Gait Adaptation to a Phase-Specific Nociceptive Electrical Stimulation Applied at the Ankle: A Model to Study Musculoskeletal-Like Pain

Introduction: Lower limb pain, whether induced experimentally or as a result of a musculoskeletal injury, can impair motor control, leading to gait adaptations such as increased muscle stiffness or modified load distribution around joints. These adaptations may initially reduce pain but can also lead to longer-term maladaptive plasticity and to the development of chronic pain. In humans, many current experimental musculoskeletal-like pain models are invasive, and most don’t accurately reproduce the movement-related characteristics of musculoskeletal pain. The main objective of this study was to measure pain adaptation strategies during gait of a musculoskeletal-like experimental pain protocol induced by phase-specific, non-invasive electrical stimulation.Methods: Sixteen healthy participants walked on a treadmill at 4 km/h for three consecutive periods (BASELINE, PAIN, and POST-PAIN). Painful electrical stimulations were delivered at heel strike for the duration of heel contact (HC) using electrodes placed around the right lateral malleolus to mimic ankle sprains. Gait adaptations were quantified bilaterally using instrumented pressure-sensitive insoles. One-way ANOVAs and group time course analyses were performed to characterize the impact of electrical stimulation on heel and forefoot contact pressure and contact duration.Results: During the first few painful strides, peak HC pressure decreased on the painful side (8.6 ± 1.0%, p < 0.0001) and increased on the non-stimulated side (11.9 ± 0.9%, p < 0.0001) while HC duration was significantly reduced bilaterally (painful: 12.1 ± 0.9%, p < 0.0001; non-stimulated: 4.8 ± 0.8%, p < 0.0001). No clinically meaningful modifications were observed for the forefoot. One minute after the onset of painful stimulation, perceived pain levels stabilized and peak HC pressure remained significantly decreased on the painful side, while the other gait adaptations returned to pre-stimulation values.Discussion: These results demonstrate that a non-invasive, phase-specific pain can produce a stable painful gait pattern. Therefore, this protocol will be useful to study musculoskeletal pain locomotor adaptation strategies under controlled conditions.

Effects of nail softness and stiffness with distance running shoes on ground reaction forces and vertical loading rates in male elite long-distance runners with pronated feet

Background To improve propulsion during running, athletes often wear spike shoes designed for training and/or competition. Running with spike shoes may cause pain and/or injuries. To address this problem, a modified spike shoe was tested. This study aimed to evaluate the effects of running with dual-versus single-stiffness spike running shoes on running mechanics in long-distance runners with pronated feet. Methods Sixteen male elite (national competitive level) runners (5000 or 10,000 m) aged 28.2 ± 2.5 years with pronated feet volunteered to participate in this study. To be included, participants had to have achieved personal best race times over 5- and/or 10-km races under 17 or 34 min during official running competitions. All participants were heel strikers and had a history of 11.2 ± 4.2 years of training. For the assessment of running kinetics, a force plate was imbedded into a walkway. Running kinematics were recorded using a Vicon-motion-capture system. Nike Zoom Rival shoes (Nike, Nike Zoom Rival, USA) were selected and adapted according to spike softness and stiffness. Participants ran at a constant speed of ~4.0 m/s across the walkway with both shoe conditions in randomized order. Six trials were recorded per condition. The main outcomes included peak ground reaction forces and their time-to-peak, average and instantaneous vertical loading rates, free moments, and peak ankle eversion angles. Results Paired t-tests revealed significantly lower lateral (p = 0.021, d = 0.95) and vertical (p = 0.010, d = 1.40) forces at heel contact during running with dual-stiffness spike shoes. Running with dual-stiffness spike shoes resulted in a significantly longer time-to-peak vertical (p = 0.004, d = 1.40) force at heel contact. The analysis revealed significantly lower average (p = 0.005, d = 0.46) and instantaneous (p = 0.021, d = 0.49) loading rates and peak negative free moment amplitudes (p = 0.016, d = 0.81) when running with dual-stiffness spike shoes. Finally, significantly lower peak ankle eversion angles were observed with dual-stiffness spike shoes (p < 0.001, d = 1.29). Conclusions Running in dual- compared with single-stiffness spike distance running shoes resulted in lower loading rates, free moment amplitudes, and peak ankle eversion angles of long-distance runners with pronated feet.

Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review

(1) Background: ankle-foot orthosis (AFO) is the most commonly prescribed orthosis to patients with foot drop, and ankle and foot problems. In this study, we aimed to review the commonly used types of AFO and introduce the recent development of AFO. (2) Methods: narrative review. (3) Results: AFO prevents the foot from being dragged, provides a clearance between the foot and the ground in the swinging phase of gait, and maintains a stable posture by allowing heel contact with the ground during the stance phase. In clinical practice, the most commonly used AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO. In addition, for compensating the demerits of these conventional AFOs, new types of AFOs, including AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, were developed. (4) Conclusions: we think that our review can guide clinicians in selecting and prescribing the appropriate AFO for each patient in accordance with their specific physical conditions.

Effects of Attentional Control on Gait and Inter-Joint Coordination During Dual-Task Walking

In the process of walking, attentional resources are flexibly allocated to deal with varying environmental constraints correlated with attentional control (AC). A dual-task paradigm was used to investigate the effects of AC on gait and inter-joint coordination. Fifty students volunteered to participate in this study. Based on the reaction time (RT) in the Stroop task, the top 15 participants were assigned to the High Attentional Control (HAC) group, while the last 15 participants were assigned to the Low Attentional Control (LAC) group. The participants in the two groups were randomly asked to perform three tasks: (i) single 2-back working memory task (ST 2-back); (ii) single walking task (ST walking); and (iii) dual task (DT). Cognitive outcomes and gait spatiotemporal parameters were measured. Continuous relative phase (CRP), derived from phase angles of two adjacent joints, was used to assess inter-joint coordination. The LAC group exhibited significant task effects regarding RT, correct rate (CR), step width, gait cycle, step time, forefoot contact times, heel-forefoot times, hip-knee mean absolute relative phase (MARP), and deviation phase (DP) in the stance and swing phases (p &lt; 0.05). In the HAC group, significant task effects were only detected in RT and foot progression angle of the left foot (p &lt; 0.05). Under the three task conditions, the LAC group exhibited a higher CR in ST, longer heel contact times, and longer heel-forefoot times when compared with the LAC group (p &lt; 0.05). Compared with the LAC group, the HAC group exhibited significantly smaller (closer to zero) MARP and weaker hip-knee DP values in the swing phase across all gait conditions (p &lt; 0.05). In the stance phase, the HAC group had smaller MARP (closer to zero) values when compared with the LAC group (p &lt; 0.05). In conclusion, the ability to maintain gait control and modulate inter-joint coordination patterns in young adults is affected by the level of attentional control in accommodating gait disturbances. AC is correlated with the performance of motor control, which theoretically supports the competitive selection of athletes and fall prevention strategies for a specific population.

Effect of Heel-First Strike Gait on Knee and Ankle Mechanics

Background and Objectives: Acquiring knowledge about the magnitude and direction of induced joint forces during modifying gait strategies is critical for proper exercise prescription. The present study aimed to evaluate whether a heel-first strike pattern during gait can affect the biomechanical characteristics of ankle and knee joints among asymptomatic people. Materials and Methods: In this cross-sectional study performed in the biomechanics laboratory, 13 professional healthy male athletes walked on an instrumented walkway under two walking conditions. For the normal condition, subjects were instructed to walk as they normally would. For the heel-first strike condition, subjects were instructed to walk with heel-first strike pattern and increase heel contact duration as much as possible. Then, knee and ankle joint range of motions and moments, as well as vertical ground reaction force was measured by the Kistler force plate and Vicon motion analysis system. Results: Knee flexion angle at the initial contact and during stance phase was significantly lower when increasing the heel strike pattern. In addition, the mean values of the knee external rotation and adductor moments during heel strike condition were lower than those in normal walking. Further, the ankle dorsiflexion range of motion (ROM) during mid-stance increased significantly during heel-first strike pattern compared to the value in normal gait pattern. Conclusions: The modification of gait pattern including heel-first strike pattern can reduce the mechanical load applied to the knee, while improving the extensibility of gastro-soleus muscle complex.

