Elizabeth R. Boyer

Rearfoot and midfoot or forefoot impacts in habitually shod runners.

PURPOSE Shear loading rates (LR) have not been investigated in runners with a mid- or forefoot strike (FFS) versus rearfoot strike (RFS). The purpose of this study was to compare three-dimensional ground reaction forces (GRF) and LR during impact in habitual rearfoot strikers (hRF) and habitual forefoot strikers (hFF) strikers. METHODS Thirty competitive runners performed 10 overground running trials with both foot strike styles. Peak three-dimensional and resultant GRF and instantaneous LR during impact were compared. RESULTS Vertical LR significantly decreased for hRF using an FFS (RFS = 148 ± 36 body weight [BW]·s(-1), FFS = 98 ± 31 BW·s(-1)) but was similar for hFF running with either foot strike (FFS = 136 ± 35 BW·s(-1), RFS = 135 ± 28 BW·s(-1)). Posterior impact forces were present during FFS but not during RFS, and posterior LR was significantly greater for both groups during FFS (-58 ± 17 vs -19 ± 6 BW·s(-1)). Medial impact forces were also present during FFS but not during RFS, and medial LR was significantly larger for both groups during FFS (-21 ± 7 vs -6 ± 6 BW·s(-1)). Interestingly, hFF had greater impact peaks and LR in all directions compared with hRF during FFS. This may be explained by hFF using a smaller strike index (hFF = 62% ± 9%, hRF = 67% ± 9%; P = 0.02), which was significantly inversely related to vertical LR and impact peak. CONCLUSIONS Peak resultant and vertical LR are not ubiquitously lower when using a shod FFS versus RFS despite an absence of resultant and vertical impact peaks. Furthermore, there were impact peaks in the posterior and medial directions, leading also to greater LR in these directions during FFS. Therefore, transitioning from RFS to FFS in traditional running shoes may not offer long-term protection against impact-related running injuries because hFF running with an FFS demonstrated many GRF and LR similar to or greater than RFS.

Medial knee joint loading during stair ambulation and walking while carrying loads

Carrying loads while walking or using stairs is a common activity of daily living. Knee osteoarthritis is associated with increased external knee adduction moment (KAM) during walking, so understanding how the additional challenges of stairs and carrying loads impact these moments is of value. Sixteen healthy individuals performed three types of MOTION (walking, stair ascent, stair descent) under three LOAD conditions (no load, carrying a 13.6kg front load, carrying 13.6kg load in a backpack). Three-dimensional gait analysis was used to measure KAM. Results of ANOVA showed a significant main effect of both MOTION and LOAD on peak KAM (p<0.001), but no significant MOTION×LOAD interaction (p=0.250). Peak KAM during stair ascent was about two-times those seen in stair descent (p<0.001) and was significantly higher than those seen in walking (p<0.001). Conditions with LOAD generated significantly greater KAM as compared to the no-LOAD conditions (p<0.001). These findings suggest that carrying a load of moderate magnitude while climbing stairs significantly increases the peak KAM - a risk factor associated with knee osteoarthritis.

Select Injury-Related Variables Are Affected by Stride Length and Foot Strike Style During Running

Background: Some frontal plane and transverse plane variables have been associated with running injury, but it is not known if they differ with foot strike style or as stride length is shortened. Purpose: To identify if step width, iliotibial band strain and strain rate, positive and negative free moment, pelvic drop, hip adduction, knee internal rotation, and rearfoot eversion differ between habitual rearfoot and habitual mid-/forefoot strikers when running with both a rearfoot strike (RFS) and a mid-/forefoot strike (FFS) at 3 stride lengths. Study Design: Controlled laboratory study. Methods: A total of 42 healthy runners (21 habitual rearfoot, 21 habitual mid-/forefoot) ran overground at 3.35 m/s with both a RFS and a FFS at their preferred stride lengths and 5% and 10% shorter. Results: Variables did not differ between habitual groups. Step width was 1.5 cm narrower for FFS, widening to 0.8 cm as stride length shortened. Iliotibial band strain and strain rate did not differ between foot strikes but decreased as stride length shortened (0.3% and 1.8%/s, respectively). Pelvic drop was reduced 0.7° for FFS compared with RFS, and both pelvic drop and hip adduction decreased as stride length shortened (0.8° and 1.5°, respectively). Peak knee internal rotation was not affected by foot strike or stride length. Peak rearfoot eversion was not different between foot strikes but decreased 0.6° as stride length shortened. Peak positive free moment (normalized to body weight [BW] and height [h]) was not affected by foot strike or stride length. Peak negative free moment was −0.0038 BW·m/h greater for FFS and decreased −0.0004 BW·m/h as stride length shortened. Conclusion: The small decreases in most variables as stride length shortened were likely associated with the concomitant wider step width. RFS had slightly greater pelvic drop, while FFS had slightly narrower step width and greater negative free moment. Clinical Relevance: Shortening one’s stride length may decrease or at least not increase propensity for running injuries based on the variables that we measured. One foot strike style does not appear universally better than the other; rather, different foot strike styles may predispose runners to different types of injuries.

