Abstract PDF

Journal of Foot and Ankle Research 2014, Volume 7 Suppl 1
http://www.jfootankleres.com/supplements/7/S1 JOURNAL OF FOOT

AND ANKLE RESEARCH
MEETING ABSTRACTS Open Access
4th Congress of the International Foot and Ankle

Biomechanics Community
Busan, Korea. 8-11 April 2014
Published: 8 April 2014
These abstracts are available online at http://www.jfootankleres.com/supplements/7/S1
8. Heiderscheit B, Hamill J, Tiberio D: A biomechanical perspective: do foot

MEETING ABSTRACTS orthoses work? British Journal of Sports Medicine 2001, 35:4-5.
9. Kirby K, Fuller E: Subtalar Joint Equilibrium and Tissue Stress Approach to
A1
Biomechanical Therapy of the Foot and Lower Extremity. Lower Extremity
Foot biomechanics- emerging paradigms
Biomechanics: Theory and Practice Denver: Albert SF, Curran SA, 1 2013,
Stephen F Albert
1:205-264, Bipedmed.
Chief Podiatric Section, Surgical Service. Dept. of Veterans Affairs Medical
10. Whitney KA: Classification and Treatment of Congenital Sagittal Plane
Center, Denver, Colorado 80220, USA
Deformity. Lower Extremity Biomechanics: Theory and Practice Denver: Albert
E-mail: Stephen.albert@va.gov
SF, Curran SA, 1 2013, 1:265-288, Bipedmed.
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A1
11. Curran SA: Sagittal Plane Facilitation of Motion Model and Associated
Foot Pathologies. Lower Extremity Biomechanics: Theory and Practice Denver:
Too many times theories of how the human foot functions and therefore
Albert SF, Curran SA, 1 2013, 1:289-315, Bipedmed.
how mechanically inducted foot problems are treated have been
presented as if they were facts. The dogmatic adherence that sometimes
ensues from such an approach has frequently stifled the evolution of foot
A2
mechanics. This has been particularly apparent in the field of podiatry
Individual and generalized lower limb muscle activity and kinematic
which has been dominated by the Root paradigm. Briefly, the Root
adaptations during running on an unpredictable irregular surface
paradigm proposes that the human foot functions ideally around the
Charlotte Apps1,2*, Rui Ding1, Jason Tak-Man Cheung1, Thorsten Sterzing1
subtalar joint’s neutral position. Additionally, the forefoot to rearfoot 1
Sports Science Research Center, Li Ning (China) Sports Goods Co Ltd,
frontal plane relationship ideally should be perpendicular. Furthermore,
Beijing 101111, China; 2School of Sport and Exercise Sciences, Liverpool John
deviations from those ideal positions are termed deformities. [1,2]
Moores University, Liverpool, L3 3AF, UK
Biomechanical treatments according to Root are intended to re-align the
E-mail: C.L.Apps@2013.ljmu.ac.uk
foot so as to function around the neutral subtalar position and/or prevent
frontal plane compensations from a deformed forefoot. In essence this
paradigm is based on foot morphology.
Background: Natural surfaces are irregular but only limited studies have
Several studies have raised doubts as to the validity of the Root
researched their effect on gait because of the predominantly flat surfaces
paradigm. [3-8] This abstract is a review of several papers which raise
where measurements are taken [1]. Regularly, biomechanical research
those doubts and explores emerging paradigms of human foot function
also tends to group mean results of many participants together to find
which align more with current research findings on foot function.[9-11]
the generalised response to a constraint. This often masks individual
References
adaptation strategies [2]. Therefore, the purpose of this study was to
1. Root M, Orien W, Weed J: Biomechanical evaluation of the foot. Los
analyse biomechanical responses during running on an unpredictable
Angeles: Clinical Biomechanics Corporation 1971.
irregular surface (UIS), at the individual level.
2. Root M, Orien W, Weed J: Normal and Abnormal Function of the Foot.
Methods: Seventeen healthy, male participants ran on a treadmill at 8 km/h
Los Angeles: Clinical Biomechanics Corporation 1977, 2.
with a predictable regular surface (PRS) and an UIS, created by attaching EVA
3. McPoil TG, Cornwall MW: The relationship between subtalar joint neutral
dome shaped inserts of two different heights and hardnesses. The mean
position and rearfoot motion during walking. Foot Ankle Int 1994,
and standard deviation, as a measure of variability, were calculated for lower
15:141-45.
limb kinematics and electromyography of five selected muscles of the left
4. Payne CB: The past, present, and future of podiatric biomechanics.
leg for 16 steps. Single parameters between individuals were compared, and
JAPMA 1998, 88(2):53-63.
additionally group results between the treadmill surfaces were obtained by
5. Lee WE: Podiatric biomechanics. An historical appraisal and discussion of
Wilcoxon signed ranked tests (p<.05).
the Root model as a clinical system of approach in the present context
Results: There were individual responses to UIS in mean EMG muscle
of theoretical uncertainty. Clin Podiatr Med Surg 2001, 18(4):555-684.
activation (EMA) for four out of the five leg muscles (vastus medialis, biceps
6. Nigg BM, Nurse MA, Stefanyshyn DJ: Shoe inserts and orthotics for sport
femoris, tibialis anterior and gastrocnemius medialis) and variability of EMA
and physical activities. Medicine and Science in Sports and Exercise 1999, 31:
(bicep femoris, tibialis anterior, gastrocnemius and peroneus longus) during
S421-8.
total stance phase. However, within the latency period (first 30 ms after
7. Stacoff A, Reinschmidt C, Nigg BM, van den Bogert AJ, Lundberg A,
touchdown) the mean EMA was no longer individual in the vastus medialis
Denoth J, Stussi E: Effects of foot orthoses on skeletal motion during
and tibialis anterior; there was a common group increase and decrease
running. Clinical Biomechanics 2000, 15:54-64.
© 2014 various authors, licensee BioMed Central Ltd. All articles published in this supplement are distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Journal of Foot and Ankle Research 2014, Volume 7 Suppl 1 Page 2 of 99
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Figure 1(abstract A2) Normalized mean EMA of tibialis anterior: individual response during stance phase (left) indicated by no systematic relationship
between surfaces, generalized group response during latency period (right) indicated by increased EMA on UIS for all participants. Squares denote
irregular surface, diamonds regular surface.
respectfully on UIS (Figure 1). Contrastingly, the response of the peroneus strategies [2]. Therefore, the purpose of this study was to analyse
longus during the latency phase was individual, with participants applying biomechanical responses during walking on an unpredictable irregular
either increased or decreased EMA strategies for frontal plane ankle control. surface (UIS), at the individual level.
Sagittal plane shoe, ankle, knee and hip touchdown kinematic characteristics Methods: Seventeen healthy, male participants (mean (SD): 24.2 (1.6)
were directly affected by the surface constraint as they were common years, 1.76 (0.05) m, 71.6 (8.2) kg) walked on a treadmill at 5 km/h with a
between participants throughout. Variability of the kinematics on UIS predictable regular surface (PRS) and on UIS, created by attaching EVA
was not individual and increased regardless of joint and stance phase period dome shaped inserts of different heights (10 mm and 15 mm, both in
analysed. diameter of 140 mm) and hardness (40 and 70 Asker C). The mean and
Conclusion: Individual lower limb muscle activation strategies, standard deviation, as a measure of variability, were calculated for lower
accompanied by common group sagittal plane joint angles at touchdown limb kinematics and electromyography of five selected muscles of the left
occurred during running stance phase on UIS. Due to the nature of the leg for 16 steps. Single parameters between individuals were compared,
UIS, it remains unknown whether personal muscular control was triggered and additionally, group results between the treadmill surfaces were
by the different perturbation experienced or executed proactively obtained by Wilcoxon signed ranked tests (p<.05).
by runners. For better understanding of adaptations to shoe-surface Results: The step mean and step variability of EMG muscle activation
interactions, next to searching for common neuro-muscular patterns, more (EMA) of thigh muscles, vastus medialis and bicep femoris, were specific
focus should be placed on analyses of individual responses and the sub- to the individual, with no systematic alterations between surfaces. In
periods of stance phase. contrast, shank muscles showed individual and common EMA strategies
References depending on the period of the gait cycle (Figure 1). During total stance
1. Thies SB, Richardson JK, Ashton-Miller JA: Effects of surface irregularity and phase, mean EMA of the tibialis anterior and gastrocnemius medialis
lighting on step variability during gait: A study in healthy young and altered individually. However, within the muscular latency period (first 30
older women. Gait Posture 2005, 22:26-31. ms after foot strike) mean EMA strategies were no longer individual.
2. Dadswell CE, Payton C, Holmes P, Burden A: Biomechanical analysis of the There was a common group decrease and increase observed in mean
change in pistol shooting format in modern pentathlon. Journal of Sports EMA of the tibialis anterior and gastrocnemius respectively on UIS.
Sciences 2013, 31(12):1294-1301. Conversely, kinematic characteristics appeared rather common between
participants throughout. Mean and especially variability of sagittal and
frontal plane ankle angles, as well as knee and hip characteristics were
similar on PRS and UIS between individuals.
A3 Conclusion: Individual thigh muscle EMG responses were accompanied
Individual and generalized lower limb muscle activity and kinematic by similar kinematics between participants when walking on UIS. Thus,
adaptations during walking on an unpredictable irregular surface mainly the surface constraint altered movement kinematics, although
Charlotte Apps1,2*, Rui Ding1, Jason Tak-Man Cheung1, Thorsten Sterzing1 underlying muscle activation strategies were individualised. For a better
1
Sports Science Research Center, Li Ning (China) Sports Goods Co Ltd, understanding of adaptations to shoe-surface interactions, next to
Beijing 101111, China; 2School of Sport and Exercise Sciences, Liverpool John searching for common neuro-muscular patterns during the whole gait
Moores University, Liverpool, L3 3AF, UK cycle or total stance phase, more focus should be placed on individual
E-mail: C.L.Apps@2013.ljmu.ac.uk analyses of sub-periods of stance phase.
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A3 References
1. Thies SB, Richardson JK, Ashton-Miller JA: Effects of surface irregularity and
Background: Natural surfaces are irregular but limited studies have lighting on step variability during gait: A study in healthy young and
researched their effect on gait because of the predominantly flat surfaces older women. Gait Posture 2005, 22:26-31.
where measurements are taken [1]. Regularly, biomechanical research also 2. Dadswell CE, Payton C, Holmes P, Burden A: Biomechanical analysis of the
tends to group mean results of many subjects together to find the change in pistol shooting format in modern pentathlon. Journal of Sports
generalised response to a constraint. This often hides individual adaptation Sciences 2013, 31(12):1294-1301.
Figure 1(abstract A3) Normalized mean EMA of gastrocnemius medialis: Individual response during stance phase (left) indicated by no systematic
relationship between surfaces, generalized group response during latency period (right) indicated by increased EMA on UIS for vast majority of
participants. Squares denote irregular surface, diamonds regular surface.
100 Hz) and two Kistler force platforms (9281B, 400 Hz). Five walking trials
A4 were obtained for both groups at a self-selected speed with an additional
Age-related changes in foot kinematics during walking five trials from the young adults at a slow speed. Joint angles were
John Arnold1*, Shylie Mackintosh2,3, Sara Jones3, Dominic Thewlis1,2 computed using the joint coordinate system [3]. Variables of interest were
1
Biomechanics and Neuromotor Laboratory, School of Health Sciences, the joint angles between the calcaneus-shank, midfoot-calcaneus,
University of South Australia, Adelaide, Australia; 2Sansom Institute for Health metatarsus-midfoot and hallux-metatarsus at initial contact, end of loading
Research, University of South Australia, Adelaide, Australia; 3International response and toe-off and the joint range of motion (ROM). Differences in
Centre for Allied Health Evidence (iCAHE), University of South Australia, means of variables between the young adults (preferred and slow speeds)
Adelaide, Australia and older adults were compared using Student’s t-tests. Effect sizes
E-mail: john.arnold@mymail.unisa.edu.au (Cohen’s d) for the differences were also computed.
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A4 Results: The older adults had a less plantarflexed calcaneus at toe-off
(-9.6° vs. -16.1°, d = 1.0, p = <0.001), a smaller sagittal plane ROM of the
Background: Differences in dynamic foot function between young and midfoot (11.9° vs. 14.8°, d = 1.3, p = <0.001, fig. 1) and smaller coronal
older adults have been reported [1], however foot kinematics during plane ROM of the metatarsus (3.2° vs. 4.3°, d = 1.1, p = 0.006) compared
walking remain largely unquantified. Our understanding of foot to the young adults. Walking speed did not alter these changes as they
kinematics during walking is largely based on single-segment foot existed when groups walked at comparable speeds.
models, which limits the inferences that can be made about foot motion. Conclusions: Independent of walking speed, older adults exhibit
This study aimed to determine if differences in foot kinematics existed differences in foot kinematics compared to younger adults. These are
between young and older adults during walking using a multi-segment characterised by reduced mobility of the calcaneus, midfoot and metatarsus
foot model [2]. and changes in angular position of the hindfoot at toe-off. Further research
Participants and methods: Forty adults participated– 20 young adults is required to establish possible links to the development of pathology and
(10F:10M, mean age 23.2 years SD 3.0, height 1.75 m SD 0.1, mass 73.6 kg their influence on broader physical function in older adults.
SD 19.5) and 20 older adults (11F:9M, mean age 73.2 years, height 1.69 m References
SD 0.11, mass 76.9 kg SD 15.5). Surface markers were attached to 1. Scott G, et al: Gait & Posture 26(1):68-7.
anatomical landmarks consistent with the protocol by Leardini et al [2]. 2. Leardini A, et al: Gait & Posture 25(3):453-462.
Kinematic and kinetic data were acquired with 12 cameras (VICON MX-F20, 3. Wu G, et al: J.Biomechanics 28(10):1257-126.
Figure 1(abstract A4) Midfoot angles for older (solid line), young (dashed) and young (slow) groups (dotted)
Table 1(abstract A5) Mean ± SD inversion/eversion

A5 rotation (degrees) at baseline, 10min into each session
The effect of exercise on ligament laxity during inversion/eversion
rotations at the ankle joint and 20min into each session
Alison S Attenborough1*, Peter J Sinclair1, Richard M Smith1, Claire E Hiller2 Baseline 10min 20min
1
Discipline of Exercise and Sport Science, The University of Sydney,
Control 34.7 ± 8.1 34.3 ± 8.4 34.7 ± 11.4
Lidcombe, NSW, 2141, Australia; 2Discipline of Physiotherapy, The University
of Sydney, Lidcombe, NSW, 2141, Australia Exercise* 35.8 ± 10.0 38.4 ± 9.5 39.9 ± 9.0
E-mail: aatt4376@uni.sydney.edu.au * p<0.05
Background: Previous literature investigating the effect of exercise on measures with healthy reference values. At present there is a great need
ligament laxity at the knee found that basketball and distance running elicit for comprehensive lower limb reference data representing the healthy
a significant increase in knee laxity post exercise [1], whereas powerlifting population. The 1000 Norms Project is currently recruiting to provide
[1] and cycling [2] do not change after exercise. This suggests that, to have reference values for a set of widely-used clinical and biomechanical
an effect on ligament laxity, an activity must be weight bearing and measures of the foot and ankle. A volunteer sample of 1000 healthy
repetitive in nature. We aimed to use a multidirectional exercise protocol to individuals between the ages of 3 and 100 years is participating in the
determine whether the ligaments responsible for controlling inversion/ Project. Measures of plantar pressure, gait, ankle range of motion, foot
eversion at the ankle allowed greater rotation following dynamic and ankle muscle strength, foot posture and ankle instability are included
movement. This will form the basis of future methodological decisions in the comprehensive battery of items (Table 1).
regarding the conditions under which laxity should be measured, and will The 1000 Norms Project reliability study was completed in November
help to describe the acute response of ligaments during exercise with 2013. Inter-rater reliability was found to be excellent (ICC>.75) for all foot
applications to injury prevention. and ankle measures (Table 2). Recruitment and data collection will take
Methods: 17 female volunteers (22.8 ± 2.3years, 165.4 ± 5.4 m, 61.7 ± 8.3 place over the next two years. The release of the final database to the
kgs) were tested on two separate mornings, having limited incidental international community via a secure, free online network is anticipated
activity and refrained from exercise. The order of the exercise and control to occur in March 2016. The 1000 Norms Project will provide a
session was randomised amongst participants, as was the leg tested. substantial contribution to our understanding of the range of normal foot
Ligament laxity was quantified as the joint rotation resulting from a 3 Nmm and ankle function in healthy individuals. The reference dataset will be a
torque applied in both an inversion and eversion direction using a Hollis useful tool for disease diagnosis and management, health surveillance
Ankle Arthrometer (BlueBay Research, Milton FL). The exercise session and future outcome measure development for clinical trials of
involved 20min of physical activity separated into two identical 10min rehabilitative, surgical and pharmacological interventions.
blocks that involved side stepping, agility tasks and jogging. Ankle laxity in
the inversion/eversion plane was measured at baseline, following 10min of
exercise and again following the second bout of 10 min of exercise. The A7
control session was identical to the exercise session however the exercise Does size matter? The influence of shoe-hole sizes on foot-mounted
component was omitted in exchange for quiet sitting. A repeated measures marker motion during walking gait
ANOVA was used for analysis. Chris Bishop1*, John B Arnold1, Francois Fraysse1, Dominic Thewlis1,2,3
1
Results: The magnitude of inversion/eversion rotation that resulted from Biomechanics and Neuromotor Laboratory, School of Health Sciences,
the applied torques is presented in Table 1. There was a main effect of University of South Australia, Australia; 2Sansom Institute for Health Research,
session (p=0.03) however no effect for time (p=0.07) or the interaction University of South Australia, Australia; 3Centre for Orthopaedic and Trauma
between session and time (p=0.14). Research, University of Adelaide, Australia
Conclusions: Multidirectional aerobic exercise increased the rotational E-mail: Christopher.bishop@mymail.unisa.edu.au
movement at the ankle and implies that, with exercise, there is an acute Journal of Foot and Ankle Research 2014, 7(Suppl 1):A7
mechanical response of the ligaments that support the ankle. The increase
in laxity during exercise may explain the ankle sprain susceptibility during Background: To quantify in-shoe foot kinematics, studies have relied on
participation in sporting activities. To determine an individual’s baseline cutting holes in the shoe upper to allow markers to be placed on the
mechanical laxity, and ensure continuity between investigations, it is foot. Although previous research has suggested optimum hole sizes to
suggested that future measures are taken prior to engagement in physical preserve the structural integrity of the shoe [1], there is no empirical
activity. basis for what size holes are required to allow free-motion of individual
References markers during gait. The aim of this study was to determine the effect of
1. Steiner ME, Grana WA, Chillag K, Schelberg-Karnes E: The effect of exercise different diameter holes on skin-mounted marker motion during walking
on anterior-posterior knee laxity. Am J Sports Med 1986, 14:24-9. in athletic footwear.
2. Belanger MJ, Moore DC, Crisco JJ 3rd, Fadale PD, Hulstyn MJ, Ehrlich MG: Methods: Eighteen healthy adults participated in this study (10M:8F, mean
Knee laxity does not vary with the menstrual cycle, before or after age 22.7 years SD 3.7, height 1.74 m SD 0.08, body mass 71.2 kg SD 8.5).
exercise. Am J Sports Med 2004, 32:1150-7. Wand-mounted surface markers were attached directly to the foot [2] or
directly to the foot for barefoot measurements, which were used as a
reference for comparisons. Each participant performed five walking trials in
A6 athletic footwear (ASICS Gel-Pulse 3). Three sets of identical shoes were used
1000 Norms Project: understanding foot and ankle health, disease and with holes of 15 mm (A), 20 mm (B) and 25 mm (C). All conditions were
normality tested in a random order. Marker trajectories were acquired with 12 VICON
Jennifer N Baldwin1*, Marnee M McKay1, Claire E Hiller1, Jean E Nightingale1, cameras (MX-F20, VICON, UK) at 100 Hz. Data analysis was conducted in two
Niamh Moloney1, Natalie Vanicek1, Paulo Ferreira1, Milena Simic1, parts; firstly, the movement (marker trajectory) of individual markers relative
Kathryn Refshauge1, Joshua Burns1,2, the 1000 Norms Project Consortium1 to the origin of a fixed shoe reference frame was quantified. Secondly, we
1
Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, adapted a method proposed by Cappozzo et al. [3] quantified the isotropy
The University of Sydney, Australia; 2Institute for Neurosciences and Muscle of the marker motion on a plane.
Research, The Children’s Hospital at Westmead, Australia Results: Where movement of the markers in the 15 and 20 mm conditions
E-mail: jbal2575@uni.sydney.edu.au were restricted by the surrounding shoe upper, the marker movement in
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A6 the 25 mm condition did not exceed the radius of any of the shoe-holes.
Despite significant differences in the isotropy index between 25 mm and
A primary goal of healthcare is to understand the boundaries of health barefoot at the medial and lateral calcaneus markers (P < 0.05), the
and normality and identify when abnormalities are harmful. Diagnosis of differences identified were due to the effect of footwear on the foot and
disease or impairment is often made by comparing results from clinical not a result of the marker wands hitting the shoe upper.
Table 1(abstract A6) Foot and ankle items assessed in the 1000 Norms Project
Item Item Description Measurement variables
Plantar Collection of plantar pressure during gait using two-step protocol and Peak pressure, mean pressure and pressure-time
pressure Emed pressure platform (Novel) integral at different regions of the foot
Ankle range Active ankle plantarflexion measured using goniometry Plantarflexion angle in degrees
of motion Passive ankle dorsiflexion measured using weight-bearing lunge test Dorsiflexion angle in degrees
Ankle Plantarflexion strength assessed using fixed dynamometry Results from three trials presented as raw data in
strength Dorsiflexion strength assessed using handheld dynamometry Newtons and also normalised to body weight
Toe flexor Paper Grip Test assessing strength of hallux and four lesser toes Pass/fail score recorded for ability to grip paper under
strength toes
Gait Spatio-temporal aspects of gait measured using Zeno walkway Step time, step length and width, gait velocity and foot
(Protokinetics) progression angle
Foot posture Foot Posture Index consisting of six assessments relating to foot posture Foot posture graded on a 15-point scale from -12
(varus) to +12 (valgus)
Ankle Cumberland Ankle Instability Tool (Adult and Youth versions) consisting of Overall score out of 30 where higher scores indicate
instability 9 items pertaining to self-perception of ankle stability greater instability
Table 2(abstract A6) Inter-rater reliability of foot and ankle items assessed in the 1000 Norms Project
Item ICC (95% CI) SEM SEM % mean
Ankle plantarflexion ROM .885 (.538-.971) 1.36 2.2
Ankle dorsiflexion lunge test .875 (.498-.969) 1.73 4.8
Dorsiflexion strength .958 (.831-.990) 4.36 2.9
Plantarflexion strength .973 (.892-.993) 3.57 1.9
Foot Posture Index Left Total Score .978 (.916-.994) 0.09 2.0
Foot Posture Index Right Total Score .958 (.820-.990) 0.14 3.3
Note: ROM, range of motion; ICC, Intraclass Correlation Coefficient (95% Confidence Interval); SEM, Standard Error of Measurement; SEM % mean, Standard Error
of Measurement expressed as a percentage of the mean
Conclusion: When quantifying in-shoe foot kinematics, the size of the References
holes cut in the shoe upper can have a significant impact on the motion 1. Shultz R, Jenkyn T: Determining the maximum diameter for holes in the
of surface markers attached to the foot. Using the methods in this study, shoe without compromising shoe integrity when using a multi-segment
it appears hole diameters smaller than 25 mm resulted in a restriction of foot model. Med Eng Phys 2012, 34:118-122.
surface marker motion, which may impact upon the resultant joint 2. Bishop C, Paul G, Thewlis D: The reliability, accuracy and minimal
kinematics. detectable difference of a multi-segment kinematic model of the foot-
shoe complex. Gait Posture 2013, 37:552-557.
Figure 1(abstract A7) Example X-Y trajectory plots with ellipses to represent the radius of each shoe holes size for Calc 1 marker.
3. Cappozzo A, Cappello A, DellaCroce U, Pensalfini F: Surface-marker cluster 2. Moe-Nilssen R, Helbostad JL: Estimation of gait cycle characteristics by
design criteria for 3-D bone movement reconstruction. IEEE Trans Biomed trunk accelerometry. J Biomech 2004, 37(1):121-6.
Eng 1997, 44:1165-1174.
A9
A8 Mechanical variations induce by foot orthoses on calcaneal fracture
Effects of differently cushioned running shoes at left and right foot on T Breard1,2,3*, M Janin1,2
1
running symmetry Applied Podiatry College, 7 Treguel, 86000 Poitiers, France; 2Podiatrist, PhD,
Torsten Brauner1*, Thorsten Sterzing2, Mathias Wulf1, Thomas Horstmann1,3 Clinic, 7 Treguel, 86000 Poitiers, France; 3Maison médical de Roaillan, 33210
1
Technische Universität München, Munich 80992, Germany; 2Sports Science Roaillan, France
Research Center, Li Ning (China) Sports Goods Co Ltd, Beijing 101111, China; Journal of Foot and Ankle Research 2014, 7(Suppl 1):A9
3
Medicalpark St. Hubertus, Bad Wiessee 83707, Germany
E-mail: torsten.brauner@tum.de This work is meant to quantify the benefits of the foot orthoses [1,2] through
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A8 the clinical case of a female patient aged 67 who broke her right calcaneum.
To investigate this, we implemented three experiments commonly used
Background: The cushioning of running shoes and leg stiffness influence during podiatric examinations to assess walking parameters: the passive
tibial impact shock [1]. This knowledge, however, is based on antepulsion test, the stabilo-baro-podometrie analysis [3,4] and the
investigations with the same cushioning at both feet. Unknown is Latero-Medial Index, measures taken immediately (T0) and after 16 days
whether leg stiffness can be adjusted for each leg individually. Thus, the (T16) wearing plantar orthotics. (figure 1) Foot orthoses, deduced after
purpose of this study was to quantify effects of differently cushioned clinical examination and quantitative analysis of walking, are molded,
running shoes at the left and right foot on running symmetry. wisch are supplemented by the addition of specific low stimulations. The
Methods: Twenty-eighty physically active males (26.8±8.4years, 1.80 results clearly show the benefits on stability. The foot orthoses allows the
±0.05m, 74.8±7.5kg), with similar left and right leg stiffness, participated patient to recover the normal use of the ankle thanks to the positive
in this study. Two pairs of identical custom-made running shoes, effects on support and movement of a fractured foot [5]. Therefore, the
representing harder-cushioned (mechanical impact testing at rearfoot: foot orthoses tends to improve the balance of the fractured foot.
13.8g) and softer-cushioned (10.2g) footwear, were used. The four single Moreover, these positive effects are persistent throughout the time.
shoes were combined into four experimental conditions (left foot-right In a latter phase, the adjustments carried out on the foot orthoses that
foot): hard-hard, hard-soft, soft-hard, soft-soft). In each condition, subjects modify the foot simulation [3,4], result in the improvement of the assessed
ran 200m on a concrete track at self-selected pace. Conditions were parameters (static and dynamic). These variations tend to prove the
blinded, the order randomized and a 100m run was performed in a benefits of the foot orthoses and justify the podiatric approach developed
neutral running shoe between conditions. Directly following each on this clinical case.
condition, subjects rated the cushioning of the left and right shoe References
separately on a visual analogue scale (0cm=soft, 10cm=hard). A mobile 1. Murley GS, Landorf KB, Menz HB: Do foot orthoses change lower limb
3D accelerometer (Humotion, Germany) strapped to the lower back at L5- muscle activity in flat-arched feet towards a pattern observed in normal-
S1 recorded vertical acceleration. As a measure of running symmetry [2], arched feet? Clin Biomech 2010, 25:728-736.
peak vertical impacts of 32 foot-falls were determined for each leg. Left 2. Murley GS, Landorf KB, Menz HB, Bird AR: Effect of foot posture, foot
and right impact peaks and subjective cushioning ratings were compared orthoses and footwear on lower limb muscle activity during walking
using paired Student T-Tests (a=.05). and running: a systematic review. Gait Posture 2009, 29:172-87.
Results: In both of the mixed conditions, subjects perceived the soft shoe 3. McPoil TG, Cornwall MW: Use of plantar contact area to predict medial
to be significantly softer than the hard shoe (p=.031), according to their longitudinal arch height during walking. JAMPA 2006, 96:489-494.
actual mechanical impact hardness. Vertical impact peaks at the lower 4. Wong L, Hunt A, Burns J, Crosbie J: Effect of foot morphology on center-
back did not differ between any of the tested conditions and were of-pressure excursion during barefoot walking. JAPMA 2008, 98:112-127.
symmetrical for the mixed conditions. 5. Gillespie WJ, Gillespie LD, Paker MJ: Hip protectors for preventing hip
Discussion: Despite the well described effects of shoe cushioning on tibial fractures in older people. Cochrane Database Syst. Rev 2010, 6(10):CD001255.
impact shock, impact at the lower back was not influenced by differently 6. Janin M, Dupui P: The effects of unilateral medial arch support
cushioned running shoes. Thus, runners adapted their ankle, knee and/or stimulation on plantar pressure and center of pressure adjustment in
hip stiffness, reducing the impact shock on its way upward. Interestingly, as young gymnasts. Neuroscience Letters 2009, 461:245-248.
runners perceived different cushioning of shoes correctly, this adaptation 7. Janin M, Toussaint L: Change in center of pressure with stimulations via
was controlled for each leg individually, so that also in the mixed cushioning anterior orthotic devices. Gait Posture 2005, 21:1.S79.
conditions the shock at the lower back remained symmetrical.
Conclusion: Maintaining low and symmetrical impacts at the lower back
seems to be important during running, and is achieved by adjusting the A10
leg stiffness, which can even be controlled for each leg individually. In Insole-pressure distribution in three pressure-relief postoperative shoes
further research, the mechanism of this individual leg stiffness control Paolo Caravaggi1*, Alessia Giangrande1, Lisa Berti1, Sandro Giannini1,2,
should be investigated. Carlo Ferraresi3, Alberto Leardini1
1
Acknowledgement: We thank the Li Ning Sports Science Research Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, 40136,
Center for funding this research. Italy; 21st Division of orthopedic surgery, Istituto Ortopedico Rizzoli, Bologna,
References 40136, Italy; 3DIMEAS, Politecnico di Torino, Torino, 10129, Italy
1. Potthast W, Brüggemann G, Lundberg A, Arndt A: The influences of Journal of Foot and Ankle Research 2014, 7(Suppl 1):A10
impact interface, muscle activity, and knee angle on impact forces and
tibial and femoral accelerations occurring after external impacts. J Appl Background: Patients undergoing forefoot surgery often require specific
Biomech 2010, 26(1):1-9. footwear to relieve the operated area. Post-operative footwear can be
Table 1(abstract A8) Vertical impact at lower back and VAS rating of cushioning perception
Left hard Right soft Left soft Right hard Left hard Right hard Left soft Right soft
Impact [g] 1.97 2.01 2.01 2.01 2.01 2.02 2.00 2.02
(0.50) (0.47) (0.54) (0.49) (0.55) (0.48) (0.52) (0.47)
Rating [VAS 0-10] 5.1 4.1 4.3 5.0 5.2 5.2 4.6 4.7
(2.5) (2.2) (1.9) (2.1) (2.3) (2.3) (2.2) (2.2)
Figure 1(abstract A9) T0, Force Cuves without foot orthose. Left/Right and T16, Force Cuves without foot orthoses. Left/right
Figure 1(abstract A10) From left to right: boxplot of the peak pressure at the rearfoot, midfoot and forefoot across 30 samples for each shoe group. *
denotes statistically significant difference (p<0.05) between groups.
very different in relation to the amount of weight born by the forefoot the peak pressure at the forefoot (Fig. 1), with much less variability over
[1,2]. While these special shoes are intended to be worn for short periods subjects in the TD® group. In general, the WPS® showed the smallest
following surgery, a compromise must be found between level of comfort pressure and force values under the forefoot and the largest at the midfoot,
and functionality. In this study the insole-pressure distribution of two especially when compared to the Deambulo®. At the rearfoot, force and
shoes, specifically designed to unload the forefoot, was compared to that pressure were the largest in the TD® group.
of a comfortable shoe manufactured by the same company. Conclusions: Both WPS® and TD® helped decrease forefoot pressure thus
Material and methods: 10 healthy female subjects (28.2 ± 10.0 yrs, 1.64 ± are indicated for the postoperative course of patients undergoing forefoot
0.04 m, 55.1 ± 3.7 kg) were asked to walk at comfortable speed wearing surgery. Some load compensation with larger pressures at either the
three shoe types produced by the same company: WPS®, TD® and midfoot or rearfoot has been revealed respectively in these two shoes.
Deambulo® (Podartis, Treviso, Italy). WPS® and TD® are post-op shoes References
designed explicitly for forefoot off-loading, whereas Deambulo® is meant to 1. Hans-Dieter C, et al: Assessment of Plantar Pressure in Forefoot Relief
be worn in the rehabilitation period, about 20/30 days after surgery. An Shoes of Different Designs. Foot Ankle Int 2006, 27:117-120.
insole pressure measurement system (Pedar X, Novel GmbH, Munich, 2. Deleu P-A, et al: Plantar pressure relief using a forefoot offloading shoe.
Germany) was employed to record plantar pressure. Several walking trials Foot and Ankle Surgery 2010, 16(4):178-182.
were recorded for each subject in three configurations of shoes for left and
right foot respectively: WPS® + Deambulo®, TD® + Deambulo® and
Deambulo® + Deambulo®. The configurations were established to be A11
consistent with the post-op clinical course when patients wear the pressure- Foot segments mobility and plantar pressure in the normal foot
relief shoe on the operated side, and a more comfortable one on the Paolo Caravaggi1*, Claudia Giacomozzi2, Alberto Leardini1
1
contralateral foot. Mean and peak pressure, vertical force, force and pressure Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, 40136,
time integral, were recorded for different regions of the insole together with Italy; 2Department of Technology and Health, Istituto Superiore di Sanità,
spatiotemporal parameters. For each subject in each configuration, three Roma, 00161, Italy
consistent steps from the same trial were used in the analysis. Journal of Foot and Ankle Research 2014, 7(Suppl 1):A11
Results: Good consistency in the baropodometric measurements was found
in each group across all subjects. No difference was detected in walking Background: The foot is generally regarded as a flexible structure which
speed between the three shoe groups. Both WPS® and TD® helped decrease can adjust its flexibility in response to variable dynamic conditions in
different phases within different motor tasks. In gait, both kinematics and
baropodometry have shown to be affected by functional and structural
factors [1]. In fact pressure distribution can be seen as the effectiveness of
the musculoskeletal system in absorbing the ground reaction forces via
the foot and its joints. Excessive foot pressure may develop into calluses,
which become sites of peak pressure and pain. The relationship between
foot joints mobility and plantar pressure has not been thoroughly
investigated. Aim of this study was to combine a multi-segment kinematics
model [2] and baropodometric analysis based on anatomical masking [3],
to investigate correlations between intersegmental kinematics and
regional baropodometric parameters in the normal foot.
Materials and methods: Ten able-bodied subjects (26.8 ± 6.9 years;
67.5 ± 12.6 Kg) volunteered in the study. An eight-camera motion system
(Vicon, UK) was used to track foot segments during the stance phase of
level walking, according to an established protocol (Figure 1, top) [2].
Simultaneously, a pressure plate (Novel, Gmbh) recorded foot plantar
pressure over three repetitions. An anatomical-based selection of areas of
interest was employed to divide the pressure footprints in seven subareas
(Figure 1, bottom) [3]. Maximum of mean and peak pressure, of vertical
force, contact-area and -time, and pressure- / force-time integrals, were
determined for each subarea. The relationship between range of motion Figure 2(abstract A11) Scatter plot of the relationship between peak
(ROM) of each foot joint and baropodometric parameters in each subarea pressure (kPa) at the forefoot (S4 in fig. 1) and sagittal-plane ROM (deg)
was investigated using Pearson’s and Spearman’s coefficients. at the tarso-metatarsal joint (J4 in fig.1). The linear regression line is
Results: Most of the statistically significant correlations (p<0.05) between superimposed to the data points.
foot joints ROM and baropodometric parameters were moderate (|R|
=0.36 – 0.67). In general, mean and peak pressure at rearfoot and
forefoot were negatively correlated with the amount of motion at the
ankle and tarso-metatarsal joints (Figure 2). In contrast, pressure at the References
hallux and midfoot were positively correlated with the ROM of the joints 1. Morag E, Cavanagh PR: Structural and functional predictors of regional
across the midfoot. Strong correlation was found between ROM of the peak pressures under the foot during walking. J Biomechanics 1997,
medial longitudinal arch angle (J7) and pressure-time-integral at the 32:359-370.
forefoot (Spearman Rho = - 0.93, p<0.05). 2. Leardini A, et al: Rear-foot, mid-foot and fore-foot motion during the
Conclusions: According to the sample of normal feet analyzed in this stance phase of gait. Gait and Posture 2007, 25:453-62.
study, those feet presenting smaller joint mobility are associated with 3. Giacomozzi C, et al: Distributed loading and multi-segment kinematics
larger pressure at the rear- and forefoot. A trend for decreased pressure for the functional evaluation of foot pathologies: preliminary experience
at the midfoot and toes was also detected in feet with a stiffer medial with varying degrees of flat-foot severity. Proceedings of the XXIV Congress
longitudinal arch. of ISB Natal, Brazil 2013, 75.
A12
Effects of different customized foot orthoses on isolated subtalar
arthrodesis
E Ceccaldi1,2*, M Janin1,3
1
Applied Podiatry College, 7 Treguel, 86000 Poitiers, France; 2Podiatrist,
Office, 35 rue Sermonoise, 77380 Combs-la-Ville, France; 3Podiatrist, PhD,
Clinic, 7 Treguel, 86000 Poitiers, France
E-mail: ceccaldi.podologie@gmail.com
Background: Studies describe subtalar and ankle arthrodesis as a factor

