Frank L. Buczek

Analysis of a kinetic multi-segment foot model part II: Kinetics and clinical implications

Kinematic multi-segment foot models have seen increased use in clinical and research settings, but the addition of kinetics has been limited and hampered by measurement limitations and modeling assumptions. In this second of two companion papers, we complete the presentation and analysis of a three segment kinetic foot model by incorporating kinetic parameters and calculating joint moments and powers. The model was tested on 17 pediatric subjects (ages 7-18 years) during normal gait. Ground reaction forces were measured using two adjacent force platforms, requiring targeted walking and the creation of two sub-models to analyze ankle, midtarsal, and 1st metatarsophalangeal joints. Targeted walking resulted in only minimal kinematic and kinetic differences compared with walking at self selected speeds. Joint moments and powers were calculated and ensemble averages are presented as a normative database for comparison purposes. Ankle joint powers are shown to be overestimated when using a traditional single-segment foot model, as substantial angular velocities are attributed to the mid-tarsal joint. Power transfer is apparent between the 1st metatarsophalangeal and mid-tarsal joints in terminal stance/pre-swing. While the measurement approach presented here is limited to clinical populations with only minimal impairments, some elements of the model can also be incorporated into routine clinical gait analysis.

Translational and rotational joint power terms in a six degree-of-freedom model of the normal ankle complex

We hypothesized that defining joint power (JP) merely on the basis of joint rotations ignores important translational power terms, and may not adequately represent the energy flow profile for a given muscle group. A novel six degree-of-freedom (6 DOF) model of the ankle complex was implemented, accounting for previously ignored joint translations as well as traditional rotations. Foot and shank kinematic and kinetic data were collected over a stride cycle on five male and five female adults, walking five trials each at 0.69 statures s-1. During intra-subject analyses, ensemble averages were calculated (n = 5) for JP associated with each DOF, and for related velocity and force/moment data. Translational joint velocities typically peaked below 10% of the mean walking velocity. The largest peak in JP occurred for the rotational DOF associated with dorsi/plantar flexion (360 W). The next largest peak in JP was for the vertical translational DOF, and was nearly 10% of the predominant peak. Positive work during push-off was significantly less p < or = 0.05) for the 6 DOF model (27.9 J) than for either 1 or 3 DOF rotational models (30.3 and 29.9 J, respectively). Negative work during early stance was significantly less for the 6 DOF model (-10.3 J) than for either the 1 or 3 DOF models (-13.1 and -12.6 J, respectively). Inter-subject analyses (n = 50) were conducted for JP data only, with similar results. We conclude that translational JP terms are of practical importance in mechanical energy studies, and may be of particular concern when evaluating energy storing prostheses, when summing total power at several joints, and when studying pathologies that disturb joint geometry.

Implications of using hierarchical and six degree-of-freedom models for normal gait analyses

Hierarchical biomechanical models (conventional gait model, CGM) are attractive because of simple data collection demands, yet they are susceptible to errors that are theoretically better controlled using six degree-of-freedom models that track body segments independently (OPT1). We wished to compare gait variables obtained with these models. Twenty-five normal children walked while wearing a hybrid marker configuration, permitting identical strides to be analyzed using CGM and OPT1. Kinematics and ground reaction forces were obtained using a common motion capture system. CGM and OPT1 were implemented in Visual3D software, where inverse dynamics provided 20 clinically relevant gait variables (joint angles, moments and powers). These were compared between models using dependent t-tests (Bonferroni-adjusted alpha of 0.0025), and ensemble averages. We hypothesized that OPT1 would provide data similar to CGM in the sagittal plane, and different from CGM in coronal and transverse planes. Six variables were significantly different in the sagittal plane, suggesting that CGM produced a more extended lower extremity; this was explained by a posterior bias to the lateral knee marker during knee flexion, as a result of skin movement artifact. No significant differences were found in coronal plane variables. Four variables were significantly different in the transverse plane. Ensemble averages were comparable between models. For normal children, biomechanical interpretations based upon these tested variables are unlikely to change due to independent segment tracking alone (CGM vs. OPT1). Additional differences may appear due to pathology, and when segment reference frames are changed from those used in CGM to reflect individual anatomy.

Analysis of a Kinetic Multi-Segment Foot Model. Part I: Model Repeatability and Kinematic Validity

Kinematic multi-segment foot models are still evolving, but have seen increased use in clinical and research settings. The addition of kinetics may increase knowledge of foot and ankle function as well as influence multi-segment foot model evolution; however, previous kinetic models are too complex for clinical use. In this study we present a three-segment kinetic foot model and thorough evaluation of model performance during normal gait. In this first of two companion papers, model reference frames and joint centers are analyzed for repeatability, joint translations are measured, segment rigidity characterized, and sample joint angles presented. Within-tester and between-tester repeatability were first assessed using 10 healthy pediatric participants, while kinematic parameters were subsequently measured on 17 additional healthy pediatric participants. Repeatability errors were generally low for all sagittal plane measures as well as transverse plane Hindfoot and Forefoot segments (median<3°), while the least repeatable orientations were the Hindfoot coronal plane and Hallux transverse plane. Joint translations were generally less than 2mm in any one direction, while segment rigidity analysis suggested rigid body behavior for the Shank and Hindfoot, with the Forefoot violating the rigid body assumptions in terminal stance/pre-swing. Joint excursions were consistent with previously published studies.

