Adjustments in the Range of Angular Motion during Walking after Amputation of the Toes: A Case Report

The forefoot plays an important role in providing body support and propulsion during walking. We investigated the effect of forefoot dysfunction on the gait pattern of a young adult with partial bilateral amputation of the toes. We measured our participant’s gait kinematics during barefoot and shod overground walking and analysed time-distance and joint range of motion (RoM) parameters against a group of healthy adults. Forefoot dysfunction gait is improved by footwear and walking experience; however, this improvement was still remarkably different (exceeded 95% CI) when compared to healthy gait at matching walking speed. Compared to healthy gait, walking barefoot had a slower speed and a 30% reduction in ankle and knee joint RoM, but a larger hip RoM. Shod gait resulted in a remarkable increase in ankle RoM and walking speed compared to barefoot gait. These results are consistent with the important role of the forefoot (tarsals and metatarsophalangeal joints) and suggest that footwear can facilitate gait function following toe amputation.

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Arthroscopy in Arthrosis: Is It Worth it? A case Presentation

Revista de Chimie ◽

10.37358/rc.18.8.6506 ◽

2018 ◽

Vol 69 (8) ◽

pp. 2232-2235

Author(s):

Marius Moga ◽

Mark Edward Pogarasteanu ◽

Antoine Edu

Keyword(s):

Clinical Status ◽

Loose Body ◽

Point Of View ◽

The Other ◽

Joint Range Of Motion ◽

Objective Evidence ◽

Before And After ◽

Total Knee ◽

Joint Range

The role of arthroscopy in incipient and mild arthrosis, even combined with proximal tibial ostetomy, is well known and well documented. On the other hand, its role in the treatment of advanced arthrosis of the large joints, especially the knee, is a subject of controversy. The proponents of the use of arthroscopy in advanced arthrosis claim that meniscectomy, synovectomy, ostophytectomy, chondral lesion stabilization, arthroscopic release, plica and loose body removal greatly improve the quality of life for most patients, especially if followed by the use of viscoelastic injection, by diminishing pain and improving joint range of motion. The opponents claim that, even though the advantages are clear in the cases that refuse arthroplasty, in all the other cases the surgical indication should be total knee arthroplasty, as the clinical relief is temporary, but with all the risks of a surgical intervention. We have conducted an overview of the recent literature, in order to find objective evidence to sustain either point of view. We focused on articles published that included an objective measurement of before and after clinical status through clinical scores and objective measurements. We also focused on the follow-up period and on the evolution of the pathology after arthroscopy.

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The role of mechanical and neural restraints to joint range of motion during passive stretch

Medicine & Science in Sports & Exercise ◽

10.1097/00005768-199806000-00023 ◽

1998 ◽

Vol 30 (6) ◽

pp. 928-932 ◽

Cited By ~ 52

Author(s):

MALACHY P. McHUGH ◽

IAN J. KREMENIC ◽

MICHAEL B. FOX ◽

GILBERT W. GLEIM

Keyword(s):

Range Of Motion ◽

Joint Range Of Motion ◽

Joint Range ◽

Passive Stretch

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Modeling the Stance Leg in Two-Dimensional Analyses of Sprinting: Inclusion of the MTP Joint Affects Joint Kinetics

Journal of Applied Biomechanics ◽

10.1123/jab.28.2.222 ◽

2012 ◽

Vol 28 (2) ◽

pp. 222-227 ◽

Cited By ~ 15

Author(s):

Neil E. Bezodis ◽

Aki I.T. Salo ◽

Grant Trewartha

Keyword(s):

High Speed ◽

Stance Phase ◽

Two Dimensional ◽

Joint Moments ◽

Joint Power ◽

Joint Kinetics ◽

Joint Range Of Motion ◽

Foot Model ◽

Joint Range

Two-dimensional analyses of sprint kinetics are commonly undertaken but often ignore the metatarsal-phalangeal (MTP) joint and model the foot as a single segment. The aim of this study was to quantify the role of the MTP joint in the early acceleration phase of a sprint and to investigate the effect of ignoring the MTP joint on the calculated joint kinetics at the other stance leg joints. High-speed video and force platform data were collected from four to five trials for each of three international athletes. Resultant joint moments, powers, and net work at the stance leg joints during the first stance phase after block clearance were calculated using three different foot models. Considerable MTP joint range of motion (>30°) and a peak net MTP plantar flexor moment of magnitude similar to the knee joint were observed, thus highlighting the need to include this joint for a more complete picture of the lower limb energetics during early acceleration. Inclusion of the MTP joint had minimal effect on the calculated joint moments, but some of the calculated joint power and work values were significantly (P < .05) and meaningfully affected, particularly at the ankle. The choice of foot model is therefore an important consideration when investigating specific aspects of sprinting technique.