altering the biomechanics of the foot during walking [1-3]. Furthermore,
foot orthoses (FOs) are also recognized for their actions on the dynamics
of the foot [4] but not for their actions on an isolated subtalar arthrodesis
(ISA). Previous studies have shown that depending on the type of FOs [5]
and along the comfort felt by the subject [6], the variations induced by
different FOs were significantly different. The aim of this study was to
compare the effects of different types of FOs on gait analysis with an ISA.
Two subjects with ISA were volunteers for one session of three repeated
measures: without FOs (Control), with Classical FOs (FOsC) and with
Molded FOs (FOsM). After a clinical examination, these two types of FOs
are custom-made including same posting. We compared walking
variations through the Latero-Medial Index (LMI) on force platform. Four
data’s have been compared: Latero-Medial Force Index (LMFI), Latero-
Medial Area Index (LMAI) together with observation of these index at
100ms which correlate with hind foot activity phase during walking [7].
The perception of comfort was evaluated by using previously established
footwear comfort measures [6]: 100mm visual analog scale (VAS).
Figure 1(abstract A11) Schematic drawing of the seven foot joints
Results: Using the VAS, subjects didn’t feel a real comfort in shoes
(J1-J6 and the medial longitudinal arch angle J7), according to [2], and of
without FOs (VAS=47,5mm). FOs increased VAS (>17,9mm). Thus, FOsM
the footprint subareas (S1-S6) as follows: S1, rearfoot; S2, lateral midfoot;
were perceived as significantly more comfortable than FOsC, respectively
S3, medial midfoot; S4, forefoot; S5, hallux; S6, 2-5 toes. Stot is the total
97mm and 65,5mm. Dynamics assessment showed the ISA and control
footprint area.
foot had same LMI except for the LMAI. LMAI observed at 100ms, FOsC
Figure 1(abstract A12) LMAI at 100ms and VAS
induce pronation on both hind feet while FOsM induce wider lateral reaction force on the hind foot during walking could induce greater comfort
contact (Figure 1). LMFI showed FOsC produced an asymmetrical ground of patients with ISA.
reaction force between ISA and control foot. For LMFI at 100ms, the References
difference increased with FOsC, which induced a higher supination of the 1. Wu WL, et al: Lower extremity kinematics and kinetics during level
ISA and a pronation of the control hind foot. FOsM reduced this walking andstair climbing in subjects with triple arthrodesis or subtalar
difference increasing both supination (Figure 2). fusion. Gait Posture 2005, 21(3):263-70.
Conclusions: FOs induced effects on the gait of subjects with ISA 2. Rouhani H, et al: Multi-segment foot kinematics after total ankle
depending on orthoses type and parameters observed. The comfort is replacement and ankle arthrodesis during relatively long-distance gait.
significantly improved by FOs and much more by FOsM. The data suggests Gait Posture 2012, 36(3):561-6.
no correlations between linear improvement of VAS and variations of LMI. 3. Flavin R, et al: Comparison of gait after total ankle arthroplasty and ankle
However, a wider lateral contact and a greater lateral excursion of ground arthrodesis. Foot Ankle Int 2013, 34(10):1340-8.
Figure 2(abstract A12) LMFI at 100ms and VAS

4. Telfer S, et al: Dose-response effects of customised foot orthoses on been demanded at each measure: Normal stance, One-leg stance on the
lower limb kinematics and kinetics in pronated foot type. J Biomech ISA (OnISA) and One-leg stance on the control foot (OnControl). Three
2013, 46(9):1489-95. data’s have been compared: Center of Pressure Area (CoP), CoP
5. McPoil TG, et al: Effect of foot orthoses contour on pain perception in Movement (MoV) and Mean Velocity (Vel). The perception of comfort was
individuals with patellofemoral pain. J Am Podiatr Med Assoc 2011, 101(1):7-16. evaluated by using previously established footwear comfort measures [7]:
6. Mills K, et al: Influence of contouring and hardness of foot orthoses on 100mm visual analog scale (VAS).
ratings of perceived comfort. Med Sci Sports Exerc 2011, 43(8):1507-12. Results: Using the VAS, subjects didn’t feel a real comfort in their shoes
7. Castro M, et al: Ground reaction forces and plantar pressure distribution without FOs (VAS=47,5mm). FOs increased VAS (>17,9mm). Thus, FOsM
during occasional loaded gait. Appl Ergon 2013, 44:503-509. were perceived as significantly more comfortable than FOsC, respectively
97mm and 65,5mm. Postural assessment showed the CoP (Figure 1), the
MoV (Figure 2) and the Vel (Figure 3) were improved by both FOs with
A13 Normal stance. For OnISA, the data’s indicate postural control was
Comparison of postural control with different customized foot orthoses significantly altered by FOsC and improved by FOsM. For OnControl,
on isolated subtalar arthrodesis postural control was more improved by FOsC.
E Ceccaldi1,2 Conclusions: FOs induced different effects on the balance of subjects with
1
Applied Podiatry College, 7 Treguel, 86000 Poitiers, France; 2Podiatrist, ISA depending on orthoses type and parameters observed. FOsM appear
Office, 35 rue Sermonoise, 77380 Combs-la-Ville, France as clearly preferable to improve postural control on an ISA. The comfort is
E-mail: ceccaldi.podologie@gmail.com significantly improved by FOs and much more by FOsM. The data suggests
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A13 correlations between improvement of balance and perception of comfort
for patients with an ISA.
Background: Studies describe subtalar and ankle arthrodesis as a factor References
altering the biomechanics of the foot during walking [1-3] whereas 1. Wu WL, et al: Lower extremity kinematics and kinetics during level
postural control appears physiological [3]. Furthermore, foot orthoses walking andstair climbing in subjects with triple arthrodesis or subtalar
(FOs) are also recognized for their actions on dynamics [4] and balance fusion. Gait Posture 2005, 21(3):263-70.
[5] but not for their postural impact on an isolated subtalar arthrodesis 2. Rouhani H, et al: Multi-segment foot kinematics after total ankle
(ISA). Previous studies have shown that depending on the type of FOs [6] replacement and ankle arthrodesis during relatively long-distance gait.
and along the comfort felt by the subject [7], the variations induced by Gait Posture 2012, 36(3):561-6.
different FOs were significantly different. The aim of this study was to 3. Flavin R, et al: Comparison of gait after total ankle arthroplasty and ankle
compare effects of different types of FOs on balance of patients with an arthrodesis. Foot Ankle Int 2013, 34(10):1340-8.
ISA. Two subjects with ISA were volunteers for one session of three 4. Telfer S, et al: Dose-response effects of customised foot orthoses on
repeated measures: without FOs (Control), with Classical FOs (FOsC) and lower limb kinematics and kinetics in pronated foot type. J Biomech
with Molded FOs (FOsM). After a clinical examination, these two types of 2013, 46(9):1489-95.
FOs are custom-made including same posting. We compared postural 5. Gross , et al: Effects of foot orthoses on balance in older adults. J Orthop
variations through a force platform with shoes. Three modalities have Sports Phys Ther 2012, 42(7):649-657.
Figure 1(abstract A13) CoP Area in mm2

Figure 2(abstract A13) CoP Movement in mm
Figure 3(abstract A13) Mean Velocity in mm/s

6. McPoil TG, et al: Effect of foot orthoses contour on pain perception in

individuals with patellofemoral pain. J Am Podiatr Med Assoc 2011, A15
101(1):7-16. The use of a robotic gait simulator for the development of an
7. Mills K, et al: Influence of contouring and hardness of foot orthoses on alignment tool for lower limb prostheses
ratings of perceived comfort. Med Sci Sports Exerc 2011, 43(8):1507-12. Eveline De Raeve1*, Tom Saey1, Luiza Muraru1,2, Louis Peeraer3
1
MOBILAB, University College Thomas More, Geel, Belgium; 2BMe,
Department of Mechanical Engineering, KU Leuven, Leuven, Belgium;
3
A14 Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven,
The effects of the angle between the sole and the heel of heeled Belgium
footwear on single and double support time, stride duration and toe E-mail: Eveline.DeRaeve@thomasmore.be
off plantar flexion of females Journal of Foot and Ankle Research 2014, 7(Suppl 1):A15
SAR Darshika*, TDMSB Dassanayake
Allied Health Sciences Unit, Faculty of Medicine, University of Colombo, Sri Lanka Aim: An innovative tool to optimise the configuration and alignment of
E-mail: sardruda@gmail.com lower leg prostheses based on individual comfort needs of the patient
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A14 will be developed in this project.
Background: This tool meets the demand of prosthetists to optimise and
Introduction: This study was conducted to analyze the changes of gait objectify the dynamic alignment of transtibial prostheses. Nowadays, the
parameters between two different footwear size groups due to change of prosthetists mainly rely on their own expertise and experience.
angle between heel and sole of the footwear by keeping the same heel Current methods to align the prosthesis start with a static alignment of
height for both groups. transtibial prosthesis. This method does not take the individual patient
Study design: A cross-sectional descriptive study design. comfort into account. Afterwards, adjustments to the alignment are done
Research problem: The effects of the angle between the sole and the by trial and error. This is a time-consuming and exhausting activity for
heel of heeled footwear on single and double support time, stride both prosthetist and patient.
duration and toe off plantar flexion of females. Methods: 10 amputees were asked to walk with 20 different alignments
Methodology: Hundred (100) female subjects were participated for the and a neutral alignment (Figure 1A). The effect on comfort was questioned
study and fifty one (51) subjects were included to the footwear size 36 and measured. Therefore ground reaction force, 3D movement of the foot,
group with 23.8years mean age (SD = 2.5) and forty nine subjects to the the shank, upper leg, pelvic and torso and muscle activity were recorded
footwear size 40 group with 24.4 (SD = 2.4) years mean age. Both groups with a force plate (AMTI), a motion tracking system (Codamotion) and
were given similar type three centimeters height heeled footwear and EMG-sensors (Delsys). Simultaneously, contact pressure between stump
there was 6 greater angle locate between heel and sole of size 36 and socket was recorded on 32 reference points with pressure sensors
footwear than size 40.Two cameras (frontal stationary camera and lateral (mFLEX). All data was recorded synchronously at 200Hz.
running camera) were used to capture the walking trials and each Subsequently, the 3D movement of the shank was recalculated to Euler
individual perform three trials. Captured two dimensional walking trials angles to be used as kinematic input for an industrial robot with 6
were analyzed with Motion view 8.0 video analysis software. Independent degrees of freedom (KUKA) (Figure 1B). An energy consumption system
sample t-test in Statistical Package for Social Sciences Statistics version with spring enables us to simulate kinematic and kinetics of prosthetic
17.0 (SPSS Statistics 17.0) was used to analyze the data. gait. To objectively measure the pressure, an artificial stump was
Results: Mean toe off phase plantar flexion and double support time was developed to connect the lower limb prosthesis to the robot (Figure 1C).
shown a significant difference (p<0.05) while the single support time and This artificial stump, which consists of SLS-3D printed bones and soft
stride duration was not shown a significance (p>0.05). tissue (silicon) allows us to objectively measure the pressure between
Conclusion: The angle between heal and sole of footwear significantly stump and socket.
deviate gait parameters so rather than heel height footwear type it need For different alignments, forces (AMTI), motion trajectories and contact
to consider about shoe length. pressure between stump and socket (mFLEX) were registered simultaneously
Figure 1(abstract A15) A. gait analyses of an amputee, B. robotic gait simulator, C. artificial stump
during the unroll of the prosthetic foot. These measurements are translated balance [2,3]. Orthotic interventions change foot posture [4] and load
into comfort parameters during post-processing. distribution under the foot [5] and therefore may have important effects on
Results and discussion: Using our robotic gait simulator, the effect of balance in older people.
prostheses alignment on patient comfort is mapped. The biggest Objective: To investigate whether a pronated foot posture is associated
advantage of this approach is the possibility to test numerous and extreme with poorer standing balance in older people and whether medial heel
alignments, without the need for test subjects. After validation with gait and forefoot wedge orthoses affect their standing balance.
analyses, this data is translated in an algorithm which will be converted Design: Between groups, repeated-measures design.
into a useful method as a tool for the prosthetist. Methods: Ten healthy older people with a pronated foot posture (age
The outcome of this project will lead to an improved efficiency and 67.1± 5.5 years) and sixteen healthy elderly with normal foot posture (age
effectiveness of the alignment process, and contribute to the quality of 67.1± 5.9 years) were recruited.The Foot Posture Index (FPI) was used to
life of the amputee. determine pronated and normal foot posture. Static balance in double
Trial registration: Clinical Trial Center - CTC 55509. limb stance was assessed using Kistler force plate measures during four
Acknowledgments: This study is funded by TETRA IWT-Vlaanderen shod conditions: 1) 5° medial heel and forefoot wedge (W5); 2) 8° medial
(project Ticoon-IWT120144). heel and forefoot wedge (W8); 3) Control insole for W5 (flat EVA base
with the same thickness as W5 (NW5)); 4) Control insole for W8 (flat EVA
base with the same thickness as W8 (NW8)). Each of the four cases was
completed with eyes open and eyes closed. The center-of-pressure (COP)
A16 total excursion and mean velocity and area of 95% confidence ellipse
Kinetic and kinematic effects of asymmetric load carrying in the lower were derived as measures of standing balance.
extremity Results: Participants with a pronated foot type (Mean FPI: 7.5) demonstrated
Jasmien JE de Vette1*, Taeyong Lee2, Xuezhen Song2 greater total excursion (298.19±28.59mm versus 262.69±22.92mm) and total
1
Department of Biomechanical Engineering, University of Twente, Enschede, mean velocity (11.78±1.41mm.s-1 versus 10.41±1.13mm.s-1), and larger ellipse
7500AE, The Netherlands; 2Department of Biomedical Engineering, National area (630.81±244.19mm 2 versus 298.15±195.79 mm 2 ), compared with
University of Singapore, 119077, Singapore participants with normal foot type (Mean FPI: 3.8) during normal standing,
E-mail: jasmien.devette@gmail.com but this did not reach statistical significance (p>0.05) (Figure 1). There was a
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A16 significant main effect for eyes open (p<0.05) with the total excursion
(290.0 ± 14.7mm versus 321.9 ± 14.1mm) and mean velocity of COP in ML
In everyday life, people have to transfer weight in all different forms from (8.9 ± 0.5mm.s-1 versus 10.2 ± 0.6mm.s-1) being significantly lower.
one place to the other. By the human body, this can be done in various There were no statistically significant effects from the four orthoses in the
ways. The impact in upper extremity of bearing load has been investigated pronated nor the normal foot types (p<0.05). There were no significant
throughout, especially with regard to load carried on the back or the front. differences in interaction of all conditions (foot posture × eye condition ×
However, the asymmetrical carrying of load has not been investigated in orthoses) (p<0.05).
detail yet for the lower extremity. Hence, this investigation is established Conclusion: A trend towards less stable balance was observed in
to study this topic in detail and to fill the gap of information regarding the pronated foot type but this was not significant. Use of orthoses had no
asymmetrical bearing of weight. effect on balance parameters including negating the effects of eyes
Ten healthy individuals with no foot pathology (age: 20-30 years; 5 male, closed. Orthoses showed no negative effects on standing balance and
5 female) were recruited, and the testing session were carried out at the therefore do not pose a threat to balance (e.g. if they are used for
Biomechanical Gait Analysis Laboratory at National University of Singapore. another purpose).
Subjects were asked to perform two sets of natural gait performance; first References
while carrying a hand-held bag, then by carrying a crossed sling-bag. The 1. Scott G, Menz HB, Newcombe L: Age-related differences in foot structure
bag is weighted with 10% of the subjects’ body weight. Motion is recorded and function. Gait &Posture 2007, 26:68-75.
using an 8-camera VICON system and two force plates. Post processing of 2. Menz HB, Morris ME, Lord SR: Foot and ankle characteristics associated
data is performed using Nexus 1.8.3 (Vicon, Oxford Metric, UK) and Polygon with impaired balance and functional ability in older people. J Gerontol
3.5 (Vicon, Oxford Metric, UK). A Biol Sci Med Sci 2005, 60:1546-1552.
An overall detailed view of the kinetic and kinematic effects of asymmetrical 3. Tsai L-C, BING Y, Mercer VS, Gross MT: Comparison of different structural
load carrying is given as a result of this research. Overall found weight is foot types for measures of standing postural control. J Orthop Sports
shifted towards the forefoot. At these points, ankle instability increases and Phys Ther 2006, 36:942-953.
therefore kinematic parameters in these areas are more tended to alter due 4. Nigg BM, Nurse MA, Stefanyshyn DJ: Shoe inserts and orthotics for sport
to the extra weight. Overall, using a crossed sling bag is more favorable in and physical activities. Med Sci Sports Exerc 1999, 31:421-428.
terms of kinetic and kinematics in the lower extremity, especially showing in 5. Tsung BY, Zhang M, Mak AF, Wong MW: Effectiveness of insoles on
the heel-off and swing phase. Conclusions were the following. During the plantar pressure redistribution. J Rehabil Res Dev 2004, 41:767-774.
contact phases of the gait cycle, higher forces were found in the left side of
the lower extremity in subjects bearing an extra weight on the right side of
the body. Also, moments were found higher on the left side of the body,
pointing out the counterbalancing effects to maintain posture during gait. A18
All of these significant moments were pointed in medial direction. Ankle The effect of stroke on foot biomechanics; underlying mechanisms and
angles were found significantly asymmetric mostly in heel-off and the functional consequences
pre-swing, where foot roll-off takes place. Saeed Forghany1,2*, Christopher J Nester1, Sarah F Tyson1,3, Stephen Preece1,
Richard K Jones1
1
Centre for Health Sciences Research, University of Salford, UK;
2
Musculoskeletal Research Centre, School of Rehabilitation Sciences, Isfahan
A17 University of Medical Sciences, Iran; 3Stroke Research Centre, School of
The effects of pronated foot posture and medial heel and forefoot Nursing Midwifery and Social Work, University of Manchester, UK
wedge orthoses on static balance in older people E-mail: Saeed_forghany@rehab.mui.ac.ir
Fateme Hemmati1, Saeed Forghany1,2*, Christopher Nester2 Journal of Foot and Ankle Research 2014, 7(Suppl 1):A18
1
Musculoskeletal Research Centre, Isfahan University of Medical Sciences,
Iran; 2Centre for Health Sciences Research, University of Salford, UK Background: Although approximately one-third of stroke survivors
E-mail: Saeed_forghany@rehab.mui.ac.ir suffer abnormal foot posture and this can influence mobility [1],
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A17 there is very little objective information regarding the foot and ankle
after stroke.
Background: Aging has been associated with increasing foot pronation [1] Objective: The aim of this study was to investigate foot and ankle
and changes in foot mobility and posture which may influence standing biomechanics, multi-segment foot kinematics and plantar pressure
Figure 1(abstract A17) Percentage of mean differences in COP parameters between participants with a pronated foot type and those with normal foot
type across different orthoses and eyes conditions (open and close)
distribution in people with stroke and explore the possible causes and
consequences of any abnormalities. A19
Methods: In a single assessment session, mobility limitations (Walking The effect of three different insoles on balance in people with
Handicap Scale), multi-segment foot and ankle kinematics and plantar functional ankle instability
pressure distribution, electromyography of major posterior and anterior leg Khadijeh Bapirzadeh1, Akram Jamali1, Saeed Forghany1,2*, Christopher Nester2,
muscles, plantarflexor stiffness, plantarflexor and dorsiflexor strength and Sanam Tavakoli1, Fateme Hemmati1
1
spasticity, and ankle proprioception were measured during stance phase of Musculoskeletal Research Centre, Isfahan University of Medical Sciences,
walking in 20 mobile chronic stroke survivors and 15 sex and age-matched Iran; 2Centre for Health Sciences Research, University of Salford, UK
healthy volunteers. Independent t-tests were used to compare the data for E-mail: Saeed_forghany@rehab.mui.ac.ir
the stroke and healthy control groups. Multiple linear and binary logistic Journal of Foot and Ankle Research 2014, 7(Suppl 1):A19
regressions were used to determine possible causes and functional
consequences, respectively. Background: Functional ankle instability (FAI) has been reported to be
Results: Compared to the healthy volunteers, the stroke survivors associated with sensorimotor deficits which could result in impaired
demonstrated consistently reduced range of motion across most segments balance [1] and altered foot kinematics [2]. Textured insoles that increase
and planes, increased pronation and reduced supination, disruption of the plantar cutaneous afferent information may compensate for a deficit of
rocker and the timing of joint motion (Table 1). A more pronated foot prior sensory input in FAI, improving postural control and reduce the risk of
to heel off and a less supinated foot during propulsion were biomechanical injury. Also, a lateral plantar wedge will reduce the external ankle
abnormalities significantly associated with limited functional ability. Soleus inversion moment and help prevent inappropriate foot inversion motion
spasticity, excessive coactivity of tibialis anterior and medial gastrocnemius, and perhaps further improve postural control. The aim of this study
and soleus, and plantarflexor stiffness were associated with these therefore was to investigate the effect of texture and a lateral wedge on
biomechanical abnormalities. standing balance in people with FAI.
Conclusions: Our findings highlight structural and movement deficiencies Methods: 20 athletes (age: 26.55±5.35years) with clinically diagnosed FAI
in foot joints in all three planes which does not support common clinical were recruited. Static balance in double limb stance was assessed using
practices that focus on sagittal ankle deformity and assumed excessive Kistler force plates during four shod conditions: 1) flat EVA base insole
foot supination. Some of foot abnormalities were associated with limitation 2) Textured flat EVA insole 3) Lateral heel and sole wedge (Salford insole)
in functional ability. Spasticity, the hyperexcitability of the stretch reflex, 4) Textured lateral heel and sole wedge (Salford insole). Texture was a
was a common predictor of all dynamic biomechanical abnormalities semirigid rubber with semi-circular mounds with center to center
limiting functional ability. Biomechanical abnormalities and neuromuscular distances of 4 mm. The center-of-pressure excursion and mean velocity
impairments of foot and ankle can be modified using physical in anterior-posterior and medial-lateral directions and area of 95%
therapies and future interventions might better target specific aspects of confidence circle were derived as measures of standing balance. The
foot function and thereafter improve functional ability post stroke. results were statistically analyzed using the nonparametric Fridman test
Reference followed by Wilcoxon Signed Rank.
1. Forghany S, Tyson S, Nester C, Preece S, Jones R: Foot posture after stroke: Result: Statistically significant differences were observed only for the
frequency, nature and clinical significance. Clinical Rehabilitation 2011, textured flat EVA insole. The mean COP velocity was reduced compared
25(11):1050-5. to the lateral wedge condition (p <0.05) and the 95% confidence circle
Table 1(abstract A18) Mean and standard deviation movements of each foot segment in each plane
Parameter Stroke survivors healthy volunteers P value (95%CI)
REARFOOT MOTION - SAGITTAL PLANE
Range of movement during initial plantarflexion 3.3° ± 2.1° 5.4° ± 2.5° P < 0.007
(-3.6 to -0.6)
Range of plantarflexion during late stance 11° ± 4.6° 15.6° ± 4.5° P < 0.003
(-7.5 to -1.7)
REARFOOT MOTION - FRONTAL PLANE
Total range of movement 8.9° ± 3.2° 12° ± 3.3° P < 0.006
(-5.1 to -0.9)
maximum eversion 3.5° ± 2.1° 2.3° ± 1.5° P < 0.05
(-0.06 to 2.3)
Range of inversion during late stance 8.8° ± 3.4° 12° ± 3.4° P < 0.006
(-5.3 to -1.0)
REARFOOT MOTION – TRANSVERSE PLANE
Total range of movement 6.4° ± 2.6° 9.0° ± 4.9° P < 0.04
(-5.1 to -0.09)
Maximum abduction 1.3 ± 2.7° 3.3° ± 3.2° P < 0.05
(-3.8 to -0.03)
Range of movement during the adduction phase 6.1 ± 2.9° 9.0° ± 4.9° P < 0.03
(-5.5 to -0.3)
FOREFOOT MOTION - SAGITTAL PLANE
Range of final plantarflexion phase 1.9° ± 2.1° 4.6° ± 3.3° P < 0.008
(-4.8 to -0.8)
FOREFOOT MOTION – TRANSVERSE PLANE
Range of the final adduction phase 1.3° ± 1.8° 3.1° ± 1.9° P < 0.009
(-3.1 to -0.5)
area decreased significantly compared with all other insoles conditions

