Ryan Chang

Quantifying rearfoot–forefoot coordination in human walking

A method is proposed to facilitate the quantification and interpretation of inter-joint/-segment coordination. This technique is illustrated using rearfoot-forefoot kinematic data. We expand existing vector coding techniques and introduce a set of operational terms through which the coordinative patterns between the rearfoot segment and the forefoot segment are summarized: in-phase, anti-phase, rearfoot phase and forefoot phase. The literature on foot mechanics has characterized the stable foot at pushoff by a decreasing medial longitudinal arch angle in the sagittal plane, which is accompanied by forefoot pronation and concurrent rearfoot supination-in other words, anti-phase motion. Nine skin markers were placed on the rearfoot and forefoot segments according to a multi-segment foot model. Three healthy subjects performed standing calibration and walking trials (1.35ms(-1)), while a three-dimensional motion capture system acquired their kinematics. Rearfoot-forefoot joint angles were derived and the arch angle was inferred from the sagittal plane. Coupling angles of rearfoot and forefoot segments were derived and categorized into one of the four coordination patterns. Arch kinematics were consistent with the literature; in stance, the arch angle reached peak dorsiflexion, and then decreased rapidly. However, anti-phase coordination was not the predominant pattern during mid- or late stance. These preliminary data suggest that the coordinative interactions between the rearfoot and the forefoot are more complicated than previously described. The technique offers a new perspective on coordination and may provide insight into deformations of underlying tissues, such as the plantar fascia.

Variability in kinematic coupling assessed by vector coding and continuous relative phase

Variability in the spatio-temporal coordination of human movement kinematics is often assessed by vector coding and continuous relative phase (CRP). To facilitate appropriate comparisons between the findings of studies that have used different techniques to assess variability, the purposes of this study were: (1) to determine if both vector coding and CRP behave according to dynamical systems theories on variability and state space transitions; and (2) to determine if trends in coordination variability during movement are consistent when using either vector coding or CRP. We present both a theoretical case (the Lorenz Attractor) and two experimental cases (rearfoot-forefoot coupling during overground walking for 22 subjects; the effect of treadmill speed on thigh-leg coupling for five subjects). In the theoretical case, variability quantified by CRP agreed with dynamical systems theory on state space transitions more so than variability quantified by vector coding. In experimental cases, this distinction was less clear, although CRP appeared to be a more conservative metric for variability. The magnitudes (all p<0.001) and timings (all p<0.04) of peaks in variability during the stance phase of overground walking depended on whether vector coding or CRP was used for two couplings. Similar distinctions were observed for peaks during the stride cycle of treadmill locomotion (all effect sizes >2.8). However, changes in the average variability during the stride cycle as speed increased were consistent for both methods (all effect sizes <0.2). The results suggest that comparisons between the findings of studies that have quantified variability using CRP and those that have used vector coding should be made with caution.

Use of MRI for Volume Estimation of Tibialis Posterior and Plantar Intrinsic Foot Muscles in Healthy and Chronic Plantar Fasciitis Limbs

BACKGROUND Due to complexity of the plantar intrinsic foot muscles, little is known about their muscle architecture in vivo. Chronic plantar fasciitis may be accompanied by muscle atrophy of plantar intrinsic foot muscles and tibialis posterior compromising the dynamic support of the foot prolonging the injury. Magnetic resonance images of the foot may be digitized to quantify muscle architecture. The first purpose of this study was to estimate in vivo the volume and distribution of healthy plantar intrinsic foot muscles. The second purpose was to determine whether chronic plantar fasciitis is accompanied by atrophy of plantar intrinsic foot muscles and tibialis posterior. METHODS Magnetic resonance images were taken bilaterally in eight subjects with unilateral plantar fasciitis. Muscle perimeters were digitally outlined and muscle signal intensity thresholds were determined for each image for volume computation. FINDINGS The mean volume of contractile tissue in healthy plantar intrinsic foot muscles was 113.3 cm(3). Forefoot volumes of plantar fasciitis plantar intrinsic foot muscles were 5.2% smaller than healthy feet (P=0.03, ES=0.26), but rearfoot (P=0.26, ES=0.08) and total foot volumes (P=0.07) were similar. No differences were observed in tibialis posterior size. INTERPRETATIONS While the total volume of plantar intrinsic foot muscles was similar in healthy and plantar fasciitis feet, atrophy of the forefoot plantar intrinsic foot muscles may contribute to plantar fasciitis by destabilizing the medial longitudinal arch. These results suggest that magnetic resonance imaging measures may be useful in understanding the etiology and rehabilitation of chronic plantar fasciitis.

Medially posted insoles consistently influence foot pronation in runners with and without anterior knee pain

Anterior knee pain (AKP) is a common injury among runners and effectively treated with posted insoles and foot orthotics. While clinically effective, the underlying biomechanical mechanisms that bring about these improvements remain debatable. Several methodological factors contribute to the inconsistent biomechanical findings, including errors associated with removing and reattaching markers, inferring foot motion from markers placed externally on a shoe, and redefining segmental coordinate systems between conditions. Therefore, the purpose of this study was to evaluate the influence of medially posted insoles on lower extremity kinematics in runners with and without AKP while trying to limit the influence of these methodological factors. Kinematics of 16 asymptomatic and 17 runners with AKP were collected while running with and without insoles. Reflective markers were attached to the surface of the calcaneus and kept in place (as opposed to detached) between conditions, eliminating the error associated with reattaching markers and redefining segmental coordinate systems. Using these methods, no significant interactions between insole and injury and the main effect of injury were detected (p>0.05); therefore, means were pooled across injury. Insoles, on average, reduced peak eversion by 3.6° (95% confidence interval -2.9° to -4.3°), peak eversion velocity by 53.2°/s (95% confidence interval -32.9 to -73.4) and eversion range of motion by 1.33 (95% confidence interval -0.8 to -1.9). However, while insoles systematically reduced eversion variables, they had small influences on the transverse plane kinematics of the tibia or knee, indicating that they may bring about their clinical effect by influencing other variables.

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.

Energetics of the intrinsic foot muscles in plantar fasciitis

Intrinsic foot muscles and the plantar fascia provide mechanical support for the medial longitudinal arch in gait [1]. In an injury to the plantar fascia (i.e. plantar fasciitis), there may be an increase in load on the intrinsic foot muscles resulting in increased metabolic demand. Phosphorus magnetic resonance spectroscopy (31P MRS) has shown that the ratio of inorganic phosphate to phosphocreatine ([Pi]/[PCr]) within a muscle increases proportionately with muscle work at low to moderate levels [2]. The purpose of this study was to determine whether walking elicits a relatively higher increase in activity of the intrinsic foot muscles of feet with plantar fasciitis relative to healthy feet.