Measured and estimated ground reaction forces for multi-segment foot models

Accurate measurement of ground reaction forces under discrete areas of the foot is important in the development of more advanced foot models, which can improve our understanding of foot and ankle function. To overcome current equipment limitations, a few investigators have proposed combining a pressure mat with a single force platform and using a proportionality assumption to estimate subarea shear forces and free moments. In this study, two adjacent force platforms were used to evaluate the accuracy of the proportionality assumption on a three segment foot model during normal gait. Seventeen right feet were tested using a targeted walking approach, isolating two separate joints: transverse tarsal and metatarsophalangeal. Root mean square (RMS) errors in shear forces up to 6% body weight (BW) were found using the proportionality assumption, with the highest errors (peak absolute errors up to 12% BW) occurring between the forefoot and toes in terminal stance. The hallux exerted a small braking force in opposition to the propulsive force of the forefoot, which was unaccounted for by the proportionality assumption. While the assumption may be suitable for specific applications (e.g. gait analysis models), it is important to understand that some information on foot function can be lost. The results help highlight possible limitations of the assumption. Measured ensemble average subarea shear forces during normal gait are also presented for the first time.

The Effect of Ankle Injury on Subtalar Motion

Background: Injuries to the medial and lateral ankle ligaments have been implicated in subtalar joint instability. Lateral injury increased subtalar joint varus and anterior translation, while deltoid injury increased external rotation and valgus in studies using static, non-physiologic testing. Methods: The current study employed a physiologically accurate ankle model using phasic force-couples attached to the muscle-tendon units to reproduce ankle motion. Six-degree-of-freedom kinematics of the tibia, talus, and calcaneus were measured using a VICON motion analysis system under the following experimental conditions: 1) intact ligaments 2) complete lateral ligament injury with subsequent repair, 3) superficial deltoid injury with subsequent repair, and 4) deep deltoid injury without repair in eight harvested lower extremities. Statistical analysis was by repeated measures analyses of variance. Results: At heel-strike, the subtalar joint is in internal rotation, dorsiflexion, and varus. As the leg progresses to foot-flat, there is external rotation, plantar-flexion, and valgus rotation. From foot-flat to heel-rise, there is little subtalar joint motion, while at toe-off, there is slight internal rotation, dorsiflexion, and varus rotation. The total rotations amounted to 9.0 degrees (SD 5.0 degrees) external rotation, 6.1 degrees (SD 2.5 degrees) plantarflexion, and 7.8 degrees (SD 5.5 degrees) valgus. Disruption of the superficial deltoid increased plantarflexion (p < .001) and valgus (p < .05). The additional lateral injury increased both external rotation (p < .001) and valgus (p < .02). Lateral injury alone had no significant effect on subtalar joint motion. Conclusion: Unlike most previous reports, this study showed no significant influence of isolated lateral ankle injury on subtalar joint motion, probably because the current study examined subtalar joint motion under physiologic loading and motion rather than by static stress testing. This calls into question the relevance of static stress testing to the in situ function of the subtalar joint. The increased external rotation and valgus seen with deltoid injury in the current study is consistent with previous reports.

A Simple, Anatomically Based Correction to the Conventional Ankle Joint Center

BACKGROUND Conventional motion analysis studies define the ankle joint center as the midpoint between the most medial and lateral aspects of the malleoli, yet research points toward a more distal joint center location. The purpose of this study was to develop and evaluate an anatomically based correction that would move the conventional ankle joint center to a more accurate location. METHODS Lower extremity radiographs from 30 pediatric patients were analyzed retrospectively. An offset between the conventional and more accurate ankle joint centers was measured and correlated to other common anatomical measures based on conventional skin mounted marker positions. The best correlated measure was used to define a simple correction factor, which was subsequently evaluated by its effect on six degree-of-freedom ankle joint translations during normal gait (n=8). FINDINGS Shank length was found to have the highest bivariate linear correlation (r=0.89) with the offset. Adjusting the ankle joint center using a percentage of shank length (2.7%) was also as accurate as the regression equation in predicting offset (mean error 0.6mm, or 6% offset). Adjusting the ankle joint center using this simple percentage resulted in a 25% reduction in mean ankle joint translations during normal gait. INTERPRETATION The accuracy of the ankle joint center can be increased through a simple, anatomically based correction. This correction may prove beneficial in some kinematic and kinetic applications requiring increased anatomical fidelity.

Comparison of hierarchical and six degrees-of-freedom marker sets in analyzing gait kinematics

The objective of this study was to determine how marker spacing, noise, and joint translations affect joint angle calculations using both a hierarchical and a six degrees-of-freedom (6DoF) marker set. A simple two-segment model demonstrates that a hierarchical marker set produces biased joint rotation estimates when sagittal joint translations occur whereas a 6DoF marker set mitigates these bias errors with precision improving with increased marker spacing. These effects were evident in gait simulations where the 6DoF marker set was shown to be more accurate at tracking axial rotation angles at the hip, knee, and ankle.

Challenges in hip joint modeling for a patient with proximal femoral focal deficiency.

AbstractWe were presented with a technical challenge driven by a clinical need. A patient with proximal femoral focal deficiency required gait analysis, but our typical biomechanical model [Vicon Clinical Manager (VCM)] would not have correctly identified his abnormal right hip center (RHIP). His underdeveloped right femur was fused to his ileum, his anatomical knee functioned as his right hip, and an above-knee prosthesis provided functional knee and ankle joints. During a special calibration, we estimated the global location of RHIP as the center of the femoral epicondyles, also identifying the global location of pelvic markers. These data were used in equations after Davis et al.4 to establish local coordinates for RHIP. We used a system of three simultaneous equations to solve for input to VCM that would reproduce this location for RHIP. This procedure allowed for inverse dynamics in VCM, and showed the emergence of an abduction moment at the right hip postoperatively, that exceeded changes predicted by sensitivity analyses. Although our clinical need was met, we concluded that a better approach would have involved full implementation of custom models to reflect abnormal patient anatomy.