(Table 1).There were no statistically significant effects from the lateral A20
wedge. The effect of rollover footwear on pain, disability and lumbar posture
Conclusion: Texture appears to have some impact on standing balance in patients with low back pain
but only on a flat insole. The lateral wedge had no effect on standing Atefe Rahimi1, Saeed Forghany1,2*, Christopher Nester2, Fateme pol1
1
balance. Musculoskeletal Research Centre, Isfahan University of Medical Sciences,
Competing interests: Nester declares a personal commercial interest in Iran; 2Centres for Health Sciences Research, University of Salford, UK
the insoles tested in this study. E-mail: Saeed_forghany@rehab.mui.ac.ir
References Journal of Foot and Ankle Research 2014, 7(Suppl 1):A20
1. Munn J, Sullivan SJ, Schneiders AG: Evidence of sensorimotor deficits in
functional ankle instability: A systematic review with meta-analysis. J Sci Background: Low back pain (LBP) is one of the most common
Med Sport 2010, 13:2-12. musculoskeletal disorders [1]. Exercise therapy is often advised [2,3] but
2. Delahunt E, Monaghan K, Caulfield B: Altered neuromuscular control and requires a significant time commitment, can rely on equipment or health
ankle joint kinematics during walking in subjects with functional professionals and risks low compliance. As an alternative or adjunct, shoes
instability of the ankle joint. Am J Sports Med 2006, 34:1970-1976. with a curved sole profile are thought to produce beneficial changes in
Table 1(abstract A19) Mean COP parameters during different insole conditions
a b c d
F TF L TL
e
Mean COP excursion (mm) ML 5.04±1.68 4.81±1.56 5.29±2.1 5.41±2.27
f
AP 3.02±0.91 2.75±0.89 2.92±1.29 2.74±1.06
TOTAL 6.59±1.98 6.13±1.96 6.49±2.18 6.35±2.21
Mean COP velocity (mms-1) ML 7.87±2.25 7.69±2.24 8.23±1.9 7.99±2.4
AP 5.66±2.56 5.32±2.32 5.9±1.96 5.39±2.17
(L**)
TOTAL 11.1±4.2 10.1±2.87 11.2±2.77 10.5±3.49
95% confidence circle area 621.44±440.03 433.99±243.87 608.89±355.17 613.46±539.88
(L**,F*,TL*)
a b
Flat EVA. Textured flat EVA. c lateral wedge. d
Textured lateral wedge. e
Medial-Lateral. f Anterior-Posterior. * P <0.05. **
P <0.001.
Table 1(abstract A20) Mean and amount of change in pain, disability and lumbar posture in exercise only, and
exercise and shoe groups
Pain Disability Lumbar Posture (cm)
Pretest 4 weeks change Pretest 4 weeks change Pretest 4 weeks change
Exercise 7.1±1.6 4.8±2.1a -%31.5 36.9±10.5 26.3±9.5a -%27.8 26.2±13.9 22.2±10.5 -%15.3
Exercise + shoe 7.3±1.8 3.0±2.0a -%58.9b 29.8±5.3 18.0±5.9 a
-%39.6 20.1±11.9 17.5±5.6 -%12.9
a b
P <0.05 (within group). P <0.05 (between group).
ankle, knee, hip and back position and posture [4]. Therefore, the aim of this tone. In addition, rocker profiled footwear are one of the most commonly
preliminary study was to investigate the effect of rollover footwear on pain, prescribed therapeutic shoes [1-4]. The altered movement of the body
disability and lumbar posture in patients with lumbar pain. over the foot due to the curved sole profile is assumed to alter the
Material and method: 21 patients (age: 35.5±1.4 years) with LBP (pain position of the hips and thereafter the trunk, spine and perhaps the head
distal to the buttocks that centralized with extension) were randomly too. This could have some benefits for those with back pain [5]. However,
assigned to a rollover footwear and lumbar extension exercise group whilst evidence for the effects on the lower limb is becoming
(n=11) or a lumbar extension exercise only group (n=10). Baseline and 4 comprehensive [1-4], there is a paucity of information for any effects on
weeks post intervention measures were pain (visual analog scale), head and trunk posture.
disability (Oswestry LBP disability) and lumbar posture when standing Aim: To investigate the effect of rollover footwear on head and trunk
barefoot (as described by Forghany et al [4]). posture during standing.
Participants attended six appointments of 30 minutes duration over 4 weeks. Material and methods: Head and trunk posture data of ten healthy
Exercise consisted of 3 sets of 10 repetitions of extension exercises. female participants(age:24.5±1.8 years) was collected during one minute of
Participants in the shoe and exercise group walked in rollover footwear quiet standing in two conditions (1) barefoot and (2) rollover footwear
[Perfect Steps] as often as possible over the 4 weeks (but at least 30 minutes (Perfect Steps). The positions of 11 markers mounted on the spinous
each day). processes of S2, L5, L3, L1, T11, T9, T7, T5, T3, C7 and midpoint of forehead
Results: Participants in both groups showed significant decreases in pain were collected by an eight-camera motion capture system at 100 Hz. The
levels and disability after four weeks. Participants in the shoe and exercise planar angles of head and neck, and the radii of thoracic and lumbar curve
group had significantly greater decreases in pain (p=0.04) and demonstrated in the sagittal plane were calculated using an approach described by
11.8% greater reduction in disability, but this did not reach statistical Forghany et al [6].
significance (p>0.05) (Table 1). The radius of lumbar curve was decreased in Results: The radius of lumbar curve was decreased significantly by 11.2%
both groups when standing barefoot after 4 weeks, but not significantly wearing the rollover footwear compared to the barefoot condition
(p>0.05) and there was no significant difference in the change in the radius (p<0.05) (i.e. spine more extended). The radius of thoracic curve also
of lumbar curve between two groups (p>0.05) (Table 1). increased (i.e. spine also more extended) but the differences were not
Conclusion: This result suggests that the rollover footwear could be part of statistically significant (p=0.3). Participants wearing the rollover footwear
a treatment protocol for greater reduction in pain level in patients with LBP. showed significant increase in the planar angles of head and neck by
However, the effects on lumbar biomechanics and association with changes 7.8% in comparison with barefoot condition (p = 0.01) (i.e. head and neck
in pain and disability remain unclear and requires further investigation. more extended). (Table 1).
References Conclusion: The current study showed that rollover footwear is able to
1. Dunsford A, Kumar S, Clarke S, et al: Integrating evidence in to practice: modify head and trunk posture in quiet standing compared to barefoot.
use of Mckenzie- based treatment for mechanical low back pain. Participants stood more erect in footwear than barefoot. These shoes
J Multidiscip Healthc 2011, 4:393-402. could therefore have a role in the management of some conditions
2. Peterson T, Larsen K, Jacobsen S: One-year follow-up comparison of the where an increase in back extension is desirable but the clinical relevance
effectiveness of Mckenzie treatment and strengthening training for of those changes remains to be determined.
patients with chronic low back pain. J Spine 2007, 32:2948-2956. References
3. Nigg B, Davis A, Lindsay D, Emery C: The effectiveness of an unstable 1. Nigg B, Hintzen S, Ferber R: Effect of an unstable shoe construction on
sandal on low back pain and golf performance. Clin J Sport Med 2009, 19. lower extremity gait characteristics. Clin Biomech Bristol, Avon 2006,
4. Forghany S, Nester C, Richards B: The relationship between sole curvature 21:82-8.
of roll over footwear and changes in gait. Foot Ankle 2012. 2. Demura T, Demura SI: The effects of shoes with a rounded soft sole in
the anterior-posterior direction on leg joint angle and muscle activity.
Foot Edinburgh, Scotland 2012, 17:17.
A21 3. Taniguchi M, Tateuchi H, Takeoka T, Ichihashi N: Kinematic and kinetic
The effect of rollover footwear on head and trunk posture during characteristics of Masai Barefoot Technology footwear. Gait Posture 2012,
standing 35:567-72.
Fateme Pol1, Saeed Forghany1,2*, Christopher Nester2, Atefe Rahimi1 4. Forghany S, Nester CJ, Richards B, Hatton AL, Liu A: Rollover footwear
1
Musculoskeletal Research Centre, Isfahan University of Medical Sciences, affects lower limb biomechanics during walking. Gait Posture 2013.
Iran; 2Centre for Health Sciences Research, University of Salford, UK 5. Nigg B, Federolf PA, Davis E, Lindsay D, Emery C: Unstable shoes and low
E-mail: Saeed_forghany@rehab.mui.ac.ir back pain in golf. Footwear Sci 2011, 3:S121-S2.
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A21 6. Forghany S, Nester C, Richards B, Hatton A: Effect of rollover footwear
on metabolic cost of ambulation, lower limb kinematics, kinetics,
Background: Footwear with a curved sole profile has become popular due and EMG related muscle activity during walking. J Foot Ankle Res
to the proposed benefits to gait, posture and altered muscle activity and 2012, 5:1.
Table 1(abstract A21) Head and trunk postural changes wearing the rollover footwear in comparison with barefoot
condition during standing
Barefoot Rollover footwear P value %differences
Radius of lumbar curve (cm) 16.6 14.8 0.0003 -10.8
Radius of thoracic curve (cm) 39.6 41.5 0.3 4.8
Head-C7 angle (degree) 34.8 37.5 0.01 7.8
4. Jones RK, Nester CJ, Tyson S, Kim WY, Johnson DS, Jari S, Richards JD: A
A22 comparison of the biomechanical effects of valgus knee braces and
Effects of laterally wedged insoles on static balance in patients with lateral wedged insoles in patients with knee osteoarthritis. Gait Posture
medial compartment knee osteoarthritis 2012, 37:368-372.
Fariba Ahmadi1, Saeed Forghany1,2*, Christopher Nester2, Richard Jones2
1
Musculoskeletal Research Centre, Isfahan University of Medical Sciences,
Iran; 2Centre for Health Sciences Research, University of Salford, UK
E-mail: Saeed_forghany@rehab.mui.ac.ir A23
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A22 Fourier analysis of vertical forces to integrate balance measurements
Claudia Giacomozzi1*, Francesco Martelli2, Massimo Lillia2, Antonello Fadda1
1
Background: Patients with knee OA usually present with major involvement Department of Technology and Health, Istituto Superiore di Sanità, Rome,
in the medial compartment characterized by joint inflammation, loss of Italy; 2Electronic High School ISIS Arturo Malignani, Udine, Italy
cartilage and joint space and experience increased loads across this E-mail: c_giacomozzi@yahoo.com
compartment. These contribute to pain, changes in muscle control and may Journal of Foot and Ankle Research 2014, 7(Suppl 1):A23
interfere with balance and postural control [1,2].
Laterally wedged insoles or footwear components have been used in Background: Balance during orthostatic standing is usually investigated
different forms to alter the knee adduction moments that are associated through force platforms and consolidated sets of parameters and protocols
with knee pain and progression of knee OA. They have generally been [1] based on 51.2s of observation period and on analysis of centre of
shown to have immediate beneficial effects on knee loading, pain and pressure (COP) movements in the time and in the frequency domain. Force
physical performance during walking and stair climbing [3,4]. The effects on instantaneous changes associated to centre of mass vertical oscillations
standing balance and posture control have not been reported, nor have had been scarcely investigated [2], maybe due to inadequate signal
different designs of lateral wedge components (insole vs. shoe sole quality, even though they may represent an added value to gain
modification) been compared. The aim of this study was to investigate the knowledge in muscular strategies adopted to maintain balance under
effects of four different designs of lateral wedges on static balance in pathological conditions. This study aims at assessing a newly arranged
patients with knee osteoarthritis. force plate to obtain a reliable insight into the vertical force frequency
Methods: 18 patients (age 59.6 ± 5.8 years) with painful knee OA spectrum; two small samples are used to evaluate feasibility and relevance,
confirmed by an orthopaedic surgeon were recruited. Static balance was i.e. a normal active healthy population (controls) and trained athletes.
assessed using a force plate (AMTI, 1000 Hz) during 60s double leg Materials and methods: The PODATA force plate (GPS400, Chinesport,
standing. Movement of the center-of-pressure (COP) was measured under Udine, Italy) has been used, which integrates traditional optical podoscopy
five shod randomised conditions: (1) no wedge; (2) 8.5 ° lateral heel with dynamometry. The device relies on 6 calibrated uniaxial load cells
wedge (inside shoe); (3) 8.5 ° lateral heel and forefoot wedge (inside which deliver a highly accurate dataset in terms of instantaneous COP
shoe); (4) 8.5 ° lateral heel wedge (shoe sole); (5) 8.5 ° lateral heel and coordinates and vertical force value (12bit A/D converter; overall resolution
forefoot wedge (shoe sole). 0.0125 kg, linear accuracy 5%, angular accuracy 2.5%, sampling rate 200
Balance control was quantified using the amplitude and velocity of centre Hz). The observation period is limited to 20s since Manufacturer pre-
of pressure (COP) data in the middle 20s. The results were statistically market clinical investigations had indicated this as the longest observation
analyzed using the nonparametric Fridman test followed by Wilcoxon window during which healthy individuals successfully recover the initial
Signed Rank. COP position. Preliminary accuracy tests were performed by using a
Results: Whilst there was a trend for COP parameters to decrease when purposely designed physical pendulum whose mass distribution and size
wearing of the various lateral wedges compared to no-wedge condition, determined a full oscillation period of 2.5s, thus entailing the fundamental
differences did not reach significance (Table 1). frequency of 0.4Hz for COP, doubled to 0.8Hz for vertical force. Then, two
The total mean distance over the 20 seconds, the 95% confidence circle area groups of 5 controls (41±6 years; 68±18 kg) and 5 trained judoka athletes
and 95% confidence ellipse area were all statistically significantly greater (37±6 years; 80±10 kg) were examined during open-eye orthostatic
when wearing the in-shoe lateral heel wedge compared to all shoe sole standing. COP and vertical force frequency spectra were obtained by
wedge conditions (Table 2). applying a rectangular FFT over the acquired 4096 samples (exact
Conclusion: Balance was not affected by any of the shoe sole lateral observation time 20.48s, frequency resolution 0.05Hz).
wedges, but COP excursion increased when wearing insole lateral heel Results: The preliminary tests with the physical pendulum confirmed the
wedges, suggesting a deterioration in standing balance. Changes in plantar appropriateness of the PODATA system to accurately detect fundamental
loading, ankle moments and foot position due to the wedge, and shoe fit, frequencies (Figure 1). The on-the-field application showed: no statistically
may account for this change in standing balance. significant differences between COP frequency spectra of the two groups;
References significantly higher vertical force median frequency (5.63±0.24 Hz) of
1. Ahmed AF: Effect of sensorimotor training on balance in elderly patients controls with respect to athletes (4.76±0.16 Hz) (Figure 2); significantly lower
with knee osteoarthritis. J Advanc Res 2011, 2:305-311. energy concentrated at very low frequencies in controls (percentiles at 0.5
2. Chuang S, Huang MH, Chen TW, Weng MC, Liu CW, Chen CH: Effect of Hz: 4.01±2.80 (controls), 11.03±1.22 (athletes)); significantly higher %
knee sleeve on static and dynamic balance in patients with knee variations of vertical force in athletes (0.14±0.02) than in controls (0.10±0.01).
osteoarthritis. Kaohsiung J Med Sci 2007, 23:405-411. Conclusions: The proposed device and protocol proved adequate for an
3. Alshawabka A, Tyson S, Jones RK: The effect of lateral wedge insoles on accurate analysis of vertical force in the frequency domain. Peculiar
knee loading during ascending and descending stairs in individuals with changes in its spectrum, when integrated with those of COP movements,
medial knee osteoarthritis. J Foot Ankle Res 2012, 5:11. may help in better understanding the model of muscular activation set
Table 1(abstract A22) Mean differences in COP parameters between different lateral wedges conditions and no- wedge
condition
Lateral Wedge conditions
8.5 ° Heel wedge 8.5 ° Heel & Forefoot 8.5 ° Heel wedge 8.5 ° Heel & forefoot wedge
(Insole) wedge (Insole) (shoe sole) (shoe sole)
Total Mean distance (mm) -0.036 -0.83 -0.98 -1.21
Mean COP velocity(mm/sec) 5.89 -1.27 -1.19 -0.35
95% confidence circle area (mm2) -48.09 -205.79 -249.25 -286.52
95% confidence ellipse area (mm2) -30.04 -137.42 -219.95 -216.13
Table 2(abstract A22) Mean differences of COP parameters between different the heel wedge insole and the various
out-shoe lateral wedges conditions
lateral heel wedge insole versus: Mean differences P*
Total Mean distance (mm) 8.5 ° Heel Wedge (shoe sole) -0.95 0.02
8.5 ° Heel & Forefoot wedge (shoe sole) -1.17 0.03
95% confidence circle area (mm2) 8.5 ° Heel & Forefoot wedge (shoe sole) -238.43 0.04
95% confidence ellipse area (mm2) 8.5 ° Heel Wedge (shoe sole) -189.91 0.04
8.5 ° Heel & Forefoot wedge (shoe sole) -186.08 0.006
Figure 1(abstract A23) Test with physical pendulum (24.2kg, oscillation period 2.5s). Frequency spectra of COP coordinates and Vertical force (Log scale,
resolution 0.05Hz)
Figure 2(abstract A23) FFT of vertical force from one control and one judoka (Log scale, resolution 0.05Hz)
up to maintain balance, i.e. the physiological inverse pendulum model or Background: Static radiographic angles and other clinical qualitative
rather other complex models originated by pathological conditions. observations are used traditionally for classifying flatfeet. Correlation of foot
References shape measurements, taken from pressure footprints under dynamic
1. Kaptein TS, et al: Agressologie 1983, 24(7):321-326. conditions, with radiographic angles was preliminarily investigated in young
2. Oggero E, et al: Biomed Sci Instrum 2013, 49:48-53. flatfeet [1]. The aim of this study is to assess the sensitivity and specificity of
existing or purposely defined angles and indexes obtained from both
dynamic pressure footprints and multisegment foot kinematics during the
A24 stance phase of gait. The main hypothesis is that these thorough measures
Baropodometry and stereophotogrammetry for classifying flatfoot can account for structural and functional changes in the foot, thus
severity: dynamic angles and footprint indexes improving flatfoot severity classification.
Claudia Giacomozzi1*, Paolo Caravaggi2, Lisa Berti2, Alberto Leardini2, Materials and methods: Sixty among healthy volunteers and patients
Sandro Giannini2,3 were first assessed clinically and assigned to either Control (C), Level 1
1
Department of Technology and Health, Istituto Superiore di Sanità, Rome, Flatfoot(F1), or Level 2 Flatfoot (F2, more compromised than F1) Groups.
Italy; 2Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Then, data were collected, three consistent trials per foot, on both feet if
Italy; 31st Orthopaedic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy belonging to different groups, on the right foot only otherwise. A
E-mail: c_giacomozzi@yahoo.com validated integrated pressure-kinematics technique was used based on a
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A24 VICON motion system, an EMED baropodometer, and the IORfoot model
Figure 1(abstract A24) Dynamic footprint indexes which best discriminated between the three groups: SAM (C:105±5°; F1:124±4°; F2:172±13°) and
RMFW (C:0.18±0.11; F1:0.42±0.04; F2: 0.69±0.11)
Figure 2(abstract A24) On the left: dynamic footprint measurements as in the Novel software. Additionally: M represents the intersection between
medial midfoot and the line r perpendicular to the bisecting line through OO’ midpoint; w is the midfoot width over line r. On the right: joints of the
IOR foot model, and MLA angle .
[2]. For this preliminary analysis, 15 patients (10M/5F; BMI 23.0±2.4; age classifying flatfeet. MLA angle at midstance seems to be specific for F2
25.9±7.0 years; stance 670±42.0 ms) were taken, 5 for each group. From only, accounting for significant structural changes with respect to C and
each dynamic footprint, the following was calculated (Fig. 1): Subarch F1. MLA angle ROM might help to distinguish, within the same pathologic
Angle (SA) and Arch Index (AI) as in the Novel software; Modified group, between flexible and rigid flatfoot.
Subarch Angle (SAM) hereby defined as originated at point M rather than References
L; Midfoot/Forefoot Ratio (RMFW) hereby defined as the ratio between w 1. Chia-Hsin Chen, et al: ArchPhysMed Rehabil 2006, 87(2):235-240.
and A’B’. Sagittal plane ROM for foot joints J3, J5, J6 and for medial 2. Giacomozzi C, et al: Proceedings of the XXIV Congress of ISB Natal, Brazil
longitudinal arch (MLA), frontal ROM for J3 and J6, and the absolute 2013, 75.
value at midstance for MLA were also calculated.
Results: The three five-subject groups were found homogeneous as for
BMI, age and stance duration. SAM (C:105±5°; F1:124±4°; F2:172±13°) and
RMFW (C:0.18±0.11; F1:0.42±0.04; F2: 0.69±0.11) best discriminated A25
among the three groups (Fig. 2), without any overlapping. AI was more Validation and clinical relevance of footprint anatomical masking in
variable in the C group (0.17±0.08) and did not discriminate well clubfoot
between C and F1, as well as SA and MLA; J3, J5 and J6 showed non- Claudia Giacomozzi1*, Julie Stebbins2, Louise Way2
1
statistically significant differences among the three groups. Department of Technology and Health, Istituto Superiore di Sanità, Rome,
Conclusions: Sensitivity and specificity will be more thoroughly estimated Italy; 2Nuffield Oxford Orthopaedic Centre, Oxford, UK
on the whole dataset of the 60 examined individuals. Preliminarily, SMA E-mail: c_giacomozzi@yahoo.com
and RMFW seem to be the most appropriate dynamic footprint indexes for Journal of Foot and Ankle Research 2014, 7(Suppl 1):A25
Figure 1(abstract A25) Median values and 25-75 percentile lines of peak pressure at each of the 5 plantar regions (black areas), obtained for the healthy
population (H, black lines) and the paediatric clubfeet (P, red lines) from the anatomical masking (AM, solid lines) and the geometrical masking (GM,
dotted lines).
Background: Anatomy-based regionalization of pressure dynamic anatomical masking, which may better highlight changes in the loading
footprints has been proved to be feasible when accurate kinematic and pattern.
baropodometric measurements are integrated [1]. The potential of this References
method is easily understandable when footprints are incomplete or severely 1. Giacomozzi C, et al: Med Biol Eng Comp 2000, 38(2):156-63.
altered; however, its thorough validation on healthy and pathologic feet is 2. Stebbins , et al: Gait Posture 2006, 23:401-411.
still required. This study focusses on anatomy-based masking in paediatric
clubfoot using the Oxford Foot Model (OFM, [2]), which identifies 5 plantar
regions of high clinical relevance in this population. Validation is based on A26
the comparison with traditional geometrical masking using the same Preservation of gait biomechanics during offloading treatment of
5 regions, applied to young healthy volunteers and clubfeet. diabetic foot ulcers
Materials and methods: 19 healthy volunteers (H: mean age 11.5 years, Claudia Giacomozzi
mean BMI 18.1) and 10 patients with clubfoot (P: mean age 10.8 years, Department of Technology and Health, Istituto Superiore di Sanità, Rome,
mean BMI 19.9) were examined at the Oxford Gait Lab by using the OFM Italy
and an integrated experimental setup based on a VICON motion system and E-mail: c_giacomozzi@yahoo.com
an EMED-m baropodometer. 3-5 footprints per foot were acquired for each Journal of Foot and Ankle Research 2014, 7(Suppl 1):A26
individual while walking barefoot at self-selected speed. Markers projection
onto the dynamic footprint allowed the anatomical identification (AM) of: Background: Gold standard for the management of diabetic foot
medial hindfoot (M01), lateral hindfoot (M02), midfoot (M03), medial neuropathic ulcers is the irremovable total contact cast, however evidence
forefoot (M04), lateral forefoot (M05). The automatic geometry-based of equal clinical effectiveness was proved for the removable walker
regionalization (GM) which best fitted the OFM definition was used for OPTIMA DIAB [1]. Priority of this healing treatment is the offloading of the
comparison: it is based on the bisecting line of the foot and on the 23% ulcerated foot area; however, the healing process may last for months, and
(hindfoot) and 55% (midfoot) perpendicular lines. Relevant baropodometric eventual changes in gait biomechanics may entail risks for the
parameters were calculated for each footprint using AM and GM. To avoid contralateral foot, leg joints, or even spine. Aim of this study is to setup a
smoothing effects due to intra-subject averaging, all available footprints reliable methodology to optimize the use of such offloading devices.
were used and individually compared; non-parametric statistics was applied Materials and methods: The OPTIMA DIAB (Molliter, Italy) is a special
to all comparisons. boot with an external rigid rocker sole, a fiber-glass rigid interface, a
Results: 143 healthy footprints and 84 clubfoot footprints (17 feet) were multi-layer modular insole, and a posterior rigid brace. To investigate
used in the study. Results from AM and GM were very similar for the forces at the boot external and internal interface, a Kistler force platform
healthy group, for all parameters and regions (median difference 0.9% [0.4- and an in-shoe Pedar baropodometer were used. The assessment
2.7]) except for midfoot length of contact and lateral forefoot instant of protocol was applied to a healthy volunteer (F; 41years; BMI 19; high
Maximum force; this proved that AM provides comparable results to GM in forefoot pressures; negligible foot extra-rotation; used to walk fast): 10
this population. Interestingly, the corresponding comparison applied to the consistent footsteps per foot were simultaneously acquired by the two
pathologic group showed higher differences (3.4% [2.0-6.8]), despite the systems when the subject hit the platform; a high cadence of 110 steps
fact that most feet demonstrated near complete footprints. per minute was acoustically imposed; the subject was acquired while
Conclusions: The proposed anatomical masking proved to be comparable walking barefoot (B), with primary prevention flexible shoes (F), with
to the corresponding geometrical masking on a large selection of healthy secondary prevention rigid shoes (R), with the OPTIMA DIAB without
footprints. Differences between the two methods for clubfoot footprints offloading (O), and with the OPTIMA DIAB with right central forefoot
suggested the appropriateness and the greater clinical relevance of the offloading (OS1). Pressure footprints were divided into 4 major regions
Figure 1(abstract A26) Mean GRF curves of B (dotted lines) and O (solid lines) conditions, measured by the force platform, and mean vertical force of O
(thicker blu line) condition, obtained from the in-shoe pressure system. All curves have been averaged over 10 consistent trials.
Figure 2(abstract A26) Mean COP trajectories under B, F, R, O and OS1 conditions; mean peak pressures under the same conditions and associated with
rearfoot, midfoot, forefoot and toes. Curves and values have been averaged over 10 consistent trials.
[2]. All relevant parameters were averaged, with force and COP curves by the purposely high cadence and the rigid surface of the force
resampled before averaging. platform, should be taken into account when designing the treatment.
Results: The OPTIMA DIAB force curves were 3% delayed in propulsion Further investigation is in progress to find out indicators to optimize the
with respect to all other conditions. A significant change was also found intervention, i.e. to effectively offload injured areas while preserving
at heel strike (Figure 1), entailing alterations in COM acceleration and reasonable loading pattern and gait symmetry.
body instantaneous adaptation. In-shoe force confirmed the modified References
impact at the foot interface, even though partly smoothed. Prevention 1. Piaggesi A, et al: Diabetes Care 2007, 30:586-590.
solutions F, R O and OS1 were increasingly effective in reducing forefoot 2. Giacomozzi C: Uccioli L. JBiSE 2013, 6:45-57.
pressure (B: 334.2±30.3kPa; F: 260.0±17.3kPa; R: 243.3±29.3kPa; O: 220.8
±19.8kPa; OS1: 203.5±17.0kPa); comparison between O and OS1 in the
specific offloaded area showed lower peak pressure (88.3±6.9kPa, -34%), A27
pressure-time integral (21.3±2.2kPa×s, -49%), stance duration (0.41±0.06s, Identification of diabetic neuropathic patients at risk of foot ulceration
-20%). However, differences were found in timing and loading pattern of through finite element models and cluster analysis
all regions, as well as in COP excursion (Figure 2). Differences and Annamaria Guiotto1*, Zimi Sawacha1, Alessandra Scarton1, Gabriella Guarneri2,
asymmetries between R and O (or OS1) conditions are worth of special Angelo Avogaro2, Claudio Cobelli1
1
attention since they are often used in combination, i.e. the contralateral Department of Information Engineering, University of Padova, Padova,
foot wearing a rigid sole prevention shoe. 35131, Italy; 2Department of Clinical Medicine and Metabolic Disease,
Conclusions: The used methodology seem to be valuable, also in a University Polyclinic, Padova, 35128, Italy
clinical setting, for the analysis of biomechanical changes induced by the E-mail: guiotto@dei.unipd.it
offloading device. The hereby highlighted alterations, although magnified Journal of Foot and Ankle Research 2014, 7(Suppl 1):A27
Figure 1(abstract A27) Example of the results of a FEM simulation with ulcerated subject’s boundary conditions: Plantar pressures (left) and Von Mises
internal stresses (right).
Background: Diabetic foot is an invalidating complication of diabetes Results: The hierarchical method (Ward’s linkage) which led to the
mellitus that can lead to foot ulceration and amputations. While definition of three clusters (Table 1) gave the best result: 5 US were
experimental analyses are limited solely to measurements of interfacial included in one cluster with only 3 non US.
variables, three-dimensional (3D) patient specific finite element models Conclusions: A longer follow up is needed in order to verify whether the
(FEMs) of the foot can provide both the interfacial pressures and insight neuropathic subjects in cluster 2 and 3 will develop ulcers. A larger dataset
into internal stresses and strains tolerated by the plantar tissue [1]. FEMs is needed to further validate this methodology. Besides these limitations,
allows quantifying the loads developed in the different anatomical results showed that combined FEMS and cluster analysis allowed to infer
structures of the foot and to understand how these affect foot tissue [2]. useful informations on the risk of ulceration even five years prior to the
The aim of this study was to identify the neuropathic subjects at risk of wound evolution.
ulceration with a cluster analysis classification of simulated plantar References
pressures and internal stresses. Simulations were ran with gait analysis 1. Yarnitzky G, Yizhar Z, Gefen A: Real-time subject-specific monitoring of
data acquired 5 years prior to ulcerations. internal deformations and stresses in the soft tissues of the foot: a
Methods: Foot biomechanical analysis was carried out as in [3] on 16 new approach in gait analysis. Journal of Biomechanics 2006,
diabetic neuropathic subjects by measn of a 6 cameras motion capture 39:2673-2689.
system (BTS, Padova), integrated and synchronized with 2 force plates 2. Cavanagh P, Erdemir A, Petre M, Owings T, Botek G, Chokhandre S, Bafna R:
(Bertec, USA), 2 plantar pressures systems (Imagortesi, Piacenza). For each Biomechanical factors in diabetic foot disease. Journal of Foot and Ankle
patient the 3D kinematics, ground reaction forces and plantar pressures Research 2008, 1:K4.
were calculated. Six of these subjects developed ulcers under metatarsals 3. Sawacha Z, Guarneri G, Cristoferi G, Guiotto A, Avogaro A, Cobelli C:
heads within 5 years after the acquisitions (ulcerated subjects (US)- age 62.3 Integrated kinematics–kinetics–plantar pressure data analysis: A useful
±4.1 years, BMI 26.3±2.0 kg/m2) while the other ten did not (non US - age tool for characterizing diabetic foot biomechanics. Gait & Posture 2012,
63.2±6.4 years, BMI 24.3±2.9 kg/m2). 36:20-26.
In order to obtain the internal stresses (Von Mises and principal stresses) 4. Guiotto A, Sawacha Z, Scarton A, Guarneri G, Avogaro A, Cobelli C: 3D
and the simulated plantar pressures (Figure 1), a recently developed 3D finite element model of the diabetic neuropathic foot: a gait analysis
FEM [4] was adopted and the simulations were run adopting the driven approach. Proceedings ISB Natal, Brasil 2013.
experimental kinematic and kinetics as boundary conditions as in [4]. The 5. Sawacha Z, Laudani L, Macaluso A, Vannozzi G: Identifying The Association
midstance and the push-off phases of gait were considered as they are the Between Physical Activity Levels And Physiological Factors Underlying
instants when critical loads occur in the forefoot of the diabetic subjects. mobility: a descriptive data mining approach. Proceedings of IDAMAP
K-means and hierarchical cluster analysis were performed as in [5] with Pavia, Italy 2012.
simulated plantar pressures and/or internal stresses as input.
Table 1(abstract A27) Results of the hierarchical cluster analysis: 3 clusters. Values are normalized over the subject’s
weight. PP=plantar pressure
Cluster N° subjects ulcer/no ulcer Push-off Mid-stance
Peak PP Mean PP Von Mises Peak PP Mean PP Von Mises
1 0/3 0.423 0.108 0.000381 0.323 0.080 0.000251
0.052 0.023 0.000174 0.020 0.010 0.000044
2 1/4 0.371 0.097 0.000348 0.275 0.060 0.000245
0.041 0.019 0.000050 0.017 0.007 0.000024
3 5/3 0.390 0.104 0.000378 0.277 0.062 0.000228
0.035 0.007 0.000042 0.028 0.004 0.000021
2. Fong DTP, Ha SCW, Mok KM, Chan CWL, Chan KM: Kinematics analysis of
A28 ankle inversion ligamentous sprain injuries in sports - five cases from
Comparison of ankle joint kinematics of a single athlete during an televised tennis competitions. The American Journal of Sports Medicine
ankle inversion sprain incident and normal non-injury motions 2012, 40(11):2627-2632.
Zoe YS Chan1, Sophia CW Ha2*, Daniel TP Fong3, KM Chan2
1
Division of Biomedical Engineering, Department of Electronic Engineering, The
Chinese University of Hong Kong, Hong Kong; 2Department of Orthopaedics A29
and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese A computational biomechanics study to investigate the effect of
University of Hong Kong, Hong Kong; 3School of Sport, Exercise and Health myoelectric stimulation on peroneal muscles in preventing inversion-
Sciences, Loughborough University, Leicestershire LE11 3TU, UK type ankle ligamentous sprain injury
E-mail: sophiaha@cuhk.edu.hk Sophia CW Ha1*, Jianxin Chen1, Daniel TP Fong2, KM Chan1
1
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A28 Department of Orthopaedics and Traumatology, Prince of Wales Hospital,
Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong;
2
Introduction: The purpose of this study was to compare the ankle joint School of Sport, Exercise and Health Sciences, Loughborough University,
kinematics including the angles, and their respective angular velocities of Leicestershire LE11 3TU, UK
a tennis player during an ankle sprain incident and normal non-injury E-mail: sophiaha@cuhk.edu.hk
motion. And to deduce whether the sideward cutting motion of the Journal of Foot and Ankle Research 2014, 7(Suppl 1):A29
athlete is an intrinsic factor to an ankle sprain.
Methods: Model-Based Image Matching (MBIM) motion analysis technique Introduction: The aim of this study was to develop a three-dimensional
allows us to understand the leg movement quantitatively by analyzing the (3D) computational model to justify the effect of myoelectric stimulation
three-dimensional human motion. With validation, it has been used to in preventing ankle inversion ligamentous sprain injury.
obtain ankle kinematics during ankle sprain incidents in various sports [1]. Methods: The subject who sustained a grade 1 anterior talofibular
In this study, a sideward cutting motion performed by a female athlete ligamentous sprain injury on his right ankle during our previous case
was compared against her injured incident reported in 2012 [2]. report [1] was invited to participate in this project. There were three
Results: Figure 1 and figure 2 show the right ankle kinematics profile of steps: 1) Computational model development: CT scan was performed
inversion, internal rotation, and plantarflexion during a sideward cutting from mid-femur to the foot segments. The CT images were separated
motion to the right. Previously, the same athlete got injured performing a and meshed as individual solid bodies in MIMICS. These individual bones
similar motion, regarding that incident, her peak inversion angle was were computationally separated and meshed in STL files. These files will
reported to be 67o, which happened 0.17 second after foot strike [2]. The be remeshed in MIMICS to smooth each bone in order to reduce the file
peak inversion angle of this case is 5°, significantly smaller compared to size. The 3D computational lower limb model was then imported into
the injured case. The range of inversion angle was 5° eversion to 5° SolidWorks for applying ligamentous restraints, prescribing force, motion
inversion. The degree of fluctuation of the angle of plantarflexion is constraints, prescribing muscle forces, and simulating the ankle dynamics.
greatest among the 3 planes of motion. It ranges from -33.5° to 30°. The 2) Model validation: This model will be validated against two cadaveric
peak velocity is 1600°/sec for both ways, doriflexion and plantarflexion. studies. 3) Model simulation: A systematic series of simulations will be
Conclusion: This study further demonstrates that the sideward cutting conducted to deliver the myoelectric stimulation when different ankle
motion does not require internal rotation and inversion, instead, ankle goes inversion velocity threshold is achieved, at different delay time, and at
from plantarflexed to doriflexed, and then back to plantarflexed in a short different stimulation.
time. An inverted ankle orientation on landing could be the inciting event of Results: The model is validated. Stimulation with a delay time of 25
an ankle sprain when performing similar motion. However, a rapid joint milliseconds could successfully prevent the ankle inversion sprain when the
motion in the plantarflexion/doriflexion plane is not likely to cause an ankle lower threshold of 300 or 400 degrees per second was identified.
sprain. Therefore, the risk of performing the sideward cutting depends Conclusion: This study is indispensable and crucial for evaluating the
mostly on the ankle orientation during landing. actual effect of myoelectric stimulation on peroneal muscles in preventing
References ankle inversion sprain injury. Meanwhile, this study would also contribute
1. Mok KM, Fong DTP, Krosshaug T, Hung ASL, Yung PSH, Chan KM: An ankle to the research on the intelligent anti-sprain system, which in turn would
joint model-based image-matching motion analysis technique. Gait and boost sports participation with more effective protection for the general
Posture 2011, 34(1):71-75. public.
Figure 1(abstract A28) Profile of joint orientation. Joint orientation

