analyzing muscle-driven simulations of these subjects. During early stance (0-6% gait cycle), peak ground reaction force on the leading foot was directed laterally and increased significantly (p<0.05) with walking speed. During early single support (14-30% gait cycle), peak ground reaction force on the stance foot was directed medially and increased significantly (p<0.01) with speed. Muscles accounted for more than 92% of the mediolateral ground reaction force over all walking speeds, whereas gravity and velocity-related forces made relatively small contributions. Muscles coordinate mediolateral acceleration via an interplay between the medial ground reaction force contributed by the abductors and the lateral ground reaction forces contributed by the knee extensors, plantarflexors, and adductors. Our findings show how muscles that contribute to forward progression and body-weight support also modulate mediolateral acceleration of the body mass center while weight is transferred from one leg to another during double support.     

Determining the centre of pressure during walking and running using an instrumented treadmill

In this paper, a new method of determining spatial and temporal gait parameters by using centre of pressure (CoP) data is presented. A treadmill is used which was developed to overcome limitations of regular methods for the analysis of spatio-temporal gait parameters and ground reaction forces during walking and running. The design of the treadmill is based on the use of force transducers underneath a separate left and right plate, which together form the treadmill walking surface. The results of test procedures and measurements show that accurate recordings of vertical ground reaction force can be obtained. These recordings enable a separate analysis of vertical ground reaction forces during double support phases in walking, and the analysis of changes in the centre of pressure (CoP) position during subsequent foot placements. From the CoP data, temporal gait parameters (e.g. duration of left/right support and swing phases) and spatial gait parameters (i.e. left/right step lengths and widths) can be derived.     

Estimating the complete ground reaction forces with pressure insoles in walking

This study presented a method to estimate the complete ground reaction forces from pressure insoles in walking. Five male subjects performed 10 walking trials in a laboratory. The complete ground reaction forces were collected during a right foot stride by a force plate at 1000Hz. Simultaneous plantar pressure data were collected at 100Hz by a pressure insole system with 99 sensors covering the whole plantar area. Stepwise linear regressions were performed to individually reconstruct the complete ground reaction forces in three directions from the 99 individual pressure data until redundancy among the predictors occurred. An additional linear regression was performed to reconstruct the vertical ground reaction force by the sum of the value of the 99 pressure sensors. Five other subjects performed the same walking test for validation. Estimated ground reaction forces in three directions were calculated with the developed regression models, and were compared with the real data recorded from force plate. Accuracy was represented by the correlation coefficient and the root mean square error. Results showed very good correlation in anterior-posterior (0.928) and vertical (0.989) directions, and reasonable correlation in medial-lateral direction (0.719). The root mean square error was about 12%, 5% and 28% of the peak recorded value. Future studies should aim to generalize the methods or to establish specific methods to other subjects, patients, motions, footwear and floor conditions. The method gives an extra option to study an estimation of the complete ground reaction forces in any environment without the constraints from the number and location of force plates.     

Hip contact forces and gait patterns from routine activities.

In vivo loads acting at the hip joint have so far only been measured in few patients and without detailed documentation of gait data. Such information is required to test and improve wear, strength and fixation stability of hip implants. Measurements of hip contact forces with instrumented implants and synchronous analyses of gait patterns and ground reaction forces were performed in four patients during the most frequent activities of daily living. From the individual data sets an average was calculated. The paper focuses on the loading of the femoral implant component but complete data are additionally stored on an associated compact disc. It contains complete gait and hip contact force data as well as calculated muscle activities during walking and stair climbing and the frequencies of daily activities observed in hip patients. The mechanical loading and function of the hip joint and proximal femur is thereby completely documented. The average patient loaded his hip joint with 238% BW (percent of body weight) when walking at about 4 km/h and with slightly less when standing on one leg. This is below the levels previously reported for two other patients (Bergmann et al., Clinical Biomechanics 26 (1993) 969-990). When climbing upstairs the joint contact force is 251% BW which is less than 260% BW when going downstairs. Inwards torsion of the implant is probably critical for the stem fixation. On average it is 23% larger when going upstairs than during normal level walking. The inter- and intra-individual variations during stair climbing are large and the highest torque values are 83% larger than during normal walking. Because the hip joint loading during all other common activities of most hip patients are comparably small (except during stumbling), implants should mainly be tested with loading conditions that mimic walking and stair climbing.     

