Walking slope and heavy backpack loads affect torso muscle activity and kinematics

The independent effects of sloped walking or carrying a heavy backpack on posture and torso muscle activations have been reported. While the combined effects of sloped walking and backpack loads are known to be physically demanding, how back and abdominal muscles adapt to walking on slopes with heavy load is unclear. This study quantified three-dimensional pelvis and torso kinematics and muscle activity from longissimus, iliocostalis, rectus abdominis, and external oblique during walking on 0° and ± 10° degree slopes with and without backpack loads using two different backpack configurations (hip-belt assisted and shoulder-borne). Iliocostalis activity was greater during downhill and uphill compared to level walking, but longissimus was only greater during uphill. Rectus abdominis activity was greater during downhill and uphill compared to level, while external oblique activity decreased as slopes progressed from down to up. Longissimus, but not iliocostalis, activity was reduced during both backpack configurations compared to walking with no pack. Hip-belt assisted load carriage required less rectus abdominis activity compared to using shoulder-borne only backpacks; however, external oblique was not influenced by backpack condition. Our results revealed different responses between iliocostalis and longissimus, and between rectus abdominis and external obliques, suggesting different motor control strategies between anatomical planes.     

Differential serial sarcomere number adaptations in knee extensor muscles of rats is contraction type dependent.

Sarcomerogenesis, or the addition of sarcomeres in series within a fiber, has a profound impact on the performance of a muscle by increasing its contractile velocity and power. Sarcomerogenesis may provide a beneficial adaptation to prevent injury when a muscle consistently works at long lengths, accounting for the repeated-bout effect. The association between eccentric exercise, sarcomerogenesis and the repeated-bout effect has been proposed to depend on damage, where regeneration allows sarcomeres to work at shorter lengths for a given muscle-tendon unit length. To gain additional insight into this phenomenon, we measured fiber dynamics directly in the vastus lateralis (VL) muscle of rats during uphill and downhill walking, and we measured serial sarcomere number in the VL and vastus intermedius (VI) after chronic training on either a decline or incline grade. We found that the knee extensor muscles of uphill walking rats undergo repeated active concentric contractions, and therefore they suffer no contraction-induced injury. Conversely, the knee extensor muscles during downhill walking undergo repeated active eccentric contractions. Serial sarcomere numbers change differently for the uphill and downhill exercise groups, and for the VL and VI muscles. Short muscle lengths for uphill concentric-biased contractions result in a loss of serial sarcomeres, and long muscle lengths for downhill eccentric-biased contractions result in a gain of serial sarcomeres.     

Pregnant women exaggerate cautious gait patterns during the transition between level and hill surfaces

Falls are the leading cause of nonfatal injury across all age groups and a common incident for pregnant women. Thus, there is a critical demand for research to evaluate if walking strategies in pregnant women change throughout pregnancy in order to effectively intervene and minimize the incidence rate. The aim of the present study was to analyze modifications in temporal–spatial parameters as well as muscle activity during hill walking transitions in pregnant women between gestational week 20 and 32. Based upon previous literature, we hypothesized that in comparison to level walking, the transition strides of pregnant women would be distinct between trimesters in order to accommodate the physical changes within twelve weeks. Thirteen pregnant women completed a series of randomly assigned walking conditions on level and hill surfaces during gestational week 20 and 32. Our results demonstrated that pregnant women modulated their gait patterns throughout pregnancy with additional joint flexion as well as muscle activity at the ankle, knee and hip. In summary, pregnant women exaggerate cautious gait patterns by walking slower and wider with greater joint flexion and muscle activity in order to safely transition between level and hill surfaces.     

Mechanical work performed by the individual legs during uphill and downhill walking

Previous studies of the mechanical work performed during uphill and downhill walking have neglected the simultaneous negative and positive work performed by the leading and trailing legs during double support. Our goal was to quantify the mechanical work performed by the individual legs across a range of uphill and downhill grades. We hypothesized that during double support, (1) with steeper uphill grade, the negative work performed by the leading leg would become negligible and the trailing leg would perform progressively greater positive work to raise the center of mass (CoM), and (2) with steeper downhill grade, the leading leg would perform progressively greater negative work to lower the CoM and the positive work performed by the trailing leg would become negligible. 11 healthy young adults (6 M/5 F, 71.0±12.3 kg) walked at 1.25 m/s on a dual-belt force-measuring treadmill at seven grades (0, ±3, ±6, ±9°). We collected three-dimensional ground reaction forces (GRFs) and used the individual limbs method to calculate the mechanical work performed by each leg. As hypothesized, the trailing leg performed progressively greater positive work with steeper uphill grade, and the leading leg performed progressively greater negative work with steeper downhill grade (p<0.005). To our surprise, unlike level-ground walking, during double support the leading leg performed considerable positive work when walking uphill and the trailing leg performed considerable negative work when walking downhill (p<0.005). To understand how humans walk uphill and downhill, it is important to consider these revealing biomechanical aspects of individual leg function and interaction during double support.     

