An in vitro simulation study of impulsive force transmission along the lower skeletal extremity

Several investigators have revealed that a relationship exists between articular cartilage deterioration and the mechanical stress that results from transient impulsive forces created in the lower extremity during gait. This study is an investigation of the transmission of impulse waves through the lower extremity and the effect of knee pathology and prosthetic knee replacement on their transmission. An in vitro experiment is performed using human cadaver specimens that are instrumented with accelerometers. The distal end of the tibia is impacted with a vibration shaker to simulate heel strike. The results indicate that the normal knee joint is able to attenuate 59% of the transient peak force applied to it by the tibia. This attenuation capacity is reduced by knee pathology and decreases further with implantation of a knee prosthesis. The results indicate that abnormalities at the knee may increase the risk of degenerative changes at the ankle, hip and in the spine due to increased transient impulsive forces.     

In vivo biomechanical behavior of the human heel pad during the stance phase of gait

A technique is introduced for simultaneous measurements of the heel pad tissue deformation and the heel–ground contact stresses developing during the stance phase of gait. Subjects walked upon a gait platform integrating the contact pressure display optical method for plantar pressure measurements and a digital radiographic fluoroscopy system for skeletal and soft tissue motion recording. Clear images of the posterior-plantar aspect of the calcaneus and enveloping soft tissues were obtained simultaneously with the pressure distribution under the heel region throughout the stance phase of gait. The heel pad was shown to undergo a rapid compression during initial contact and heel strike, reaching a strain of 0.39±0.05 in about 150 ms. The stress–strain relation of the heel pad was shown to be highly non-linear, with a compression modulus of 105±11 kPa initially and 306±16 kPa at 30% strain. The energy dissipation during heel strike was evaluated to be 17.8±0.8%. The present technique is useful for biomechanical as well as clinical evaluation of the stress–strain and energy absorption characteristics of the heel pad in vivo, during natural gait.     

The oscillatory behavior of the CoM facilitates mechanical energy balance between push-off and heel strike

Humans use equal push-off and heel strike work during the double support phase to minimize the mechanical work done on the center of mass (CoM) during the gait. Recently, a step-to-step transition was reported to occur over a period of time greater than that of the double support phase, which brings into question whether the energetic optimality is sensitive to the definition of the step-to-step transition. To answer this question, the ground reaction forces (GRFs) of seven normal human subjects walking at four different speeds (1.1-2.4 m/s) were measured, and the push-off and heel strike work for three differently defined step-to-step transitions were computed based on the force, work, and velocity. To examine the optimality of the work and the impulse data, a hybrid theoretical-empirical analysis is presented using a dynamic walking model that allows finite time for step-to-step transitions and incorporates the effects of gravity within this period. The changes in the work and impulse were examined parametrically across a range of speeds. The results showed that the push-off work on the CoM was well balanced by the heel strike work for all three definitions of the step-to-step transition. The impulse data were well matched by the optimal impulse predictions (R(2)>0.7) that minimized the mechanical work done on the CoM during the gait. The results suggest that the balance of push-off and heel strike energy is a consistent property arising from the overall gait dynamics, which implies an inherited oscillatory behavior of the CoM, possibly by spring-like leg mechanics.     

An in vitro simulation study of impulsive force transmission along the lower skeletal extremity

Several investigators have revealed that a relationship exists between articular cartilage deterioration and the mechanical stress that results from transient impulsive forces created in the lower extremity during gait. This study is an investigation of the transmission of impulse waves through the lower extremity and the effect of knee pathology and prosthetic knee replacement on their transmission.

An in vitro experiment is performed using human cadaver specimens that are instrumented with accelerometers. The distal end of the tibia is impacted with a vibration shaker to simulate heel strike. The results indicate that the normal knee joint is able to attenuate 59% of the transient peak force applied to it by the tibia. This attenuation capacity is reduced by knee pathology and decreases further with implantation of a knee prosthesis. The results indicate that abnormalities at the knee may increase the risk of degenerative changes at the ankle, hip and in the spine due to increased transient impulsive forces.     

