Effect of biomechanical footwear on upper and lower leg muscle activity in comparison with knee brace and normal walking

AimTo evaluate the activity of knee stabilizing muscles while using custom-made biomechanical footwear (BF) and to compare it when walking barefoot and with a knee brace (Unloader®).MethodsSeventeen healthy working-aged (mean age: 29 years; standard deviation: 8 years) individuals participated. The knee brace was worn on the right knee and BF in both legs. Surface electromyography (sEMG) data was recorded bilaterally from vastus medialis (VM), semitendinosus (ST), tibialis anterior (TA) and lateral gastrocnemius (LG) muscles during walking, and repeated-measures ANOVA with a post-hoc t-test was used to determine differences between the different walking modalities (barefoot, brace and BF).ResultsAveraged sEMG was significantly higher when walking with BF than barefoot or knee brace in the ST muscles, in the right LG, and left TA muscle. It was significantly lower when walking with the brace compared to barefoot in the right ST and LG muscles, and left TA muscle. Analysis of the ensemble-averaged sEMG profiles showed earlier activation of TA muscles when walking with BF compared to other walking modalities.ConclusionBF produced greater activation in evaluated lower leg muscles compared to barefoot walking. Thus BF may have an exercise effect in rehabilitation and further studies about its effectiveness are warranted.     

Unholey shoes: Experimental considerations when estimating ankle joint complex power during walking and running

For studies that aim to assess biological ankle function, calculating ankle joint complex (AJC) power between the calcaneus and shank is recommended over conventional inverse dynamics estimates between a rigid-body foot and shank. However, when designing a new experiment, it remains unclear whether holes should be cut in footwear to permit motion tracking via skin-mounted markers, or whether marker placement locations should be tightly controlled across conditions. Here we provide data to assist researchers in answering these questions. We performed a gait analysis study of walking (0.8, 1.2, 1.6 m·s⁻¹) and running (2.6, 2.8, 3.0 m·s⁻¹) while subjects (N = 10) wore custom-modified footwear, which allowed markers to be placed either on the shoe, or on the skin via cut-out windows in the shoes. First, we compared foot markers affixed to the skin vs. on the same locations on the shoe. Using statistical non-parametric mapping techniques, we discovered that skin vs. shoe markers had no statistically significant effect on net AJC power estimates throughout stance phase, for all walking and running speeds. Second, we compared calcaneal markers in the nominal shoe configuration vs. markers in a nearby location (∼27 mm below) on the shoe. We observed significant differences when marker placement on the shoe was varied, which may be relevant to repeated-measures study designs. The results suggest that when computing AJC power for walking and running, you may want to put down the scissors (i.e., forego cutting holes in your footwear), and instead pick up a Sharpie® (pen) or use a template, to maintain consistent marker placement across trials and conditions.     

Active and passive contributions to joint kinetics during walking in older adults

The objectives of this study were to characterize the active and passive contributions to joint kinetics during walking in healthy young and older adults, and assess whether isokinetic ankle strength is associated with ankle power output during walking. Twenty healthy young (18–35 years) and 20 healthy older (65–85 years) adults participated in this study. We measured subject-specific passive-elastic joint moment–angle relationships in the lower extremity and tested maximum isokinetic ankle strength at 30 deg/s. Passive moment–angle relationships were used to estimate active and passive joint moment, power, and work quantities during walking at 80%, 100% and 120% of preferred walking speed. There were no significant differences in walking speed, step length, or cadence between the older and young adults. However, the older adults produced significantly more net positive work at the hip but less net positive work at the ankle at all walking speeds. Passive contributions to hip and ankle work did not significantly differ between groups, inferring that the older adults generated the additional hip work actively. Maximum isokinetic ankle strength was significantly less in the older adults, and correlated with peak positive plantar-flexor power at both the preferred and fast walking speeds. The results of this study suggest that age-related shifts in joint kinetics do not arise as a result of increased passive hip joint stiffness, but seem to be reflected in plantar-flexor weakness.     