Long-term changes in femoral anteversion and hip rotation following femoral derotational osteotomy in children with cerebral palsy

BACKGROUND Excessive femoral anteversion is common in cerebral palsy (CP), is often associated with internal hip rotation during gait, and is frequently treated with a femoral derotational osteotomy (FDO). Concerns exist regarding long-term maintenance of surgical outcomes. Past studies report varying rates of recurrence, but none have employed a control group. METHODS We conducted a retrospective analysis examining long-term (∼5 years) changes in anteversion and hip rotation following FDO in children with CP. We included a control group that was matched for age and exhibited excessive anteversion (>30°) but did not undergo an FDO. Anteversion, mean stance hip rotation, and rates of problematic remodeling and recurrence were assessed (>15° change and final level outside of normal limits). RESULTS The control group was reasonably well matched, but exhibited 9° less anteversion and 3° less internal hip rotation at the pre time point. At a five year follow-up, the FDO group had less anteversion than the control group (20° vs. 35°, p<0.05). The mean stance phase hip rotation did not differ between the groups (4° vs. 5°, p=0.17). Over one third of limbs remained excessively internal in both groups (FDO: 34%, Control: 37%). Rates of problematic recurrence and remodeling were low (0%-11%). CONCLUSIONS An FDO is an effective way to correct anteversion in children with CP. Long-term hip rotation is not fully corrected by the procedure, and is not superior to a reasonably well matched control group. Rates of problematic recurrence and remodeling are low, and do not differ between the groups.

Changes in hip abductor moment 3 or more years after femoral derotation osteotomy among individuals with cerebral palsy

To examine the effect of femoral derotation osteotomy (FDO) on dimensionless hip abductor moment during gait in children with cerebral palsy.

Medial Longitudinal Arch Mechanics Before and After a 45- Minute Run

BACKGROUND Medial longitudinal arch integrity after prolonged running has yet to be well documented. We sought to quantify changes in medial longitudinal arch kinematics before and after a 45-min run in healthy recreational runners. METHODS Thirty runners performed barefoot seated, standing, and running trials before and after a 45-min shod treadmill run. Navicular displacement, arch lengthening, and the arch height index were used to quantify arch deformation, and the arch rigidity index was used to quantify arch stiffness. RESULTS There were no statistically significant differences in mean (95% confidence interval) values for navicular displacement (5.6 mm [4.7-6.4 mm]), arch lengthening (3.2 mm [2.6-3.9 mm]), change in arch height index (0.015 [0.012-0.018]), or arch rigidity index (0.95 [0.94-0.96]) after the 45-min run (all multivariate analyses of variance P ≥ .065). CONCLUSIONS Because there were no statistically significant changes in arch deformation or rigidity, the structures of a healthy, intact medial longitudinal arch are capable of either adapting to cyclical loading or withstanding a 45-min run without compromise.

Lower extremity joint loads in habitual rearfoot and mid/forefoot strike runners with normal and shortened stride lengths

ABSTRACT Our purpose was to compare joint loads between habitual rearfoot (hRF) and habitual mid/forefoot strikers (hFF), rearfoot (RFS) and mid/forefoot strike (FFS) patterns, and shorter stride lengths (SLs). Thirty-eight hRF and hFF ran at their normal SL, 5% and 10% shorter, as well as with the opposite foot strike. Three-dimensional ankle, knee, patellofemoral (PF) and hip contact forces were calculated. Nearly all contact forces decreased with a shorter SL (1.2–14.9% relative to preferred SL). In general, hRF had higher PF (hRF-RFS: 10.8 ± 1.4, hFF-FFS: 9.9 ± 2.0 BWs) and hip loads (axial hRF-RFS: −9.9 ± 0.9, hFF-FFS: −9.6 ± 1.0 BWs) than hFF. Many loads were similar between foot strike styles for the two groups, including axial and lateral hip, PF, posterior knee and shear ankle contact forces. Lateral knee and posterior hip contact forces were greater for RFS, and axial ankle and knee contact forces were greater for FFS. The tibia may be under greater loading with a FFS because of these greater axial forces. Summarising, a particular foot strike style does not universally decrease joint contact forces. However, shortening one’s SL 10% decreased nearly all lower extremity contact forces, so it may hold potential to decrease overuse injuries associated with excessive joint loads.

