Impaired Gait in Ankylosing Spondylitis

NewsBot · Jan 14, 2011

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Impaired gait in ankylosing spondylitis.
Del Din S, Carraro E, Sawacha Z, Guiotto A, Bonaldo L, Masiero S, Cobelli C.
Med Biol Eng Comput. 2011 Jan 13. [Epub ahead of print]

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. The spine becomes rigid from the occiput to the sacrum, leading to a stooped position. This study aims at evaluating AS subjects gait alterations. Twenty-four subjects were evaluated: 12 normal and 12 pathologic in stabilized anti-TNF-alpha treatment (mean age 49.42 (10.47), 25.44 (3.19) and mean body mass index 55.75 (3.19), 23.73 (2.7), respectively). Physical examination and gait analysis were performed. A motion capture system synchronized with two force plates was used. Three-dimensional kinematics and kinetics of trunk, pelvis, hip, knee and ankle were determined during gait. A trend towards reduction was found in gait velocity and stride length. Gait analysis results showed statistically significant alterations in the sagittal plane at each joint for AS patients (P < 0.049). Hip and knee joint extension moments showed a statistically significant reduction (P < 0.044). At the ankle joint, a decreased plantarflexion was assessed (P < 0.048) together with the absence of the heel rocker. Gait analysis, through gait alterations identification, allowed planning-specific rehabilitation intervention aimed to prevent patients' stiffness together with improve balance and avoid muscles' fatigue.
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HansMassage · Jan 27, 2011

Confirmation of the spinal spring model of gate mechanics.
Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist
http://reflexposturology.weebly.com/

NewsBot · Jul 24, 2012

Postural control is altered in patients with ankylosing spondylitis.
Vergara ME, O'Shea FD, Inman RD, Gage WH.
Clin Biomech (Bristol, Avon). 2012 May;27(4):334-40

BACKGROUND:
Ankylosing spondylitis is a chronic inflammatory disorder that can lead to increased axial and peripheral joint stiffness, impairing joint mobility. Impaired axial mobility due to vertebral ankylosis may result in changes in standing postural control. Little research has addressed changes in standing postural control in the ankylosing spondylitis population, nor how these issues might affect clinical understanding and treatment.

METHODS:
Sixteen ankylosing spondylitis patients, and 17 healthy controls participated. Each individual completed two 120-second quiet standing trials with eyes open and eyes closed, while standing upon two force platforms. Net center of pressure displacement and mean power frequency in the frontal and sagittal planes were calculated. A Spearman's rank correlation analysis was performed between net center of pressure measures and several clinical measures of disease activity.

FINDINGS:
Frontal plane net center of pressure displacement and frequency content, and sagittal plane net center of pressure displacement were significantly greater within the ankylosing spondylitis patient group. Ankylosing spondylitis patients demonstrated a significant increase in frontal plane net center of pressure displacement in the eyes-closed condition. Net center of pressure displacement and frequency were significantly correlated to the Bath Ankylosing Spondylitis Functional Index, and individual components of the Bath Ankylosing Spondylitis Metrology Index.

INTERPRETATION:
Quiet standing postural control was altered particularly so in the frontal plane in patients with ankylosing spondylitis, which may be associated with increased fall risk. Posturographic measures of postural control may serve as valuable clinical tools for the monitoring of disease progression and disease status in ankylosing spondylitis.
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NewsBot · Jun 12, 2013

PLANTAR PRESSURE VALUES IN PATIENTS WITH ANKYLOSING SPONDYLITIS AND THEIR RELATION WITH CLINICAL AND RADIOLOGICAL PARAMETERS
E. Topcu, L. Cerrahoğlu, T. Duruöz
Annual European Congress of Rheumatology; Madrid 12-15 June 2013

Background: Pedobarography is a device used for sensitive measurement of ground reaction force. It is used for determination of foot biomechanics. In ankylosing spondylitis (AS) foot disorders are common.

Objectives: We aimed to determine the plantar pressure values of patients with ankylosing spondylitis (AS) and to identify the relationship of these values with the clinical and radiological parameters which placed in the follow-up of the disease.