Kinematic evaluation of cruciate-retaining total knee replacement patients during level walking: A comparison with the displacement-controlled ISO standard

Differences between wear-scar features of simulator-tested and retrieved tibial total knee replacement (TKR) liners have been reported. This disagreement may result from differences between in vivo kinematic profiles and those defined by the International Organization for Standardization (ISO). The purpose of this study was to determine the knee kinematics of a TKR subject group during level walking and compare them with the motion profiles defined by the ISO standard for a displacement-controlled knee wear testing simulator. Twenty-nine patients with a posterior cruciate ligament-retaining TKR design were gait tested using the point cluster technique to obtain flexion–extension (FE) rotation, anterior–posterior (AP) translation and internal–external (IE) rotation knee motions during a complete cycle of level walking. Relative ranges of motion and timing of key points within the in vivo motion data were compared against the same ranges and same key points from the input profiles of the displacement-controlled wear testing standard ISO14243-3. The subjects exhibited a FE pattern similar to ISO, with an insignificant difference in range of FE rotation from midstance to terminal stance. However, the subjects had a significantly higher range of knee flexion from terminal stance into swing. The subjects also exhibited a phase delay for the entire gait cycle. For AP translation, the standard profile had statistically significant lower magnitudes than seen in vivo. Opposite pattern of AP motion was also apparent from midstance and swing. Similarly, ISO specified a smaller IE total range of rotation with a motion pattern in complete opposition to that seen in vivo. In conclusion, significant differences were found in both the magnitudes and pattern of in vivo motion compared with ISO.     

Joint moments and contact forces in the foot during walking

The net force and moment of a joint have been widely used to understand joint disease in the foot. Meanwhile, it does not reflect the physiological forces on muscles and contact surfaces. The objective of the study is to estimate active moments by muscles, passive moments by connective tissues and joint contact forces in the foot joints during walking. Joint kinematics and external forces of ten healthy subjects (all males, 24.7 ± 1.2 years) were acquired during walking. The data were entered into the five-segment musculoskeletal foot model to calculate muscle forces and joint contact forces of the foot joints using an inverse dynamics-based optimization. Joint reaction forces and active, passive and net moments of each joint were calculated from muscle and ligament forces. The maximum joint reaction forces were 8.72, 4.31, 2.65, and 3.41 body weight (BW) for the ankle, Chopart’s, Lisfranc and metatarsophalangeal joints, respectively. Active and passive moments along with net moments were also obtained. The maximum net moments were 8.6, 8.4, 5.4 and 0.8%BW∙HT, respectively. While the trend of net moment was very similar between the four joints, the magnitudes and directions of the active and passive moments varied between joints. The active and passive moments during walking could reveal the roles of muscles and ligaments in each of the foot joints, which was not obvious in the net moment. This method may help narrow down the source of joint problems if applied to clinical studies.     

Partitioning of knee joint internal forces in gait is dictated by the knee adduction angle and not by the knee adduction moment

Medial knee osteoarthritis is a debilitating disease. Surgical and conservative interventions are performed to manage its progression via reduction of load on the medial compartment or equivalently its surrogate measure, the external adduction moment. However, some studies have questioned a correlation between the medial load and adduction moment. Using a musculoskeletal model of the lower extremity driven by kinematics–kinetics of asymptomatic subjects at gait midstance, we aim here to quantify the relative effects of changes in the knee adduction angle versus changes in the adduction moment on the joint response and medial/lateral load partitioning. The reference adduction rotation of 1.6° is altered by ±1.5° to 3.1° and 0.1° or the knee reference adduction moment of 17 N m is varied by ±50% to 25.5 N m and 8.5 N m. Quadriceps, hamstrings and tibiofemoral contact forces substantially increased as adduction angle dropped and diminished as it increased. The medial/lateral ratio of contact forces slightly altered by changes in the adduction moment but a larger adduction rotation hugely increased this ratio from 8.8 to a 90 while in contrast a smaller adduction rotation yielded a more uniform distribution. If the aim in an intervention is to diminish the medial contact force and medial/lateral load ratio, a drop of 1.5° in adduction angle is much more effective (causing respectively 12% and 80% decreases) than a reduction of 50% in the adduction moment (causing respectively 4% and 13% decreases). Substantial role of changes in adduction angle is due to the associated alterations in joint nonlinear passive resistance. These findings explain the poor correlation between knee adduction moment and tibiofemoral compartment loading during gait suggesting that the internal load partitioning is dictated by the joint adduction angle.     

