Threshold of equinus which alters biomechanical gait parameters in children

NewsBot · Feb 28, 2013

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Threshold of equinus which alters biomechanical gait parameters in children
Laetitia Houx, Mathieu Lempereur, Olivier Rémy-Néris, Sylvain Brochard
Gait & Posture; Article in Press

The main aim of this study was to define the threshold angle of equinus beyond which significant changes in 3D lower limb kinematics and kinetics occur in typically developing children and to describe these changes.A customized orthosis was fitted on the right ankle of 10 typically developing children and was adjusted to +10° ankle dorsiflexion, 0°, −10°, −20° plantarflexion and maximum plantarflexion. Gait was analyzed using an optoelectronic system. A gait velocity of 1m/s was imposed.Most of the kinematic and kinetic changes were significantly altered from the −10° condition. In the sagittal plane, the results showed increased knee flexion at initial contact, increased knee flexion or hyperextension in stance, increased hip flexion at initial contact and increased anterior pelvic tilt. Other changes included increased knee varus, reduced hip adduction and more internal foot progression. The ankle plantarflexion moment was bi-phasic during stance, peak ankle power generation was reduced, peak knee extension moment was decreased and hip extension moments increased. On the contralateral side, there was a significant increase in ankle plantarflexion at initial contact and a significant decrease in knee flexion during swing phaseat maximum plantarflexion.Although slight modifications occurred for smaller degrees of equinus, the results suggest that significant kinematic and kinetic changes occurred during gait in both limbs from 10° of plantarflexion. The results of this study also provide some indications regarding the primary causes of gait deviations and secondary compensatory strategiesin children with a clinical dorsiflexion limitation.
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Highlights
► Kinematic and kinetic changes occurred during gait from 10° of plantarflexion.
► Knee flexion and hyperextension can appear due to an induced equinus in children gait.
► Description of 3D joint kinematics and kinetics of induced equinus may help clinician.
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Admin2 · Mar 3, 2013

Related threads:
Other threads tagged with equinus

NewsBot · Jun 15, 2013

The association between premature plantarflexor muscle activity, muscle strength, and equinus gait in patients with various pathologies
Katrin Schweizer, Jacqueline Romkes, Reinald Brunner
Research in Developmental Disabilities Volume 34, Issue 9, September 2013, Pages 2676–2683

This study provides an overview on the association between premature plantarflexor muscle activity (PPF), muscle strength, and equinus gait in patients with various pathologies. The purpose was to evaluate whether muscular weakness and biomechanical alterations are aetiological factors for PPF during walking, independent of the underlying pathology. In a retrospective design, 716 patients from our clinical database with 46 different pathologies (orthopaedic and neurologic) were evaluated. Gait analysis data of the patients included kinematics, kinetics, electromyographic activity (EMG) data, and manual muscle strength testing. All patients were clustered three times. First, patients were grouped according to their primary pathology. Second, all patients were again clustered, this time according to their impaired joints. Third, groups of patients with normal EMG or PPF, and equinus or normal foot contact were formed to evaluate the association between PPF and equinus gait. The patient groups derived by the first two cluster methods were further subdivided into patients with normal or reduced muscle strength. Additionally, the phi correlation coefficient was calculated between PPF and equinus gait. Independent of the clustering, PPF was present in all patient groups. Weak patients revealed PPF more frequently. The correlations of PPF and equinus gait were lower than expected, due to patients with normal EMG during loading response and equinus. These patients, however, showed higher gastrocnemius activity prior to foot strike together with lower peak tibialis anterior muscle activity in loading response. Patients with PPF and a normal foot contact possibly apply the plantarflexion–knee extension couple during loading response. While increased gastrocnemius activity around foot strike seems essential for equinus gait, premature gastrocnemius activity does not necessarily produce an equinus gait. We conclude that premature gastrocnemius activity is strongly associated with muscle weakness. It helps to control the knee joint under load independent from the underlying disease, and it is therefore a secondary deviation. If treated as primary target, caution should be exercised.
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Highlights
•716 patients with different pathologies were investigated retrospectively.
•Premature plantarflexor activity was present in orthopaedic and neurologic patients.
•Muscular weakness is strongly associated with abnormal gastrocnemius activity.
•Increased gastrocnemius activity around foot strike seems essential for equinus gait.
•The plantarflexion–knee extension couple can also act in loading response.
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NewsBot · Mar 25, 2014

