Ryan Mahaffey

Evaluation of multi-segmental kinematic modelling in the paediatric foot using three concurrent foot models

BackgroundVarious foot models are used in the analysis of foot motion during gait and selection of the appropriate model can be difficult. The clinical utility of a model is dependent on the repeatability of the data as well as an understanding of the expected error in the process of data collection. Kinematic assessment of the paediatric foot is challenging and little is reported about multi-segment foot models in this population. The aim of this study was to examine three foot models and establish their concurrent test-retest repeatability in evaluation of paediatric foot motion during gait.Methods3DFoot, Kinfoot and the Oxford Foot Model (OFM) were applied concurrently to the right foot and lower limb of 14 children on two testing sessions. Angular data for foot segments were extracted at gait cycle events and peaks and compared between sessions by intraclass correlation coefficient (ICC) with 95% confidence intervals (95%CI) and standard error of measurement (SEM).ResultsAll foot models demonstrated moderate repeatability: OFM (ICC 0.55, 95% CI 0.16 to 0.77), 3DFoot (ICC 0.47, 95% CI 0.15 to 0.64) and Kinfoot (ICC 0.43, 95% CI -0.03 to 0.59). On the basis of a cut-off of 5°, acceptable mean error over repeated sessions was observed for OFM (SEM 4.61° ± 2.86°) and 3DFoot (SEM 3.88° ± 2.18°) but not for Kinfoot (SEM 5.08° ± 1.53°). Reliability of segmental kinematics varied, with low repeatability (ICC < 0.4) found for 14.3% of OFM angles, 22.7% of 3DFoot angles and 37.6% of Kinfoot angles. SEM greater than 5° was found in 26.2% of OFM, 15.2% of 3DFoot, and 43.8% of Kinfoot segmental angles.ConclusionFindings from this work have demonstrated that segmental foot kinematics are repeatable in the paediatric foot but the level of repeatability and error varies across the segments of the different models. Information on repeatability and test-retest errors of three-dimensional foot models can better inform clinical assessment and advance understanding of foot motion during gait.

The impact of body fat on three dimensional motion of the paediatric foot during walking.

Childhood obesity is commonly associated with a pes planus foot type and altered lower limb joint function during walking. However, limited information has been reported on dynamic intersegment foot motion with the level of obesity in children. The aim of this study was to explore the relationships between intersegment foot motion during gait and body fat in boys age 7-11 years. Fat mass was measured in fifty-five boys using air displacement plethysmography. Three-dimensional gait analysis was conducted on the right foot of each participant using the 3DFoot model to capture angular motion of the shank, calcaneus, midfoot and metatarsals. Two multivariate statistical techniques were employed; principle component analysis reduced the multidimensional nature of gait analysis, and multiple linear regression analysis accounted for potential confounding factors. Higher fat mass predicted greater plantarflexion of the calcaneus during the first half and end of stance phase and at the end of swing phase. Greater abduction of the calcaneus throughout stance and swing was predicted by greater fat mass. At the midfoot, higher fat mass predicted greater dorsiflexion and eversion throughout the gait cycle. The findings present novel information on the relationships between intersegment angular motion of the foot and body fat in young boys. The data indicates a more pronated foot type in boys with greater body fat. These findings have clinical implications for pes planus and a predisposition for pain and discomfort during weight bearing activities potentially reducing motivation in obese children to be physically active.

Reliability of three foot models to examine paediatric gait

Background A variety of multi-segmental foot models have been produced to examine patterns of foot segmental movement during gait cycle to identify biomechanical differences between normal and pathological foot function[1-3]. The reliability of foot models to accurately describe motion of the foot joints is dependent on the ability of the examiner to repeatedly apply markers to specific landmarks and the relevance of models’ segmental descriptions to underlying anatomy. The aim of this study was to test the reliability of segmental angles measured by three published foot models during paediatric gait. Materials and methods Sixteen children, aged 6 to 12 years old, were recruited to the study. Marker sets for three foot models 3DFoot [1], Oxford Foot Model (OFM)[2], and Kinfoot[3] were applied to their right feet simultaneously which to the authors knowledge, is the first direct comparison of the three models during gait. Each foot model was assessed for repeatability of maximal joint angle and range of motion during the gait cycle between two testing occasions. Absolute angular differences and standard error of measurement (SEM) are reported. Results Repeatability of all maximal segmental angles and range of motions were higher in 3DFoot compared to OFM and Kinfoot (Table 1).