Patterns in the knee flexion-extension moment profile during stair ascent and descent in patients with total knee arthroplasty

The aim of this study was to investigate the prevalence of abnormal knee biomechanical patterns in 40 patients with a modern TKA prosthesis, compared to 40 matched control participants when ascending and descending stairs. Fewer patients were able to ascend (65%) or descend stairs (53%) unassisted than controls (83%). Of the participants who could ascend and descend, cluster analysis classified most patients (up to 77%) as demonstrating a similar knee moment pattern as all controls. A small subgroup of patients who completed the tasks did so with distinctly abnormal biomechanics compared to other patients and controls. These findings suggest that recovery of normal stair climbing is possible. However, rehabilitation might be more effective if it were tailored to account for these differences between patients.     

Real-time biofeedback can increase and decrease vertical ground reaction force,knee flexion excursion,and knee extension moment during walking in individuals with anterior cruciate ligament reconstruction

Individuals with anterior cruciate ligament reconstruction (ACLR) often exhibit a “stiffened knee strategy” or an excessively extended knee during gait, characterized by lesser knee flexion excursion and peak internal knee extension moment (KEM). The purpose of this study was to determine the effect of real-time biofeedback (RTBF) cuing an acute change in peak vertical ground reaction force (vGRF) during the first 50% of the stance phase of walking gait on: (1) root mean square error (RMSE) between actual vGRF and RTBF target vGRF; (2) perceived difficulty; and (3) knee biomechanics. Acquisition and short-term recall of these outcomes were evaluated. Thirty individuals with unilateral ACLR completed 4 separate walking sessions on a force-measuring treadmill that consisted of a control (no RTBF) and 3 experimental loading conditions using RTBF including: (1) 5% vGRF increase (high-loading), (2) 5% vGRF decrease (low-loading) and (3) symmetric vGRF between limbs. Bilateral biomechanical outcomes were analyzed during the first 50% of the stance phase, and included KEM, knee flexion excursion, peak vGRF, and instantaneous vGRF loading rate (vGRF-LR) for each loading condition. Peak vGRF significantly increased and decreased during high-loading and low-loading, respectively compared to control loading. Instantaneous vGRF-LR, peak KEM and knee flexion excursion significantly increased during the high-loading condition compared to low-loading. Perceived difficultly and RMSE were lower during the symmetrical loading condition compared to the low-loading condition. Cuing an increase in peak vGRF may be beneficial for increasing KEM, knee flexion excursion, peak vGRF, and vGRF-LR in individuals with ACLR. Clinical Trials Number: NCT03035994.     

Comparison of global and joint-to-joint methods for estimating the hip joint load and the muscle forces during walking

A three-dimensional musculoskeletal model of the lower limb was developed to study the influence of biarticular muscles on the muscle force distribution and joint loads during walking. A complete walking cycle was recorded for 9 healthy subjects using the standard optoelectronic motion tracking system. Ground contact forces were also measured using a 6-axes force plate. Inverse dynamics was used to compute net joint reactions (forces and torques) in the lower limb. A static optimization method was then used to estimate muscle forces. Two different approaches were used: in the first one named global method, the biarticular muscles exerted a torque on the two joints they spanned at the same time, and in the second one called joint-by-joint method, these biarticular muscles were divided into two mono-articular muscles with geometrical (insertion, origin, via points) and physiological properties remained unchanged. The hip joint load during the gait cycle was then calculated taking into account the effect of muscle contractions. The two approaches resulted in different muscle force repartition: the biarticular muscles were favoured over any set of single-joint muscles with the same physiological function when using the global method. While the two approaches yielded only little difference in the resultant hip load, the examination of muscle power showed that biarticular muscles could produce positive work at one joint and negative work at the other, transferring energy between body segments and thus decreasing the metabolic cost of movement.     