Effect of training on skeletal muscle injury from downhill running in rats

Experiments were conducted to test the hypothesis that injury to skeletal muscle in rats resulting from prolonged downhill running is prevented to a greater extent by prior downhill training than by either uphill or level training. Changes in plasma creatine phosphokinase (CPK) activity and glucose-6-phosphate dehydrogenase (G-6-PDase) activity in the soleus (S), vastus intermedius (VI), and medial head of triceps brachii (TM) muscles were evaluated as markers of muscle injury 48 h after 90 min of intermittent downhill running (16 m . min -1). Prior to this acute downhill run, groups of rats were trained by either downhill (-16 degrees), level (0 degrees), or uphill (+16 degrees) running (16 m . min -1) for 30 min/day. Training duration was either 5 days or 1 day. A training effect (i.e., reduced muscle injury) was indicated if muscle G-6-PDase or plasma CPK activity in a trained group following the 90-min downhill run was not different from that of nonexercised control animals and/or if it was lower than that of nontrained runners. A significant training effect was achieved in all three muscles with 5 days of either downhill or level training, but only in S after 5 days of uphill training. Elevation of plasma CPK activity was prevented by 5 days of training on all three inclines.(ABSTRACT TRUNCATED AT 250 WORDS)     

The series elastic shock absorber: tendon elasticity modulates energy dissipation by muscle during burst deceleration

During downhill running, manoeuvring, negotiation of obstacles and landings from a jump, mechanical energy is dissipated via active lengthening of limb muscles. Tendon compliance provides a ‘shock-absorber’ mechanism that rapidly absorbs mechanical energy and releases it more slowly as the recoil of the tendon does work to stretch muscle fascicles. By lowering the rate of muscular energy dissipation, tendon compliance likely reduces the risk of muscle injury that can result from rapid and forceful muscle lengthening. Here, we examine how muscle–tendon mechanics are modulated in response to changes in demand for energy dissipation. We measured lateral gastrocnemius (LG) muscle activity, force and fascicle length, as well as leg joint kinematics and ground-reaction force, as turkeys performed drop-landings from three heights (0.5–1.5 m centre-of-mass elevation). Negative work by the LG muscle–tendon unit during landing increased with drop height, mainly owing to greater muscle recruitment and force as drop height increased. Although muscle strain did not increase with landing height, ankle flexion increased owing to increased tendon strain at higher muscle forces. Measurements of the length–tension relationship of the muscle indicated that the muscle reached peak force at shorter and likely safer operating lengths as drop height increased. Our results indicate that tendon compliance is important to the modulation of energy dissipation by active muscle with changes in demand and may provide a mechanism for rapid adjustment of function during deceleration tasks of unpredictable intensity.     

Slack length of gastrocnemius medialis and Achilles tendon occurs at different ankle angles

Although muscle–tendon slack length is a crucial parameter used in muscle models, this is one of the most difficult measures to estimate in vivo. The aim of this study was to determine the onset of the rise in tension (i.e., slack length) during passive stretching in both Achilles tendon and gastrocnemius medialis. Muscle and tendon shear elastic modulus was measured by elastography (supersonic shear imaging) during passive plantarflexion (0° and 90° of knee angle, 0° representing knee fully extended, in a random order) in 9 participants. The within-session repeatability of the determined slack length was good at 90° of knee flexion (SEM=3.3° and 2.2° for Achilles tendon and gastrocnemius medialis, respectively) and very good at 0° of knee flexion (SEM=1.9° and 1.9° for Achilles tendon and gastrocnemius medialis, respectively). The slack length of gastrocnemius medialis was obtained at a significantly lower plantarflexed angle than for Achilles tendon at both 0° (P<0.0001; mean difference=19.4±3.8°) and 90° of knee flexion (P<0.0001; mean difference=25.5±7.6°). In conclusion, this study showed that the joint angle at which the tendon falls slack can be experimentally determined using supersonic shear imaging. The slack length of gastrocnemius medialis and Achilles tendon occurred at different joint angles. Although reporting this result is crucial to a better understanding of muscle–tendon interactions, further experimental investigations are required to explain this result.     