Gastrocnemius inflexibility on foot progression angle and ankle kinetics during walking
Shyi-Kuen Wu et al
Clinical Biomechanics; Available online 19 March 2014

Background
Gastrocnemius inflexibility is a major problem in many orthopedic and neurological patients. Clinically, inflexible gastrocnemius muscles interfere with the performance of functional abilities and associate with many overuse injuries of the lower extremity. The purpose of this study was to investigate the effects of the gastrocnemius inflexibility on the foot progression angle and ankle kinetics during walking.
Method
There were 50 subjects, 23 patients with the inflexible gastrocnemius and 27 normal subjects, included in this investigation. Participants were asked to walk at two preset cadences of 100 steps/min and 140 steps/min. Data were collected from a motion analysis system and force plates. Kinematic and kinetic variables of gait were computed and analyzed.
Findings
Compared with the control group, greater toe-out foot progression angle (P = 0.001, Effect size = 0.314) and knee external rotation (P = 0.008, Effect size = 0.136) were found in the inflexible group during stance phase. Furthermore, significant greater plantarflexion moment (P = 0.032, Effect size = 0.093) and medial ground reaction force (P = 0.009 Effect size = 0.135) during midstance were discovered in the inflexible group.
Interpretation
The present results indicate that gastrocnemius inflexibility might bring about the changes in the joint angles, ankle moments and ground reaction forces. The abnormal joint alignment in the lower extremities and greater force upon joint tissue might be significant for the clinical considerations on soft tissue injuries for the patients with inflexible gastrocnemius muscles.
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NewsBot · Feb 9, 2016

Simulated Ankle Equinus Affects Knee Kinematics During Gait.
Drefus LC et al
HSS J. 2016 Feb;12(1):39-43

BACKGROUND:
It is critical to distinguish gait compensations from true abnormalities when planning interventions to improve gait in individuals with neuromuscular disorders.
QUESTIONS/PURPOSES:
The aim of this study was to determine the effect of isolated ankle equinus on knee kinematics during the initial contact phase of gait.
METHODS:
Ten healthy subjects (29 + 4.3 years) participated, and testing occurred in a motion analysis laboratory. This cross-sectional study investigated five gait conditions in each subject: shoe alone, shoe with unilateral ankle foot orthosis locked at neutral, 10?, 20?, and 30? of fixed ankle plantar flexion. Gait kinematics were recorded and calculated with 3D motion analysis. The difference between the shoe and each brace condition was analyzed by repeated-measures ANOVA. The primary outcome was knee flexion at initial contact.
RESULTS:
With greater than 10? simulated ankle equinus, the primary gait compensation pattern was increased knee flexion at initial contact. A significant degree of knee flexion occurred ranging from 7? to 22?.
CONCLUSION:
Our data suggests that observed knee flexion at initial contact may be a compensation pattern in individuals with >10? ankle equinus. However, in individuals with ≤10? ankle equinus, observed knee flexion may represent a true gait deviation. This has clinical significance in the realm of cerebral palsy for treatment planning to improve gait.
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NewsBot · Mar 13, 2016

An investigation of the relationship between a static diagnosis of ankle equinus and dynamic function of the ankle joint
De Giorgio, Stephanie
dissertation; University of Malta; 2015