Figure 2(abstract A28) Profile of angular velocities. Joint velocity
Reference
1. Fong DTP, Hong Y, Shima Y, Krosshaug T, Yung PSH, Chan KM:
Table 1(abstract A30) Peak value of the ankle angles and
Biomechanics of supination ankle sprain: a case report of an accidental velocities (inversion, internal rotation and plantarflexion)
injury event in the laboratory. The American Journal of Sports Medicine were shown in the table below. The lowest row indicates
2009, 37:822-827. the duration of the ankle sprain injury
Max. Inversion angle (deg) 110
A30 Max. Inversion velocity (deg/sec) 2916.
Analysis of ankle inversion sprain injury mechanism from accidental
injury cases captured in televised basketball matches Time of peak inversion (sec) 0.24
KM Chan1, Sophia CW Ha2*, Daniel TP Fong3, KM Chan2 Max. Internal rotation angle (deg) 56
1
Division of Biomedical Engineering, Department of Electronic Engineering,
The Chinese University of Hong Kong, Hong Kong; 2Department of
Max. Internal rotation velocity (deg/sec) 551
Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Time of peak internal rotation (sec) 0.52
Medicine, The Chinese University of Hong Kong, Hong Kong; 3School of
Max. Plantarflexion angle (deg) 32
Sport, Exercise and Health Sciences, Loughborough University, Leicestershire
LE11 3TU, UK Max. Plantarflexion velocity (deg/sec) 580
E-mail: sophiaha@cuhk.edu.hk
Time of peak plantarflexion (sec) 0.40
Whole duration (sec) 0.52s
Introduction: The aim of this study was to use model-based image
matching method (MBIM) to study ankle inversion sprain injury mechanism
from basketball cases. MBIM can be used to understand the injury
mechanism quantitatively by analyzing the three-dimensional human cases have been analyzed before, so more basketball cases should be
motion [1]. analyzed by MBIM in order to understand the real injury mechanism.
Methods: An ankle inversion sprain injury occurred in a televised basketball Reference
match was found from the internet. The videos were transformed into 1. Fong DTP, Ha SCW, Mok KM, Chan CWL, Chan KM: Kinematics analysis of
uncompressed AVI image sequence by using Adobe Premiere Pro (CS4, ankle inversion ligamentous sprain injuries in sports - five cases from
Adobe Systems Inc, San Jose, California). Then the image sequences were televised tennis competitions. The American Journal of Sports Medicine
synchronized and rendered into 1-Hz video sequences by Adobe After- 2012, 40(11):2627-2632.
Effects (CS4, Adobe Systems Inc). 3-dimension animation software Poser 4
and Poser Pro Pack (Curious Labs Inc, Santa Cruz, California) were used to
perform the matching part. Virtual environment was built according to the A31
real dimensions of a basketball court and it was manually matched to the Are lower limb biomechanical factors associated with night-time calf
background for each frame in every single camera view. The skeleton model cramps in adults? A case-control study
from Zygote Media Group Inc. (Provo, Utah) was used to match with the Fiona Hawke1,2*, Vivienne Chuter1, Joshua Burns2,3
1
athlete. The segment dimensions were adjusted according to the subject’s Podiatry Program, The University of Newcastle, Ourimbah, NSW, 2258,
height. The skeleton matching started with the hip, thigh, shank segment Australia; 2Sydney Medical School, The University of Sydney, Westmead,
and then distally matched the foot and toe segments frame by frame. The NSW, 2145, Australia; 3Arthritis and Musculoskeletal Research Group, Faculty
ankle time histories were input into Microsoft Excel (Microsoft Office, of Health Sciences, The University of Sydney / Institute for Neuroscience and
Microsoft, US) to calculate the velocity-related information. Muscle Research / Paediatric Gait Analysis Service of NSW, Sydney Children’s
Results: The peak inversion in this case lies within the range (48°-142°) Hospitals Network (Randwick and Westmead), Australia
obtained in previous studies [1]. Different from previous studies [1], E-mail: Fiona.Hawke@newcastle.edu.au
plantarflexion is found at the time of peak ankle inversion during the Journal of Foot and Ankle Research 2014, 7(Suppl 1):A31
injuring motion.
Conclusion: The analysis of basketball ankle inversion ligamentous sprain Background: Night-time calf muscle cramps are highly prevalent and are
case was done and compared with previous studies. Since no basketball associated with reduced quality of sleep and health-related quality of life
[1]. The underlying mechanism is poorly understood and no treatment joint stiffness using a tactile pressure sensing system (Figure 1A) together
has shown consistent efficacy or safety. The aim of this study was to with simple video analysis.
identify factors associated with night-time calf cramping in adults to To illustrate the method, data were collected on one female flat-footed
explore potential underlying mechanisms and therapeutic targets. subject with posterior tibial tendon dysfunction (age 25 yr, body mass index
Methods: 160 adults were recruited the Greater Newcastle and Central 20.6 kg/m2). The moment arm was measured from the tuberosity of the first
Coast regions of New South Wales, Australia: 80 who experienced night-time metatarsal head to just beneath the tuberosity of the 1st distal phalanx
calf cramp at least once per week and 80 age- and sex-matched adults who (Figure 1B). A qualified podiatrist moved the 1st MPJ of the subject through
never experienced lower limb muscle cramping. Participants were assessed its full range of motion before data collection. For each trial, joint movement
using reliable tests of foot/ankle and toe strength, range of ankle is paused briefly at 3 interval points between the resting and maximally
dorsiflexion, hamstring flexibility, foot alignment, and calf circumference. dorsiflexed position. At each interval point, the corresponding force applied
Participants also completed a bespoke survey examining health and lifestyle was measured using a tactile pressure sensing system (Figure 1C). The
factors, exercise, lower limb symptoms and footwear characteristics. procedures were recorded by a synchronised webcam such that the angular
Results: Presence of night-time calf cramps was significantly correlated displacement of the 1st MPJ can be quantified using video analysis. A total
with weakness of foot and ankle inversion, eversion, dorsiflexion and of 3 trials were taken, resulting in nine sets of data points to plot a torque-
plantarflexion; weakness of toe grip; restricted hamstring flexibility; lower angular displacement graph (Figure 2). The joint stiffness was then
limb tingling sensations; muscle twitching, and coldness of legs or feet in calculated as the slope of the line of best fit as 3.8 Nmm/deg. The R 2
bed at night. Conditional logistic regression identified three factors indicates that 61% of variability can be explained by this model.
independently associated with night-time calf cramps: muscle twitching The proposed method of quantifying 1st MPJ stiffness is potentially useful
(OR 4.6; 95%CI: 1.6 to 15.5; p=0.01), lower limb tingling (OR 4.1; 95%CI: for measuring small joint stiffness in clinical practice. Quantified joint
1.6 to 10.3; p=0.003) and foot dorsiflexion weakness (OR 1.02; 95%CI: 1.01 stiffness provides greater accuracy to facilitate clinicians in their diagnoses
to 1.03; p=0.002), which represented other measures of lower limb and prescription of treatment.
weakness in the model. References
Conclusion: Night-time calf muscle cramps were associated with markers of 1. Hopson MM, McPoil TG, Cornwall MW: Motion of the first
neurological dysfunction and potential musculoskeletal therapeutic targets. metatarsophalangeal joint. Reliability and validity of four measurement
References techniques. Journal of the American Podiatric Medical Association 1995,
1. Hawke F, Chuter V, Burns J: Impact of nocturnal calf cramping on quality of 85(4):198-204.
sleep and health-related quality of life. Qual Life Res 2013, 22: 1281-1286. 2. Jones AM, Curran SA: Intrarater and interrater reliability of first
2. Gulich M, Heil P, Zeitler H-P: Epidemiology and determinants of nocturnal metatarsophalangeal joint dorsiflexion. Goniometry versus visual
calf cramps. Eur J Gen Pract 1998, 4:109-13. estimation. Journal of the American Podiatric Medical Association 2012,
102(4):290-298.
A32
A novel technique of quantifying first metatarsophalangeal (1st MPJ) A33
joint stiffness People with recurrent ankle sprains do not change their ankle strategy
Marabelle L Heng1,2, Pui W Kong1* in anticipation of a perturbation event
1
Physical Education & Sports Science Academic Group, National Institute of Claire E Hiller1*, Stuart Blair1, Elizabeth J Nightingale1, Milena Simic1,
Education, Nanyang Technological University, Singapore 637616; 2Podiatry Joshua Burns1,2
1
Department, Singapore General Hospital, Singapore 169608 Arthritis & Musculoskeletal Research Group, Faculty of Health Sciences,
E-mail: puiwah.kong@nie.edu.sg University of Sydney, NSW, Australia; 2Institute for Neuroscience and
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A32 Muscular Research, The Children’s Hospital at Westmead, Sydney, NSW,
Australia
The first metatarsophalangeal joint (1st MPJ) mobility is usually described by E-mail: claire.hiller@sydney.edu.au
(i) range of motion in degrees (°) or (ii) stiffness based on an experienced Journal of Foot and Ankle Research 2014, 7(Suppl 1):A33
tester’s subjective feel, ie. hypermobile, normal or stiff. Approximately 65° of
1 st MPJ dorsiflexion is required for normal effective walking [1]. Visual Background: It is unclear why people with an ankle sprain continue to
estimation of 1st MPJ range of motion is often used in current practice [2], resprain. People that do resprain take longer to return to equilibrium
reflecting the absence of a reliable and practical method for clinicians to after an ankle perturbation event suggesting there is a change in the
quantify 1st MPJ stiffness. This study presents a novel technique to measure sensorimotor system [1,2].
Figure 1(abstract A32) A. Finger sleeve with pressure pad (circled) on tip of thumb to measure force applied to move the 1st MPJ. B. Moment arm
(length of proximal phalanx) from joint fulcrum to point of force application. C. Displacement force applied to proximal phalanx, dorsiflexing 1st MPJ
through its range of motion.
Figure 2(abstract A32) Plot of torque (Nmm) against angular displacement (degrees) of the 1st MPJ to determine joint stiffness from the slope.
Aim: The aim of this study was to determine whether anticipation of an

ankle inversion perturbation changes the ankle strategy used by A34
participants with an inversion perturbation. Foot type symmetry and change of foot structures from sitting to
Methods: Two groups of participants were recruited: 14 with no history of standing conditions
ankle injury (age 22.6 ± 0.7 yrs, 10 females) and 14 with a history of two or Howard Hillstrom1*, Jinsup Song2, Michael Neary3, William Brechue3,
more ankle sprains (Age 21.1 ± 0.2 yrs, 9 females, 6 ± 2.5 sprains). Participants Rebecca A Zifchock3, Steven Svoboda3, Marian T Hannan4
1
stood in single leg stance on an inversion perturbation platform. The Hospital for Special Surgery, New York, New York, USA; 2Temple University
perturbation platform dropped 15 degrees in the frontal plane on a trigger School of Podiatric Medicine, Philadelphia, Pennsylvania, USA; 3United States
activated by the researcher. Movement Oscillation at the ankle was measured Military Academy, West Point, New York, USA; 4Hebrew Senior Life, Harvard
via a 3Space fastrak (Polhemius Ltd) with a receiver taped one cm above the Medical School, Boston, USA
lateral malleolus. Oscillation was determined as the standard deviation of the E-mail: hillstomh@hss.edu
movement in the frontal plane (mm) measured over 10s while the platform Journal of Foot and Ankle Research 2014, 7(Suppl 1):A34
was horizontal. Three conditions were investigated: standing with no change
in the platform, standing with a 15 deg drop occurring at a specified time, Introduction: Foot symmetry and change in foot structure as a function
and standing with a drop occurring at anytime. Data were compared of weight bearing status have not been investigated in a large cohort
between groups using a Mann-Whitney U test, as the data were not normally study. The foot structure of 1,054 incoming cadets at the US Military
distributed. Academy (172 female, 18.5±1.1 years, 24.5±3.0 kg/m2 ) was examined.
Results: There was a significant difference between groups for the no Arch Height Index (AHI) was assessed in sitting and standing condition,
change condition with the control group holding their ankle within a and its value was used to classify each foot into 3 foot types as
tighter oscillation range than the injured group (Table 1). There was no previously described [1].
difference between the groups for the other two conditions. Method: Based on standing AHI, 68.1%, 24.5%, and 7.5% of the study
Discussion: The uninjured group increased the range of ankle oscillation subjects’ left foot was categorized into planus, neutral, and cavus foot
in the frontal plane when an inversion drop was anticipated, which types, respectively. An asymmetrical foot type was observed in 28.6% of
implies they are able to change their envelop of stability to meet subjects in sitting and 23.6% standing conditions. Foot length increased
changing conditions. The participants who had recurrent sprains had one from sitting to standing conditions; this change was significantly greater
strategy during single leg stance and were not able to change their in cavus and neutral foot type groups than the planus group. In contrast,
oscillation across the conditions. Previous research using a perturbation arch height flexibility (AHF) was significantly greater in the planus group
drop may have over-estimated the time it takes uninjured participants to than both cavus and neutral foot type groups.
reach equilibrium after a perturbation as the no change condition is used Results: Results of this study suggest the importance of controlling for
as the baseline rather than the oscillation immediately prior to a drop [2]. weight bearing status when assessing foot structure or fitting footwear.
Conclusions: Consideration of the baseline measure in perturbation tests Given that about a quarter of participants demonstrated an asymmetrical
should be further explored. The lack of ability to change the envelop of foot type, findings also suggest the importance of assessing both feet
stability in anticipation of an ankle rolling event is worth investigating in independently. Table 1.
people with recurrent ankle sprains. Acknowledgements: Volunteers from the New York College of Podiatric
References Medicine, Temple University School of Podiatric Medicine, the Hospital for
1. Hertel J: Functional Anatomy, pathomechanics, and pathophysiology of Special Surgery, and novel GmbH were instrumental in the collection of
lateral ankle instability. J Athl Train 2002, 37:364-75. these data. We appreciate the study participants and support of the
2. Hiller CE, Refshauge KM, Herbert RD, Kilbreath SL: Balance and recovery United States Military Academy.
from a perturbation are impaired in people with functional ankle
instability. Clin J Sports Med 2007, 17:269-75.
Table 1(abstract A34) Mean arch height flexibility and