The effect of fixed charge density and cartilage swelling on mechanics of knee joint cartilage during simulated gait

The effect of swelling of articular cartilage, caused by the fixed charge density (FCD) of proteoglycans, has not been demonstrated on knee joint mechanics during simulated walking before. In this study, the influence of the depth-wise variation of FCD was investigated on the internal collagen fibril strains and the mechanical response of the knee joint cartilage during gait using finite element (FE) analysis. The FCD distribution of tibial cartilage was implemented from sodium (²³Na) MRI into a 3-D FE-model of the knee joint (“Healthy model”). For comparison, models with decreased FCD values were created according to the decrease in FCD associated with the progression of osteoarthritis (OA) (“Early OA” and “Advanced OA” models). In addition, a model without FCD was created (“No FCD” model). The effect of FCD was studied with five different collagen fibril network moduli of cartilage. Using the reference fibril network moduli, the decrease in FCD from “Healthy model” to “Early OA” and “Advanced OA” models resulted in increased axial strains (by +2 and +6%) and decreased fibril strains (by −3 and −13%) throughout the stance, respectively, calculated as mean values through cartilage depth in the tibiofemoral contact regions. Correspondingly, compared to the “Healthy model”, the removal of the FCD altogether in “NoFCD model” resulted in increased mean axial strains by +16% and decreased mean fibril strains by −24%. This effect was amplified as the fibril network moduli were decreased by 80% from the reference. Then mean axial strains increased by +6, +19 and +49% and mean fibril strains decreased by −9, −20 and −32%, respectively. Our results suggest that the FCD in articular cartilage has influence on cartilage responses in the knee during walking. Furthermore, the FCD is suggested to have larger impact on cartilage function as the collagen network degenerates e.g. in OA.     

Foot center of pressure manipulation and gait therapy influence lower limb muscle activation in patients with osteoarthritis of the knee

Background

Foot center of pressure (COP) manipulation has been associated with improved gait patterns. The purpose of this study was to determine lower limb muscle activation changes in knee osteoarthritis patients, both immediately after COP manipulation and when COP manipulation was combined with continuous gait therapy (AposTherapy).

Methods

Fourteen females with medial compartment knee osteoarthritis underwent EMG analyzes of key muscles of the leg. In the initial stage, trials were carried out at four COP positions. Following this, gait therapy was initiated for 3 months. The barefoot EMG was compared before and after therapy.

Results

The average EMG varied significantly with COP in at least one phase of stance in all examined muscles of the less symptomatic leg and in three muscles of the more symptomatic leg. After training, a significant increase in average EMG was observed in most muscles. Most muscles of the less symptomatic leg showed significantly increased peak EMG. Activity duration was shorter for all muscles of the less symptomatic leg (significant in the lateral gastrocnemius) and three muscles of the more symptomatic leg (significant in the biceps femoris). These results were associated with reduced pain, increased function and improved spatiotemporal parameters.

Conclusions

COP manipulation influences the muscle activation patterns of the leg in patients with knee osteoarthritis. When combined with a therapy program, muscle activity increases and activity duration decreases.     

Kinematic,kinetic and electromyographic differences between young adults with and without chronic ankle instability during walking

The objective of this study was to quantify the kinematic, kinetic and electromyography differences between individuals with and without chronic ankle instability (CAI) during comfortable (CW) and fast (FW) walking. Twenty-one individuals with CAI and 21 healthy controls were recruited to walk at CW and FW speeds. The dependent variables were gluteus medius, vastus lateralis, gastrocnemius lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles mean activity, ankle and knee angles and moments. Kinematic, kinetic and electromyography variables were compared between groups with a one-dimensional statistical non-parametric mapping analysis. The CAI group exhibited no significant difference for ankle angles and moments compared to the control group. However, the CAI group showed less external knee rotation from 56 to 100% (CW) and 51 to 98% (FW) and more knee abduction moment from 1 to 6% and 7 to 9% (CW) and 1 to 2% (FW) of the stance phase. Less gluteus medius muscle activity was also observed from 6 to 9% and 99 to 100% (CW) of the stance phase for the CAI group. These results suggest proximal biomechanical compensations and will help better understand the underlying deficits associated with CAI. They also indicate that regardless of walking speeds, individuals with CAI exhibit similar differences compared to healthy participants.     