Influence of gait parameters on the loading of the lower limb

The ground reaction force which acts on the foot during normal walking consists of the sum of two components: the support of the weight of the body and the acceleration of the body. The relationships between the initial loading rate of the lower limb (ignoring the contribution of the heelstrike transient) and the general gait parameters — cadence, stride length, and velocity — have been examined. Plots of the resultant ground reaction force were used to calculate the loading rate of the limb. A sample of 13 normal male subjects, aged from 18 to 63 years, walked at five different self-selected speeds. Velocity showed the highest correlation with loading rate (r = 0.95) and stride length the lowest (r = 0.85). The relationship between cadence and loading rate was non-linear.     

Accelerometer counts and raw acceleration output in relation to mechanical loading

The purpose of this study was to assess the relationship of accelerometer output, in counts (ActiGraph GT1M) and as raw accelerations (ActiGraph GT3X+ and GENEA), with ground reaction force (GRF) in adults. Ten participants (age: 29.4 ± 8.2 yr, mass: 74.3 ± 9.8 kg, height: 1.76 ± 0.09 m) performed eight trials each of: slow walking, brisk walking, slow running, faster running and box drops. GRF data were collected for one step per trial (walking and running) using a force plate. Low jumps and higher jumps (one per second) were performed for 20 s each on the force plate. For box drops, participants dropped from a 35 cm box onto the force plate. Throughout, three accelerometers were worn at the hip: GT1M, GT3X+ and GENEA. A further GT3X+ and GENEA were worn on the left and right wrist, respectively. GT1M counts correlated with peak impact force (r = 0.85, p < 0.05), average resultant force (r = 0.73, p < 0.05) and peak loading rate (r = 0.76, p < 0.05). Accelerations from the GT3X+ and GENEA correlated with average resultant force and peak loading rate irrespective of whether monitors were worn at the hip or wrist (r > 0.82, p < 0.05, r > 0.63 p < 0.05, respectively). In conclusion, accelerometer count and raw acceleration output correlate positively with GRF and thus may be appropriate for the quantification of activity beneficial to bone. Wrist-worn monitors show a similar relationship with GRF as hip-worn monitors, suggesting that wrist-worn monitors may be a viable option for future studies looking at bone health.     

Biomechanical gait analysis of pigs walking on solid concrete floor

Inappropriate floors in pig pens and slippery floor conditions may cause leg problems that reduce animal welfare. Therefore the objectives of the present study were to characterise the walk of pigs on dry concrete solid floor, to evaluate whether pigs modify their gait according to floor condition, and to suggest a coefficient of friction (COF) that ensures safe walking on solid concrete floors for pigs. Kinematic (50 Hz video recordings in the sagittal plane) and kinetic (1 KHz force plate measuring three perpendicular ground reaction forces) data were collected from four strides of both the fore- and hindlimbs of 30 healthy pigs walking on dry, greasy and wet concrete floor with 10 pigs on each floor condition. The COF of the floor conditions were tested in a drag-test. The results from the gait analysis showed that the pigs adapted their gait to potentially slippery floors by lowering their walking speed and reducing their peak utilised COF on greasy and wet (contaminated) floors compared with dry floors. Moreover, the pigs shortened their progression length and prolonged their stance phase duration on greasy floor compared with dry and wet floors. Thus the greasy floor appeared the most slippery condition to the pigs, whereas the wet floor was intermediate to the other two conditions. The pigs walked with a four-beat gait, and the limbs differed biomechanically, as the forelimbs carried more load, received higher peak vertical forces and had longer lasting stance phases than did the hindlimbs. The utilised COF from the gait analysis indicated that a high floor COF (>0.63) is needed to prevent pigs from slipping and thus to ensure safe walking on dry concrete floors.     