Table 1(abstract A33) Median and Interquartile range of the change in foot length across the 3 foot type groups
standard deviation of ankle oscillation in the frontal plane
Cavus Neutral Planus P-value
Platform condition Instability Control p*
group Group N (female) 53 (5) 184 (34) 711 (133)
a,c
No perturbation (mm) 0.085 (0.09) 0.054 (0.03) 0.023* AHF (mm/kN) 13.2 ± 7.4 14.8 ± 7.4 16.6 ± 7.4 0.0001
Perturbation at Specific time 0.090 (0.09) 0.067 (0.06) 0.646 ΔFoot Length (mm) 4.8 ± 2.6 4.3 ± 2.2 3.6 ± 2.1 <.0001 a,c
(mm) Arch height flexibility = [(arch height in sitting – arch height in standing) /
a
Perturbation Anytime (mm) 0.088 (0.10) 0.074 (0.03) 0.581 (0.4 * body weight)]. A significant difference (P<0.05) was observed between
cavus and planus foot types and c between neutral and planus foot types.
Reference be able to sense the foot position and if necessary, correct the position
1. Hillstrom HJ, Song J, Kraszewski AP, Hafer JF, Moontanah R, Dufour AB, of the foot, thus preventing potential foot injuries.
Chow BS, Deland JT: Foot type biomechanics part 1: structure and Whilst studies have been also done to relate foot structure and functional
function of the asymptomatic foot. Gait Posture 2013, 37:445-51. stability [6], as well as functional stability and gait patterns [12,14], no
study has been done to investigate the combined effect of foot structure
and functional foot stability on gait patterns. Therefore, this study
A35 examines the combined effect of foot structure and functional foot
Podiatric intervention in managing the gait related symptoms of stability on running gait patterns.
Developmental Coordination Disorder (Dyspraxia). A retrospective Method: Sixty-five subjects (mean age 31 years SD 7.1) had their foot
study structure scored according to the Foot Posture Index (FPI) [5,10,13] and
Pamela Hindmoor their functional foot stability was assessed with balance errors scored
Durham School of Podiatric Medicine, New College Durham, Durham, DH1 according to the criteria set out by the Balance Error Scoring System
5ES, UK (BESS) [2,7]. Subjects were then put into six groups- Flat foot Stable, Flat
E-mail: pamela.hindmoor@newdur.ac.uk foot Unstable, Normal Stable, Normal Unstable, High Arched Stable and
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A35 High Arch Unstable. The total excursion of the rearfoot, midfoot and first
metatarso-phlangeal joints were noted with three dimensional motion
Introduction: The current interventions for children with DCD are analysis. The results were then analysed using ANOVA.
predominantly provided by the OT and Physiotherapist. There is a lack of Results and conclusion: The results showed a significant difference in
research related to podiatric interventions for the symptoms and total excursion of rearfoot inversion/eversion of the flat foot unstable
disability resulting from DCD in children. The Podiatrist commonly group compared to the other groups.
undertakes assessment including: balance deficits, examination of a References
patient’s postural control and gait. Although no studies have identified 1. Tong J, Kong P: Association between foot type and lower extremity
appropriate interventions for deficits in children with Dyspraxia they are injuries: a systematic literature review with meta-analysis. J. Orthop Sports
important factors that can substantially affect a patient’s function and are Phys Ther 2013, (Epub ahead of print).
important areas for study. A thorough examination of the patient’s 2. Bell D, Guskiewicz K, Clark M, Padua D: Systemic review of the Balance
postural alignment, muscle strength and gait pattern will aid a targeted Error Scoring System. Sports Health 2011, 3(3):287-295.
treatment in which specific exercises and orthotics can be prescribed to 3. Burns J, Keenan A, Redmond A: Foot type and overse injury in triathletes.
improve impairments identified but no studies have been performed to Journal of the American Podiatric Medical Association 2005, 95(3):235-241.
assess their effectiveness in reducing pain or disability. 4. Chuter V: Relationships between foot type and dynamic rearfoot frontal
The main objective of this research was to review the clinical outcomes in plane motion. Journal of Foot and Ankle Research 2010, 3(9).
a cohort of paediatric patients diagnosed with dyspraxia, attending 5. Cornwall M, McPoil T, Lebec M, Vicenzino B, Wilson J: Reliability of the
biomechanics clinic and who had accessed podiatric care for the first Modified Foot Posture Index. J Am Podiatr Med Assoc 2008, 98(1):7-13.
time during the course of their condition. 6. Cote K, Brunet M, Gansneder B, Shultz S: Effects of pronated and
Design: This research employed a retrospective study design and was supinated foot postures on static and dynamic postural stability. Journal
conducted in a biomechanics clinical setting in the UK. This study of Athl Train 2005, 40(1):41-46.
includes data from a cohort of patients referred during 2011/12 and 7. Docherty C, Valovich McLeod T, Shultz S: Postural control deficits in
2012/13 using convenience sampling. The clinical assessments used participants with functional ankle instability as measured by the balance
during this screening programme were based on validated and previously error scoring system. Clin J Sport Med 2006, 16(3):203-208.
published tools such as Foot Posture Index (FPI), Lower Limb Assessment 8. Fan Y, Fan Y, Li Z, Li C, Luo D: Natural gaits of the non-pathological flat
Score (LLAS). Gait characteristics were measured with pressure plate and foot and high arched foot. PLos ONE 2011, 6(3):e17749, Retrieved from
gait analysis software. Participants data (group n = 21, mean age 14 doi:10.1371/journal.pone.0017749.
years) were compare to a control group (n=20, mean age 11 years) who 9. Hunt A, Smith R: Mechanics and control of the flat versus normal foot
had no diagnosis of dyspraxia. during the stance phase of walking. Clinical Biomechanics 2004,
Results and conclusions: A pes planus foot posture (mean FPI score = 8) 19:391-197.
and hypermobile lower limb (mean LLAS score = 11) was observed. 10. Keenan A, Redmond A, Horton M, Conaghan P, Tennant A: The Foot
Significant differences in gait characteristic were found between the Posture Index: Rasch Analysis of a novel foot specific outcome measure.
groups (p < 0.05), following orthotic intervention. The results support Arch Phys Med Rehabil 2007, 88:88-83.
podiatric assessment and treatment in the rehabilitation of children with 11. Levinger P, Murley G, Barton C, Cotchett M, McSweeney S, Menz H: A
DCD. Further research is required to explore qualitative measures (time to comparison of foot kinematics in people with normal and flat arched
fatigue) in children with this disorder to enhance understanding of foot foot using the Oxford Foot Model. Gait and Posture 2010, 32:519-523.
function is this challenging patient group. 12. Liu K, Uygur M, Kaminski T: Effect of ankle instability on gait reports.
Athletic Training and Sports Health Care 2012, 4.
13. Redmond A, Crane Y, Menz H: Normative values for the Foot Posture
A36 Index. Journal of Foot and Ankle Research 2008.
The effect of foot structure and functional foot stability on the gait 14. Ridder R, Willems T, Roosen P: Plantar pressure distribution during gait
patterns of the foot and runnning in subjects with chronic ankle instability. Journal of Foot
Malia T Ho*, John Tan and Ankle Research 2012.
Physical Education and Sports Science, Nanyang Technological University,
Singapore 637616, Singapore
E-mail: Maliahotd@gmail.com A37
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A36 The effect of balance training on ankle proprioception in patients with
functional ankle instability
Background: Poor foot structure, such as flat feet or high arched feet Tarang K Jain1*, Clayton N Wauneka2, Wen Liu1,2
1
were thought to cause excessive foot movement during gait, which in Physical Therapy and Rehabilitation Science, University of Kansas Medical
turn is the pre-cursor to foot injuries [1,3]. Center, Kansas City, KS, 66160, USA; 2Bioengineering Graduate Program,
However, some studies claimed that the differences in gait patterns may University of Kansas, Lawrence, KS, 66405, USA
not be due to foot structure alone [4,8,11]. It has been suggested that E-mail: tjain@kumc.edu
good foot functional stability can ‘protect’ the mal-aligned foot from Journal of Foot and Ankle Research 2014, 7(Suppl 1):A37
injuries [9].
Functional Foot Stability is defined in this study as ‘the ability of the foot Background: Approximately 40-70% of individuals who suffer an ankle
to continually adjust its position to maintain the body in an upright, sprain report residual symptoms 6 weeks to 18 months post injury [1].
balanced position’. An individual with good functional foot stability will Balance training is often the first choice of treatment in patients with
functional ankle instability (FAI); however the effect of balance training on

