Reduction in the Knee Adduction Moment During Walking Using Laterally-Wedged Shoes With and Without Ankle Support

2010 ◽  
Author(s):  
Jennifer Erhart ◽  
Thomas Andriacchi
Keyword(s):  
Knee Adduction Moment ◽  
Dynamic Effects ◽  
Medial Compartment Osteoarthritis ◽  
Ankle Motion ◽  
Ankle Foot Orthosis ◽  
Rate Of Progression ◽  
High Maximum ◽  
Ankle Support ◽  
Lateral Wedges ◽  
Foot Orthosis

A high maximum adduction moment at the knee during walking has been associated with an increased rate of progression [1] and worse treatment outcome [2] of medial compartment osteoarthritis (OA) of the knee. Laterally-wedged insoles and shoes have been shown to reduce the knee adduction moment in healthy and osteoarthritic populations [3,4]. However, the mechanism of the effectiveness of such interventions is not well understood. Toda et al. showed that subtalar strapping with laterally wedged insoles in osteoarthritic subjects can improve valgus correction, but the authors did not look at the dynamic effects of walking [5]. A second study looked at the effects of lateral wedges with both semi-rigid ankle support and a rigid ankle-foot-orthosis and found a reduction in the adduction moment only with ankle support and a 10° lateral wedge. The wedge alone did not produce a reduction in the adduction moment [6]. Thus, it seems that the mechanism of action of the lateral wedge may be influenced by ankle motion.

Biomechanical Comparison of a New Dynamic Ankle Orthosis to a Standard Ankle-Foot Orthosis During Walking

2020 ◽  
Vol 142 (5) ◽  
Author(s):  
Chloe L. Chung ◽  
Denis J. DiAngelo ◽  
Douglas W. Powell ◽  
Max R. Paquette
Keyword(s):  
Angular Velocity ◽  
Cartilage Damage ◽  
Three Dimensional ◽  
Frontal Plane ◽  
Ankle Injuries ◽  
Ankle Motion ◽  
Ankle Foot Orthosis ◽  
Plantar Pressures ◽  
Biomechanical Comparison ◽  
Foot Orthosis

Abstract Patients who sustain irreversible cartilage damage or joint instability from ankle injuries are likely to develop ankle osteoarthritis (OA). A dynamic ankle orthosis (DAO) was recently designed with the intent to offload the foot and ankle using a distractive force, allowing more natural sagittal and frontal plane ankle motion during gait. To evaluate its efficacy, this study compared ankle joint kinematics and plantar pressures among the DAO, standard double upright ankle-foot orthosis (DUAFO), and a nonorthosis control (CON) condition in healthy adults during walking. Ten healthy subjects (26 ± 3.8 yr; 69.6 ± 12.7 kg; and 1.69 ± 0.07 m) walked on a treadmill at 1.4 m/s in three orthosis conditions: CON, DAO, and DUAFO. Ankle kinematics were assessed using a three-dimensional (3D) motion capture system and in-shoe plantar pressures were measured for seven areas of the foot. DAO reduced hallux peak plantar pressures (PPs) compared to CON and DUAFO. PPs under toes 2–5 were smaller in DAO than DUAFO, but greater in DUAFO compared to CON. Early stance peak plantarflexion (PF) angular velocity was smaller in DAO compared to CON and DUAFO. Eversion (EV) ROM was much smaller in DUAFO compared to CON and DAO. Early stance peak eversion angular velocity was smaller in DAO and much smaller in DUAFO compared to CON. This study demonstrates the capacity of the DAO to provide offloading during ambulation without greatly affecting kinematic parameters including frontal plane ankle motion compared to CON. Future work will assess the effectiveness of the DAO in a clinical osteoarthritic population.

Portable Pneumatic Power-Harvesting Ankle-Foot-Orthosis

2008 ◽  
Author(s):  
Robin Chin ◽  
Elizabeth T. Hsiao-Wecksler ◽  
Eric Loth ◽  
Andrew Alleyne ◽  
Scott Manwaring ◽  
...  
Keyword(s):  
Power Source ◽  
Power Harvesting ◽  
Ankle Motion ◽  
Ankle Foot Orthosis ◽  
Locking Mechanism ◽  
External Power Source ◽  
Cam Follower ◽  
External Power ◽  
Pneumatic Power ◽  
Foot Orthosis

In this paper, we present a novel ankle-foot-orthosis (AFO) design that controls ankle motion by providing a plantarflexion stop with free dorsiflexion during gait. The biomechanical controls are accomplished with a unique application of a cam-follower design that uses pneumatic power harvested via an air bellow embedded into the insole of the AFO (Figure 1). This portable design is self-contained and does not require any external power source to provide for the plantarflexion stop locking mechanism. It is the first step in a series of untethered fluid-powered orthotic devices.

scholarly journals The role of rigid and hinged polypropylene ankle-foot-orthoses in the management of cerebral palsy: a case study