Determination of toe-off event time during treadmill locomotion using kinematic data

Researchers collecting gait kinematic data during treadmill locomotion are often interested in determining the times of toe off and heel strike for each stride. In the absence of additional hardware, only position data collected with motion-capture equipment may be available. Others have published methods for using kinematic data for detecting overground gait events. However, during treadmill locomotion, especially running, overground methods may not possess sufficient accuracy. The purpose of this paper is to describe a method for using kinematic data to determine the time of toe off during treadmill locomotion. Ten subjects walked and ran on a treadmill while a motion-capture system collected positional data from heel and toe markers. The treadmill was equipped with force platforms that allowed an accurate determination of foot-ground contact. The time of toe off was determined using the vertical component of the toe marker, and this method was found to have greater accuracy for event detection than other published methods. Researchers can use the described method to determine times of heel strike and toe off during treadmill locomotion using only kinematic data.     

Trunk's Natural Inclination Influences Stance Limb Kinetics,but Not Body Kinematics,during Gait Initiation in Able Men

The imposing mass of the trunk in relation to the whole body has an important impact on human motion. The objective of this study is to determine the influence of trunk''s natural inclination - forward (FW) or backward (BW) with respect to the vertical - on body kinematics and stance limb kinetics during gait initiation.Twenty-five healthy males were divided based on their natural trunk inclination (FW or BW) during gait initiation. Instantaneous speed was calculated at the center of mass at the first heel strike. The antero-posterior impulse was calculated by integrating the antero-posterior ground reaction force in time. Ankle, knee, hip and thoraco-lumbar (L5) moments were calculated using inverse dynamics and only peaks of the joint moments were analyzed. Among all the investigated parameters, only joint moments present significant differences between the two groups. The knee extensor moment is 1.4 times higher (P<0.001) for the BW group, before the heel contact. At the hip, although the BW group displays a flexor moment 2.4 times higher (P<0.001) before the swing limb''s heel-off, the FW group displays an extensor moment 3.1 times higher (P<0.01) during the swing phase. The three L5 extensor peaks after the toe-off are respectively 1.7 (P<0.001), 1.4 (P<0.001) and 1.7 (P<0.01) times higher for the FW group. The main results support the idea that the patterns described during steady-state gait are already observable during gait initiation. This study also provides reference data to further investigate stance limb kinetics in specific or pathologic populations during gait initiation. It will be of particular interest for elderly people, knowing that this population displays atypical trunk postures and present a high risk of falling during this forward stepping.     

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.     

A Phase-Dependent Hypothesis for Locomotor Functions of Human Foot Complex

The human foot is a very complex structure comprising numerous bones, muscles, ligaments and synovial joints. As the only component in contact with the ground, the foot complex delivers a variety of biomechanical functions during human locomotion, e.g. body support and propulsion, stability maintenance and impact absorption. These need the human foot to be rigid and damped to transmit ground reaction forces to the upper body and maintain body stability, and also to be compliant and resilient to moderate risky impacts and save energy. How does the human foot achieve these apparent conflicting functions？ In this study, we propose a phase-dependent hypothesis for the overall locomotor functions of the human foot complex based on in-vivo measurements of human natural gait and simulation results of a mathematical foot model. We propse that foot functions are highly dependent on gait phase, which is a major characteristics of human locomotion. In early stance just after heel strike, the foot mainly works as a shock absorber by moderating high impacts using the viscouselastic heel pad in both vertical and horizontal directions. In mid-stance phase （-80% of stance phase）, the foot complex can be considered as a springy rocker, reserving external mechanical work using the foot arch whilst moving ground contact point forward along a curved path to maintain body stability. In late stance after heel off, the foot complex mainly serves as a force modulator like a gear box, modulating effective mechanical advantages of ankle plantiflexor muscles using metatarsal-phalangeal joints. A sound under- standing of how diverse functions are implemented in a simple foot segment during human locomotion might be useful to gain insight into the overall foot locomotor functions and hence to facilitate clinical diagnosis, rehabilitation product design and humanoid robot development.     