the ankle proprioceptive sensation in these patients is debatable [2]. A38
Purpose: To examine the effect of 4-week balance training intervention Effects of boundary conditions on foot behaviour in the standing
on self-reported ankle instability using Cumberland ankle instability tool position in 3D finite element foot model
questionnaire (CAIT) and ankle joint position sense (JPS) using joint Shane Johnson*, Haihua Ou
position-reposition test in patients with FAI. University of Michigan and Shanghai Jiao Tong University Joint Institute,
Methods: Twenty-four recreationally active patients with unilateral FAI Shanghai, 200240, China
were randomized to either the control (n = 12, 34.6±9.04 years, CAIT E-mail: shane.johnson@sjtu.edu.cn
score = 13.9±4.3) or experimental (n = 12, 33.8±6.4 years, CAIT score = Journal of Foot and Ankle Research 2014, 7(Suppl 1):A38
13.4±3.3) group. Patients in the experimental group were trained on the
affected limb using static and dynamic balance components with Biodex Introduction: The most common physical injuries are injuries of the
balance stability system. CAIT questionnaire was administered at baseline lower extremity. In fact, controlled studies on highly physically active
and 6-week post-intervention. The passive ankle JPS at 15 and 30 groups such as athletes and military personnel show that five injury types
degrees of ankle inversion on the affected and unaffected limbs was are repeatedly cited as accounting for over 50 percent of all training
measured at baseline and 4-week post-intervention using Biodex injuries: stress fractures, overuse injuries of the knee, Plantar Fasciitis,
dynamometer. CAIT questionnaire score and mean error in angular Achilles Tendonitis, and ankle sprains [1-5].
displacement at baseline and post-intervention were compared using Three-dimensional finite element analysis (3D FEA) of the foot in the standing
two-tailed paired Student t tests. position allows researchers to analyze the relationship between foot behavior
Results: At baseline, CAIT questionnaire scores were similar between the and orthotic designs, which may help to relieve or prevent such injuries.
two groups. There was a significant side-to-side difference in the mean error Various 3D FEA models of the foot in the standing position show very
at 30° (4.1±2.6 vs. 2.5±2.0, p=0.03, 95% CI [0.170, 3.024]) of ankle inversion. different boundary conditions, including: fixing the fibula and tibia at
Following balance training, the experimental group showed significant different points between the ankle and knee, fixing the talus, and applying
improvement in CAIT questionnaire score (22.3±2.5, p=0.001, 95% CI [2.983, slip/no-slip conditions in the articular surfaces [6-12]. This may have a large
9.183]). The experimental group also showed significant reduction in mean effect on overall foot stiffness and the strain of the Plantar Aponeurosis.
error on the affected limb following intervention at both 15° (1.9±1.4, p = This study is developed to investigate the influence of these boundary
0.008, 95% CI [-5.376, -1.013]) and 30° (1.4±1.2, p = 0.001, 95% CI [-4.531, conditions on the overall foot stiffness and strain in the Plantar
-1.580]) of ankle inversion. When compared to the affected limb in the Aponeurosis in the standing position.
control group, affected limb in the experimental group demonstrated Method: A parametric study was conducted by varying the boundary
significant reduction in mean error at 30° (p=0.002) but not at 15° of ankle conditions on a 3D FEA foot model by:
inversion following balance training intervention (Figure 1). 1. Varying slip/no slip conditions at the articular surfaces (Tibia/Talus,
Conclusion: The 4-week balance training program was effective in Fibula/Talus, Talus/Calcaneous, Talus/Navicular, Calcaneous/Cuboid);
reducing the self-reported ankle instability and improving the deficit of 2. Fixing/Pinning different points between the proximal and distal ends of
ankle joint position sense in patients with FAI. the tibia and fibula;
Level of evidence: Therapy, 2b 3. Applying Achilles tendon forces of different magnitudes;
ClinicalTrials.gov Identifier: NCT00703456 The strain of the Plantar Aponeurosis and plantar pressures under
Supported by NIH Grant R21 AR062205 and Kansas Partners in Progress, Inc. different boundary conditions are compared with experimental results
References found in the literature [13,14].
1. Yeung MS, et al: An epidemiological survey on ankle sprain. Br J Sports Results: The result shows that changing boundary conditions has a large
Med 1994, 28(2):112-6. effect on the overall foot stiffness and strain in the Plantar Aponeurosis.
2. Ashton-Miller JA, et al: Can proprioception really be improved by This analysis provides researchers conducting 3D finite element analysis on
exercises? Knee Surg Sports Traumatol Arthrosc 2001, 9(3):128-36. the foot with a guide on which parameters, especially the force-displacement
Figure 1(abstract A37) Reduction in mean replication error in both the groups following balance training intervention.
boundary conditions, have the largest effect on particular foot behaviors. This Gothenburg, Sweden) and kinetic (AMTI, USA) analysis whilst walking in a
is critical in later analyzing the interaction between the foot and new orthotic control shoe and the two different lateral wedge insoles which were
designs. inserted bilaterally into the control shoe. The order of testing was
References randomised. We classified participants as biomechanical responders
1. Gardner LI, Dziados JE, Jones BH, Brundage JF, Harris JM, Sullivan R, Gill P: (responder) if participants decreased EKAM under both lateral wedge
Prevention of lower extremity stress fractures: a controlled trial of a conditions compared to the control shoe. We defined biomechanical non-
shock absorbent insole. Am J Public Health 1988, 78:1563-1567. responders (non-responder) as those whose EKAM increased when
2. Jones BH: Overuse injuries of the lower extremities associated with wearing both lateral wedges compared to the control shoe. Fixed-effects
marching, jogging, and running: a review. Mil Med 1983, 148:783-787. multiple linear regressions were used to test for effects of the lateral
3. Jones BH, Knapik JJ: Physical training and exercise-related injuries. wedge on coronal ankle variables, in both wedge conditions and
Surveillance, research and injury prevention in military populations. subsequently when dichotomising individuals into biomechanical
Sports Med 1999, 27:111-125. responder and non-responders. Finally, logistic regression was performed
4. Kowal DM: Nature and causes of injuries in women resulting from an to see which coronal ankle variables, measured in the control condition
endurance training program. Am J Sports Med 1980, 8:265-269. only, could predict response to EKAM.
5. Reinker KA, Ozburne S: A comparison of male and female orthopaedic Results: Of the 70 participants studied (43 male), 20% increased their
pathology in basic training. Mil Med 1979, 144:532-536. EKAM and 54% decreased their EKAM. Both pairs of lateral wedge insoles
6. Liu Q-H, Yu B, JIN D, Zhang M-C, Hu Y-J, Wang D, Luo J-W: Construction of caused the foot to be in a significantly more everted position compared
a finite element model of normal human foot and ankle. Chin J Orthop to the control condition with one insole greater. Change in ankle angle
Trauma 2010, 12. excursion significantly predicted EKAM change with lateral wedge insoles.
7. Chen W-P, Tang F-T, Ju C-W: Stress distribution of the foot during mid- Additionally, individuals with a higher peak ankle eversion angle (OR 1.31;
stance to push-off in barefoot gait: a 3-D finite element analysis. Clin 95% CI 1.019 to 1.703; p = 0.036) or a higher eversion angle at peak
Biomech 2001, 16:614-620. EKAM (OR 1.31; 95% CI 1.02 to 1.70; p = 0.037) during the control
8. Bandak FA, Tannous RE, Toridis T: On the development of an osseo- condition were more likely to classified as a biomechanical responder to
ligamentous finite element model of the human ankle joint. Int J Solids the lateral wedges.
Struct 2001, 38:1681-1697. Conclusions: In conclusion, we have demonstrated for the first time that
9. Gefen A: Stress analysis of the standing foot following surgical plantar coronal plane foot and ankle biomechanical measures are key mechanisms
fascia release. J Biomech 2002, 35:629-637. for the reduction of EKAM when wearing lateral wedge insoles. Furthermore,
10. Tao K, Wang D, Wang C, Wang X, Liu A, Nester CJ, Howard D: An In Vivo our findings also demonstrate that coronal plane ankle biomechanical
Experimental Validation of a Computational Model of Human Foot. measures under the control condition predict if an individual is likely to
J Bionic Eng 2009, 6:387-397. decrease their EKAM when wearing lateral wedge insoles. These findings
11. Chueng JT-M, Zhang M: A 3-Dimensional Finite Element Model of the may provide future insights into determining who will respond to lateral
Human Foot and Ankle for Insole Design. Arch Phys Med Rehabil 2005, wedge insoles.
86:353-360. Trial registration: ISRCTN: 83706683.
12. Antunes PJ, Dias GR, Coelho AT, Rebelo F, Pereira T: Non-Linear Finite
Element Modelling of Anatomically Detailed 3D Foot Model. 2008.
13. Kogler GF, Solomonidis SE, Paul JP: In vitro method for quantifying the
effectiveness of the longitudinal arch support mechanism of a foot A40
orthosis. Clin Biomech 1995, 10:245-252. The effect of various subject characteristics on plantar pressure pattern
14. Sharkey NA, Hamel AJ: A dynamic cadaver model of the stance phase of Noël LW Keijsers1*, Niki M Stolwijk1, Jan-Willem K Louwerens2
1
gait: performance characteristics and kinetic validation. Clin Biomech Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands;
2
1998, 13:420-433. Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, the
Netherlands
E-mail: n.keijsers@maartenskliniek.nl
A39 Journal of Foot and Ankle Research 2014, 7(Suppl 1):A40
Foot and ankle biomechanics play a role in biomechanical response to
lateral wedge insoles Background: Plantar pressure is highly influenced by many factors such
Richard K Jones1*, Graham J Chapman2, Matthew J Parkes3, Laura Forsythe3, as walking velocity, body weight, and age. The impact of these subject
David T Felson3 characteristics on plantar pressure is usually studied separately. However,
1
Centre for Health Science Research, University of Salford, Greater many of these factors are interact with each other; for example walking
Manchester, M6 6PU, UK; 2Institute of Rheumatic and Musculoskeletal velocity is negatively correlated with body weight and age. The purpose
Disease, University of Leeds, Leeds, UK; 3Arthritis Research UK Epidemiology of this study is to investigate the effect of several subject characteristics
Unit, University of Manchester, Manchester, UK in relation to plantar pressure pattern for a large group of subjects.
E-mail: r.k.jones@salford.ac.uk Materials and methods: Plantar pressure measurements of 589 subjects
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A39 were used in this study. All subjects walked barefoot over a Foot Scan
pressure plate (Rsscan International, Olen, Belgium) mounted on top of a
Background: Lateral wedge insoles have consistently shown to reduce the force plate (Kistler Instruments, Switzerland) at their preferred walking
external knee adduction moment (EKAM) in medial knee osteoarthritis (OA) speed. A total of five trials per foot were measured using a 3-step-protocol.
patients; although there is evidence that certain patients have a Plantar pressure data was analyzed for each pixel by using the normalization
paradoxical increase in EKAM. This may be a key factor in determining method of Keijsers et. al. [1]. For each pixel, a multiple step forward linear
clinical response and thus identifying and understanding why these regression analysis was used with mean pressure as dependent variable and
patients increase EKAM is critical for prescribing the correct treatment for the following subject characteristics as independent variables: body weight,
these patients. Previous evidence has suggested that foot and ankle contact time, age, body length, sex, foot progression angle, foot length, foot
biomechanics play a role in reducing EKAM by shifting the centre of foot width, and side. Finally, the correlation coefficient of the full model for each
pressure (COFP) laterally and increasing the valgus orientation of the pixel was calculated.
calcaneus, which shortens the lever arm in respect of the knee, thus Results: The subject characteristics varied largely between subjects. The
reducing the EKAM. To date, patients have been studied irrespective of influence of each factor on the pressure of each pixel is shown in Figure 1.
biomechanical response to lateral wedge insoles. In this study we Body weight was the most important factor and was selected as parameter
investigated whether dynamic ankle biomechanics can assist in identifying in 80.0% of the pixels. Body weight and walking velocity mainly have a
and explaining why some patients increase EKAM and other decrease positive effect on plantar pressure, whereas body length has a negative
EKAM when wearing a lateral wedge. effect. The pressure under the heel, midfoot and distal part of the
Methods: Participants diagnosed with medial knee OA were recruited to forefoot showed the highest correlation coefficient values with subject
the study. Each participant underwent a 3D kinematic (Qualysis OQUS, characteristics.
Figure 1(abstract A40) Red indicates an increase in pressure (sex: man; side: left) and blue a decrease in pressure with increasing subject characteristic.
Conclusions: Subject characteristics and especially the body weight and measuring the STJ sagittal plane inclination. Intra Correlation Coefficient
foot size play an important role in plantar pressure. Multiple regression (ICC) was used to analyze day-to-day reliability of the locator.
analysis or adding subject characteristics as covariates is recommended Conclusion: The locator may be used in the clinical setting since validity
when differences in plantar pressure between groups are studied. verified by correlation was high and the intra-test correlation coefficient was
Reference large indicating consistent measurements. Along with the locator
1. Keijsers, et al: J. Biomech 2009, 42:87-90. measurement, it is suggested that further study including motion analysis
may provide more information regarding the relationship between
inclination of STJ AoR and movement at the STJ.
A41 References
Validity and reliability of a novel subtalar joint axis of rotation locator 1. McClay I, Bray J: The Subtalar Angle: A Proposed Measure of Rearfoot
measurement device Structure. Foot Ankle Intl 1996, 17(8):495-502.
BH Kim, SC Lee, HD Lee, SY Lee* 2. Spooner SK, Kirby KA: The Subtalar Joint Axis Locator. J Am Podiatr Med
Department of Physical Education, Yonsei University, Seoul, Korea Assoc 2006, 96(3):212-219.
E-mail: sylee1@yonsei.ac.kr
A42
Context: Inclination of the subtalar joint (STJ) in the transverse and Template-based landmark and region mapping of bone
sagittal planes may be highly associated with ankle sprain mechanisms. Jaeil Kim1, Sang Gyo Seo2, Dong Yeon Lee2, Jinah Park1*
1
However, the validity and reliability of measuring inclination of the STJ Department of Computer Science, Korea Advanced Institute of Science and
axis of rotation (AoR) is not well established. Technology, Daejeon, South Korea; 2Orthopedic Surgery, Seoul National
Objective: The purposes of this study were to: 1) examine the validity of University Hospital, Seoul, South Korea
a custom made instrument (locator) to measure the STJ AoR on the basis E-mail: jinahpark@kaist.ac.kr
of the STJ inclination measured by X-ray, 2) to measure the intra-tester Journal of Foot and Ankle Research 2014, 7(Suppl 1):A42
reliability of the locator.
Design: Cross sectional study. Background: The shape morphology using 3D surface models has been
Setting: Biomechanics laboratory. recently emerged for biomechanics research, such as the quantitative
Participants: Twenty nine healthy male (age: 22.89±9.11 yrs; weight: 77.68 assessment of bone deformity with clinical factors [1] and the correlation
±18.32 kg; height: 176.16±14.16 cm) and Nine health female (age: 25±8 yrs; analysis between bone shape and joint motion [2]. In the bone shape
weight: 54.42±8.42 kg; height: 164.33±7.67 cm) subjects were recruited for morphology, the morphological difference of the bones across subjects is
this study. quantified by the geometric measures, such as the curvature of the
Intervention: No Intervention. articular surface and the relative bone orientation in joints, defined with
Main outcome measures: Variables that were measured in this study the anatomical landmarks and regions on the bone surface. However, the
were as follows: 1) Inclination of STJ AoR in the sagittal plane measured by landmark and region determination on individual cases is a difficult and
radiographic images (Median MDXP-40 Inc, Korea) of the foot in the time-consuming task, because of the various size and shape of the bones
sagittal plane. In order to collect radiological images of the foot, subjects and operator’s errors.
stood with a tandem position and the STJ was placed in neutral position. In this paper, we propose an automated landmark and region mapping
Sagittal plane inclination of the STJ AoR were further analyzed using method based on a non-rigid template-to-image registration. The template
ViewRex (TechHeim, Korea) per McClay‘s method [1]; 2) Inclination of the model is a triangular mesh including the generic shape of the target. It also
STJ AoR in the sagittal plane was measured by the locator; 3) Inclination of encodes the landmarks and regions as a subset of the points in the
the STJ AoR in the transverse plane was measured by the locator. The triangular mesh. For the landmark and region mapping to individual bones,
anterior and posterior exit point were determined per Kirby’s method [2]. the template model is non-rigidly deformed by a Laplacian deformation
Once the locator was aligned along two points, (anterior medial and framework [3]. This framework derives the point transformation into the
posterior lateral exit point) a Digital Mini Protractor (WWC-TE Bevel Box, image boundary while minimizing the distortion of the point distribution in
USA) was used to measure inclination angle. Pearson correlation was used the template model. This behavior of the deformation framework helps to
to analyze the relationship of validity between radiographs and the locator trace the positions of the anatomical landmarks and regions across subjects.
Results: For our experiment, the calcaneus template model was constructed
from the manually segmented CT scans. We assigned 7 landmarks and the
Table 1(abstract A41) Intra-test reliability about STJ articular surface for the talus in the calcaneus model. We applied our
sagittal plane method to the segmentations of three subjects having the different size
calcanei. Figure 1 (top) shows the reconstructed models with the articular
Pearson correlation(.782) ICC(.907) surfaces, which were automatically labeled, shown in different colors. The
1) X-ray 2) Locator T.1 T.2 accuracy of the individual shape reconstruction was a volume overlap
(complete overlap=1.0) of 0.981±0.009 and a mean distance of 0.349±0.423
M°±SD° 42.50±2.76 43.58±3.23 42.22±1.79 42.86±2.02 mm with respect to the segmentations. To validate the consistency of the
Figure 1(abstract A42) Articular surface and landmarks, which are automatically identified for the calcanei of 3 subjects
automatic landmark determination, three blinded operators manually of constraining the movement of the tendon. If our hypothesis is true, the
assigned the landmarks in the reconstructed models. Considering the interaction of obstruction should be strongly synchronized to that of the tip of
operator variations, the automatic landmarks (green) were consistent with the Sol muscle as the ankle rotates.
the manual landmarks (yellow) in the template and individual models, as Methods: The anatomical location (x and y coordinates) and tissue
shows in Figure 1 (bottom). These results indicate that our method movement (velocity) of Achilles tendon inflection point, which corresponds
determines the accurate positions of the anatomical landmarks and regions to the obstruction, and also those of the extremity of Sol distal edge were
while restoring the individual shape characteristics of bones. We plan to determined during passive and active contractions using MRI (n=6).
assess the robustness and accuracy of the automatic landmark and region A simple geometrical model was used to investigate how the position of the
mapping with larger datasets. obstruction influences force and velocity gains.
Acknowledgement: This research was supported by Basic Science Results and discussions: With increasing ankle angle, inflection point and
Research Program through the National Research Foundation of Korea extremity of the Sol distal edge moved in proximal and anterior directions
(NRF) funded by the Ministry of Education, Science and Technology (Figure 1B). The displacement vector, which implies a magnitude and
(No. 2011-0009761). direction, of the inflection point during ankle rotation was significantly
References correlated with the extremity of Sol distal edge (Figure 1C). A remarkable
1. Neogi T, Bowes MA, Niu J, De Souza KM, Vincent GR, Goggins J, Zhang Y, similarity of the cross-correlation coefficient was also found (Figure 1D).
Felson DT: Magnetic resonance imaging-based three-dimensional bone When the ankle initiated the plantarflexion force exertion, the Kager’s fat
shape of the knee predicts onset of knee osteoarthritis: data from the pad moved posteriorly, but the Sol muscle moved anteriorly. These results
osteoarthritis initiative. Arthritis Rheum 2013, 65:2048-2058. can be interpreted as direct evidence that the Sol muscle constrained the
2. Peeters K, Schreuer J, Burg F, Behets C, Van Bouwel S, Dereymaeker G, posterior movement of the Achilles tendon as ankle rotated, while the
Sloten JV, Jonkers I: Alterated talar and navicular bone morphology is Kager’s fat pad did not. The gain would depend on the location of the
associated with pes planus deformity: A CT-scan study. J Orthop Res obstruction relative to the ankle center of rotation. A more distal located
2012, 31:282-287. obstruction resulted in variable gain over the range of motion; reduced
3. Kim J, Park J: Organ Shape Modeling Based on the Laplacian force gain but increased velocity gain at high angles of plantarflexion.
Deformation Framework for Surface-Based Morphometry Studies. Conclusions: The Achilles tendon obstruction is likely to be emerged the
J Comp Sci Eng 2012, 6:219-226.3. location of boundary region between the Sol muscle and Kager’s fat pad
when ankle positioned plantarflexion. Further, obstruction can provide a
means of managing the tradeoff between force and velocity inherent in a
A43 finite power source and may effectively emerge in a location of terminal
Uncover the identity of obstruction on the Achilles tendon part of a joint such as foot or hand due to responsible for quicker
Ryuta Kinugasa1*, John A Hodgson2, V Reggie Edgerton2, Shantanu Sinha3 movement rather than larger force exertions.
1
Department of Human Sciences, Kanagawa University, Yokohama,
Kanagawa, 2218686, Japan; 2Department of Integrative Biology and
Physiology, University of California Los Angeles, Los Angles, California, 90095, A44
USA; 3Department of Radiology, University of California San Diego, San Effects of the Thai massage program on range of motion of lower
Diego, California, 92121, USA extremities and vertical jump performance in collegiate volleyball
E-mail: rk@kanagawa-u.ac.jp players, Burapha Univeristy, Thailand
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A43 Sirikool Klumkool1,3*, Kawiya Sintara1, Sakesan Tongkhambancsong2
1
Faculty of Sport Science, Burapha University, Thailand; 2Faculty of Education,
Introduction: A mechanism must operate directly on the Achilles tendon Burapha University, Thailand; 3 School of Health Science, Mae Fah Luang
which in effect introduces an obstruction to the outward movement of the University, Thailand
Achilles tendon, but the features of this obstruction (what is the E-mail: AKEATM@hotmail.com
fundamental nature and cause and its physiological significance) are Journal of Foot and Ankle Research 2014, 7(Suppl 1):A44
largely unexplored. We hypothesized that the obstruction arises from the
differences in mechanical properties between muscle contractile tissue and Sport massage can enhance athletic physical performance which is similar to
non-contractile tissue. A possibility is that the pennate arrangement of Thai traditional massage but no evidence reports the increase in athletic
muscle fibers results in a mechanical system which applies force vectors performance before competition. The purpose of this research was to study
perpendicular to the muscle fiber axis, similar to that described for the effects of the Thai massage program on range of motion (ROM) of lower
action of intercostal muscle on the rib cage. The distal region of soleus extremities and vertical jump performance (VJP) in collegiate volleyball
(Sol) muscle has an unipennate arrangement, with fibers oriented between players. Twelve males and twelve females in collegiate volleyball, age
the posterior aponeurosis and anterior surface of the muscle. Although this between 18-22 years, were randomly divided into two groups; experimental
configuration can constitute a constraint to the posterior movement of the (N = 12) and control groups (N=12). All subjects were measured ROM
Achilles tendon, the Kager’s fat pad, being non-contractile tissue, will be including knee flexion, ankle plantarflexion and dorsiflexion, and VJP. Thai
unable to actively develop any force and – render it mechanical incapable massage program was applied to the experimental group for 30 minutes
Figure 1(abstract A43) The synchronized movement between the inflection point and extreme distal edge of soleus (Sol) muscle during muscle
contraction.
and the control group sat still for 30 minutes. The post-test was done and and Rt. ankle dorsiflexion were significantly different between groups
the tests were repeatedly measured every other day for 3 days. The mean (p = .015, .002, .011, .004, .000, and .000, respectively). Vertical jump
differences of the pre and post-test data were calculated and statistically performance was significantly different between groups (p = .026). Thai
analyzed by using repeatedly measured ANCOVA at the level of .05. The massage program was able to increase ROM of the lower extremities and
results showed that the mean difference of ROM of Lt. knee flexion, Rt. knee jump performance. Thai Massage was able to warm for improving
flexion, Lt. ankle plantarflexion, Rt. ankle plantarflexion, Lt. ankle dorsiflexion, performance in competition.
A45 A46
Comparison of biomechanical foot analyses between nine Flemish foot- Measuring foot and ankle kinematics using a bi-plane fluoroscopic
experts system
Ingrid Knippels1*, Tom Saey1, Inge Van den Herrewegen1, Mario Broeckx1, Seungbum Koo1*, Kyoung M Lee2
Kris Cuppens1, Louis Peeraer1,2 1
School of Mechanical Engineering, Chung-Ang University, Seoul, South
1
MOBILAB, Thomas More Kempen, Geel, Belgium; 2Faculty of Kinesiology and Korea; 2Department of Orthopedic Surgery, Seoul National University
Rehabilitation Sciences, KU Leuven, Leuven, Belgium Bundang Hospital, Seongnam, South Korea
E-mail: ingrid.knippels@thomasmore.be E-mail: skoo@cau.ac.kr
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A45 Journal of Foot and Ankle Research 2014, 7(Suppl 1):A46
Introduction: Treatment or prevention of specific foot problems often Background: Accurate measurements of skeletal kinematics of the foot
requires an analysis of the biomechanics of the foot. These analyses can be would increase our understanding on the interaction between foot and
performed by different experts. Specifically, in Flanders, they may be footwear. Previously foot kinematics was measured using reflective markers
performed by medical doctors in orthopaedics and rehabilitation, but the method had inherent limitation of skin marker-based methods.
orthopaedic technologists, or podiatrists. It is well known that there is no Recently fluoroscopic imaging-based methods has been developed and
standardization yet of clinical methods to analyse foot biomechanics [1,2]. widely used to measure knee kinematics [1,2]. We have made a bi-plane
The purpose of this study was to investigate to what extent foot experts fluoroscopic imaging system and a walkway where continuous foot X-ray
differ in biomechanical foot analyses. The presented data is a pilot study on images could be taken during walking. The objective of the study was to
6 subjects, analysed by 9 experts. The complete study will be performed on understand the possibility of bi-plane fluoroscopic system for measuring
78 subjects by 10 experts. In that larger study, all subjects will also be foot and ankle kinematics.
analysed with advanced gait analyses methods. This to correlate the clinical Methods: The walkway was made of high density polystyrene foam,
data to objective, quantitative data, and develop foot typology. whose size was 1.2 m, 0.6 m and 4.0 m for height, width and length,
Methods: Nine Flemish foot experts; 3 podiatrists, 5 orthopaedic respectively. The target foot position was marked on the walkway and the
technologists and 1 foot surgeon performed a biomechanical analysis of the directions of the two X-ray imaging systems were carefully determined to
left foot of 6 adult subjects. All subjects were healthy, wearing normal shoes. capture the silhouettes of talus, calcaneus, navicular and tibia during the
There were 3 male and 3 female subjects, average age 37 (range 26 – 54). stance phase of walking. The study was approved by the IRB at Chung-Ang
The tools used were different for all experts; ranging from podoscopes to University. An informed consent was obtained from each volunteer prior to
goniometers, an instrumented treadmill and pressure plates. All experts testing. Subjects walked on the walkway at their self-selected normal
used the techniques they normally use in clinical practice and took between speed and the bi-plane fluoroscopic images were taken for 2 seconds.
5 and 25 minutes per subject. The results of the analyses were filled in on a Images for calculating geometric calibration of the imaging system were
specially developed form, containing multiple choice questions on 13 taken. The subjects underwent computed tomographic (CT) imaging and
mobility, 16 static and 18 dynamic features of the feet. Also, 10 questions on three-dimensional bone models were obtained. A semi-automatic and
pressure related parameters were added. All experts were free to choose manual registration methods were used to determine the positions and
which questions were answered. orientations of the four target bones for each frame of the bi-plane images
Results: The results varied substantially between the 9 experts. As an during the stance phase of walking. The quality of silhouettes of the bones
example, data of 4 static parameters is summarized in Table 1. For all varied throughout the stance phase.
other parameters, agreement between experts was more or less similar, Results: Ten subjects (age 21.5±1.9, all males, BMI 21.7±1.9) volunteered
with experts disagreeing frequently. for the study. The registration results showed some degrees of vibration of
Discussion: We compared all analyses between 9 experts for 6 subjects. the bones, motion noise. The general trend of foot and ankle kinematics
With the total of 78 subjects we will perform statistical analyses to see which could be observed.
parameters are performing worst. The link with gait, dynamic 3d scanning, Conclusions: Foot and ankle skeletons could be imaged during the
pressure and force plate measurements will show which parameters can be stance phase of walking using a bi-plane fluoroscopic system set-up
measured correctly clinically, without the need of special equipment, and along a polystyrene foam walkway. The positions and orientations of the
which parameters cannot. With the use of machine learning techniques foot foot and ankle bones could be calculated from the bi-plane images but
types will be defined. This foot typology will also give insight in which the results showed some degrees of noise in their motions.
parameters are essential to correctly determine the foot type of an Acknowledgements: This research was supported by Basic Science
individual. Research Program through the National Research Foundation of Korea
References (NRF) funded by the Ministry of Science, ICT & Future Planning (MSIP)
1. Wrobel J, Amstrong D: Reliability and validity of current physical (No. 2013R1A2A2A03015668).
examination techniques of the foot and ankle. J Am Podiatr Med Assoc References
2008, 98(3):197-206. 1. Tashman S, Collon D, Anderson K, Kolowich P, Anderst W: Abnormal
2. Jarvis H, Nester C, Jones R, et al: Inter-assessor reliability of practice based rotational knee motion during running after anterior cruciate ligament
biomechanical assessment of the foot and ankle. J Foot Ankle Res 2012, 5:14. reconstruction. Am J Sports Med 2004, 32:975-983.
Table 1(abstract A45) Summary of 4 static parameters for 6 subjects analysed by 9 experts. Numbers represent the
number of experts that chose that option. The bold values indicate contradictory responses.
Calcaneus in relaxed stance Forefoot position (relative to hindfoot) Hallux valgus Longitudinal arch
Subject Varus Valgus Normal .Abduct .Adduct Normal No Yes Extreme High Low Normal
1 0 5 4 2 0 4 6 3 0 1 1 7
2 0 2 7 1 1 4 9 0 0 0 3 6
3 1 3 5 2 0 4 8 1 0 5 0 4
4 0 4 5 0 0 6 7 1 1 4 0 5
5 0 2 6 1 0 5 7 2 0 2 0 7
6 0 2 7 0 0 6 8 1 0 0 1 7
Figure 1(abstract A46) Bi-plane fluoroscopic imaging system and walking (left) and the calculation results for the positions and orientations of talus,
calcaneus, navicular and tibia (right)
2. Li G, Wuerz TH, DeFrate LE: Feasibility of using orthogonal fluoroscopic of COP in the forefoot. This observation is probably related to the
images to measure in vivo joint kinematics. J Biomech Eng 2004, 126:314-318. hindfoot eversion and forefoot pronation seen in flat footed individuals.
This result combined with the reduction in percentage of ROP in the
forefoot region and reduced walking speed would suggest a dysfunction
A47 in progression of the second rocker.
Centre of pressure progression and gait parameter deviations may be References
related to second rocker dysfunction in children with flat feet 1. Jameson ED, Anderson J, Davis R, Blackhurst D, Christopher L: Dynamic
Alpesh Kothari1*, Catriona Kerr2, Julie Stebbins3, Amy B Zavatsky2, pedobarography for children. Use of the centre of pressure progression.
Tim Theologis1 Journal of Pediatric Orthopaedics 2008, 28:254-258.
1
Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal 2. Westberry DE, et al: The operative correction of symptomatic flat foot
Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK; deformities in children: The relationship between static alignment and
2
Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, dynamic loading. Bone & Joint Journal 2013, 95-B(5):706-713.
UK; 3Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
A48
Background: The Centre of Pressure Progression (COPP) is thought to be The flexibility of the transverse arch of the forefoot on the forefoot
a useful measure of dynamic function of the foot [1]. The COPP has been loading in the flat feet deformity
used as an outcome measure in flat foot surgery, with an improved COPP Shintarou Kudo1*, Yasuhiko Hatanaka1,2
1
defining a successful surgical result [2]. It is, however, unclear how the Graduate school of medical science, Suzuka University of Medical Science,
COPP varies in children with flat feet (FF) compared to those with normal Suzuka, Mie, 510-0293, Japan; 2Department of Physiotherapy, Suzuka
arches (NA) and how this relates to dynamic function of the foot. The University of Medical Science, Suzuka, Mie, 510-0293, Japan
aim of this study was to quantify the differences in COPP between flat E-mail: shintarou.iimt@gmail.com
and normal arched children and also assess how these related to Journal of Foot and Ankle Research 2014, 7(Suppl 1):A48
temporal-spatial gait parameters.
Patient/materials and methods: Forty children with NA and twenty-one
with FF (age 8-15) underwent dynamic pedobarography with the Novel
Emed-M pressure plate system. A representative pressure trial at a self-
selected walking speed was masked into three foot regions (heel, midfoot
and forefoot). The position of the COPP line with respect to the long axis
of the foot was calculated and interpolated to sixty points and this was
normalised to foot size. Mean differences between COPP position for FF
and NA were calculated with 95% confidence intervals (CI) for each
interpolated point. The percentage of roll over process (ROP) in each foot
region was calculated and differences between groups were assessed
using a t-test. Walking speed normalised (NWS) to leg length was
obtained from three dimensional motion analysis.
Results: There were no significant age or gender differences between the
FF and NA group. The COP was more laterally placed in the FF group at
initial contact, but diverged medially as it progressed to the forefoot
(figure 1). The timings of the ROP demonstrated a significantly decreased
percentage of the ROP in the forefoot region of the FF group compared Figure 1(abstract A47) Mean difference and 95% confidence intervals
to the NA group; 50% vs 55% (p=0.03). NWS was significantly slower in (CIs) of COPP, as a proportion of foot width, between FF and NA
the FF group compared to the NA group (p=<0.001). groups. Significant differences are noted where confidence intervals
Conclusion: In this study we demonstrate that FF children have altered do not cross zero.
COPP compared to NA. The biggest difference is a more medial position
Table 1(abstract A48) The difference four parameters Methods: Seven male and 8 female subjects without a history of ankle
between standing and forefoot loading [median sprains participated. The order of rest intervals (10, 20, 40 seconds) and
reach direction (AM;anteriormedial, M:medial, PM:posteriormedial) were
(25%-75%)]. counterbalanced. A total of three visits were required. Subjects performed
Normal feet Flat feet p-values 7 consecutive trials of the SEBT in each of the 3 directions. The final 3
trials were used for analysis. Initial and peak ankle joint angles of
Diff-FFW 1.52 % (1.17-2.11) 2.08 % (1.78-3.07) p<0.001
eversion(EV), dorsiflexion(DF), and tibial internal rotation(TIR) were
Diff-TAHH 1.79 % (1.28-2.45) 2.78 % (2.15-3.63) p<0.001 measured using three-dimensional motion analysis. Excursions and
Diff-MFW 1.31 % (0.94-1.66) 1.17 % (0.94-1.66) p=0.21 coupling angles were calculated for each individual and ensemble
averages were created. Two-factor analyses of variance were used to
Diff-TAHB 3.20 % (2.33-4.68) 3.18 % (2.68-4.23) p=0.46 compare excursions of DF, EV and TIR and coupling ratios of TIR/DF and
TIR/EV across the 3 directions in the 3 rest interval groups.
Results: There were no significant differences for any variables across rest
Background: For the flat foot deformity, the custom made foot orthosis intervals. Differences existed across directions only (Table 1). There were
supported medial longitudinal arch using the navicular pad. And we no interactions on any variables.
experienced many cases that addition the metatarsal pad which Conclusions: Different intervals of rest ranging from 10 to 40s did not
supported transverse arch of the forefoot was more effective treatments. influence ankle angular excursions or coupling ratios during the SEBT in a
However, the flexibility of the transverse arch in the flat foot deformity healthy population. There is a progressively decreased demand for ankle DF
was unclear. The aim of this study was to clarify the flexibility of the when moving from AM to PM. Further, TIR of ankle in AM occurs less than in
transverse arch of the forefoot in the flat foot deformity on the forefoot both M and PM. Based on these results, DF, TIR, and the coupling of these
loading condition. motions may play an important role in dynamic postural control as
Methods: The sixty-one feet of fifty-two normal volunteers (32 males and measured by the 3 directions of the SEBT. Future studies will focus on the
19 females, 22.0±3.8 years old) were participated in this study. They were comparison of healthy subjects and those with CAI.
categorized normal feet group and flat feet group by their foot posture References
and medical history around the foot. The ten spherical 4mm diameter 1. Kipp K, Palmieri-Smith RM: Differences in kinematic control of ankle joint
skin markers were mounted over the each metatarsal heads and bases. motions in people with chronic ankle instability. Clinical Biomechanics
Measurement foot stance forward and body weight lorded on the 2013, 23:562-567.
forefoot as well as possible with whole plantar surface in contacted with 2. Olmsted LC, Carcia CR, Hertel J, Shultz SJ: Efficacy of the Star Excursion
the floor. Foot motion was recorded using four Hi-definition digital video Balance Tests in detecting reach deficits in subjects with chronic ankle
cameras with 60 Hz. The ground reaction force and plantar foot instability. Journal of Athletic Training 2002, 37:501-506.
distributions were recorded using the force plate (Anima.co, Japan) and
the Win-pod (Medicaputures s.a.s. France) with 180 Hz, respectively. The
each marker was manually digitized using the Flame Dias4. The A50
calibration flame was used 64mm3 acryl cubes. The distance from the first Reduced plantar sensation leads to heterogeneous reactions in plantar
to the fifth metatarsal head and base were calculated as forefoot and mid pressure distribution during normal walking
foot width (FFW and MFW), respectively. The transverse arch height of Justin S Lange*, Thomas L Milani
both the metatarsal head and base (TAHH and TAHB) was defined as the Technische Universität Chemnitz, Chemnitz, Germany
distance from the second metatarsal head and base to the floor divided E-mail: justin.lange@hsw.tu-chemnitz.de
by FFW and MFW, respectively. The difference FFW and TAHH, MFW, Journal of Foot and Ankle Research 2014, 7(Suppl 1):A50
TAHB between rearfoot and forefoot loading were measured as Diff- FFW
and Diff-TAHH, Diff-MFW, Diff-TAHB. The four parameters were assessed Introduction: Many studies have determined the influence of provoking
among the two groups using Mann-Whitney test. reduced plantar foot sensitivity on plantar pressure distribution patterns
Results: The Diff-FFW and the Diff-TAHH had significant difference during the roll-over process (ROP) [1-3], but differ considerably in their
between two groups. And the Diff-MFW and the Diff-TAHB didn’t have approaches and results. This raises the question of whether the method
significant difference (Table 1). of provoking decreased plantar foot sensitivity is responsible for the
Conclusion: It was needed for physical therapy of the foot to understand different results or whether subjects respond so differently that there is
kinematics of the forefoot in the dynamic condition. The forefoot no uniform ROP reaction.
flexibility with the flat foot deformity was greater than that with the Therefore, the aim of this study was to evaluate individual response
normal feet. It might be better to insert the metatarsal pad which aimed patterns in the ROP after provoking reduced plantar foot sensitivity and
to increase the rigidity of the forefoot. to consider the homogeneity of this reaction pattern within the sample.
Methods: The plantar foot of 19 subjects was treated with EMLA® cream
containing the active ingredients lidocaine and prilocaine [4,5]. For each
subject, the plantar sensations of vibration and touch at heel, forefoot
A49 and hallux were measured before the intervention and at three intervals
Effects of rest intervals on lower extremity kinematics and coupling of 45 minutes (+15 min measuring time). Thereby the active course of
during the Star Excursion balance test the cream was documented. Nine anatomical sub-areas were identified
Yongung Kwon1*, Dorsey S Williams2
1
Department of Health and Human Performance, Virginia Commonwealth
University, Richmond, VA, 23284, USA; 2Department of Physical Therapy, Table 1(abstract A49) Mean(sd)° across directions
Virginia Commonwealth University, Richmond, VA, 23298, USA
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A49 AM M PM p value (ANOVA)
Excursion
Background: Kinematic differences exist in ankle joint motion between
individuals with and without chronic ankle instability (CAI) and have been EV 4.9(2.9) 4.7(2.8) 4.9(3.0) 0.90
recognized during walking, running and jumping[1]. The Star Excursion DF 13.2(5.1) *± 11.8(5.5) ¥
9.3(5.4) <0.01
Balance Test (SEBT) is a common test used to evaluate dynamic postural TIR -6.7(2.6) -8.2(4.7) *
-8.5(4.0) ±
0.05
control by measuring reach distance[2]. However, little is known
regarding lower extremity joint motion and coupling during this task and Ratio
regarding the between trial rest interval and its potential relationship to TIR/DF -0.6(0.4) -0.9(0.8) * -1.6(2.3) ±¥
<0.01
fatigue and kinematics. Therefore, the purpose of this study is to
TIR/EV -2.4(6.2) -2.4(3.1) -2.8(3.4) 0.93
investigate lower extremity kinematics and coupling relationships during
the SEBT at different rest intervals. p<0.05: *AM vs. M, ±AM vs. PM, ¥M vs. PM
Figure 1(abstract A50) Percentage change of relative load under the first metatarsal head of each subject
on the peak pressure footprint [6]. The average ROP of 10 steps was 9. Ivanenko YP, Cappellini G, Solopova IA, Grishin AA, MacLellan MJ,
determined at each measurement. Regression analyses were used to Poppele RE, Lacquaniti F: Plasticity and modular control of locomotor
estimate the relationships among sensation and ROP variables. Using patterns in neurological disorders with motor deficits. Frontiers in
data from a control group, ’clinical significance’[7] was used to evaluate computational neuroscience 2013, 7:123.
individual subject reactions. A hierarchical cluster analysis was used to
form groups with similar behaviour within the sample.
Results: Results showed strong interindividual differences in the process A51
of sensation reduction over time. A linear relationship between change in Relationship between intrinsic foot muscle weakness and pain: a
sensory perceptions and plantar pressure variables was not detected. systematic review
Nevertheless, the ROP results observed for each measurement differed Penelope J Latey1*, Joshua Burns1,2, Claire Hiller1, Elizabeth J Nightingale1
1
strongly between and within subjects (e.g. Figure 1). Using cluster Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences,
analysis, a group with a forefoot load increase was detected. Another University of Sydney, NSW, Australia; 2Institute for Neuroscience and
group showed less variation in their forefoot pressure variables. Muscular Research, The Children’s Hospital at Westmead, Sydney, NSW,
Discussion: The heterogeneity in the responses shows that subjects react Australia
differently when plantar foot sensitivity is perturbed by EMLA® cream. E-mail: plat6993@uni.sydney.edu.au
Thereby the ROP reaction seems to be not linear dependent from the Journal of Foot and Ankle Research 2014, 7(Suppl 1):A51
level of reduction of plantar sensation. Indications for the existence of
similar response patterns could be found despite the small sample size. Background: Foot muscle weakness has been linked with painful foot
In this study only a small time period of treatment was analysed. It pathologies. This systematic review evaluated the relationship between
remains unclear what would happen if plantar sensitivity was reduced for foot muscle weakness and foot pain in adults.
a longer period. Methods: Electronic databases (AgeLine, MEDLINE, CINHAL, AMED,
The complex interaction between the body, nervous system and Scopus, SPORT Discus, Web of Science) and reference lists were searched
environment may lead to various adaptive behaviours [8]. The idea of for all years up to March 2013. Two independent reviewers rated all
plasticity and modular control of locomotor patterns [9] could be useful included papers for methodological quality using a modified checklist
for further interpretations. from the Quality Index Tool. Due to the heterogeneity of studies, no data
References were pooled for meta-analysis.
1. Nurse M, Nigg BM: The effect of changes in foot sensation on plantar Results: Seven studies evaluated the relationship between foot muscle
pressure and muscle activity. Clinical Biomechanics 2001, 16:719-727. weakness and foot pain. Methodological quality varied from poor (40%) to
2. Eils E, Nolte S, Tewes M, Thorwesten L, Völker K, Rosenbaum D: Modified very good (89%). Four studies reported a significant relationship between
pressure distribution patterns in walking following reduction of plantar foot muscle weakness and foot pain. Participants with plantar fasciitis were
sensation. Journal of biomechanics 2002, 35(10):1307-1313. reported to have significant foot pain associated with a decrease in the
3. Höhne A, Stark C, Brüggemann GP: Plantar pressure distribution in gait is cross-sectional area of the forefoot musculature and reduced toe flexor
not affected by targeted reduced plantar cutaneous sensation. Clinical force. A study considering non-specific foot pain found a significant
Biomechanics 2009, 24(3):308-313. difference in dynamic toe flexor force between participants with disabling
4. Wahlgren CF, Quiding H: Depth of cutaneous analgesia after application foot pain versus no pain on some day(s) and on most/every day. Finally, a
of a eutectic mixture of the local anesthetics lidocaine and prilocaine clinical trial evaluating hallux limitus reported a significant improvement in
(EMLA cream). Journal of the American Academy of Dermatology 2000, pain and hallux plantar muscle strength after treatment. Of the three
42(4):584-588. studies reporting no association, two reported only on hind foot muscles
5. McDonnell M, Warden-Flood A: Effect of partial foot anaesthesia on and one had a restricted sample. Summary of data extracted and quality
normal gait. Australian journal of physiotherapy 2000, 46(2):115-122. index scores is shown in Table 1.
6. Maiwald C, Grau S, Krauss I, Mauch M, Axmann D, Horstmann T: Conclusion: Despite some conflicting data encountered in this systematic
Reproducibility of plantar pressure distribution data in barefoot running. review, there is evidence of a significant association between foot pain and
Journal of applied biomechanics 2008, 24:14-23. muscle weakness, primarily related to toe flexion and foot pain, when the
7. Jacobson NS, Truax P: Clinical significance: a statistical approach to pain is of frequent disabling intensity.
defining meaningful change in psychotherapy research. Journal of References
consulting and clinical psychology 1991, 59(1):12-19. 1. Munteanu SE, et al: Rheumatology 2012, 51(1):176-83.2.
8. Chiel HJ, Beer RD: The brain has a body: adaptive behavior emerges 2. Duranti R, et al: American Journal of Physical Medicine 1985, 64(6):295-304.3.
from interactions of nervous system, body and environment. Trends in 3. Schmid DT, et al: Radiology 2009, 253(1):160-6.4.
neurosciences 1997, 20(12):553-557. 4. Chang R, et al: Clinical Biomechanics 2012, 27(5):500-5.5.
Table 1(abstract A51) Summary of Participant Characteristics, Outcome Measures and Quality Index Scores of Included
Studies
Munteanu et al. Duranti et al. Schmid et al. Chang et al. Allen et al. Mickle et al. Shamus et al.
2012[1] 1985[2] 2009[3] 2012[4] 2003[5] 2011[6] 2004[7]
Sample size n=151 A: n=15 A: n=80 A: n=8 A: n=20 n=312 A: n=10
B: n=5 B: n=80 B: n=8 Bilat B: n=20 B: n=10
Mean age 54.5 (11.2) A: 55.4 A: 48 44.9 (8.4) A: 44.9 (9.2) 71 (6.5) A: 32 (6.3)
(SD), yrs
B: 51.7 B: 48 B: 43.1 (8.0) B: 33.6 (5.4)
Gender 95 M 56W A: 5M 10W A: 38M 42W 1M 7 W A: 4M 16W 158M 154W A: 2M 8W
B: 2M 3W B: 38M 42W B: 4M 16W B: 3M 7W
Pathologya OA of 1st MPJ HV/Chronic pain Foot pain Plantar fasciitis Plantar fasciitis Foot pain Hallux limitus
Muscle testsb Direct/PP Indirect/EMG Indirect/MRI Indirect/MRI Direct/St. G Direct/PP Direct/Dyno
Pain scalesc FHSQ P/A P/A FFI P+≥ 2 mths/A MFPDI Verbal p scale
Association No No No No/Yes Yes Yes Yes
Quality Index 81% 40% 56% 82% 78% 89% 71%
Score
Legend: A: Symptomatic Group B: Control Group Bilat - bilateral feet as control.
Pathologya: OA of 1st MPJ- osteoarthritis of 1st metatarsophalangeal joint; HV- hallux valgus.
Muscle testsb: Indirect: MRI- magnetic resonances imaging, EMG- electromyography. Direct: PP- pressure plate, St. G-strain gauge, Dyno- dynamometry.
Pain scalesc: FHSQ- Foot health survey questionnaire; P/A- present or absent; P + ≥ 2mths- present plus greater than or equal to 2 months duration;
FFI- Foot function index; MFPDI-Manchester foot pain and disability index; Verbal pain scale
5. Allen RH, et al: Journal of Orthopaedic & Sports Physical Therapy 2003, and post-op. Ground reaction force showed that the deficits in propulsion
33(8):468-478.6. and stability pre-op were resolved in both feet, i.e. with both implants.
6. Mickle KJ, et al: Arthritis Care & Research 2011, 63(11):1592-8.7. Conclusion: The combined lower limb and multi-segment foot kinematics
7. Shamus J, et al: Journal of Orthopaedic & Sports Physical Therapy 2004, analyses was found adequate and provided a thorough and accurate
34(7):368-76. functional assessment of the entire limbs. Both surgical treatments enabled
good restoration of the normal kinematics of the foot and of the lower limb
joints. This population will be monitored further to assess the functional
A52 progresses in time; preservation, or even improvement, of these results, are
Biomechanical assessment of two different surgical treatments for the expected.
correction of flat foot References
Lisa Berti1, Giulia Celin1, Paolo Caravaggi1*, Sandro Giannini1,2, 1. Giannini S, et al: Surgical treatment of flexible flatfoot in children: a four
Alberto Leardini1 year follow-up study. J Bone Joint Surg Am 2001, 83-A(Suppl 2 Pt 2):73-9.
1
Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, 40136, 2. Roth S, et al: Minimally invasive calcaneo-stop method for idiopathic,
Italy; 21st Division of Orthopedic Surgery, Istituto Ortopedico Rizzoli, Bologna, flexible pes planovalgus in children. Foot Ankle Int 2007, 28(9):991-5.
40136, Italy 3. Leardini A, et al: A new anatomically based protocol for gait analysis. Gait
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A52 Posture 2007, 26(4):560-71.
4. Leardini A, et al: Rear-foot, mid-foot and fore-foot motion during the
Introduction: The flat foot is a very frequent deformity in orthopedics and stance phase of gait. Gait Posture 2007, 25(3):453-62.
can be observed at different levels of severity already in childhood and
infancy. The possible functional alterations associated with flat feet are not
fully established. These can result in critical clinical consequences, such as A53
secondary deformities of the forefoot and lower limb, pain and muscle Preliminary model-based validation of a biplane fluoroscopy system
fatigue. The prescription of orthotics or indication for surgical interventions Joseph M Iaquinto1,2*, Richard Tsai1, Quoc-Bao Vu1, David R Haynor3,
are still much debated. A diagnosis based only on foot morphology is not Bruce J Sangeorzan1,4, William R Ledoux1,2,4
1
sufficient to decide the therapeutic approach. In fact, the degree of severity RR&D Center of Excellence, VA Puget Sound Healthcare System, Seattle, WA,
of the deformity and the effects of treatments require also careful functional 98108, USA; 2Depts. of Mechanical Eng, University of Washington, Seattle,
assessment. This study aims at investigating by means of movement WA, 98195, USA; 3Radiology, University of Washington, Seattle, WA, 98195,
analysis the effects of two different surgical treatments for severe flat foot. USA; 4Orthopaedics, University of Washington, Seattle, WA, 98195, USA
Methods: Ten children (11.3 ± 1.6 yrs, 19.7 ± 2.8 BMI) were operated for the Journal of Foot and Ankle Research 2014, 7(Suppl 1):A53
correction of flat foot [1,2] in both feet. One foot was corrected with a
calcaneo-stop method, i.e. a screw implanted into the calcaneus, and the Background: Biplane fluoroscopy can directly track the motion of bones
other with an endoprosthesis implanted into the sinus-tarsi. Gait analysis and therefore measure joint kinematics. Our prior marker-based work has
was performed pre- and 12 month post-operative, using a 8-camera motion demonstrated the ability of our system to accurately and precisely track
system (Vicon, UK). An established protocol for lower limb [3] and a multi- the motion of known objects (i.e., tantalum beads) [1]. In this study, we
segment foot kinematic analysis [4] were used to calculate joint rotations present the preliminary bone-based validation of our system by tracking
and moments during three walking trials for each subject. the bones of the foot from cadaveric specimens.
Results: Significant differences in standard X-ray measurements were Methods: Six bones (two each: calcaneus, talus and first metatarsal) were
observed between pre- and post-op, but not between feet. Analysis of the harvested from cadaveric feet and computed tomography (CT) scans of each
kinematic variables revealed important functional corrections. In particular, bone were obtained. The CT data were used to create digitally reconstructed
joint rotations at the ankle (Figure 1, left) and those between the metatarsus radiographs (DRRs) of each bone. Bones were attached to a single axis
and calcaneus segments (Figure 1, right) improved significantly between pre- translational stage and imaged at 1000Hz at 13 discrete positions; data were
Figure 1(abstract A52) Patterns of joint rotations between calcaneus and shank (two left columns), and between metatarsus and calcaneus (two right
columns), during pre-op (top) and at 12 month post-op (bottom). Where in red is the calcaneo-stop group, in green is the endoprosthesis group, and in
grey is the control group.
averaged to an effective 100Hz sampling rate. DRRs of each bone 2. Massimini DF, Warner JJ, Li G: Non-invasive determination of coupled
were matched to X-ray data from each fluoroscope, and the three- motion of the scapula and humerus– an in-vitro validation. J Biomech
dimensional position of each bone was calculated. Initial positions were 2011, 44(3):408-12.
manually found prior to the optimization algorithm calculating the 3. Bey MJ, Kline SK, Tashman S, Zauel R: Accuracy of biplane x-ray imaging
“best” pose for every frame of each position (Figure 1). Accuracy is the combined with model-based tracking for measuring in-vivo
root mean square (RMS) value of the difference between the software patellofemoral joint motion. J Orthop Surg Res 2008, 3(38).
determined position and the known linear stage position. Precision is
the standard deviation of the differences between these known and
measured positions. A54
Results: The translational accuracy for the entire data set (6 bones * 13 Ankle proprioception correlates with functional mobility in people with
positions per bone * 10 frames per position = 780 frames) was 0.066mm Peripheral Neuropathy
with a precision of ± 0.062mm (Table 1). Shuqi Zhang1,2, Li Li1*
1
Preliminary conclusions: These translational accuracy and precision Department of Health and Kinesiology, Georgia Southern University,
values match well with other similar dual fluoroscopy systems studying Statesboro, GA, 30458, USA; 2School of Kinesiology, Louisianan State
areas of the body such as the spine [2] and knee [3]. Further, these values University, Baton Rouge, LA, 70803, USA
are an order of magnitude improvement over optical motion capture E-mail: lili@georgiasouthern.edu
systems and have the ability to measure kinematics which are traditionally Journal of Foot and Ankle Research 2014, 7(Suppl 1):A54
difficult to capture in the foot, such as talar motion. The full model-based
validation of this system (which includes rotational and dynamic trials) is Introduction: The ankle proprioception could influence the functional
currently underway. stability of ankle joint. In addition, ankle proprioception may indirectly
Acknowledgements: The work was funded by VA RR&D Grant F7468R. influence postural control. Furthermore, ankle proprioception may play an
References important role in the impaired somatosensory system.
1. Iaquinto JM, Tsai R, Haynor DR, Fassbind MJ, Sangeorzan BJ, Ledoux WR: Purpose: The purpose is to examine if ankle proprioception is correlated
Marker-based validation of a biplane fluoroscopy system for quantifying with functional mobility in people with Peripheral Neuropathy (PN) and
foot kinematics. Med Eng Phys 2013, 24, in press. health age-matched control.
Figure 1(abstract A53) Fluoroscopy data with matched DRR overlay. Note: dense fluoroscope objects, such as the translational stage adaptor (to the left
of the bone) show brighter than the background, while the DRR bone is displayed by pixel intensities darker than the background. Beads were not used.
Table 1(abstract A53) Individual bone accuracy and precision values, along with grand values for the six bone set.
Calcaneus 1 Calcaneus 2 Talus 1 Talus 2 Metatarsal 1 Metatarsal 2 Grand
Accuracy 0.075 0.026 0.025 0.033 0.023 0.012 0.066
Precision 0.087 0.025 0.029 0.028 0.030 0.018 0.062
Methods: Twenty one people with, and twelve age-matched without PN,
were recruited. Active (AAP) and passive (PAP) ankle proprioception were
assessed using Biodex 3 dynamometer (Biodex Medical System, Inc,
Shirley, NY, USA). Participants sat in the Biodex chair with the back of the
chair positioned at 70° with lower leg parallel with the ground. The
protocol of the active and passive reposition tests consisted of localizing
three target positions: 15° of inversion, 0° subtalar neutral, 10° of eversion
[1]. We have also tested foot sole sensation. The foot sole sensitivity (FSS)
was tested at big toe (BT), 1st and 5th metatarsal (M1 and M5), midfoot
(MF) and medial heel (MH) with a 5.07 monofilament [2]. The overall
score of one foot was the number of its sensitive sites, ranged from 0 to
5. Functional mobility test (6-minute walk test and timed up-and-go test)
were performed following standard procedures in both groups. Group
effects were analyzed by ANOVA. Pearson correlation tests were used to
examine the relationships between ankle proprioception tests and
functional mobility measures.
Results: There were significant different of AAP (PN: 28.2 ± 17.6, H: 16.8 ±
8.3), PAP (PN: 20.7 ± 12.6, H: 11.7 ± 4.3), FSS (PN: 2.5 ± 2.0, H: 4.3 ± 1.2),
6MW (PN: 426.9 ± 95.2, H: 525.3 ± 68.1), and TUG (PN: 9.7 ± 2.4, H: 6.5 ±
1.3) between two groups. No other significant group effect was observed
among age, height and body mass. A significant positive correlation was
observed between AAP /PAP and TUG in people with PN (R= 0.52, P<.05,
R= 0.75, P<.05). A significant negative correlation was observed AAP/PAP
and 6MW (R= -0.46, P<.05, R= -0.51, P<.05). No other significant
correlation was observed.
Discussion: Ankle proprioception is important for the functional mobility
in the PN group, but not in the health control group. More accurate
ankle proprioception correlates with faster walking speed in people with Figure 1(abstract A55) Five segment foot kinematic model.
PN.
References
1. Manor B, Li L: Characteristics of Functional Gait among Older Adults with
and without Peripheral Neuropathy. Gait & Posture 2009, 30:253-6. Supinated feet classified by NCSP-RCSP and RRE had more medial excursion
2. Li L, Manor B: Long term Tai Chi exercise improves physical performance of the COP (COP-ME) during HO-TO (p<0.05). Feet classified as supinated
among people with peripheral neuropathy. Am J Chin Med 2010, by TPRE resulted in a greater COP-LMD in a stance (p<0.05) and their
38:449-59. COP_I was statistically significantly higher. Feet classified as supinated by
RRE showed higher COP-LMD value during HO-TO (p<0.05). The statistical
results showed a weak relationship between COP parameters of different
foot types (r<0.27). Dynamic measures of foot type showed a slightly
A55 stringer association to COP measures than static measures of foot type.
Association between foot types defined by static and dynamic Conclusion: Over all, whilst there were some differences between foot
measures, and the centre of pressure during gait types in some COP measures, the meaning of the observed differences
Su Liao1, Hannah L Javis2, Anmin Liu2, Christopher J Nester2*, does not support the hypothesis that COP parameters are strongly
Peter P Bowden2, Richard K Jones2, Kaiyu Xiong1 indicative of specific foot types. Thus, COP measures should not be used
1
Sport Science College, Beijing Sport University, Beijing, 100084, China; to infer foot kinematic nor foot function.
2
School of Health Sciences, University of Salford, Salford, M6 6PU, UK References
E-mail: c.j.nester@salford.ac.uk 1. Rao Smita, Riskowsk L Jody, Hannan T Marian: Musculoskeletal conditions
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A55 of the foot and ankle: Assessments and treatment options. Review Article
Best Practice & Research Clinical Rheumatology 2012, 26(3):345-368.
Background: Foot types (e.g. pronated, supinated foot) are used for
clinical reasoning [1] and widely assumed to be related to centre of
pressure (COP) patterns [2,3]. Specifically, a pronated foot will demonstrate
a medially deviated COP. It follows that COP could be a measure of foot Table 1(abstract A55)
type and inferences about function extrapolated from it. The purpose of Classification method Pronators Supinators
this study was to investigate whether COP parameters differ between foot
Foot Posture Index(FPI) ≥7 ≤-1
types.
Methods: Static foot posture, foot kinematics and COP data were Resting Calcaneal Stance Position (RCSP) ≤-2° ≥3°
collected on 90 healthy subjects during walking (Figure 1). The subjects
Difference between NCSP* and RCSP ≥8° ≤4°
were classified as pronated, supinated, and neutral groups using three
static and four dynamic methods (table 1). COP lateral and medial Peak Rearfoot Eversion(PRE) ≤-6.1° ≥-1.1°
excursion area, COP lateral medial difference (COP_LMD), and COP index
Time of Peak Rear foot Eversion (TPRE) ≥38% ≤26%
(COP_I) were calculated for different phases of stance [4-6]. Independent
T test and correlations were calculated among the different groups. Range of Rearfoot Eversion (RRE) ≥16.3° ≤10.5°
Results: Pronated feet (based on FPI) demonstrated more medial excursion Maximum Mid Foot Dorsiflexion ≥6.4° ≤1.1°
of the COP from heel strike to heel off (p<0.05). Pronated feet classified by
NCSP-RCSP demonstrated higher COP_I during HO-TO (p<0.05). *NCSP:neutral calcaneal stance position
2. Dixon SJ: Application of Centre-of-Pressure Data to Indicate Rear foot