Measuring standing hindfoot alignment: reliability of different approaches in conventional x-ray and cone-beam CT

Introduction Currently there is no consensus how hindfoot alignment (HA) should be assessed in CBCT scans. The aim of this study is to investigate how the reliability is affected by the anatomical structures chosen for the measurement. Materials and methods Datasets consisting of a Saltzman View (SV) and a CBCT of the same foot were acquired prospectively and independently assessed by five raters regarding HA. In SVs the HA was estimated as follows: transversal shift between tibial shaft axis and heel contact point (1); angle between tibial shaft axis and a tangent at the medial (2) or lateral (3) calcaneal wall. In CBCT the HA was estimated as follows: transversal shift between the centre of the talus and the heel contact point (4); angle between a perpendicular line and a tangent at the medial (5) or lateral (6) calcaneal wall; angle between the distal tibial surface and a tangent at the medial calcaneal wall (7). Intraclass correlation coefficients (ICC) were calculated to assess inter-rater reliability. A linear regression was performed to compare the different measurement regarding their correlation. Results 32 patients were included in the study. The ICCs for the measurements 1–7 were as follows: (1) 0.924 [95% CI 0.876–0.959] (2) 0.533 [95% CI 0.377–0.692], (3) 0.553 [95% CI 0.399–0.708], (4) 0.930 [95% CI 0.866–0.962], (5) 0.00 [95% CI − 0.111 to 0.096], (6) 0.00 [95% CI − 0.103 to 0.111], (7) 0.152 [95% CI 0.027–0.330]. A linear regression between measurement 1 and 4 showed a correlation of 0.272 (p = 0.036). Conclusions It could be shown that reliability of measuring HA depends on the investigated anatomical structure. Placing a tangent along the calcaneus (2, 3, 5, 6, 7) was shown to be unreliable, whereas determining the weight-bearing heel point (1, 4) appeared to be a reliable approach. The correlation of the measurement workflows is significant (p = 0.036), but too weak (0.272) to be used clinically.

Effects of a Curved Heel Shape in a Running Shoe on Biomechanical Variables and Comfort

(1) Background: The purpose of this study was to investigate the effects of a rounded heel shoe (RHS) and rounded lateral heel shoe (RLHS) on impact and lower extremity stability as well as their relationships with comfort during running. (2) Methods: Twenty healthy male adults participated in the study. The data were collected using eight infrared cameras while participants were running at a speed of 2.7 m/s in three shoe conditions on an instrumented treadmill. (3) Results: The peak vertical ground reaction force (PVGRF) was statistically smaller for the RHS and RLHS compared with the normal shoes (NS) (p < 0.05). The range of motion of inversion–eversion at the ankle joint was statistically smaller for the RLHS compared with the NS and RHS (p < 0.05). Increased dorsiflexion of the ankle joint at heel contact was negatively related to the comfort of a running shoe, and increased dorsi-plantarflexion ROM was positively related to comfort. (4) Conclusions: Based on these results, a curved heel shape of a running shoe may provide a positive influence on the biomechanical function and the comfort of running shoes. Future study, including measurements of lower extremity muscle activations and long-term comfort, would be beneficial to help validate current findings and develop further applications.

An Endurance-Dominated Exercise Program Improves Maximum Oxygen Consumption, Ground Reaction Forces, and Muscle Activities in Patients With Moderate Diabetic Neuropathy

BackgroundThe prevalence of diabetes worldwide is predicted to increase from 2.8% in 2000 to 4.4% in 2030. Diabetic neuropathy (DN) is associated with damage to nerve glial cells, their axons, and endothelial cells leading to impaired function and mobility.ObjectiveWe aimed to examine the effects of an endurance-dominated exercise program on maximum oxygen consumption (VO2max), ground reaction forces, and muscle activities during walking in patients with moderate DN.MethodsSixty male and female individuals aged 45–65 years with DN were randomly assigned to an intervention (IG, n = 30) or a waiting control (CON, n = 30) group. The research protocol of this study was registered with the Local Clinical Trial Organization (IRCT20200201046326N1). IG conducted an endurance-dominated exercise program including exercises on a bike ergometer and gait therapy. The progressive intervention program lasted 12 weeks with three sessions per week, each 40–55 min. CON received the same treatment as IG after the post-tests. Pre- and post-training, VO2max was tested during a graded exercise test using spiroergometry. In addition, ground reaction forces and lower limbs muscle activities were recorded while walking at a constant speed of ∼1 m/s.ResultsNo statistically significant baseline between group differences was observed for all analyzed variables. Significant group-by-time interactions were found for VO2max (p &lt; 0.001; d = 1.22). The post-hoc test revealed a significant increase in IG (p &lt; 0.001; d = 1.88) but not CON. Significant group-by-time interactions were observed for peak lateral and vertical ground reaction forces during heel contact and peak vertical ground reaction force during push-off (p = 0.001–0.037; d = 0.56–1.53). For IG, post-hoc analyses showed decreases in peak lateral (p &lt; 0.001; d = 1.33) and vertical (p = 0.004; d = 0.55) ground reaction forces during heel contact and increases in peak vertical ground reaction force during push-off (p &lt; 0.001; d = 0.92). In terms of muscle activity, significant group-by-time interactions were found for vastus lateralis and gluteus medius during the loading phase and for vastus medialis during the mid-stance phase, and gastrocnemius medialis during the push-off phase (p = 0.001–0.044; d = 0.54–0.81). Post-hoc tests indicated significant intervention-related increases in vastus lateralis (p = 0.001; d = 1.08) and gluteus medius (p = 0.008; d = 0.67) during the loading phase and vastus medialis activity during mid-stance (p = 0.001; d = 0.86). In addition, post-hoc tests showed decreases in gastrocnemius medialis during the push-off phase in IG only (p &lt; 0.001; d = 1.28).ConclusionsThis study demonstrated that an endurance-dominated exercise program has the potential to improve VO2max and diabetes-related abnormal gait in patients with DN. The observed decreases in peak vertical ground reaction force during the heel contact of walking could be due to increased vastus lateralis and gluteus medius activities during the loading phase. Accordingly, we recommend to implement endurance-dominated exercise programs in type 2 diabetic patients because it is feasible, safe and effective by improving aerobic capacity and gait characteristics.