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The role of mechanical and neural restraints to joint range of motion during passive stretch

Medicine & Science in Sports & Exercise ◽

10.1249/00005768-199806000-00023 ◽

1998 ◽

Vol 30 (6) ◽

pp. 928-932 ◽

Cited By ~ 5

Author(s):

MALACHY P. McHUGH ◽

IAN J. KREMENIC ◽

MICHAEL B. FOX ◽

GILBERT W. GLEIM

Keyword(s):

Range Of Motion ◽

Joint Range Of Motion ◽

Joint Range ◽

Passive Stretch

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The Weil Osteotomy of the Lesser Metatarsals: a Clinical and Pedobarographic Follow-up Study

Foot & Ankle International ◽

10.1177/107110070002100502 ◽

2000 ◽

Vol 21 (5) ◽

pp. 370-374 ◽

Cited By ~ 123

Author(s):

Geoffroy Vandeputte ◽

Greta Dereymaeker ◽

Annie Steenwerckx ◽

Louis Peeraer

Keyword(s):

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Clinical Results ◽

Complete Disappearance ◽

Joint Range Of Motion ◽

Shortening Osteotomy ◽

Joint Range ◽

Metatarsophalangeal Joints ◽

Mtp Joints

The clinical results with pedobarographic analysis were assessed in 32 patients (59 metatarsals) who underwent a distal metatarsal shortening (Weil) osteotomy for either intractable plantar keratoses or chronically dislocated lesser metatarsal phalangeal joints. All patients had increased pressure under the involved metatarsal heads. Thirty three of the 59 metatarsophalangeal (MTP) joints were chronically dislocated. At an average follow-up of 30 months, patients rated the result as excellent or good for 32 of the 37 feet (86%). The mean preoperative AOFAS score was 59 (maximum 100), which improved to 81 postoperatively. This difference is significant : p= 0,00001 (with t-test). Comparison of the pre and post-operative pedobarographic measurements showed a significant decreased load under the affected metatarsal heads (p = 0.05). A complete disappearance of the callus was noted under 44 operated metatarsals (75%) and partial disappearance under 12 metatarsals (20%). Two symptomatic transfer lesions occurred under an adjacent metatarsal head. Recurrent dislocations occurred in 5 joints (15%). While metatarsophalangeal joint range of motion was significantly diminished, toe strength was maintained. Average metatarsal shortening was 5.9 mm with no nonunions, delayed unions, or malunions. The Weil shortening osteotomy is a simple and reliable procedure which can effectively reduce the load under the lesser metatarsophalangeal joints and is helpful for the reduction of dorsally dislocated MTP joints.

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Effects of Speed and Visual-Target Distance on Toe Trajectory during the Swing Phase of Treadmill Walking

Journal of Applied Biomechanics ◽

10.1123/jab.25.1.32 ◽

2009 ◽

Vol 25 (1) ◽

pp. 32-42 ◽

Cited By ~ 4

Author(s):

Christopher A. Miller ◽

Alan H. Feiveson ◽

Jacob J. Bloomberg

Keyword(s):

Walking Speed ◽

Visual Target ◽

Treadmill Walking ◽

Target Distance ◽

Heel Strike ◽

Related Factors ◽

Gait Kinematics ◽

Fixation Distance ◽

The Difference

Gait kinematics have been shown to vary with speed and visual-target fixation distance, but their combined effects on toe trajectory during treadmill walking are not known. The purpose of this investigation was to determine the role of walking speed and target distance on vertical toe trajectory during treadmill walking. Subjects walked on a treadmill at five speeds while performing a dynamic visual-acuity task at both “far” and “near” target distances (ten trials total). The analysis concentrated on three specific toe trajectory events during swing: the first peak toe height just after toe-off; the minimum toe height (toe clearance), and the second peak toe height just before heel strike. With increasing speed, toe clearance decreased and the peak toe height just before heel strike increased. Only the peak toe height just after toe-off was significantly changed between the near-target and far-target tasks, though the difference was small. Therefore, walking speed and visual-fixation distance cannot be neglected in the analysis of toe trajectory. Otherwise, differences observed between populations may be attributed to age- or clinically related factors, instead of disparities of speed or target-fixation distance.

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Ankle and midtarsal joint quasi-stiffness during walking with added mass

PeerJ ◽

10.7717/peerj.7487 ◽

2019 ◽

Vol 7 ◽

pp. e7487 ◽

Cited By ~ 3

Author(s):

Andrew M. Kern ◽

Nikolaos Papachatzis ◽

Jeffrey M. Patterson ◽

Dustin A. Bruening ◽

Kota Z. Takahashi

Keyword(s):

Ankle Joint ◽

Body Mass ◽

Added Mass ◽

Future Research ◽

Joint Range Of Motion ◽

Robotic Devices ◽

Two Phases ◽

Midtarsal Joint ◽

Joint Range ◽

Metatarsophalangeal Joints

Examination of how the ankle and midtarsal joints modulate stiffness in response to increased force demand will aid understanding of overall limb function and inform the development of bio-inspired assistive and robotic devices. The purpose of this study is to identify how ankle and midtarsal joint quasi-stiffness are affected by added body mass during over-ground walking. Healthy participants walked barefoot over-ground at 1.25 m/s wearing a weighted vest with 0%, 15% and 30% additional body mass. The effect of added mass was investigated on ankle and midtarsal joint range of motion (ROM), peak moment and quasi-stiffness. Joint quasi-stiffness was broken into two phases, dorsiflexion (DF) and plantarflexion (PF), representing approximately linear regions of their moment-angle curve. Added mass significantly increased ankle joint quasi-stiffness in DF (p < 0.001) and PF (p < 0.001), as well as midtarsal joint quasi-stiffness in DF (p < 0.006) and PF (p < 0.001). Notably, the midtarsal joint quasi-stiffness during DF was ~2.5 times higher than that of the ankle joint. The increase in midtarsal quasi-stiffness when walking with added mass could not be explained by the windlass mechanism, as the ROM of the metatarsophalangeal joints was not correlated with midtarsal joint quasi-stiffness (r = −0.142, p = 0.540). The likely source for the quasi-stiffness modulation may be from active foot muscles, however, future research is needed to confirm which anatomical structures (passive or active) contribute to the overall joint quasi-stiffness across locomotor tasks.

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