Men and women adopt similar walking mechanics and muscle activation patterns during load carriage

Although numerous studies have investigated the effects of load carriage on gait mechanics, most have been conducted on active military men. It remains unknown whether men and women adapt differently to carrying load. The purpose of this study was to compare the effects of load carriage on gait mechanics, muscle activation patterns, and metabolic cost between men and women walking at their preferred, unloaded walking speed. We measured whole body motion, ground reaction forces, muscle activity, and metabolic cost from 17 men and 12 women. Subjects completed four walking trials on an instrumented treadmill, each five minutes in duration, while carrying no load or an additional 10%, 20%, or 30% of body weight. Women were shorter (p<0.01), had lower body mass (p=0.01), and had lower fat-free mass (p=0.02) compared to men. No significant differences between men and women were observed for any measured gait parameter or muscle activation pattern. As load increased, so did net metabolic cost, the duration of stance phase, peak stance phase hip, knee, and ankle flexion angles, and all peak joint extension moments. The increase in the peak vertical ground reaction force was less than the carried load (e.g. ground force increased approximately 6% with each 10% increase in load). Integrated muscle activity of the soleus, medial gastrocnemius, lateral hamstrings, vastus medialis, vastus lateralis, and rectus femoris increased with load. We conclude that, despite differences in anthropometry, men and women adopt similar gait adaptations when carrying load, adjusted as a percentage of body weight.     

Change in knee contact force with simulated change in body weight

The relationship between obesity, weight gain and progression of knee osteoarthritis is well supported, suggesting that excessive joint loading may be a mechanism responsible for cartilage deterioration. Examining the influence of weight gain on joint compressive forces is difficult, as both muscles and ground reaction forces can have a significant impact on the forces experienced during gait. While previous studies have examined the relationship between body weight and knee forces, these studies have used models that were not validated using experimental data. Therefore, the objective of this study was to evaluate the relationship between changes in body weight and changes in knee joint contact forces for an individual's gait pattern using musculoskeletal modeling that is validated against known internal compressive forces. Optimal weighting constants were determined for three subjects to generate valid predictions of knee contact forces (KCFs) using in vivo data collection with instrumented total knee arthroplasty. A total of five simulations per walking trial were generated for each subject, from 80% to 120% body weight in 10% increments, resulting in 50 total simulations. The change in peak KCF with respect to body weight was found to be constant and subject-specific, predominantly determined by the peak force during the baseline condition at 100% body weight. This relationship may be further altered by any change in kinematics or body mass distribution that may occur as a result of a change in body weight or exercise program.     

The between-day reliability of peroneus longus EMG during walking

The peroneus longus (PL) is a rearfoot evertor, important in frontal plane foot motion. Studying PL function has been limited by previous electromyography (EMG) studies reporting poor between-day reliability. Due to its close proximity to adjacent muscles, EMG measures of PL may be susceptible to crosstalk, thus correct electrode placement is vital. The aim of this study was to use ultrasound to aid placement of small surface EMG electrodes and determine the between-day reliability of PL EMG in healthy participants’ walking. Ten participants walked barefoot and shod at a controlled, self-selected speed. Six trials per condition, per session, were recorded over two days (mean (SD): 5 (3) days apart). The muscle belly was located using ultrasound. EMG was recorded with surface electrodes (Trigno™ Mini, Delsys, Inc.) at 2000 Hz. Amplitude was normalized to the peak per gait cycle and time normalized to the gait cycle. Reliability of discrete variables were primarily assessed with the standard error of measurement (SEM), plus the coefficient of multiple correlation (CMC), the coefficient of variation (CV) and the intra-class correlation coefficient (ICC). The pattern of the EMG profile was consistent. The SEM of peak amplitude was 4% (3–8%) and 3% (2–5%) for barefoot and shod respectively. For timing of the peak the SEM was 2% (1–3%) and 1% (1–2%) for barefoot and shod respectively. Low SEM of discrete variables suggests good reliability of PL EMG during walking supporting the future use of this protocol. Therefore activation of PL can be confidently studied in repeated-measures study designs.     