The effect of perturbing body segment parameters on calculated joint moments and muscle forces during gait

This study examined the effect of body segment parameter (BSP) perturbations on joint moments calculated using an inverse dynamics procedure and muscle forces calculated using computed muscle control (CMC) during gait. BSP (i.e. segment mass, center of mass location (com) and inertia tensor) of the left thigh, shank and foot of a scaled musculoskeletal model were perturbed. These perturbations started from their nominal value and were adjusted to ±40% in steps of 10%, for both individual as well as combined perturbations in BSP. For all perturbations, an inverse dynamics procedure calculated the ankle, knee and hip moments based on an identical inverse kinematics solution. Furthermore, the effect of applying a residual reduction algorithm (RRA) was investigated. Muscle excitations and resulting muscle forces were calculated using CMC. The results show only a limited effect of an individual parameter perturbation on the calculated moments, where the largest effect is found when perturbing the shank com (MS_com,shank, the ratio of absolute difference in torque and relative parameter perturbation, is maximally −7.81 N m for hip flexion moment). The additional influence of perturbing two parameters simultaneously is small (MS_{mass+com,thigh} is maximally 15.2 N m for hip flexion moment). RRA made small changes to the model to increase the dynamic consistency of the simulation (after RRA MS_com,shank is maximally 5.01 N m). CMC results show large differences in muscle forces when BSP are perturbed. These result from the underlying forward integration of the dynamic equations.     

Impact of ankle foot orthosis stiffness on Achilles tendon and gastrocnemius function during unimpaired gait

Ankle foot orthoses (AFOs) are designed to improve gait for individuals with neuromuscular conditions and have also been used to reduce energy costs of walking for unimpaired individuals. AFOs influence joint motion and metabolic cost, but how they impact muscle function remains unclear. This study investigated the impact of different stiffness AFOs on medial gastrocnemius muscle (MG) and Achilles tendon (AT) function during two walking speeds. We performed gait analyses for eight unimpaired individuals. Each individual walked at slow and very slow speeds with a 3D printed AFO with no resistance (free hinge condition) and four levels of ankle dorsiflexion stiffness: 0.25 Nm/°, 1 Nm/°, 2 Nm/°, and 3.7 Nm/°. Motion capture, ultrasound, and musculoskeletal modeling were used to quantify MG and AT lengths with each AFO condition. Increasing AFO stiffness increased peak AFO dorsiflexion moment with decreased peak knee extension and peak ankle dorsiflexion angles. Overall musculotendon length and peak AT length decreased, while peak MG length increased with increasing AFO stiffness. Peak MG activity, length, and velocity significantly decreased with slower walking speed. This study provides experimental evidence of the impact of AFO stiffness and walking speed on joint kinematics and musculotendon function. These methods can provide insight to improve AFO designs and optimize musculotendon function for rehabilitation, performance, or other goals.     

Exploring Muscle Activation during Nordic Walking: A Comparison between Conventional and Uphill Walking

Nordic Walking (NW) owes much of its popularity to the benefits of greater energy expenditure and upper body engagement than found in conventional walking (W). Muscle activation during NW is still understudied, however. The aim of the present study was to assess differences in muscle activation and physiological responses between NW and W in level and uphill walking conditions. Nine expert Nordic Walkers (mean age 36.8±11.9 years; BMI 24.2±1.8 kg/m²) performed 5-minute treadmill trials of W and NW at 4 km/h on inclines of 0% and 15%. The electromyographic activity of seven upper body and five leg muscles and oxygen consumption (VO₂) were recorded and pole force during NW was measured. VO₂ during NW was 22.3% higher at 0% and only 6.9% higher at 15% than during W, while upper body muscle activation was 2- to 15-fold higher under both conditions. Lower body muscle activation was similarly increased during NW and W in the uphill condition, whereas the increase in erector spinae muscle activity was lower during NW than W. The lack of a significant increase in pole force during uphill walking may explain the lower extra energy expenditure of NW, indicating less upper body muscle activation to lift the body against gravity. NW seemed to reduce lower back muscle contraction in the uphill condition, suggesting that walking with poles may reduce effort to control trunk oscillations and could contribute to work production during NW. Although the difference in extra energy expenditure between NW and W was smaller in the uphill walking condition, the increased upper body muscle involvement during exercising with NW may confer additional benefit compared to conventional walking also on uphill terrains. Furthermore, people with low back pain may gain benefit from pole use when walking uphill.     