Investigation of balance strategy over gait cycle based on margin of stability

This study was conducted to investigate the balance strategy of healthy young adults through a gait cycle using the margin of stability (MoS). Thirty healthy young adults participated in this study. Each performed walking five times at a preferred speed and at a fast speed. The MoS was calculated over a gait cycle by defining the base of support (BoS) changes during a gait cycle. The MoS was divided into medial/lateral and anterior/posterior components (ML MoS and AP MoS). The central values and the values at 12 gait events of the MoS were compared. Positive/negative integration of ML MoS (ML MoS_POS and ML MoS_NEG, respectively) and the average ML/AP MoS over a cycle (ML/AP MoS_mean) were significantly lower at a fast gait than at a preferred gait. ML/AP MoS were lower at a fast speed than at the preferred speed, except for the ML MoS immediately before left heel strike (pre left HS) and right and left heel strike (HS). ML/AP MoS were significantly lower immediately before heel strike (pre-HS) than in other gait events, regardless of walking speed. It was suggested that pre-HS is the most unstable moment in both ML/AP directions and a crucial moment in control of gait stability. The results presented above might be applicable as basic data regarding dynamic stability of healthy young adults through a gait cycle for comparisons with elderly people and patients with orthopedic disorders or neurological disorders.     

Phase-dependent modulation of corticospinal excitability during the observation of the initial phase of gait

This study was undertaken to identify the temporal characteristics of corticospinal excitability of tibialis anterior muscle during the observation of the initial phase of gait. For this purpose, using transcranial magnetic stimulation, we recorded motor evoked potentials (MEPs) during the observation of the second step of an actor’s first three steps of gait initiation with (complex gait) or without (normal gait) an obstacle and unstable surface. The results demonstrate that (1) MEPs during the observation of the initial phase of normal gait were significantly increased only at early swing phase, but not other phases (mid-swing, heel contact, mid-stance, and heel off) and (2) MEPs during the observation of the initial phase of complex gait were significantly increased at early swing and also at mid-swing and heel contact phases. These findings provide the first evidence that corticospinal excitability during the observation of gait, especially the initial phase, is modulated in phase- and motor-demanded-dependent manners.     

Effect of arm swinging on lumbar spine and hip joint forces

During level walking, arm swing plays a key role in improving dynamic stability. In vivo investigations with a telemeterized vertebral body replacement showed that spinal loads can be affected by differences in arm positions during sitting and standing. However, little is known about how arm swing could influence the lumbar spine and hip joint forces and motions during walking. The present study aims to provide better understanding of the contribution of the upper limbs to human gait, investigating ranges of motion and joint reaction forces.A three-dimensional motion analysis was carried out via a motion capturing system on six healthy males and five patients with hip instrumented implant. Each subject performed walking with different arm swing amplitudes (small, normal, and large) and arm positions (bound to the body, and folded across the chest). The motion data were imported in a commercial musculoskeletal analysis software for kinematic and inverse dynamic investigation.The range of motion of the thorax with respect to the pelvis and of the pelvis with respect to the ground in the transversal plane were significantly associated with arm position and swing amplitude during gait. The hip external-internal rotation range of motion statistically varied only for non-dominant limb. Unlike hip joint reaction forces, predicted peak spinal loads at T12-L1 and L5-S1 showed significant differences at approximately the time of contralateral toe off and contralateral heel strike.Therefore, arm position and swing amplitude have a relevant effect on kinematic variables and spinal loads, but not on hip loads during walking.     

Mechanical energy and effective foot mass during impact loading of walking and running

The human heel pad is considered an important structure for attenuation of the transient force caused by heel-strike. Although the mechanical properties of heel pads are relatively well understood, the mechanical energy (Etot) absorbed by the heel pad during the impact phase has never been documented directly because data on the effective foot mass (Meff) was previously unavailable during normal forward locomotion. In this study, we use the impulse-momentum method (IMM) for calculating Meff from moving subjects. Mass-spring-damper models were developed to evaluate errors and to examine the effects of pad property, upper body mass, and effective leg spring on Meff. We simultaneously collected ground reaction forces, pad deformation, and lower limb kinematics during impact phase of barefoot walking, running, and crouched walking. The latter was included to examine the effect of knee angle on Meff. The magnitude of Meff as a percentage of body mass (M(B)) varies with knee angle at impact and significantly differs among gaits: 6.3%M(B) in walking, 5.3%M(B) in running, and 3.7%M(B) in crouched walking. Our modeling results suggested that Meff is insensitive to heel pad resilience and effective leg stiffness. At the instant prior to heel strike, Etot ranges from 0.24 to 3.99 J. The combination of video and forceplate data used in this study allows analyses of Etot and Etot as a function of heel-strike kinematics during normal locomotion. Relationship between Meff and knee angle provides insights into how changes in posture moderate impact transients at different gaits.     

