Sagittal subtalar and talocrural joint assessment between barefoot and shod walking: A fluoroscopic study.

BACKGROUND: While wearing shoes is common in daily activities, most foot kinematic models report results on barefoot conditions. It is difficult to describe foot position inside shoes. This study used fluoroscopic images to determine talocrural and subtalar motion. RESEARCH QUESTION: What are the differences in sagittal talocrual and subtalar kinematics between walking barefoot and while wearing athletic walking shoes? METHODS: Thirteen male subjects (mean age 22.9 ±â€¯2.9 years, mean weight 77.2 ±â€¯6.9 kg, mean height 178.2 ±â€¯3.7 cm) screened for normal gait were tested. A fluoroscopy unit was used to collect images during stance. Sagittal motion of the talocrural and subtalar joints of the right foot were analyzed barefoot and in an athletic walking shoe. RESULTS: Shod talocrural position at heel strike was 6.0° of dorsiflexion and shod peak talocrural plantarflexion was 4.2°. Barefoot talocrural plantarflexion at heel strike was 4.2° and barefoot peak talocrural plantarflexion was 10.9°. Shod subtalar position at heel strike was 2.6° of plantarflexion and peak subtalar dorsiflexion was 1.5°. The barefoot subtalar joint at heel strike was in 0.4° dorsiflexion and barefoot peak subtalar dorsiflexion was 3.5°. As the result of wearing shoes, average walking speed and stride length increased and average cadence decreased. Comparing barefoot to shod walking there was a statistical significance in talocrural dorsiflexion and at heel strike and peak talocrural dorsiflexion, subtalar plantarflexion at heel strike and peak subtalar dorsiflexion, walking speed, stride length, and cadence. SIGNIFICANCE: This work demonstrates the ability to directly measure talocrural and subtalar kinematics of shod walking using fluoroscopy. Future work using this methodology can be used to increase understanding of hindfoot kinematics during a variety of non-barefoot activities.

Sagittal Subtalar and Talocrural Joint Assessment During Ambulation With Controlled Ankle Movement (CAM) Boots.

BACKGROUND: The purpose of the current study was to determine sagittal plane talocrural and subtalar kinematic differences between barefoot and controlled ankle movement (CAM) boot walking. This study used fluoroscopic images to determine talar motion relative to tibia and calcaneal motion relative to talus. METHODS: Fourteen male subjects (mean age 24.1 ± 3.5 years) screened for normal gait were tested. A fluoroscopy unit was used to collect images at 200 Hz during stance. Sagittal motion of the talocrural and subtalar joints were analyzed barefoot and within short and tall CAM boots. RESULTS: Barefoot talocrural mean maximum plantar and dorsiflexion were 9.2 ± 5.4 degrees and -7.5 ± 7.4 degrees, respectively; short CAM boot mean maximum plantar and dorsiflexion were 3.2 ± 4.0 degrees and -4.8 ± 10.2 degrees, respectively; and tall CAM boot mean maximum plantar and dorsiflexion were -0.2 ± 3.5 degrees and -2.4 ± 5.1 degrees, respectively. Talocrural mean range of motion (ROM) decreased from barefoot (16.7 ± 5.1 degrees) to short CAM boot (8.0 ± 4.9 degrees) to tall CAM boot (2.2 ± 2.5 degrees). Subtalar mean maximum plantarflexion angles were 5.3 ± 5.6 degrees for barefoot walking, 4.1 ± 5.9 degrees for short CAM boot walking, and 3.0 ± 4.7 degrees for tall CAM boot walking. Mean minimum subtalar plantarflexion angles were 0.7 ± 3.2 degrees for barefoot walking, 0.7 ± 2.9 degrees for short CAM boot walking, and 0.1 ± 4.8 degrees for tall CAM boot walking. Subtalar mean ROM decreased from barefoot (4.6 ± 3.9 degrees) to short CAM boot (3.4 ± 3.8 degrees) to tall CAM boot (2.9 ± 2.6 degrees). CONCLUSION: Tall and short CAM boot intervention was shown to limit both talocrural and subtalar motion in the sagittal plane during ambulation. The greatest reductions were seen with the tall CAM boot, which limited talocrural motion by 86.8% and subtalar motion by 37.0% compared to barefoot. Short CAM boot intervention reduced talocrural motion by 52.1% and subtalar motion by 26.1% compared to barefoot. CLINICAL RELEVANCE: Both short and tall CAM boots reduced talocrural and subtalar motion during gait. The short CAM boot was more convenient to use, whereas the tall CAM boot more effectively reduced motion. In treatments requiring greater immobilization of the talocrural and subtalar joints, the tall CAM boot should be considered.

Sagittal subtalar and talocrural joint assessment with weight-bearing fluoroscopy during barefoot ambulation.

BACKGROUND: Identifying talar position during ambulation has proved difficult as the talus lacks palpable landmarks for skin marker placement and more invasive methodologies such as bone pins are not practical for most clinical subjects. A fluoroscopic motion system was used to track the talus and calcaneus, allowing kinematic analysis of the talocrural and subtalar joints. METHODS: Thirteen male subjects (mean age 22.9 ± 3.0 years) previously screened for normal gait were tested. A fluoroscopy unit was used to collect images at 120 fps during stance. Sagittal motion of the talocrural and subtalar joints were analyzed. RESULTS: The intersubject mean and standard deviation values for all 58 trials of 13 subjects are reported. Maximum talocrural joint plantarflexion of 11.2 degrees (4.3 degrees of standard deviation) occurred at 11% stance and maximum dorsiflexion of -6.9 degrees (5.6 degrees of standard deviation) occurred at 85%. Maximum subtalar joint plantarflexion of 4.8 degrees (1.0 degrees of standard deviation) occurred at 96% stance and maximum dorsiflexion of -3.6 degrees (2.3 degrees of standard deviation) occurred at 30%. Talocrural and subtalar range of motion values during stance were 18.1 and 8.4 degrees, respectively. CONCLUSION: Existing fluoroscopic technology was capable of defining sagittal plane talocrural and subtalar motion during gait. These kinematic results compare favorably with more invasive techniques. This type of assessment could support more routine analysis of in vivo bony motion during gait. CLINICAL RELEVANCE: Fluoroscopic technology offers improved sagittal plane motion evaluation during weight-bearing with potential application in patients with end-stage ankle arthritis, postoperative ankle replacements and fusions, and orthotics and braces.

Gait abnormality following amputation in diabetic patients.

Amputations of the lower extremity may result from several etiologic factors. Most amputations performed in the United States result from a dysvascular limb. A majority of the population with vascular impairment comprises people with diabetes. These individuals frequently have comorbidities that may also affect the ultimate outcome of amputation. Loss of protective sensation, propensity toward infection, and visual and balance impairment all create additional issues with postamputation gait in the population with diabetes. Amputations about the foot and ankle affect gait and energy consumption. More gait disturbances tend to be seen as amputation level becomes more proximal; however, loss of the metatarsophalangeal joints has a profound effect, regardless of the proximal level of amputation. Soft tissue balance is key to maximizing gait, particularly prevention of equinus and equinovarus deformity from unopposed plantarflexors. Orthotic, prosthetic, and shoe modifications can help minimize gait abnormalities; however alterations of ground reaction force and center of pressure may still remain.