Ethnic differences in triceps surae muscle-tendon complex and walking economy

The purposes of this study were to (a) determine whether structural differences in triceps surae muscle-tendon complex and walking economy exist between 14 African American and 19 Caucasian sedentary women and (b) determine whether muscle-tendon parameters are associated with walking economy. African American and Caucasian subjects were matched on body weight, height, and body composition. Muscle-tendon parameters were determined by magnetic resonance imaging and walking economy was evaluated at 4.8 km.h(-1). Medial gastrocnemius and total triceps surae muscle shape were different across ethnicity despite no ethnic differences in plantar flexion strength or in maximal cross-sectional area for any triceps surae muscles. African American women had shorter gastrocnemius muscles and longer tendons and performed walking more economically. Tendon length was the only variable related to walking economy. No ethnic differences were observed in walking economy after adjusting for tendon length. Data show gastrocnemius tendon length is related to level walking and longer gastrocnemius tendons may partly explain more economical walking in African American women. These preliminary findings indicate the structure of the muscle-tendon complex could be a factor partially accounting for reported ethnic differences in certain types of athletic-related performance.     

Himalayan porter's specialization: metabolic power, economy, efficiency and skill

Carrying heavy loads in the Himalayan region is a real challenge. Porters face extreme ranges in terrain condition, path steepness, altitude hypoxia and climate for 6-8h a day, many months a year, since they were boys. It has been previously shown that, when carrying loads on level terrain, porters' metabolic economy is higher than in Caucasians but the reasons are still unknown. We monitored Nepalese porters both during 90 km trekking in Khumbu Valley and at two different altitudes (3490 and 5050 m above sea-level), where they were compared to Caucasian mountaineers during (22%) gradient walking. Both subject groups carried a load of up to 90% body mass. The remarkably higher performance of porters during uphill locomotion (+60% in speed, +39% mechanical power) is only partly explained by the lower cost of loaded walking (-20%), being also the result of a better cardio-circulatory adaptation to altitude, which generates a higher mass-specific metabolic power (+30%). Consequently, Nepalese porters show higher efficiency, both during uphill and downhill loaded walking. Their higher economy on steep paths cannot be ascribed to a better exchange between potential and kinetic energy, as in our experiments the body centre of mass travelled monotonically uphill (or downhill). A different oscillation pattern of the loaded head-trunk segment, together with the analysis of the different components of the mechanical work during load carrying, suggests that achieved motor skills in balancing the loaded body segment above the hip could play a role in determining the better economy of porters.     

Muscle activity patterns of the tensor fascia latae and adductor longus for ramp and stair walking

Walking on both outdoor and indoor surfaces requires the ability to negotiate connections between vertical distances, simply known as hills and stairs. Therefore, the purpose of the present study was to evaluate the muscle activity patterns of the TFL and ADL during both hill and stair walking. We hypothesized that TFL and ADL activity during initial swing, initial stance, and late stance of up-ramp and up-stair walking would be greater than level walking. In contrast, we hypothesized that both TFL and ADL activity during initial swing of down-ramp and down-stair walking would be less. We utilized a 15° ramp, a 35° stair set, and for comparison of this steep angle, we also collected data on a 33° ramp. During up-ramp and up-stair walking, TFL and ADL activity during both initial swing and late stance of the up conditions were greater than level walking. For the down conditions, ADL activity during the swing phase of the steep down-ramp was less. Practically, our muscle activity results demonstrate that the hip abductors and hip adductors may provide additional pelvic stability and supplementary thigh acceleration during ramp and stair walking.     