Proximal versus distal femoral derotation osteotomy in bilateral cerebral palsy

Femoral derotation osteotomy (FDO) can be conducted either proximally or distally to correct internal rotation gait (IRG) and increased anteversion in children with cerebral palsy (CP). Previous studies with limited numbers of participants have presented comparable short‐term static and kinematic outcomes for both techniques. The objective of this retrospective multicentre study was to verify this thesis with a larger number of patients.

Evidence of knee extensor dysfunction during sit-to-stand following distal femoral extension osteotomy and patellar tendon advancement in young adults with cerebral palsy: A pilot study

A distal femoral extension osteotomy with patellar tendon advancement (DFEO+PTA) is a common treatment for individuals with cerebral palsy (CP) who walk in crouch. Musculoskeletal modeling suggests that the typical patella baja position post-DFEO+PTA may limit ones abilities to perform sit-to-stand (STS) tasks; however, STS function has not been assessed. Our purpose was to compare how well individuals who received a DFEO+PTA can perform a 5-times STS test (FTSST) eight or more years after surgery compared to their peers who did not receive a DFEO+PTA (non-DFEO+PTA group). Twenty-one participants completed the task (12 DFEO+PTA, 9 non-DFEO+PTA). Three-dimensional kinematics and kinetics were captured. Kinetics were non-dimensionalized to facilitate group comparisons. Non-DFEO+PTA participants performed the FTSST moderately faster than the DFEO+PTA group (median(IQR), 14.6(9.3) seconds vs. 20.3(10.1) seconds, non-parametric effect size ɣ=0.97, p=0.241). Peak negative knee power was larger for the non-DFEO+PTA group (Mean±SD, -0.063±0.025 vs. -0.048± 0.020, Cohens d=0.66, p=0.165). A similar but weaker trend was observed for negative hip power (median(IQR) -0.120(0.066) vs. -0.105(0.044), ɣ=0.43, p=0.671). Both groups used their hips approximately twice as much as their knees to perform the task. The functional deficit among DFEO+PTA participants may be due to patella baja decreasing the knee extensor moment arm, which concurs with the modeling prediction. The group differences may also be due to the non-DFEO+PTA group being slightly higher functioning. Future research is warranted to determine if optimizing patella position during a DFEO+PTA may improve unaided STS function without compromising gait improvements.

Gait pathology subtypes are not associated with self-reported fall frequency in children with cerebral palsy

BACKGROUND Trips and falls are common concerns reported by parents of children with cerebral palsy. Specific gait pathologies (excessive internal hip rotation, intoeing, and stiff knee gait) are anecdotally associated with higher rates of falls. RESEARCH QUESTION Is fall frequency higher for the aforementioned gait pathologies? METHODS Parent-reported fall frequency from 1063 children with cerebral palsy who also had a three-dimensional gait analysis was retrospectively reviewed. Frequency of 10 common gait pathologies was determined and fall frequency for the gait pathologies of interest were compared to matched control groups. Possible effects of Gross Motor Functional Classification System (GMFCS) level and age on fall frequency were also assessed and matched in the control group, as appropriate. RESULTS In general, parent-reported fall frequency increased from GMFCS level I to II and then decreased until level IV. Moreover, younger children tended to report greater fall frequency, though children who reported never falling were of similar age as those who reported weekly falls, resulting in an inverted-U shaped relationship. Children with cerebral palsy who walked with excessive internal hip rotation, excessive intoeing, or stiff knee gait did not report increased fall frequencies compared to other children with cerebral palsy matched on GMFCS level and age that did not walk with those gait patterns. Approximately 35% of children reported never falling, 35% reported falling daily, and 30% reported falling monthly or weekly for each gait pattern. Therefore, elevated fall frequency appears to be a generic problem for most children with CP rather than a function of a specific gait pattern. SIGNIFICANCE Clinicians should be aware of these relationships, or lack thereof, when trying to decipher the cause of a childs falling and when determining appropriate interventions. Future studies may seek to more objectively quantify fall frequency, as self-report is the main limitation of this study.