Development of a finite element musculoskeletal model with the ability to predict contractions of three-dimensional muscles

Representation of realistic muscle geometries is needed for systematic biomechanical simulation of musculoskeletal systems. Most of the previous musculoskeletal models are based on multibody dynamics simulation with muscles simplified as one-dimensional (1D) line-segments without accounting for the large muscle attachment areas, spatial fibre alignment within muscles and contact and wrapping between muscles and surrounding tissues. In previous musculoskeletal models with three-dimensional (3D) muscles, contractions of muscles were among the inputs rather than calculated, which hampers the predictive capability of these models. To address these issues, a finite element musculoskeletal model with the ability to predict contractions of 3D muscles was developed. Muscles with realistic 3D geometry, spatial muscle fibre alignment and muscle-muscle and muscle-bone interactions were accounted for. Active contractile stresses of the 3D muscles were determined through an efficient optimization approach based on the measured kinematics of the lower extremity and ground force during gait. This model also provided stresses and strains of muscles and contact mechanics of the muscle-muscle and muscle-bone interactions. The total contact force of the knee predicted by the model corresponded well to the in vivo measurement. Contact and wrapping between muscles and surrounding tissues were evident, demonstrating the need to consider 3D contact models of muscles. This modelling framework serves as the methodological basis for developing musculoskeletal modelling systems in finite element method incorporating 3D deformable contact models of muscles, joints, ligaments and bones.     

Computational stability of human knee joint at early stance in Gait: Effects of muscle coactivity and anterior cruciate ligament deficiency

As one of the most complex and vulnerable structures of body, the human knee joint should maintain dynamic equilibrium and stability in occupational and recreational activities. The evaluation of its stability and factors affecting it is vital in performance evaluation/enhancement, injury prevention and treatment managements. Knee stability often manifests itself by pain, hypermobility and giving-way sensations and is usually assessed by the passive joint laxity tests. Mechanical stability of both the human knee joint and the lower extremity at early stance periods of gait (0% and 5%) were quantified here for the first time using a hybrid musculoskeletal model of the lower extremity. The roles of muscle coactivity, simulated by setting minimum muscle activation at 0–10% levels and ACL deficiency, simulated by reducing ACL resistance by up to 85%, on the stability margin as well as joint biomechanics (contact/muscle/ligament forces) were investigated. Dynamic stability was analyzed using both linear buckling and perturbation approaches at the final deformed configurations in gait. The knee joint was much more stable at 0% stance than at 5% due to smaller ground reaction and contact forces. Muscle coactivity, when at lower intensities (<3% of its maximum active force), increased dynamic stability margin. Greater minimum activation levels, however, acted as an ineffective strategy to enhance stability. Coactivation also substantially increased muscle forces, joint loads and ACL force and hence the risk of further injury and degeneration. A deficiency in ACL decreases total ACL force (by 31% at 85% reduced stiffness) and the stability margin of the knee joint at the heel strike. It also markedly diminishes forces in lateral hamstrings (by up to 39%) and contact forces on the lateral plateau (by up to 17%). Current work emphasizes the need for quantification of the lower extremity stability margin in gait.     

Foot arch deformation and plantar fascia loading during running with rearfoot strike and forefoot strike: A dynamic finite element analysis

Forefoot strike becomes popular among runners because it facilitates better impact attenuation. However, forefoot strike may overload the plantar fascia and impose risk of plantar fasciitis. This study aimed to examine and compare the foot arch deformation and plantar fascia tension between different foot strike techniques in running using a computational modelling approach. A three-dimensional finite element foot model was reconstructed from the MRI of a healthy runner. The foot model included twenty bones, bulk soft tissue, ligaments, tendons, and plantar fascia. The time-series data of segmental kinematics, foot muscle force, and ankle joint reaction force were derived from a musculoskeletal model of the same participant based on the motion capture analysis and input as the boundary conditions for the finite element analysis. Rearfoot strike and forefoot strike running were simulated using a dynamic explicit solver. The results showed that, compared to rearfoot strike, forefoot strike reduced the foot arch height by 9.12% and increased the medial longitudinal arch angle by 2.06%. Forefoot strike also increased the plantar connective tissues stress by 18.28–200.11% and increased the plantar fascia tensile force by 18.71–109.10%. Although it is currently difficult to estimate the threshold value of stress or force that results in injury, forefoot strike runners appeared to be more vulnerable to plantar fasciitis.     