How Do Ants Make Sense of Gravity? A Boltzmann Walker Analysis of Lasius niger Trajectories on Various Inclines

The goal of this study is to describe accurately how the directional information given by support inclinations affects the ant Lasius niger motion in terms of a behavioral decision. To this end, we have tracked the spontaneous motion of 345 ants walking on a 0.5×0.5 m plane canvas, which was tilted with 5 various inclinations by rad ( data points). At the population scale, support inclination favors dispersal along uphill and downhill directions. An ant''s decision making process is modeled using a version of the Boltzmann Walker model, which describes an ant''s random walk as a series of straight segments separated by reorientation events, and was extended to take directional influence into account. From the data segmented accordingly ( segments), this extension allows us to test separately how average speed, segments lengths and reorientation decisions are affected by support inclination and current walking direction of the ant. We found that support inclination had a major effect on average speed, which appeared approximately three times slower on the incline. However, we found no effect of the walking direction on speed. Contrastingly, we found that ants tend to walk longer in the same direction when they move uphill or downhill, and also that they preferentially adopt new uphill or downhill headings at turning points. We conclude that ants continuously adapt their decision making about where to go, and how long to persist in the same direction, depending on how they are aligned with the line of maximum declivity gradient. Hence, their behavioral decision process appears to combine klinokinesis with geomenotaxis. The extended Boltzmann Walker model parameterized by these effects gives a fair account of the directional dispersal of ants on inclines.     

Empirical evaluation of gastrocnemius and soleus function during walking

Distinguishing gastrocnemius and soleus muscle function is relevant for treating gait disorders in which abnormal plantarflexor activity may contribute to pathological movement patterns. Our objective was to use experimental and computational analysis to determine the influence of gastrocnemius and soleus activity on lower limb movement, and determine if anatomical variability of the gastrocnemius affected its function. Our hypothesis was that these muscles exhibit distinct functions, with the gastrocnemius inducing limb flexion and the soleus inducing limb extension. To test this hypothesis, the gastrocnemius or soleus of 20 healthy participants was electrically stimulated for brief periods (90 ms) during mid- or terminal stance of a random gait cycle. Muscle function was characterized by the induced change in sagittal pelvis, hip, knee, and ankle angles occurring during the 200 ms after stimulation onset. Results were corroborated with computational forward dynamic gait models, by perturbing gastrocnemius or soleus activity during similar portions of the gait cycle. Mid- and terminal stance gastrocnemius stimulation induced posterior pelvic tilt, hip flexion and knee flexion. Mid-stance gastrocnemius stimulation also induced ankle dorsiflexion. In contrast mid-stance soleus stimulation induced anterior pelvic tilt, knee extension and plantarflexion, while late-stance soleus stimulation induced relatively little change in motion. Model predictions of induced hip, knee, and ankle motion were generally in the same direction as those of the experiments, though the gastrocnemius? results were shown to be quite sensitive to its knee-to-ankle moment arm ratio.     

Peak triceps surae muscle activity is not specific to knee flexion angles during MVIC

There is limited research on peak activity of the separate triceps surae muscles in select knee flexion (KF) positions during a maximum voluntary isometric contraction (MVIC) used to normalize EMG signals. The aim of this study was to determine how frequent peak activity occurred during an MVIC for soleus (SOL), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) in select KF positions, and if these peaks were recorded in similar KF positions. Forty-eight healthy individuals performed unilateral plantar-flexion MVIC in standing with 0°KF and 45°KF, and in sitting with 90°KF. Surface EMG of SOL, GM, and GL were collected and processed in 250 ms epochs to determine peak root-mean-square amplitude. Peak activity was most frequently captured in standing and rarely in sitting, with no position selective to SOL, GM or GL activity. Peak GM and GL activity was more frequent in 0°KF than 45°KF, and more often in similar KF positions than not. Peak SOL activity was just as likely in 45°KF as 0°KF, and more in positions similar to GM, but not GL. The EMG amplitudes were at least 20% greater in positions that captured peak activity over those that did not. The overall findings support performing an MVIC in more than one KF position to normalize triceps surae EMG. It is emphasized that no KF position is selective to SOL, GM, or GL alone.     