Identifying biomechanical gait parameters in adolescent boys with haemophilia using principal component analysis

Improvements in the medical management for those with haemophilia have resulted in improved clinical outcomes. However, current treatment regimens do not alleviate all joint haemarthroses with the potential for long‐term joint deterioration remaining. The evaluation of functional activities such as gait, using standardized tools to monitor children with haemophilia is emerging.

Biomechanical characteristics of lower limb gait waveforms: Associations with body fat in children

BACKGROUND Childhood obesity is associated with musculoskeletal dysfunction and altered lower limb biomechanics during gait. Few previous studies have explored relationships between childhood obesity measured by body fat and lower limb joint waveform kinematics and kinetics. RESEARCH QUESTION What is the association between body fat and hip, knee and ankle joint angles and moments during gait and in 7 to 11 year-old boys? METHODS Fifty-five boys participated in the study. Body fat was measured by air displacement plethysmography. Hip, knee and ankle 3D waveforms of joint angles and moments were recorded during gait. Principle component analysis was used to reduce the multidimensional nature of the waveform into components representing parts of the gait cycle. Multiple linear regression analysis determined the association between the components with body fat. RESULTS Higher body fat predicted greater hip flexion, knee flexion and knee internal rotation during late stance and greater ankle external rotation in late swing/early stance. Greater hip flexion and adduction moments were found in early stance with higher body fat. In mid-stance, greater knee adduction moments were associated with high body fat. Finally, at the ankle, higher body fat was predictive of greater internal rotation moments. SIGNIFICANCE The study presents novel information on relationships between body fat and kinematic and kinetic waveform analysis of paediatric gait. The findings suggest altered lower limb joint kinematics and kinetics with high body fat in young boys. The findings may help to inform research in to preventing musculoskeletal comorbidities and promoting weight management.

Is neuromuscular inhibition detectable in elite footballers during the Nordic hamstring exercise

Background: The presence of neuromuscular inhibition following injury may explain the high incidence of biceps femoris injury recurrence in elite (soccer) footballers. This phenomenon may be detectable in elite players during the Nordic hamstring exercise. Thus, the first purpose of this study was to assess biceps femoris muscle activation during this exercise in players with hamstring injury history. Additionally, following injury, observed increases in synergistic muscle activation may represent a protective mechanism to the presence of neuromuscular inhibition. Thus, the second purpose was to identify if the relative contributions of biceps femoris, and its synergists reflected a post‐injury pattern of activation suggestive of these potentially compensatory neural mechanisms. Methods: Ten elite players with a history of hamstring injury and ten elite players without a history of hamstring injury, completed six repetitions of the Nordic hamstring exercise. During each trial, biceps femoris, semitendinosus and gluteus maximus muscle activations were collected at 90–30° and 30–0° of knee flexion. Findings: Biceps femoris activation was significantly higher at 90–30° of knee flexion compared to 30–0° (P < 0.001) but did not differ between the groups. In players with a history of injury, muscle activation ratios for the biceps femoris/semitendinosus (P = 0.001) and biceps femoris/gluteus maximus (P = 0.023) were significantly greater at 30–0° of knee flexion than in the control group. Interpretation: Neuromuscular inhibition of the biceps femoris was not detected during the exercise within elite footballers, yet the relative contributions of biceps femoris and its synergists appear to change following injury. HighlightsWe investigate the purported effects of neuromuscular inhibition in soccer players.Biceps femoris activity was greater at short compared to long muscle lengths.Biceps femoris activation was no different for previously injured players.Muscle activation ratios differed between the groups at long muscle lengths.Altered relative contribution of muscle synergists is detectable post‐injury.

Clinical outcome measures for monitoring physical function in pediatric obesity: An integrative review

Measuring physical function in children with obesity is important to provide targets for clinical intervention to reduce impairments and increase participation in activities. The objective of this integrative review was to evaluate measurement properties of performance‐based measures of physical function in children with overweight and obesity.

Evaluating the biomechanics of the pediatric foot in Turner syndrome: a case report.

Turner syndrome is a genetic disorder that can present clinically with multiple concurrent comorbidities. This case report describes a 12-year-old girl with Turner syndrome who was referred for podiatric medical assessment and explores the application of optoelectronic stereophotogrammetry in the biomechanical assessment of the foot and lower limb. A four-segment kinematic foot model using 14-mm reflective markers was applied to the foot and lower limb of the patient to track motion at the tibia, rearfoot, forefoot, and hallux. Kinematic results presented in this case study illustrate evidence of excessive foot pronation throughout the stance phase of gait. Whether excessive pronation is a general characteristic of foot function in Turner syndrome remains to be confirmed, but the findings presented suggest that a comprehensive evaluation of foot biomechanics in patients with Turner syndrome may be warranted.