is characterised by a limited ankle joint range of motion which is usually caused by
the contracture of the triceps surea muscle group. There are numerous definitions and
techniques to diagnose ankle equinus. A commonly used examination utilised in a clinical
setting is as described by Root et al., (1977) where passive ankle joint dorsiflexion is
examined using a hand held goniometer. Several studies have proven this to be unreliable.
Unfortunately literature has failed to correlate static examinations of the ankle joint with its
dynamic motion.
Aim: The aim of this research was to investigate whether there is a relationship between the
static diagnosis of ankle equinus and the dynamic motion of the ankle joint.
Research Design and Method: A quantitative non-experimental same subject research
design was employed in this study. Twenty participants with a mean age of 34 years were
divided into two equal groups which were of normal (0 to +5) or pronated (+6 to +10)
foot type, using the foot posture index. The static examination was then carried out using a
fixed goniometer, following which they were divided into two categories of ‘between
-5 to 0 degrees’ or ‘less than -5 degrees’ of ankle equinus. Dynamic examination was
then carried out using a 3D optoelectronic capture system where markers were placed
according to the Rizzoli foot model. An average of the maximum dynamic ankle joint and
foot dorsiflexion was taken.
Results: No relationship was found between static examination findings and dynamic motion
of ankle joint dorsiflexion. 66.7% of participants in the ‘between -5 to 0 degrees’ category
had more than 10 degrees of ankle joint motion during gait. On the other hand in the 'less
than -5 degrees' of static ankle equinus, all of the individuals had less than 10 degrees of
dynamic ankle joint dorsiflexion but there was still an increase of average dynamic
motion. Similar results were obtained in the dynamic foot dorsiflexion, where a marginal
increase in dynamic ankle joint dorsiflexion was observed which was attributed to the
midtarsal joint dorsiflexion. Also, a significant relationship between gender and dynamic
ankle and foot motion was noted, as the female population had a higher degree of ankle joint
range of motion than males.
Conclusion: There was no significant correlation between the static diagnosis of ankle
equinus and the dynamic motion of the ankle joint in the category of 'between -5 to 0
degrees'. This indicates that the technique as explained by Root theory is not enough to
classify an individual as having ankle equinus. This implies that clinicians should carry
out a dynamic examination to confirm diagnosis of ankle equinus. However, in the
category of 'less than -5 degrees' of ankle equinus, the participants had less than 10 degrees
of ankle joint dorsiflexion. Therefore, although there is no correlation between the two,
dynamic ankle equinus was still present. This may also suggest that a standard definition
of ankle equinus may be that of having less than -5 degrees of static ankle equinus.
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NewsBot · Feb 7, 2017

A pilot investigation into the relationship between static diagnosis of ankle equinus and dynamic ankle and foot dorsiflexion during stance phase of gait: Time to revisit theory?
Alfred Gatt, Stephanie De Giorgio, Nachiappan Chockalingam, Cynthia Formosa
The Foot; Article in Press

Highlights
•Participants with a plantarflexed foot exhibit less than 10° of dorsiflexion during gait.
•Participants with limited dorsiflexion do not necessarily exhibit reduced dorsiflexion during gait.
•We recommend that patients with equinus should be assessed using instrumented gait analysis.
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Background
Although the clinical assessment of ankle dorsiflexion has traditionally been measured utilizing various goniometric means, the validity of this static examination has never been investigated. Since any impairment in ankle flexibility is likely to result in injuries, it is imperative that the correct examination technique is conducted.

Hypothesis/Purpose
To determine whether a clinical diagnosis of ankle equinus, or limited ankle dorsiflexion, correlates with a decreased dorsiflexion range of movement of the foot and ankle during gait.

Methods
Twenty participants with a clinical diagnosis of ankle equinus underwent optoelectronic motion capture utilizing the Rizzoli foot model. Participants were divided into two groups, Group A with <-5° of dorsiflexion and Group B with −5° to 0° of ankle dorsiflexion.

Results
Participants in Group B had a mean dynamic ankle dorsiflexion angle of 13.9°, while those in Group A had a mean dorsiflexion angle of 4.4°, resulting in a significant difference (p = 0.004) between the two groups. Likewise, foot mean dynamic dorsiflexion angle of Group B was 17.13° and Group A 8.6° (p = 0.006).

Conclusion
There is no relationship between a static diagnosis of ankle dorsiflexion at 0° with dorsiflexion during gait. On the other hand, those subjects with less than −5° of dorsiflexion during static examination did exhibit reduced ankle range of motion during gait.
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NewsBot · Aug 10, 2020

GASTROCNEMIUS TIGHTNESS AFFECTS HIP AND PELVIC MOVEMENT IN GAIT
Shyi-Kuen Wu, Jia-Yuan You, Han-Yu Chen and Shu-Zon Lou
Source

The passive extensibility of skeletal muscles is an important health-related component of physical fitness. Tight gastrocnemius is a common orthopedic problem and frequently leads to overuse injuries of the lower extremity. Moreover, gastrocnemius tightness is commonly associated with lower back pain. Previous studies have reported that tight gastrocnemius results in kinematic and kinetic deviations of the ankle and knee during gait and a greater hip flexion at the moment of maximal ankle dorsiflexion. Accordingly, this study performs an experimental investigation into the effects of tight gastrocnemius on the hip and pelvic movements in gait. Sixteen subjects with tight gastrocnemius (defined as <10∘ of ankle dorsiflexion with knee extended) and 16 healthy individuals matched by age and gender participated in the study. The three-dimensional angles of the hip and pelvis and moments of the hip were obtained for both groups during the stance phase of gait using force plates and a motion analysis system. Compared with the control group, the peak hip flexion angle is significantly higher in the tight group (p=0.001), while the peak hip extension angle is significantly lower (p=0.001). Moreover, the peak pelvic anterior tilt is significantly higher than that of the control group (p=0.001), while the peak pelvic posterior tilt is significantly lower (p=0.001). Finally, the peak extensor moment of the tight group is significantly higher than that of the control group (p=0.049), while the peak flexor moment is significantly lower (p=0.003). The results confirm that tight gastrocnemius leads to changes in the three-dimensional hip and pelvic angles and hip moments during gait. Disturbance of the hip and pelvic movement is thus a critical clinical consideration when evaluating soft tissue injuries in patients with tight gastrocnemius.
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NewsBot · Oct 14, 2020