A comparison of optimisation methods and knee joint degrees of freedom on muscle force predictions during single-leg hop landings

The aim of this paper was to compare the effect of different optimisation methods and different knee joint degrees of freedom (DOF) on muscle force predictions during a single legged hop. Nineteen subjects performed single-legged hopping manoeuvres and subject-specific musculoskeletal models were developed to predict muscle forces during the movement. Muscle forces were predicted using static optimisation (SO) and computed muscle control (CMC) methods using either 1 or 3 DOF knee joint models. All sagittal and transverse plane joint angles calculated using inverse kinematics or CMC in a 1 DOF or 3 DOF knee were well-matched (RMS error<3°). Biarticular muscles (hamstrings, rectus femoris and gastrocnemius) showed more differences in muscle force profiles when comparing between the different muscle prediction approaches where these muscles showed larger time delays for many of the comparisons. The muscle force magnitudes of vasti, gluteus maximus and gluteus medius were not greatly influenced by the choice of muscle force prediction method with low normalised root mean squared errors (<48%) observed in most comparisons. We conclude that SO and CMC can be used to predict lower-limb muscle co-contraction during hopping movements. However, care must be taken in interpreting the magnitude of force predicted in the biarticular muscles and the soleus, especially when using a 1 DOF knee. Despite this limitation, given that SO is a more robust and computationally efficient method for predicting muscle forces than CMC, we suggest that SO can be used in conjunction with musculoskeletal models that have a 1 or 3 DOF knee joint to study the relative differences and the role of muscles during hopping activities in future studies.     

Solution structure of the first SH3 domain of human vinexin and its interaction with vinculin peptides

Solution structure of the first Src homology (SH) 3 domain of human vinexin (V_SH3_1) was determined using nuclear magnetic resonance (NMR) method and revealed that it was a canonical SH3 domain, which has a typical beta-beta-beta-beta-alpha-beta fold. Using chemical shift perturbation and surface plasmon resonance experiments, we studied the binding properties of the SH3 domain with two different peptides from vinculin hinge regions: P856 and P868. The observations illustrated slightly different affinities of the two peptides binding to V_SH3_1. The interaction between P868 and V_SH3_1 belonged to intermediate exchange with a modest binding affinity, while the interaction between P856 and V_SH3_1 had a low binding affinity. The structure and ligand-binding interface of V_SH3_1 provide a structural basis for the further functional study of this important molecule.     

Alterations of plasma inflammatory biomarkers in the healthy and chronic obstructive pulmonary disease patients with or without acute exacerbation

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortally and morbidity, associated with acute exacerbations (AECOPD) resulted from smoking, infection or air pollution. Systemic inflammation has been considered as one of major pathophysiologic alterations in AECOPD. The present study aimed at developing disease-specific biomarker evaluation by integrating proteomic profiles of inflammatory mediators in AECOPD with clinical and biological informatics. Plasma samples from 18 subjects including healthy people or patients with stable COPD or AECOPD were collected to measure 507 inflammatory mediators using antibody microarray. Clinical informatics was achieved by a Digital Evaluation Score System (DESS) for assessing severity of patients. 20 mediators were significantly different between 3 groups (p<0.05), of which, Cerberus 1, Growth Hormone R, IL-1F6, IL-17B R, IL-17D, IL-19, Lymphotoxin beta, MMP-10, Thrombopoietin and TLR4 were correlated with DESS scores (p<0.05). There was a down-regulation of systemic inflammatory responses in AECOPD. The integration of proteomic profile with clinical informatics as part of clinical bioinformatics is important to screen disease-specific and disease-staged biomarkers. This article is part of a Special Issue entitled: Proteomics: The clinical link.