Forward dynamic simulation of Japanese macaque bipedal locomotion demonstrates better energetic economy in a virtualised plantigrade posture

A plantigrade foot with a large robust calcaneus is regarded as a distinctive morphological feature of the human foot; it is presumably the result of adaptation for habitual bipedal locomotion. The foot of the Japanese macaque, on the other hand, does not have such a feature, which hampers it from making foot–ground contact at the heel during bipedal locomotion. Understanding how this morphological difference functionally affects the generation of bipedal locomotion is crucial for elucidating the evolution of human bipedalism. In this study, we constructed a forward dynamic simulation of bipedal locomotion in the Japanese macaque based on a neuromusculoskeletal model to evaluate how virtual manipulation of the foot structure from digitigrade to plantigrade affects the kinematics, dynamics, and energetics of bipedal locomotion in a nonhuman primate whose musculoskeletal anatomy is not adapted to bipedalism. The normal bipedal locomotion generated was in good agreement with that of actual Japanese macaques. If, as in human walking, the foot morphology was altered to allow heel contact, the vertical ground reaction force profile became double-peaked and the cost of transport decreased. These results suggest that evolutionary changes in the foot structure were important for the acquisition of human-like efficient bipedal locomotion.

The effect of chronic ankle instability on muscle activations in lower extremities

Background/Purpose Muscular reflex responses of the lower extremities to sudden gait disturbances are related to postural stability and injury risk. Chronic ankle instability (CAI) has shown to affect activities related to the distal leg muscles while walking. Its effects on proximal muscle activities of the leg, both for the injured- (IN) and uninjured-side (NON), remain unclear. Therefore, the aim was to compare the difference of the motor control strategy in ipsilateral and contralateral proximal joints while unperturbed walking and perturbed walking between individuals with CAI and matched controls. Materials and methods In a cross-sectional study, 13 participants with unilateral CAI and 13 controls (CON) walked on a split-belt treadmill with and without random left- and right-sided perturbations. EMG amplitudes of muscles at lower extremities were analyzed 200 ms after perturbations, 200 ms before, and 100 ms after (Post100) heel contact while walking. Onset latencies were analyzed at heel contacts and after perturbations. Statistical significance was set at alpha≤0.05 and 95% confidence intervals were applied to determine group differences. Cohen’s d effect sizes were calculated to evaluate the extent of differences. Results Participants with CAI showed increased EMG amplitudes for NON-rectus abdominus at Post100 and shorter latencies for IN-gluteus maximus after heel contact compared to CON (p<0.05). Overall, leg muscles (rectus femoris, biceps femoris, and gluteus medius) activated earlier and less bilaterally (d = 0.30–0.88) and trunk muscles (bilateral rectus abdominus and NON-erector spinae) activated earlier and more for the CAI group than CON group (d = 0.33–1.09). Conclusion Unilateral CAI alters the pattern of the motor control strategy around proximal joints bilaterally. Neuromuscular training for the muscles, which alters motor control strategy because of CAI, could be taken into consideration when planning rehabilitation for CAI.