Knee joint kinematics during walking influences the spatial cartilage thickness distribution in the knee

The regional adaptation of knee cartilage morphology to the kinematics of walking has been suggested as an important factor in the evaluation of the consequences of alteration in normal gait leading to osteoarthritis. The purpose of this study was to investigate the association of spatial cartilage thickness distributions of the femur and tibia in the knee to the knee kinematics during walking. Gait data and knee MR images were obtained from 17 healthy volunteers (age 33.2 ± 9.8 years). Cartilage thickness maps were created for the femoral and tibial cartilage. Locations of thickest cartilage in the medial and lateral compartments in the femur and tibia were identified using a numerical method. The flexion-extension (FE) angle associated with the cartilage contact regions on the femur, and the anterior-posterior (AP) translation and internal-external (IE) rotation associated with the cartilage contact regions on the tibia at the heel strike of walking were tested for correlation with the locations of thickest cartilage. The locations of the thickest cartilage had relatively large variation (SD, 8.9°) and was significantly associated with the FE angle at heel strike only in the medial femoral condyle (R(2)=0.41, p<0.01). The natural knee kinematics and contact surface shapes seem to affect the functional adaptation of knee articular cartilage morphology. The sensitivity of cartilage morphology to kinematics at the knee during walking suggests that regional cartilage thickness variations are influenced by both loading and the number of loading cycles. Thus walking is an important consideration in the analysis of the morphological variations of articular cartilage, since it is the dominant cyclic activity of daily living. The sensitivity of cartilage morphology to gait kinematics is also important in understanding the etiology and pathomechanics of osteoarthritis.     

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.     

The effects of gastrocnemius–soleus muscle forces on ankle biomechanics during triple arthrodesis

This paper presents a finite element model of the ankle, taking into account the effects of muscle forces, determined by a musculoskeletal analysis, to investigate the contact stress distribution in the tibio-talar joint in patients with triple arthrodesis and in normal subjects. Forces of major ankle muscles were simulated and corresponded well with the trend of their EMG signals. These forces were applied to the finite element model to obtain stress distributions for patients with triple arthrodesis and normal subjects in three stages of the gait cycle, i.e. heel strike, midstance, and heel rise. The results demonstrated that the stress distribution patterns of the tibio-talar joint in patients with triple arthrodesis differ from those of normal subjects in investigated gait cycle stages. The mean and standard deviations for maximum stresses in the tibo-talar joint in the stance phase for patients and normal subjects were 9.398e7 ± 1.75e7 and 7.372e7 ± 4.43e6 Pa, respectively. The maximum von Mises stresses of the tibio-talar joint for all subjects in the stance phase found to be on the lateral side of the inferior surface of the joint. The results also indicate that, in patients with triple arthrodesis, increasing gastrocnemius–soleus muscle force reduces the stress on the medial malleolus compared with normal subjects. Most of stresses in this area are between 45 and 109 kPa, and will decrease to almost 32 kPa in patients after increasing of 40% in gastrocnemius–soleus muscle force.     

Gait dynamics on an inclined walkway

OBJECTIVE: This paper documents research that quantifies and describes the biomechanics of normal gait on inclined surfaces. DESIGN: Experimental, investigative. BACKGROUND: It is necessary to walk on inclined surfaces to negotiate the natural and built environments. Little research has been conducted on the biomechanics of normal gait on inclined surfaces. METHODS: The gait of 11 healthy male volunteers was measured using a Vicon system 370 on an inclinable walkway. Gait was measured at 0 degrees , 5 degrees , 8 degrees and 10 degrees of incline. Passive optical markers were placed on each subject and they walked at a self-selected speed up and down the walkway. Ground reaction forces and EMG were measured. Gait data were analysed in Vicon Clinical Manager. RESULTS: Changes in the dynamics of the lower limbs with respect to incline angles are described. Between subject and between condition differences in biomechanical parameters were significant. Hip flexion increased at heel strike with inclines from -10 degrees to +10 degrees . Knee flexion and ankle dorsiflexion at heel strike increased with increasing angle walking up, but not down. Changes in joint moments and powers due to change in the angle of incline or direction of walking were observed. CONCLUSIONS: The mechanisms by which the body enables walking up and downhill, specifically raising and lowering the centre of mass, and preventing slipping, can be seen in the alteration in the dynamics of the lower limbs. Increases in range of motion and muscle strength requirements need to be considered in the design of lower limb prostheses and in orthopaedic and neurological rehabilitation. RELEVANCE: Gait, prosthetics, rehabilitation, balance and falls.     