A comparative study between isolated gastrocnemius tightness patients and controls by quantitative Gait analysis and baropodometry
MatthieuLalevée et al
Foot and Ankle Surgery 14 October 2020

Highlights
•Isolated gastrocnemius tightness has an influence on foot and ankle pathology.
•Ankle dorsiflexion limitation inducing forefoot hyperpressure is the shared belief.
•However Quantitative Gait Analysis shows only compensatory knee flexion.
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Background
Isolated gastrocnemius tightness (IGT) has been suggested as an etiologic factor in mechanical disorders of the foot and ankle without a clear pathophysiological mechanism in the literature. We hypothesized that restricted ankle dorsiflexion inducing increased forefoot pressure in IGT patients could be this pathophysiological mechanism.

Methods
Case/control experimental observational investigation. Forty lower limbs in 20 asymptomatic IGT patients were included and compared to controls. Quantitative gait analyses coupled with dynamic baropodometry were used for comparison between groups. The primary outcome was maximum ankle dorsiflexion during stance phase. Secondary outcomes were knee flexion and forefoot pressure.

Results
Maximum ankle dorsiflexion and maximum forefoot pressure were similar between groups. Increased knee flexion was found in the asymptomatic IGT group.

Conclusions
IGT induced compensatory knee flexion during stance phase, which probably prevents increased pressure on the forefoot by allowing ankle dorsiflexion.
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NewsBot · Jan 26, 2022

Foot kinematics and leg muscle activation patterns are altered in those with limited ankle dorsiflexion range of motion during incline walking
YujinKwonGwanseobShin
Gait & Posture; Volume 92, February 2022, Pages 315-320

Highlights
•Dorsiflexion ROM affects gait patterns and muscle activity during incline walking.
•Limited ROM causes smaller peak dorsiflexion during swing phase of incline walking.
•Tibialis anterior and Soleus muscle activities were increased due to limited ROM.
•Limited ROM increases stress in the posterior ankle tissues during stance.
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Background
Larger ankle dorsiflexion (DF) is required when walking on inclined surfaces. Individuals with limited DF range of motion (ROM) may experience greater tissue stress on sloped surfaces and walk in altered gait patterns compared to the those with normal DF ROM.

Research question
Would the individuals with limited DF ROM walk with distinctive ankle DF patterns compared to those with normal DF ROM on the inclined surfaces?

Methods
Ten Limited DF ROM (passive ROM=35.3 ± 2.7°) and nine Normal DF ROM (passive ROM=46.4 ± 4.2°) participants walked on a treadmill at five slope angles (0°, 5°, 10°, 15°, 20°) for 2 min at a self-selected speed. The peak DF angles and the peak myoelectric activity levels of the tibialis anterior (TA) and soleus (SOL) muscles were quantified during the swing and stance phases of each walking trial, and they were compared between the two groups.

Results
Participants with limited DF ROM walked with smaller peak DF (3.1° at 0° slope ~ 8.4° at 20° slope) and greater peak TA activity in swing than those of the Normal ROM participants (3.4° ~ 12.2°), with significant differences at 20° slope. The peak DF angle in stance (Limited: 9.6° ~ 19.0°; Normal: 10.1° ~ 21.0°) did not differ between the two groups at all slopes, but the peak activity of the SOL muscle was significantly greater for the Limited group at slopes of 10° and higher.

Significance
Study results indicate that incline walking could be more challenging to the individuals with limited DF ROM as they need to approach and push-off the sloped surfaces with more efforts of the dorsiflexor and the plantar flexor muscles, respectively. Prolonged walking on inclined surfaces may produce faster development of muscle fatigue or tissue damage than those with normal DF ROM.
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