Inversion-Eversion in Shod Running. Journal of the American Podiatric
Medical Association 2006, 96(4):305-12.
3. Han TR, Paik NJ, Im MS: Quantification of the path of centre of pressure
(COP) using an F-scan in-shoe transducer. 1999, 10:248-54.
4. Redmond AC, Crane1 YZ, Menz HB: Normative values for the Foot Posture
Index. Journal of Foot and Ankle Research 2008, 1(6).
5. Sobel Ellen, et al: Re-evaluation of the Relaxed Calcaneal Stance Position-
Reliability and Normal Values in Children and Adults. J Am Podiatric
Med. Assoc 1999, 89(5):258-64.
6. Landorf K, Keenan AM, Rushworth RL: Foot Orthosis Prescription Habits of
Australian and New Zealand Podiatric Physicians. J Am Podiatric Med.
Assoc 2001, 91(4):174-83.
Figure 1(abstract A57) Mean (± SD) abductor hallucis CSA in women
with and without hallux valgus deformity. * indicates significant difference.
A56
No relationship between foot posture and frontal knee alignment in
healthy adolescents
Shinsuke Matsumoto*, Shigeharu Tanaka
Dept. of Physical Therapy, Kawasaki Junior College of Rehabilitation, Toe deformities are highly prevalent in older people with up to 74% of older
Kurashiki, Okayama, 701-0192, Japan men and women having some degree of hallux valgus [1]. Despite the well
E-mail: shinn226@med.kawasaki-m.ac.jp documented hypotheses that atrophied, or weak toe flexor muscles are
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A56 associated with the formation of toe deformities [2], there has been little
evidence to support this theory. Only one study has directly compared the
Background: Foot posture has been suggested to be related to the toe flexor strength of individuals with toe deformities to those without,
development of lower-limb musculoskeletal conditions because of its revealing that older people with hallux valgus have reduced hallux strength
potential influence on the mechanical alignment and dynamic function of compared to those without the deformity [3]. Therefore, to further
the lower limb. During most weight bearing activities, the posture and investigate the pathomechanics of hallux valgus, this study aimed to
motion of the foot and knee are coupled within a closed kinematic chain. determine whether the size of the abductor hallucis muscle differed in older
The exact relationship, however, between them in healthy individuals is women with and without hallux valgus deformity.
not known. The purpose of this study was therefore to investigate if foot Forty-four older adults (60+ years) were recruited to participate in the
posture was related with frontal knee alignment in healthy adolescents. study. Each participant had their feet assessed by the Chief Investigator
Methods: The foot posture and frontal knee alignment of Forty-eight healthy (KJM), with hallux valgus severity rated using the Manchester Scale [4].
individuals ( 27 females, average age 21.1±2.8 yr, BMI 21.0±1.9) was assessed The abductor hallucis muscle was imaged using a GE Venue 40 US with a
and then analyzed to determine if any relationship exist between them. 6-9 MHz transducer [5]. Muscle cross-sectional area (CSA) was measured
The foot posture measurement was evaluated using FPI [1]. FPI values using Image J software with the assessor blinded to group allocation. Ten
ranged from -2 to +2 for each of the six criteria and from -12(highly participants (all women) were classified as having moderate or severe
supinated) to +12(highly pronated) for the total score. The raw FPI scores hallux valgus and their muscle size was compared to 10 age and BMI
were converted to transformed scores to allow the scores to be used as matched women without any hallux deformity.
interval data for statistical analysis. The older women with moderate-severe hallux valgus were found to have a
The Knee alignment measure was performed by measuring the femoral significantly reduced cross-sectional area of the abductor hallucis muscle
tibial angle (FTA) with a goniometer [2]. The axis of the goniometer was (p < 0.05; Figure 1). This may suggest that muscle weakness and atrophy is
positioned over the centre of the patella and the arms were aligned with associated with the development or progression of hallux valgus, however
the mid-thigh and with the tibial shaft. further longitudinal studies are required to confirm this notion. Further
Means of the FPI score and FTA were compared by gender using research is also required to determine whether strengthening the toe flexor
Student’s t-test. Pearson’s correlation coefficient was used to investigate muscles results in hypertrophic changes to muscle morphology and these
the relationship between the FPI score and FTA. results highlight the need to investigate whether strengthening the intrinsic
Results: There was no difference between FTA of males and females toe muscles could reduce the incidence and severity of toe deformities.
(176.5 vs. 176.7; p=0.792). The significant difference in FPI score between References
males and females was found (5.95 vs. 2.85; p=0.001). No relationship 1. Dunn JE, et al: Prevalence of foot and ankle conditions in a multiethnic
was found between the FPI score and FTA (r = 0.006, p = 0.978). community sample of older adults. Am. J. Epidemiol 2004, 159(5):491-8.
Conclusion: Static foot posture as quantified by FPI and frontal knee 2. Myerson MS, Shereff MJ: The pathological anatomy of claw and hammer
alignment as quantified by FTA do not seem to correlate each other in toes. J. Bone Joint Surg. Am 1989, 71-A(1):45-9.
healthy adolescents. These results should be interpreted with caution due 3. Mickle KJ, et al: ISB Clinical Biomechanics Award 2009: Toe weakness and
to a small sample size. deformity increase the risk of falls in older people. Clin. Biomech 2009,
References 24:787-791.
1. Redmond AC, Crosbie J, Ouvrier RA: Development and validation of a 4. Garrow AP, et al: The grading of hallux valgus. The Manchester Scale.
novel rating system for scoring standing foot posture: the Foot Posture J. Am. Podiatr. Med. Assoc 2001, 91(2):74-8.
Index. Clin Biomech 2006, 21:89-98. 5. Mickle K, et al: Reliability of ultrasound to measure morphology of the
2. Kraus VB, Vail TP, Worrell T, McDaniel G: A comparative assessment of toe flexor muscles. J Foot Ankle Res 2013, 6(1):12.
alignment angle of the knee by radiographic and physical examination
methods. Arthritis Rheum 2005, 52:1730-5.
A58
Effects of plantar fascia on first metatarsophalangeal joint stress in
A57 different foot types
Size of the abductor hallucis muscle in older women with hallux valgus Rajshree Mootanah1,4*, Khadija Saoudi2, Joel Mazella3, Antoine Truchetet2,
Karen J Mickle1*, Christopher J Nester2 Jonathan Deland4, Scott Ellis4, Josh Baxter4, Howard J Hillstrom4,1
1
1
Biomechanics Research Laboratory, University of Wollongong, NSW, 2522, Anglia Ruskin University, Chelmsford, Essex, UK; 2Universite de Lorraine,
Australia; 2Centre for Health Sciences Research, University of Salford, Salford, Nancy, France; 3Ecole des mines d’Albi-Carmaux, Albi, France; 4Hospital for
M6 6PU, UK Special Surgery, NY, USA
E-mail: kmickle@uow.edu.au E-mail: rajshree.mootanah@anglia.ac.uk
Figure 1(abstract A58) 1st MTPJ stress a) rectus, b) planus, and c) cavus foot types
Figure 2(abstract A58) Fascia stiffness effects
Osteoarthritis (OA) is the leading cause of disability in older adults [1] and important ‘tension band’ effect (Figure 2). Future research should develop
1st metatarsophalangeal joint (MTPJ) OA, is the most common form of OA methods of tuning plantar fascia material properties to represent a
in the foot [2]. Many foot pathologies are of a biomechanical nature and specific patient.
often associated with one foot type over another [3,4]. OA is postulated Acknowledgement: This work was in part supported by an NIH grant
to result from elevated joint stress. However, the link between stress 1R03HD053135-01.
distribution in the 1 st MTPJ and different foot types is not well References
understood. Furthermore the tension band effect of the plantar fascia 1. CDC: MMWR Morb Mortal Wkly Rep 2007, 56(01):4-7.
upon 1st MTP joint function is also not well understood. 2. Horton GA, et al: Foot Ankle Int 1999, 20(12):777-80.
A high resolution 7 Tesla MRI was used to create a geometrically accurate 3. Ledoux WR, et al: Foot Ankle Int 2003, 24(11):845-850.
3D model of the 1 st MTPJ using Mimics v14 imaging software. To 4. Sugathan HK, Sherlock DA: J Foot Ankle Surg 2009, 48(6):637-641.
simulate rectus, planus and cavus feet, 1st metatarsal declination angles 5. Cheung JT, Zhang M, An KN: Clin Biomech Bristol, Avon 2004, 19(8):839-46.
of 20.2°, 10.1° and 30.7° were constructed. Plantar fascia material 6. Rao S, Song J, Kraszewski A, et al: Gait Posture 2011, 34(1):131-7.
properties were altered. Physiological material properties and boundary
conditions were applied to solve for stress, using ABAQUS. The ligaments
were simulated by linear spring elements. The base of the first metatarsal A59
bone was mechanically grounded in this model. Plantar loading Modelling of forefoot injuries caused by brake pedal loading – a finite
conditions were applied, based on plantar pressure data collected from element analysis case study
different foot types. Bisola Mutingwende1*, Robert Ashford1, Clive Neal-Sturgess2, Maxine Lintern1,
Results of our static 3D FE model (Figure 1) during mid-stance of gait Jens Lahr3
1
showed peak stresses in the distal 1st MTPJ cartilage of 0.61 MPa, 0.97 Centre for Health and Social Care Research, Birmingham City University, UK;
2
MPa and 1.10 MPa for the rectus, cavus and planus foot type, respectively Department of Mechanical Engineering, The University of Birmingham, UK;
3
(Figure 1). First MTP joint stress is largest for planus and cavus foot types Faculty of Technology, Engineering and the Environment, Birmingham City
and least for well-aligned rectus feet. Global foot alignment affected the University, UK
magnitude and location of peak stress within the joint. Peak stress E-mail: bisola.mutingwende@bcu.ac.uk
decreases as the k increases suggesting that the plantar fascia plays an Journal of Foot and Ankle Research 2014, 7(Suppl 1):A59
Figure 1(abstract A59) Flow chart of method
Introduction: Lower extremity injuries, in particular the foot/ankle are one fractures in a car crash victim can be dictated by the loading pattern [5].
of the most common in automotive crashes.[1] Although not life However, there is little information about whether the pedal has an effect
threatening, they can lead to long term medical complications or on the mechanism or extent of injury. In order to evaluate the effect of
permanent disability[2]. In most cases foot and/or ankle fractures are caused brake pedal loading on the injury tolerance of the metatarsal, a computer
during frontal automotive crashes, while the driver attempts an emergency based finite element analysis was performed to assess the regional
brake and the foot is subject to crash loading [3]. In these cases, fractures of capabilities in terms of loading transmission around the forefoot.
the forefoot, in particular the metatarsals are very common [4] and range Methods: A Finite Element (FE) model of the foot and ankle was
from simple fractures to severe crush injuries [5]. The location of metatarsal developed from a 3D reconstruction of CT images [6] of a female subject
Figure 2(abstract A59) Equivalent Stress Distribution

using Simpleware (Simpleware® Ltd) segmentation software. The model Amputees suffer a higher metabolic demand on their bodies. Passive
was then imported into ANSYS Workbench for FE analysis (ANSYS® prostheses seek to reduce this deficit through elastic distribution of the
Academic Research, Release 14.0). Material properties for the analysis energy inherently dissipated in walking. Yet with no capacity to
were assumed to be homogenous and linearly isotropic. The cortical and generate torque they lack truly biomimetic function. The active
simple ligamentous structures attaching the bones together were prosthesis is a solution to this and opens up a world of active control
modelled. Variable pedal forces obtained from automobile crash data in the timing and magnitude of energy return. Being able to also
were applied to the forefoot region (i.e. ball of the foot) of the model, modulate the dynamic character of the replaced joint, in impedance
and the loading patterns of stress were analysed (Figure 1). and position, brings us closer to a true model of the ankle-foot
Results: The maximum stresses and angles of deflection were obtained complex. And so the ankle-foot complex can be seen to be modelled as
from applying a range of pedal forces (2kN-10kN). The resultant predicted a visco-elastic system with loading and unloading phases and active
loading patterns for the metatarsals were then analysed (Figure 2). The power output.
highest stresses were found at the smallest cross-sections of the metatarsals. It was identified that the concept of the active automobile suspension
Although bending stresses increase with increasing distance from the point system designed by Bose has the capacity to satisfy these functional
of load application, the larger cross-sections compensate for this effect. demands and so was investigated as a viable model for a prosthetic
Conclusion: The results of the current study show that the locations of device. In using this model, the ankle joint was modelled as a motor,
the maximum stresses appear on the second and third metatarsals. This driven in drive and dynamo modes to convert an elastic system into an
compares with findings from crash data. electromagnetic system based around a battery. Low power drain
References derived from significant power recovery makes this concept particularly
1. Crandall JR, Martin PG, Sieveka EM, Pilkey WD, Dischinger PC, interesting. The versatility of this concept is regarded as approaching
Burgess AR, O’Quinn TD, Schmidhauser CB: Lower Limb Response and that of the human beyond those devices that rely on passive or fixed
Injury in Frontal Crashes. Accident Analysis and Prevention 1998, elastic systems. This is active elasticity.
30(5):667-677. A CAD model was generated along with a corresponding control scheme.
2. Dischinger PC, Read KM, Kufera JA, Kerns TJ, Burch CA, Jawed N, Ho SM, The control system is proposed as a viable and innovative concept for
Burgess AR: Consequences and Costs of Lower Extremity Injuries. future prosthetics with great potential for development.
AnnuProcAssocAdvAutomot Med 2004, 48:339-53. This proposal makes use of underfoot sensors to determine the
3. Neale M, Thomas R, Bateman H, Hynd D: A Finite Element Modelling displacement of the fore and aft sections of the foot above ground, and
Investigation of Lower Leg Injuries. TRL Limited 2012, 07-0077. is proposed as an effective sensory concept to facilitate handling of
4. Mihai-Costin C: Injuries of the Foot and Ankle Joint and Their various terrain including slopes and stairs. The concept is seen as highly
Mechanisms. Technical paper for students and young engineers, University for versatile in this respect. Models for both slope and stair walking have
Medicine and Pharmacy “IuliuHatieganu” Cluj-Napoca- Fisita - World been implemented.
Automotive Congress, Barcelona 2004. An exponential function was proposed as a model for the action of
5. Arangio GA, Beam HN, Kowalczyk G, Salatht EP: Analysis of stress in the impedance at the ankle. This is a highly versatile function that can be
metatarsals. Foot and Ankle Surgery 1998, 4:123-128. matched, using discrete tuning parameters, to each phase of stance
6. Visible Human Project® (National Library of Medicine, National Institutes against a majority of samples during level walking. This function also
of Health, 8600 Rockville Pike Bethesda, MD 20894). . facilitates the smooth and controlled contact between the foot and the
ground when combined with the underfoot sensors.
The concept is not fully developed but has been initiated. Much further
A60 work is possible.
Active control of a powered ankle-foot prosthesis Thesis Supervisor: Professor Andrzej Ordys
Ashwin Needham*, Andrzej Ordys November 2013
School of Mechanical and Automotive Engineering, Kingston University, Reference
London, UK 1. Au SK: Powered ankle-foot prosthesis for the improvement of amputee
E-mail: ashwin.needham@hotmail.co.uk walking economy. Ph.D. dissertation, Massachusetts Inst. Technol Cambridge,
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A60 MA 2007, 21.
Figure 1(abstract A60) Torque-angle, or stiffness profile derived from exponential function. (Figure 1 inspired largely by [1] as a means of comparison to
a typical torque-angle profile.)
Table 1(abstract A62) HEE and MID placement error and