The relationship between joint kinetic factors and the walk-run gait transition speed during human locomotion

The primary purpose of this project was to examine whether lower extremity joint kinetic factors are related to the walk-run gait transition during human locomotion. Following determination of the preferred transition speed (PTS), each of the 16 subjects walked down a 25-m runway, and over a floor-mounted force platform at five speeds (70, 80, 90, 100, and 110% of the PTS), and ran over the force platform at three speeds (80, 100, and 120% of the PTS) while being videotaped (240 Hz) from the right sagittal plane. Two-dimensional kinematic data were synchronized with ground reaction force data (960 Hz). After smoothing, ankle and knee joint moments and powers were calculated using standard inverse dynamics calculations. The maximum dorsiflexor moment was the only variable tested that increased as walking speed increased and then decreased when gait changed to a run at the PTS, meeting the criteria set to indicate that this variable influences the walk-run gait transition during human locomotion. This supports previous research suggesting that an important factor in changing gaits at the PTS is the prevention of undue stress in the dorsiflexor muscles.     

Kinetic asymmetry in female runners with and without retrospective tibial stress fractures

Gait asymmetry may be linked to the tendency for runners to sustain chronic overuse injuries. This paper compares gait asymmetry in female runners who have never sustained a running-related injury to those who have sustained unilateral tibial stress fractures. The symmetry index was used to characterize asymmetry in the kinetics of both subject groups. There were three aims to this study: (1) to report natural levels of asymmetry for healthy, never-injured female runners, (2) to compare asymmetry levels between never-injured runners and those who have sustained stress fractures, and (3) to examine the kinetics between the involved and uninvolved limbs of runners who have sustained stress fractures. In all three aims, peak medial, lateral, braking, vertical impact, and vertical ground reaction forces, average and peak instantaneous vertical loading rates, and peak shock were examined. In the never-injured runner group, natural levels of asymmetry ranged from 3.1% for peak vertical ground reaction force up to 49.8% for peak lateral ground reaction force. Symmetry indices were not significantly different in the runners who had previously sustained stress fractures. The involved limb of the previously injured runners demonstrated higher values for braking and vertical impact ground reaction force and peak shock. Interestingly, these runners appeared to have bilaterally-elevated lateral ground reaction forces and loading rates as compared to the never-injured group, although this was not statistically tested. This suggests that previously injured runners may be closer to the injury threshold and, thus, more susceptible. Asymmetry may simply influence the side on which they become injured.     

Footwear and Foam Surface Alter Gait Initiation of Typical Subjects

Gait initiation is the task commonly used to investigate the anticipatory postural adjustments necessary to begin a new gait cycle from the standing position. In this study, we analyzed whether and how foot-floor interface characteristics influence the gait initiation process. For this purpose, 25 undergraduate students were evaluated while performing a gait initiation task in three experimental conditions: barefoot on a hard surface (barefoot condition), barefoot on a soft surface (foam condition), and shod on a hard surface (shod condition). Two force plates were used to acquire ground reaction forces and moments for each foot separately. A statistical parametric mapping (SPM) analysis was performed in COP time series. We compared the anterior-posterior (AP) and medial-lateral (ML) resultant center of pressure (COP) paths and average velocities, the force peaks under the right and left foot, and the COP integral x force impulse for three different phases: the anticipatory postural adjustment (APA) phase (Phase 1), the swing-foot unloading phase (Phase 2), and the support-foot unloading phase (Phase 3). In Phase 1, significantly smaller ML COP paths and velocities were found for the shod condition compared to the barefoot and foam conditions. Significantly smaller ML COP paths were also found in Phase 2 for the shod condition compared to the barefoot and foam conditions. In Phase 3, increased AP COP velocities were found for the shod condition compared to the barefoot and foam conditions. SPM analysis revealed significant differences for vector COP time series in the shod condition compared to the barefoot and foam conditions. The foam condition limited the impulse-generating capacity of COP shift and produced smaller ML force peaks, resulting in limitations to body-weight transfer from the swing to the support foot. The results suggest that footwear and a soft surface affect COP and impose certain features of gait initiation, especially in the ML direction of Phase 1.