Ground reaction forces during downhill and uphill running

We investigated the normal and parallel ground reaction forces during downhill and uphill running. Our rationale was that these force data would aid in the understanding of hill running injuries and energetics. Based on a simple spring-mass model, we hypothesized that the normal force peaks, both impact and active, would increase during downhill running and decrease during uphill running. We anticipated that the parallel braking force peaks would increase during downhill running and the parallel propulsive force peaks would increase during uphill running. But, we could not predict the magnitude of these changes. Five male and five female subjects ran at 3m/s on a force treadmill mounted on the level and on 3 degrees, 6 degrees, and 9 degrees wedges. During downhill running, normal impact force peaks and parallel braking force peaks were larger compared to the level. At -9 degrees, the normal impact force peaks increased by 54%, and the parallel braking force peaks increased by 73%. During uphill running, normal impact force peaks were smaller and parallel propulsive force peaks were larger compared to the level. At +9 degrees, normal impact force peaks were absent, and parallel propulsive peaks increased by 75%. Neither downhill nor uphill running affected normal active force peaks. Combined with previous biomechanics studies, our normal impact force data suggest that downhill running substantially increases the probability of overuse running injury. Our parallel force data provide insight into past energetic studies, which show that the metabolic cost increases during downhill running at steep angles.     

Economical Speed and Energetically Optimal Transition Speed Evaluated by Gross and Net Oxygen Cost of Transport at Different Gradients

The oxygen cost of transport per unit distance (CoT; mL·kg^-1·km^-1) shows a U-shaped curve as a function of walking speed (v), which includes a particular walking speed minimizing the CoT, so called economical speed (ES). The CoT-v relationship in running is approximately linear. These distinctive walking and running CoT-v relationships give an intersection between U-shaped and linear CoT relationships, termed the energetically optimal transition speed (EOTS). This study investigated the effects of subtracting the standing oxygen cost for calculating the CoT and its relevant effects on the ES and EOTS at the level and gradient slopes (±5%) in eleven male trained athletes. The percent effects of subtracting the standing oxygen cost (4.8 ± 0.4 mL·kg^-1·min^-1) on the CoT were significantly greater as the walking speed was slower, but it was not significant at faster running speeds over 9.4 km·h^-1. The percent effect was significantly dependent on the gradient (downhill > level > uphill, P < 0.001). The net ES (level 4.09 ± 0.31, uphill 4.22 ± 0.37, and downhill 4.16 ± 0.44 km·h^-1) was approximately 20% slower than the gross ES (level 5.15 ± 0.18, uphill 5.27 ± 0.20, and downhill 5.37 ± 0.22 km·h^-1, P < 0.001). Both net and gross ES were not significantly dependent on the gradient. In contrast, the gross EOTS was slower than the net EOTS at the level (7.49 ± 0.32 vs. 7.63 ± 0.36 km·h^-1, P = 0.003) and downhill gradients (7.78 ± 0.33 vs. 8.01 ± 0.41 km·h^-1, P < 0.001), but not at the uphill gradient (7.55 ± 0.37 vs. 7.63 ± 0.51 km·h^-1, P = 0.080). Note that those percent differences were less than 2.9%. Given these results, a subtraction of the standing oxygen cost should be carefully considered depending on the purpose of each study.     

Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis

Background

Clinically, plantar fasciitis (PF) is believed to be a result and/or prolonged by overpronation and excessive loading, but there is little biomechanical data to support this assertion. The purpose of this study was to determine the differences between healthy individuals and those with PF in (1) rearfoot motion, (2) medial forefoot motion, (3) first metatarsal phalangeal joint (FMPJ) motion, and (4) ground reaction forces (GRF).

Methods

We recruited healthy (n=22) and chronic PF individuals (n=22, symptomatic over three months) of similar age, height, weight, and foot shape (p>0.05). Retro-reflective skin markers were fixed according to a multi-segment foot and shank model. Ground reaction forces and three dimensional kinematics of the shank, rearfoot, medial forefoot, and hallux segment were captured as individuals walked at 1.35 ms⁻¹.

Results

Despite similarities in foot anthropometrics, when compared to healthy individuals, individuals with PF exhibited significantly (p<0.05) (1) greater total rearfoot eversion, (2) greater forefoot plantar flexion at initial contact, (3) greater total sagittal plane forefoot motion, (4) greater maximum FMPJ dorsiflexion, and (5) decreased vertical GRF during propulsion.

Conclusion

These data suggest that compared to healthy individuals, individuals with PF exhibit significant differences in foot kinematics and kinetics. Consistent with the theoretical injury mechanisms of PF, we found these individuals to have greater total rearfoot eversion and peak FMPJ dorsiflexion, which may put undue loads on the plantar fascia. Meanwhile, increased medial forefoot plantar flexion at initial contact and decreased propulsive GRF are suggestive of compensatory responses, perhaps to manage pain.