Methods: 75 patients with the diagnosis of AS according to the modified New York criteria were recruited in the study consecutively in outpatient clinic. Exclusion criteria were cognitive dysfunction, visual, auditory and vestibular problems that affect walking on the pedobarography platform independently, history of previous surgery to lower extremity and lower extremity neurologic deficits. Demographic data of the patients such as age and gender were recorded. Disease activity was assessed with BASDAI. Functional status (BASFI), quality of life (ASQoL) and metrological score (BASMI), enthesis score (MESES, MEI) were assessed. Thoracic kyphosis angle was measured with a bubble inclinometer device. By radiographic evaluation left and right axis angles and mSASSS scores were determined. Both static and dynamic plantar pressures were recorded in pedobarographic studies of patients. The data were evaluated with SPSS 15.0 software. For all results p <0.05 was considered statistically significant.

Results: Seventy five AS patients (62 male) with mean age 37,98 (SD=9,96) years were recruited. The disease duration was 115,13 (SD=85,61) months. 42.7% of participants (32 patients) had a history of foot pain in the last week. Patients with foot pain had higher BASDAI (p<0.001), BASFI (p=0.002), ASQoL (p<0.001), MASES (p<0.001) and MEI (p<0.001) scores. Dynamic right mid-foot peak pressure and left middle forefoot peak pressure were lower in high disease activity (BASDAI> 4.1) group from low disease activity group (p=0.037 and p=0.022 respectively). In patients with low disease activity the right foot contact area was found higher than patients with high disease activity (p=0.029). Thoracic kyphosis angle was correlated with the static right and left medial forefoot peak pressure (p=0.05 and p=0.02 respectively), the percentage of the right and left forefoot loading (p<0.001 and p=0.019, respectively), percentage of right hindfoot loading (p<0.001) and right peak heel pressure (p=0.041).

Conclusions: We observed that plantar pressure measurements in patients with AS correlated with clinical and radiological parameters. Especially with increased thoracic kyphosis angle, some of the pressures in forefoot and midfoot measurements were decreased and some in rearfoot were increased. Moreover increased BASDAI, BASMI and BASFI scores were associated with decreased forefoot values and increased rearfoot loading. These findings suggest that with the disease progression the total load of rearfoot was increased. Therefore pedobarography seems to be an appropriate tool for the evaluation of the impact of disease on foot and clinical outcome of disease on patients with AS.

References: 1.Sahin N, Ozcan E, Baskent A, Karan A, Ekmeci O, Kasikcioglu E. Isokinetic evaluation of ankle muscle strength and fatigue in patients with ankylosing spondylitis. Eur J Phys Rehabil Med. 2011 Sep;47(3):399-405. Epub 2011 Mar 2.
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NewsBot · Feb 8, 2015

Plantar pressure distribution in patients with ankylosing spondylitis
Elif Aydin, Yasemin Turan, Engin Taştaban, İmran Kurt Omurlu, Omer Faruk Sendur
Clinical Biomechanics; Article in Press

Highlights
•Static plantar pressure distribution was not different in ankylosing spondylitis.
•Pressure under forefoot, midfoot were higher during gait in ankylosing spondylitis.
•Lower pressures of forefoot and rearfoot were associated with higher clinical scores.
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Background
Ankylosing spondylitis is one of the most common inflammatory rheumatic diseases and is associated with alterations in posture. The aim of this study was to investigate the pedobarographic changes among ankylosing spondylitis patients, in an attempt to understand whether the alterations in the posture affect the plantar pressure distribution.

Methods
The study population consisted of 38 patients with ankylosing spondylitis and 33 healthy volunteers. The static and dynamic pedobarographic measurements were performed to determine the plantar pressure distribution. Moreover, the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life Questionnaire and Bath Ankylosing Spondylitis Metrology Index were used to assess the clinical state of the patients.