Gait reaction reconstruction and a heel strike algorithm

A mathematical model of gait ground loading is presented. The model allows the ground reactions produced by any particular single- or multiple-footfall pattern to be constructed, given a sufficient variety of other measured ground reactions. An algorithm which uses center of vertical pressure data only to determine the instants of successive heel strikes on a large force plate is then presented. Experiments show the high accuracy of the heel strike algorithm and show that reconstructions of the vertical component of ground reactions are typically within 3% of corresponding measured reactions. The techniques presented allow certain problems associated with small force plates and other problems associated with large force plates to be largely overcome.     

Energetics of actively powered locomotion using the simplest walking model

We modified an irreducibly simple model of passive dynamic walking to walk on level ground, and used it to study the energetics of walking and the preferred relationship between speed and step length in humans. Powered walking was explored using an impulse applied at toe-off immediately before heel strike, and a torque applied on the stance leg. Although both methods can supply energy through mechanical work on the center of mass, the toe-off impulse is four times less costly because it decreases the collision loss at heel strike. We also studied the use of a hip torque on the swing leg that tunes its frequency but adds no propulsive energy to gait. This spring-like actuation can further reduce the collision loss at heel strike, improving walking energetics. An idealized model yields a set of simple power laws relating the toe-off impulses and effective spring constant to the speed and step length of the corresponding gait. Simulations incorporating nonlinear equations of motion and more realistic inertial parameters show that these power laws apply to more complex models as well.     

Contributions of individual muscles to hip joint contact force in normal walking

The human hip joint withstands high contact forces during daily activity and is therefore susceptible to injury and structural deterioration over time. Knowledge of muscle-force contributions to hip joint loading may assist in the development of strategies to prevent and manage conditions such as osteoarthritis, femoro-acetabular impingement and fracture. The main aim of this study was to determine the contributions of individual muscles to hip contact force in normal walking. Muscle contributions to hip contact force were calculated based on a previously published dynamic optimization solution for normal walking, which provided the time histories of joint motion, ground reaction forces, and muscle forces during the stance and swing phases of gait. The force developed by each muscle plus its contribution to the ground reaction force were used to determine the muscle’s contribution to hip contact force. Muscles were the major contributors to hip contact force, with gravitational and centrifugal forces combined contributing less than 5% of the total contact force. Four muscles that span the hip – gluteus medius, gluteus maximus, iliopsoas, and hamstrings – contributed most significantly to the three components of the hip contact force and hip contact impulse (integral of hip contact force over time). Three muscles that do not span the hip – vasti, soleus, and gastrocnemius – also contributed substantially to hip joint loading. These results provide additional insight into lower-limb muscle function during walking and may also be relevant to studies of cartilage degeneration and bone remodelling at the hip.     

Friction in Total Hip Joint Prosthesis Measured In Vivo during Walking

Friction-induced moments and subsequent cup loosening can be the reason for total hip joint replacement failure. The aim of this study was to measure the in vivo contact forces and friction moments during walking. Instrumented hip implants with Al₂O₃ ceramic head and an XPE inlay were used. In vivo measurements were taken 3 months post operatively in 8 subjects. The coefficient of friction was calculated in 3D throughout the whole gait cycle, and average values of the friction-induced power dissipation in the joint were determined. On average, peak contact forces of 248% of the bodyweight and peak friction moments of 0.26% bodyweight times meter were determined. However, contact forces and friction moments varied greatly between individuals. The friction moment increased during the extension phase of the joint. The average coefficient of friction also increased during this period, from 0.04 (0.03 to 0.06) at contralateral toe off to 0.06 (0.04 to 0.08) at contralateral heel strike. During the flexion phase, the coefficient of friction increased further to 0.14 (0.09 to 0.23) at toe off. The average friction-induced power throughout the whole gait cycle was 2.3 W (1.4 W to 3.8 W). Although more parameters than only the synovia determine the friction, the wide ranges of friction coefficients and power dissipation indicate that the lubricating properties of synovia are individually very different. However, such differences may also exist in natural joints and may influence the progression of arthrosis. Furthermore, subjects with very high power dissipation may be at risk of thermally induced implant loosening. The large increase of the friction coefficient during each step could be caused by the synovia being squeezed out under load.