1988 ◽  
Vol 12 (3) ◽  
pp. 129-135 ◽  
Author(s):  
E. A. Middleton ◽  
G. R. B. Hurley ◽  
J. S. McIlwain
Keyword(s):  
Cerebral Palsy ◽  
Reaction Force ◽  
Force Plate ◽  
Spastic Cerebral Palsy ◽  
Foot Orthoses ◽  
Ankle Motion ◽  
Ankle Foot Orthosis ◽  
Ankle Foot Orthoses ◽  
The Subject ◽  
Foot Orthosis

Ankle-foot orthoses are commonly used in the treatment of spastic cerebral palsy to hold the foot in a position conducive to a more functional gait. This study, utilizing quantitative biomechanical techniques, evaluates the effects of a rigid ankle-foot orthosis and a hinged ankle-foot orthosis on spastic cerebral palsy gait. The subject was a 4.5 year old female diagnosed as spastic diplegic cerebral palsied shortly after birth. Testing involved collection of kinematic coordinate data employing a WATSMART video system and ground reaction force' data using a Kistler force plate. Jensen's (1978) photogrammetric method was used to estimate body segment inertial parameters. The hinged ankle-foot orthosis was found to be more effective than the rigid ankle-foot orthosis. The subject exhibited a more natural ankle motion during the stance phase of gait, greater symmetry of segmental lower extremity motion, and decreased knee moments during stance while wearing a hinged ankle-foot orthosis.

scholarly journals Effect of an ankle–foot orthosis on knee joint mechanics: A novel conservative treatment for knee osteoarthritis

2013 ◽  
Vol 38 (6) ◽  
pp. 481-491 ◽  
Author(s):  
Cynthia H Fantini Pagani ◽  
Steffen Willwacher ◽  
Rita Benker ◽  
Gert-Peter Brüggemann
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Frontal Plane ◽  
Knee Adduction Moment ◽  
Varus Alignment ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Ankle Foot Orthosis ◽  
Lever Arm ◽  
Foot Orthosis

Background: Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. Objective: To analyze the effect of an ankle–foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. Study design: Controlled laboratory study, repeated measurements. Methods: In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle–foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. Results: Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle–foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles. Conclusion: The ankle–foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. Clinical relevance This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis.

scholarly journals Effectiveness of an ankle–foot orthosis on walking in patients with stroke: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoo Jin Choo ◽  
Min Cheol Chang
Keyword(s):  
Stride Length ◽  
Walking Speed ◽  
Sagittal Plane ◽  
Meta Analysis ◽  
Step Length ◽  
Stride Time ◽  
Plane Angle ◽  
Ankle Foot Orthosis ◽  
Biomechanical Parameters ◽  
Foot Orthosis

AbstractWe conducted a meta-analysis to investigate the effectiveness of ankle–foot orthosis (AFO) use in improving gait biomechanical parameters such as walking speed, mobility, and kinematics in patients with stroke with gait disturbance. We searched the MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, and Scopus databases and retrieved studies published until June 2021. Experimental and prospective studies were included that evaluated biomechanics or kinematic parameters with or without AFO in patients with stroke. We analyzed gait biomechanical parameters, including walking speed, mobility, balance, and kinematic variables, in studies involving patients with and without AFO use. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies, and the level of evidence was evaluated using the Research Pyramid model. Funnel plot analysis and Egger’s test were performed to confirm publication bias. A total of 19 studies including 434 participants that reported on the immediate or short-term effectiveness of AFO use were included in the analysis. Significant improvements in walking speed (standardized mean difference [SMD], 0.50; 95% CI 0.34–0.66; P < 0.00001; I2, 0%), cadence (SMD, 0.42; 95% CI 0.22–0.62; P < 0.0001; I2, 0%), step length (SMD, 0.41; 95% CI 0.18–0.63; P = 0.0003; I2, 2%), stride length (SMD, 0.43; 95% CI 0.15–0.71; P = 0.003; I2, 7%), Timed up-and-go test (SMD, − 0.30; 95% CI − 0.54 to − 0.07; P = 0.01; I2, 0%), functional ambulation category (FAC) score (SMD, 1.61; 95% CI 1.19–2.02; P < 0.00001; I2, 0%), ankle sagittal plane angle at initial contact (SMD, 0.66; 95% CI 0.34–0.98; P < 0.0001; I2, 0%), and knee sagittal plane angle at toe-off (SMD, 0.39; 95% CI 0.04–0.73; P = 0.03; I2, 46%) were observed when the patients wore AFOs. Stride time, body sway, and hip sagittal plane angle at toe-off were not significantly improved (p = 0.74, p = 0.07, p = 0.07, respectively). Among these results, the FAC score showed the most significant improvement, and stride time showed the lowest improvement. AFO improves walking speed, cadence, step length, and stride length, particularly in patients with stroke. AFO is considered beneficial in enhancing gait stability and ambulatory ability.

Effects of ankle foot orthosis in stiff knee gait in adults with hemiplegia

2012 ◽  
Vol 45 (15) ◽  
pp. 2658-2661 ◽  
Author(s):  
Marcelo Andrés Gatti ◽  
Orestes Freixes ◽  
Sergio Anibal Fernández ◽  
Maria Elisa Rivas ◽  
Marcos Crespo ◽  
...  
Keyword(s):  
Ankle Foot Orthosis ◽  
Stiff Knee ◽  
Foot Orthosis
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