Results
The static pedobarographic measurements did not reveal any intergroup difference. There were differences between the groups in the results of dynamic peak pressure measurements under the metatarsal areas and under the midfoot region. The percentage of the midfoot in the dynamic plantar contact area was higher in ankylosing spondylitis patients in comparison to the controls. No clinically significant correlation was found between the clinical scores and static pedobarographic measurements. The plantar pressures under the metatarsal heads, medial and lateral heel regions declined with increasing disease activity according to the Bath Ankylosing Spondylitis Disease Activity Index scores. The lower peak pressures on the forefoot and rearfoot, were associated with the higher Bath Ankylosing Spondylitis Metrology Index scores of the patients.

Interpretation
The alterations in the posture may have effects on the plantar pressures in patients with ankylosing spondylitis, especially during dynamic activities.
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NewsBot · Jan 26, 2016

Full Text:
American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis

NewsBot · Dec 6, 2018

Foot functions in ankylosing spondylitis.
Koca TT et al
Clin Rheumatol. 2018 Dec 3

ABTRACT:
AIM: Because of the wide diversity of developmental stages in spondyloarthropathies (SpA), clinical and radiographic weak correlations are often found in the development of enthesopathies. In this study, foot functions of ankylosing spondylitis (AS) patients were analyzed with clinical and radiological features.

METHOD:
Sixty-two AS patients and 39 age-matched, gender-matched, and body mass index (BMI)-matched healthy volunteers were included in this study. Acute-phase reactant levels of participants were recorded. The disease activity and functionality were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Foot functional index (FFI) and timed up and go test (TUG) were performed by the same educated nurse. Radiographically, the SpA-tarsal radiographic index (TRI) and the calcaneal inclination angle (CIA) were measured by the same physician to assess midfoot and arches.

RESULTS:
FFI subscores and total, TUG results, and CIA measurements were found to be significantly higher in the AS group (p < 0.05). FFI-pain, FFI-disability, and FFI-activity limitation subscores were significantly and positively correlated with BASDAI and BASFI scores (p < 0.05). Radiological changes ranging from grade 1 to grade 4 were detected in 68% of the AS paients according to TRI. Nineteen AS patients had pes planus and 26 AS patients had pes cavus deformity.

CONCLUSION:
The foot and ankle are frequently affected during the course of AS. Foot involvement and its functional impacts should be assessed regardless of the disease activity parameters in AS patients.
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NewsBot · Oct 4, 2021

The effects of a secondary task on gait in axial spondyloarthritis
Julie Soulard et al
Sci Rep. 2021 Oct 1;11(1):19537

Studies on the effects of dual tasking in patients with chronic inflammatory rheumatic diseases are limited. The aim of this study was to assess dual tasking while walking in patients with axial spondyloarthritis (axSpA) in comparison to healthy controls. Thirty patients with axSpA and thirty healthy controls underwent a 10-m walk test at a self-selected comfortable walking speed in single- and dual-task conditions. Foot-worn inertial sensors were used to compute spatiotemporal gait parameters. Analysis of spatiotemporal gait parameters showed that the secondary manual task negatively affected walking performance in terms of significantly decreased mean speed (p < 0.001), stride length (p < 0.001) and swing time (p = 0.008) and increased double support (p = 0.002) and stance time (p = 0.008). No significant interaction of group and condition was observed. Both groups showed lower gait performance in dual task condition by reducing speed, swing time and stride length, and increasing double support and stance time. Patients with axSpA were not more affected by the dual task than matched healthy controls, suggesting that the secondary manual task did not require greater attention in patients with axSpA. Increasing the complexity of the walking and/or secondary task may increase the sensitivity of the dual-task design to axial spondyloarthritis.
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NewsBot · Nov 10, 2021

Gait and Axial Spondyloarthritis: Comparative Gait Analysis Study Using Foot-Worn Inertial Sensors
Julie Soulard et al
JMIR Mhealth Uhealth. 2021 Nov 9;9(11)

Background: Axial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice.

Objective: This study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate.

Methods: A total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms-1 (mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground).

Results: Age, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17).

Conclusions: Gait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine.
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Impaired Gait in Ankylosing Spondylitis

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Impaired Gait in Ankylosing Spondylitis

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HansMassage Active Member

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H-Index Is Important for Postural Control for People with Impaired Foot Sole Sensation

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