A61 angular differences between the AP, APH, APM, and
Signs and symptoms of foot and ankle dysfunction in children with
joint hypermobility APC axes.
Leslie L Nicholson1,3*, Verity Pacey2,3, Louise Tofts3,4, Craig Munns4,5, APM – APH – APC – MID Error HEE Error
Roger Adams6 AP(°) AP (°) AP (°) (mm) (mm)
1
Discipline of Biomedical Science, Sydney Medical School, The University of
Mean -0.4 -2.1 -2.5 1.8 1.9
Sydney, Australia; 2Physiotherapy Department, The Children’s Hospital at
Westmead, Sydney, Australia; 3Kids Rehab, The Children’s Hospital at Median 0.0 0.0 -0.2 1.7 1.7
Westmead, Sydney, Australia; 4Discipline of Paediatrics and Child Health,
IQR 1.3 14.1 15.4 8.7 6.3
Sydney Medical School, The University of Sydney, Sydney, Australia;
5
Endocrinology Department, The Children’s Hospital at Westmead, Sydney,
Australia; 6Discipline of Physiotherapy, Faculty of Health Sciences, The
University of Sydney, Sydney, Australia
E-mail: leslie.nicholson@sydney.edu.au Background: Measurement accuracy of joint kinematics is influenced by
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A61 how closely the trajectories of surface markers represent the motion of
underlying bones [1]. For the Oxford Foot Model (OFM) hindfoot
Background: Foot and ankle complaints are common in people with segment, the heel (HEE), lateral calcaneus (LCA) and sustentaculum tali
hypermobility. Children with hypermobility (Beighton score ≥4/9) were (STL) markers are used to track the movement of the calcaneus [2]. This
recruited for a longitudinal study from The Children’s Hospital at paper investigates the how changes in marker placement affect the
Westmead in Sydney, Australia. Baseline data included Beighton score, orientation of the OFM hindfoot segment axes.
BMI for age, Star Excursion Balance Test (SEBT), Foot Posture Index (FPI), Methods: Twenty adult females participated in the study (40 feet in
anterior drawer, subtalar inversion stress test, Lower Limb Assessment total). Radiopaque monitoring electrodes (Type 2223, 3M Healthcare,
Scale (LLAS), physical activity and child-rated quality of life (PedsQL). Neuss, Germany) were placed on the feet at the locations specified by
Results: 53 girls and 47 boys (mean age 11.5±3.1yrs) with a mean the OFM. CT images (GE 64-slice Lightspeed VCT scanner) were
Beighton score of 6.7/9 and LLAS of 8.2/12 were recruited. Of these 100 acquired as the subjects lay supine. The 3-Dimensional (3D) coordinates
children, 94 met the Brighton criteria for Joint Hypermobility Syndrome of the electrodes and of the points corresponding to the ideal marker
[1] and 90 met the Villefranche criteria for Ehlers-Danlos Syndrome- locations were extracted from the images, using Mimics (Materialise NV,
Hypermobility Type [2]. Of the entire cohort, 50% reported experiencing Leuven, Belgium). The marker based OFM A-P axis (AP) which extends
ankle joint pain and 13% foot pain that had lasted 3 or more months, from HEE to the mid-point (MID) of LCA and STL was calculated. A
36% reported recurrent “rolling” one or both ankles while only 8% corrected A-P axis based on the ideal HEE marker location (APH) was
reported foot instability. The average FPI in this cohort was +6.6, with also calculated. MID was then adjusted by correcting either LCA or STL
86% of the children having FPI scores of 5 or more and 19% with scores to make them equidistant from HEE, as specified by the OFM marker
of 10 or more. Paired samples t-tests revealed that those children who placement protocol. From that, a corrected A-P axis based on the
reported chronic ankle pain were the ones experiencing recurrent modified MID (APM) was computed. Finally, a fully corrected A-P axis
episodes of instability (p=0.016). Recurrent instability did not significantly (APC) based on the revised HEE and MID positions were obtained. The
correlate with anterior talofibular ligament laxity as assessed with the transverse plane projections of all the axes (AP, APH, APM, APC) were
ankle anterior drawer test or the subtalar inversion test or with foot compared.
posture (all p>0.5). While the Beighton score moderately correlated [3] Results: The results (Table 1) suggest that correcting the position of
(r=0.31, p= 0.002) with the LLAS, only the LLAS correlated with physical either the LCA or the STL marker induced less than 1° of change in the
activity (r=-0.29, p=0.005). The SEBT and BMI for age correlated anterior-posterior (A-P) axis for most feet. Whereas, when the HEE
moderately (r=0.4, p<0.001; r=-0.31, p=0.003) with child-rated quality marker position was aligned with the correct anatomical location, the
of life. orientation of the A-P axis was affected more as both the mean and
Conclusion: Half of the hypermobile cohort in this study reported interquartile (IQR) values infer. There was large variation in its
experiencing chronic ankle pain which was associated with recurrent orientation relative to the original A-P axis with a slight medial bias.
episodes of instability. Interestingly, instability and laxity were not From regression analysis it was found that, 1 mm of lateral shift in HEE
correlated in these children suggesting that instability may be placement was enough to cause approximately 4° of deviation in the
neuromuscular in origin. The LLAS may provide more valid A-P axis orientation.
quantification of the extent that lower limb joint hypermobility affects Conclusion: The anteroposterior orientation of the A-P axis is more
physical activity than the more commonly used Beighton score in these sensitive to the location of the HEE marker than to the locations of the
children. LCA and STL markers. Therefore, it is essential to ensure that the HEE
References marker is placed accurately.
1. Grahame R: The revised (Brighton 1998) criteria for the diagnosis of References
benign joint hypermobility. J Rheum 2000, 27(7):1777-1779. 1. Della Croce U, Leardini A, Chiari L, Cappozzo A: Human movement
2. Beighton P, DePaepe A, Steinmann B, Tsipouras P, Wenstrup RJ: Ehlers- analysis using stereophotogrammetry: part 4: assessment of anatomical
Danlos Syndromes: Revised Nosology, Villefranche, 1997. Am J Genetics landmark misplacement and its effects on joint kinematics. Gait &
1998, 77:31-37. Posture 2005, 21:226-237.
3. Cohen J: A power primer. Psychol Bull 1992, 112(1):155-9. 2. Stebbins J, Harrington M, Thompson N, Zavatsky AB, Theologis TN:
Repeatability of a model for measuring multi-segment foot kinematics
in children. Gait Posture 2006, 23:401-411.
A62
Effect of marker placement on Oxford Foot Model hindfoot segment A63
axes Alterations in lower-extremity sagittal plane joint moments due to
Adward MH Paik1*, Julie Stebbins2,3, Alpesh Kothari3, Amy B Zavatsky1 experimental knee pain and effusion during walking
1
Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, Jihong Park1*, Devin C Francom2, Matthew K Seeley3, J Ty Hopkins3
1
UK; 2Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Oxford, OX3 7LD, Department of Sports Medicine, Kyung Hee University, Yongin, Korea;
2
UK; 3Nuffield Department of Orthopaedics Rheumatology and Department of Applied Mathematics and Statistics, University of Santa Cruz,
Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Santa Cruz, USA; 3Department of Exercise Sciences, Brigham Young
Oxford, OX3 7LD, UK University, Provo, UT, USA
E-mail: adward.paik@eng.ox.ac.uk E-mail: jihong.park@khu.ac.kr
Figure 1(abstract A63) Summary of the FANOVAs. Colours, other than green, indicate between-condition differences. For example, under the effusion
condition, hip moment was less for the condition measurement than for the precondition measurement (i.e., experimental knee effusion resulted in a
decreased the ankle dorsi-flexion moment at initial contract. L: left (uninvolved), R: right (involved) C: control, E: effusion, P: pain, PE: pain+effusion Pre:
precondition, Cond: condition, Post: postcondition
Purpose: To examine acute alterations in lower-extremity sagittal plane

joint moments due to isolated and/or combined experimental knee joint A64
pain and effusion during walking. Quantifying degree of foot use impairment in hemiplegic gait using
Methods: Nineteen able-bodied subjects walked four different conditions center-of-pressure trajectory vector difference integrals
(control, effusion, pain, and pain+effusion), with a week between each TC Pataky*, H Tanaka, M Hashimoto
condition. We used previously-used injury models of pain [1] and joint Department of Bioengineering, Shinshu University, Ueda, Nagano, Japan
effusion [2] to the right side of the knee. The control condition consisted E-mail: tpataky@shinshu-u.ac.jp
of no injection. For each condition, subjects completed three walking trials Journal of Foot and Ankle Research 2014, 7(Suppl 1):A64
at three times: precondition (prior to injection(s)), condition (3 minutes
post injection(s)), and postcondition (30 minutes post injections). We used Introduction: Gait impairment manifestations can vary greatly amongst
a standard inverse dynamics approach (combining high speed video, hemiplegic patients, so it is difficult to derive a single parameter to
ground reaction force, and anthropometric data) to estimate sagittal-plane, summarize impairment severity. In a separate study we found that the
net, internal, joint moment for the hip, knee, and ankle during walking. A variance-normalized integrated difference amongst center-of-pressure
functional analysis of variance (FANOVA) approach was used to compare (COP) trajectories was positively correlated with gait impairment severity.
the aforementioned joint moment between conditions. This statistical The purpose of this study was to test whether this COP trajectory
approach allowed us to evaluate when differences exist, across the entire difference parameter could also differentiate involved from uninvolved
stance phase of gait, as well as the magnitude of the detected differences. limbs in hemiplegia.
Results: The FANOVAs detected between-session differences for the Methods: In-shoe COP trajectories were collected from (a) eight healthy
involved (right) and uninvolved legs (left; Figure 1). The three most students during treadmill walking, and (b) six hemiplegic patients during
important observations are (1) both decreased and increased joint level-ground walking. Ten time-normalized COP trajectories per subject
moments were observed during stance phase in all joints, (2) the were analyzed. Each subject was compared to the mean Control
uninvolved leg was also affected, (3) isolated joint effusion appears to play trajectory by first computing the Hotelling’s T2 statistic at each point in
wider role in joint moment alterations compared to isolated pain, and (4) a time (Eqn.1), then integrating over stance phase (Eqn.2):
combination of pain and joint effusion resulted in a summative effect.
Conclusion: Stimulation of the receptors specific to joint pressure T 2  nrTW 1r (1)
appears to cause higher impact on alterations in sagittal plane joint
moment compared to the nociceptor stimulation. Simultaneous knee
joint pain and effusion produced a summative effect on sagittal plane 100%
joint moments. Since knee joint effusion and pain are common COP trajectory difference 
 T (t )dt
2
(2)
symptoms in knee joint injuries, both variables should be controlled in
acute and chronic phase of rehabilitation in order to avoid altered joint 0
moments.
References Here n=10 is the number of footsteps, r is the instantaneous position
1. Park J, Hopkins JT: Induced anterior knee pain immediately reduces difference between a subject’s mean COP and the mean Control COP,
involuntary and voluntary quadriceps activation. Clin J Sport Med 2013, and W is its covariance (Figure 1a).
23:19-24. Results: Control subjects’ COP trajectories were qualitatively more similar
2. Hopkins JT: Knee joint effusion and cryotherapy alter lower chain to the Control mean than were those of Hemiplegic subjects. Compared
kinetics and muscle activity. J Athl Train 2006, 41:177-84. to Controls (9.4 ± 4.3) (Figure 1b), hemiplegic subjects exhibited greater
Figure 1(abstract A64) (a) Depiction of instantaneous vector difference with covariance ellipses. (b) Example Control T2 trajectory depicting COP
trajectory differences in time. (c) Example Hemiplegic T2 trajectory.
T2 integrals in both the involved (123.7 ± 117.3) (p=0.016) and uninvolved Results: The regression analysis showed that it was possible to explain
limbs (30.2 ± 14.4) (p=0.002) (Figure 1c). The T2 integral also tended to be between 21% and 47% of the variance in peak pressure, typically with a
greater in the involved vs. uninvolved limbs within-subjects (+252.2% ± set of 3-6 gait/anthropometric variables. However, the predictive power
200.0%) (p=0.048). of the neural networks was relatively low, between 24-49%
Discussion: These results suggest that the T 2 integral appears to be Conclusion: Although the results demonstrated clear correlations
useful metric for summarizing stance-phase foot use differences both between groups of gait/anthropometric variables and peak pressure, the
within- and between-subjects. A broader range of clinical conditions are predictive power of the algorithm was not high enough for routine use in
currently under investigation. clinical practice. This may be because additional input variables, such as
Acknowledgements: This work was supported by an ASTEP grant from bony geometry are required to improve algorithm accuracy.
the Japan Science and Technology Agency. Acknowledgments: We acknowledge support from the EU framework
7 programme (NMP2-SE-2009-229261).
References
A65 1. Chapman J, Preece S, Braunstein B, et al: Effect of rocker shoe design
Is it possible to predict optimal rocker shoe design using barefoot gait features on forefoot plantar pressures in people with and without
parameters? diabetes. Clin Biomech 2013, 28:679-85.
Jonathan D Chapman1, Stephen J Preece1, Christopher J Nester1*, 2. Morag E, Cavanagh PR: Structural and functional predictors of regional
Bjoern Braunstein2, Angela Höhne2, Gert-Peter Brüggermann2 peak pressures under the foot during walking. J Biomech 1999,
1
School of Health, Sport and Rehabilitation Sciences, University of Salford, 32:359-370.
UK; 2Institute of Biomechanics and Orthopaedics, German Sport University, 3. van Schie C, Ulbrecht JS, Becker MB, Cavanagh PR: Design criteria for rigid
Cologne, Germany rocker shoes. Foot & Ankle International 2000, 21:833-844.
E-mail: c.j.nester@salford.ac.uk
A66
Background: Curved rocker shoes are routinely prescribed for people Evaluating the effect of apex position and rocker in curved rocker
with diabetes in order reduce in-shoe plantar pressures. However, shoes
previous research has shown that different individuals may require Jonathan D Chapman1, Stephen J Preece1, Christopher J Nester1*,
different rocker outsole geometries in order to optimise pressure Bjoern Braunstein2, Angela Höhne2, Gert-Peter Brüggermann2
1
reduction [1,2]. This has led some researchers to suggest that every School of Health, Sport and Rehabilitation Sciences, University of Salford,
individual should try a range of possible outsole designs to identify the UK; 2Institute of Biomechanics and Orthopaedics, German Sport University,
design which maximises pressure reduction [1]. However, this process Cologne, Germany
may not be feasible in a clinical setting. Given that plantar pressure has E-mail: c.j.nester@salford.ac.uk
been shown to depend on specific gait variables [3], it may be possible Journal of Foot and Ankle Research 2014, 7(Suppl 1):A66
to develop an algorithm which could predict an individual’s pressure
response to a specific rocker outsole design using an input of gait data. Background: Curved rocker shoes are designed with a contoured outsole
Such an algorithm would remove the need to try on a large number of which can be characteristics by three principle design features: rocker
pairs of rocker shoes. angle, apex angle and apex position. Although these shoes are routinely
Objective: To investigate the accuracy of an algorithm developed to prescribed to reduce in-shoe pressure in patients with diabetes, there is
predict peak plantar pressure for eight different rocker shoes designs only minimal scientific evidence to inform the choice of value for each of
from an input of barefoot gait data. the three design features. Results from a previous study [1], suggested that
Methods: The eight rocker shoes designs spanned different combinations a 95° apex angle may be the best compromise for offloading the different
of two design features: rocker angle (15° or 20°) and apex position (52%, regions of the forefoot. The results of this study also suggested that higher
57%, 62%, 67% shoe length). A total of n=76 patients were recruited into rocker angle may lead to decrease pressure, however, this study did not
the study and each participant wore each of the eight shoes whilst foot quantify the precise effect of rocker angle and apex position in shoes with
pressure was measured during walking. A gait assessment was then a 95° apex angle.
carried out as the participant walked barefoot and a set of gait and Objective: To investigate the combined effect of varying rocker angle and
anthropometric variables defined as algorithm inputs. A separate apex position in rocker shoes designed with a 95° apex angle. A relatively
algorithm was then developed to predict peak plantar pressure for each thick outsole is required to produce a rocker shoes with a rocker angle of
of the eight shoes in three different forefoot regions. In order to develop 20° or greater. Therefore we also sought to quantify the proportion of
each algorithm, a regression approach was first used identify a suitable individuals with diabetes for which it would be possible to achieve
subset of inputs and to estimate the percentage of the variance in peak acceptable pressure offloading with a 15° rocker angle.
pressure explained by the inputs. A neural network was then developed Methods: A factorial design was used to investigate the effect of the two
and tested to assess predictive power. design features: rocker angle (15° or 20°) and apex position (52%, 57%, 62%,
67% shoe length). Eight rocker shoes were manufactured to cover this range studied has limited application to a real-life setting. The validity and
of design features and tested on n=87 patients with diabetes. Each participant repeatability of each system effects their appropriateness for applications
walked in every shoe at 1 ms-1 whilst in-shoe pressure was recorded. A two- within clinical and research test settings. This abstract, therefore aims to
way ANOVA test was used to understand the main effect of each of the establish the suitability of each device to test protocols with differing
design features on peak plantar pressure and also to identify any possible loading magnitudes and durations.
interactions. A threshold of 200 KPa [2] was then used to identify individuals Methods: Three in-shoe pressure measurement devices (Medilogic,
who did not experience sufficient offloading with a 15° rocker angle. Tekscan and Pedar, Figure 1) were examined for their repeatability and
Results: With both the 15° and 20° rocker angle the mean optimal apex validity in a 2 day x 3 repeated trial design. The testing procedure was
position was found to be 52% of shoe length. Furthermore, there was a undertaken in the Novel calibration device (TruBlue) applying an even
significant reduction in peak pressure when rocker angle was increase from load over the entire insole surface for UK 4 and 10 insoles. The protocol
15 to 20°. Despite this increase, 66% of participants experienced sufficient applied a range of pressures (50, 100, 200, 300, 400, 500 and 600 kPa) for
offloading with a 15° rocker angle provided an optimal apex position was 0-30 seconds. The repeatability (ICC) and validity (RMSE) of the held load
selected. (for 0, 2, 10 and 30 seconds) were outcome variables.
Conclusion: Increasing rocker angle decreased peak plantar pressure. Results: The Pedar system displayed low overall RMSE (3.5 kPa) for all
However, provided the optimal apex position of 52% shoe length was magnitudes and durations applied and a peak value of 7.5 kPa when
selected, it was possible to achieve acceptable offloading with a 15° measured at 600 kPa for 30 seconds. The Tekscan (31.5 kPa) and
rocker for a large proportion of individuals. Medilogic (27.3 kPa) systems RMSE was substantially higher, with
Acknowledgments: We acknowledge support from the EU framework maximum RMSE values of 58.4 and 50.4 respectively. The between-day
7 programme (NMP2-SE-2009-229261). repeatability of the measured pressure values varied between systems.
References Medilogic ICC values ranged from .334-.947 at 100 and 600 kPa
1. Chapman J, Preece S, Braunstein B, et al: Effect of rocker shoe design respectively with a mean of .667. Pedar ICC values ranged from .345-.917
features on forefoot plantar pressures in people with and without kPa at 300 and 600 kPa respectively with a mean of .638. Tekscan ICC
diabetes. Clin Biomech 2013, 28:679-85. values ranged from .042-.919 at 50 and 500 kPa respectively with a mean
2. Owings T, Apelgvist J, Stenstrom A, et al: Plantar pressures in diabetic of .614, after exclusion of the 600 kPa data. All insole systems produced
patients with foot ulcers which have remained healed. Diabetic Medicine the highest ICC values for pressure values above 100 kPa.
2009, 26:1141-46. Conclusions: The choice of an appropriate pressure measurement device
must be based on the, duration of loading, magnitude of loading and the
outcome variables sought. Medilogic and Tekscan are most effective
A67 between 200-300 kPa; Pedar performed well across all pressures.
Validity and repeatability of three commercially available in-shoe References
pressure measurement systems 1. Giacomozzi C: Appropriateness of plantar pressure measurement devices:
Carina Price, Daniel Parker, Christopher J Nester* A comparative technical assessment. Gait & Posture 2010, 32:141-144.
Centre for Health Science Research, University of Salford, Greater Manchester, 2. McPoil TG, Cornwall MW, Yamada W: A comparison of two in-shoe plantar
M6 6PU, UK pressure measurement systems. Lower Extremity 1995, 2:95-103.
Background: In-shoe pressure measurement devices are commonly used A68

in research and clinical settings to quantify pressure on the plantar foot. Testing a mechanical protocol to replicate impact in walking footwear
Various in-shoe pressure measurement devices are currently available and Carina Price1*, Glen Cooper2, Philip Graham-Smith1, Richard Jones1
1
they differ in their size, number of sensors, sensor type and therefore their Centre for Health Science Research, University of Salford, Greater
loading response and accuracy. Previous comparisons focus on pressure Manchester, M6 6PU, UK; 2School of Engineering, Manchester Metropolitan
plates [1]. An in-shoe study highlighted that the F-Scan system became University, Manchester, UK
erroneous at pressures over 200kPa and the repeatability of the Novel E-mail: c.l.price@salford.ac.uk
device was high [2]. However the long loading durations (11 minutes) Journal of Foot and Ankle Research 2014, 7(Suppl 1):A68
Figure 1(abstract A67) Test insoles in size 4 from left to right: Tekscan, Medilogic, and Pedar.
Figure 1(abstract A68) Vertical heel velocity towards the floor in the human testing for the four footwear conditions. Triple-density sandal = SA, flip-
flop = FF, shoe = SH and trainer = TR and Barefoot (BF). Error bars denote standard deviation across the 13 subjects tested. Horizontal lines denote
statistically significant results (determined by ANOVA where p<.05).
Impact testing is commonly undertaken to quantify the shock absorption a different impact. We do know that walking changes the respond of
characteristics of footwear. The current widely reported mechanical testing motor commands [2]. Feet have a real role in walking as we know.
method mimics the vertical heel velocity at touchdown and effective mass Wearing insoles have an effect on the biomechanics of the entire body [3].
of the lower limb recorded in running. This therefore results in a greater Two kinds of corrections exist. Biomechanical insoles correct with higher
impact energy than would be expected at touchdown in walking. Despite stimulations than mediation postural ones. The remediation uses different
this mismatch, the methodology is utilised to quantify the shock absorption ways of informations regarding the insoles and so is the effective response.
properties of running and walking footwear alike. The current work modifies To compare we have made for each patient a pair of mediation postural
the mechanical testing methodology to replicate the kinematics, specifically foot orthoses (FosMP) and a pair of biomechanical foot orthoses (FosBM).
the vertical heel velocity, identified in walking footwear. Kinematic and 10 patients have walked actual 30 feet on physical practice (PP) and
kinetic data was collected for 13 subjects walking in four different styles of imagined walking, mental practice (MP).
footwear used for walking (trainer, oxford shoe, flip-flop and triple-density We have tested them in tree conditions: without insoles (control Ct), with
sandal). The kinematic data was utilised to quantify heel velocity at FosMP and with FosBM. We have looked the FosMP/BM modifications
touchdown and accelerometer and force plate data was utilised to estimate through platform’s parameters: speed, speed’s variation and area of
the effective mass of the lower limb. When walking in the toe-post style center of force; bio-clinical evaluation: posturodynamic test [4] and visual-
footwear significantly faster vertical heel velocity toward the floor was analogic-scale to evaluated their comfort. All parameters were recorded
recorded compared to barefoot and the other footwear styles (Figure 1 for before (Pre) and after (Post) PP and MP.
example flip-flop: 0.36±0.05m.s-1 compared to trainer: 0.18±0.06m.s-1). The Results expose duration of walking in MP and PP.
mechanical protocol was adapted by altering the mass and drop height Results: We can see through the results that speed is less important with
from 10.6-17.3 kg and 2-7 mm, compared to the original protocol of 8.45 kg FosBM (9,917mm.s–1 s=5,757) than with FosMP (12,851 mm.s.1 s=11,013)
dropped from 50 mm. As expected, the adapted mechanical protocol on post walking in all conditions PP and MP (figure 1).
produced significantly lower peak force and accelerometer values than the Post PP walking shows higher results on speed than pre ones (22,068mm/
ASTM protocol (p <.001). These values more closely resembled those s, s=14,973; 12,851mm/s, s=11,013).
recorded in walking. The mean difference between the human and Post MP walking are the opposite (8,283mm/s, s=6,690; 10,397mm/s,
modified protocol was 12.7±17.5% (p<.001) for peak acceleration and 25.2 s=8,095)
±17.7% (p=.786) for peak force values. The timing of peak force and Area of center of force is increased after PP (441,571mm², s=826,595; to
acceleration variables was less representative of the real-life data with larger 578,466mm², s=509.770) (figure 2). MP decreases these area (476,951mm²,
mean differences. This pilot test has demonstrated that the altered s=807,630; 194,768mm², s=333.557). Speed variation of center of force
mechanical test protocol can more closely replicate loading on the lower also shows that PP walking makes post measures increase significantly
limb in walking. Further research should consider more variables related to (68,708mm/s, s=48,781; 118.02mm/s, s=45,187).
the shock absorption properties of footwear. The results also demonstrate Conclusions: We can conclude that wearing FOsBM stabilized patients.
that testing of material properties of footbeds not only needs to be gait Indeed after walking they have a smaller surface of oscillations. They also
style specific (e.g. running versus walking), but also footwear style specific have a less important speed: motor imagery control is dominant. Wearing
due to the differences in heel touch-down velocity in footwear styles. FOsBM seems to use less energy in movement or recuperation.
PP makes speed and speed variation of center of force increase, on the
contrary of MP.
A69 Those new informations can be useful in sport or reeducation. We know
Impact of orthoses on imagined and actual walking that maintaining body segments increase the body capacity by slowing
C Puil1,2*, M Janin1,3 down his movements, especially after an effort.
1
Applied Podiatry College, 7 Treguel, 86000 Poitiers, France; 2Podiatrist, References
Office, 64 Emile Zola, 44550 Saint Malo de Guersac, France; 3Podiatrist, PhD, 1. Spruijt S, Jouen F, Molina M, Kudlinski C, Guilbert J, Steenberg B:
Clinic, 7 Treguel, 86000 Poitiers, France Assessment of motor imaginery in cerebral palsy via mental
E-mail: carole.puil@gmail.com chronometry: the case of walking. Res Dev Disabil 2013, 34(11):4154-4160.
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A69 2. Guillot A, Di Rienzo F, Mactintyre T, Moran A, Collet C: Imagining is not
doing but involves specific motor commands: a review of experimental
Background: We know that duration between an actual movement and data related to motor inhibition. Front Hum Neurosci 2012, 6:247/1-22.
an imaginary one is similar [1]. We wondered if wearing insoles has an 3. Chevalier TL, Chockalingam N: Effects of foot orthoses: how important is
impact on those timings, and particularly if different kinds of insoles have the practitioner? Gait Posture 2012, 35(3):383-388.
Figure 1(abstract A69)
4. Janin M: Correlation between clinical and kinetic testing in sport Background: Patellofemoral pain is a common disorder whose
podiatry. Ter Man 2012, 10(47):7-11. aetiology is multifactorial and is often attributed to foot function. Foot
orthoses are commonly prescribed for this condition; however the
mechanisms by which they work are poorly understood. Previous
A70 studies using single segment foot models have hypothesised that it
The effects of three quarter and full length foot orthoses on may be control of the midfoot which holds the key to understanding
patellofemoral pain sufferers when walking and descending stairs orthotic control. Over the last decade it has become possible to divide
Jim Richards*, John Burston, James Selfe the foot into multiple segments, however little work exists investi-
Allied Health Professions Research Unit, University of Central Lancashire, gating the use of orthoses on different segments of the foot in this
Preston, PR1 2HE, UK patient group. The aim of this study was to investigate the differences
E-mail: JRichards@uclan.ac.uk in the kinematics and kinetics of the lower limb during walking
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A70 and step descent between patellofemoral patients and normal
subjects and the effect of ¾ and full length foot orthoses versus no
intervention. A71
Method: Kinematic and kinetic data were recorded from 15 healthy Soft tissue artifact compensation in lower extremities using
subjects and 15 patients diagnosed with patellofemoral pain using 10 Oqus displacement relationship between anatomical landmarks and skin
cameras and 4 AMTI force platforms. Subjects were asked to walk at a self- markers
selected pace and complete a 20cm step down. The foot was modelled Taebeum Ryu*, Moonsoo Shin
using a three segment 6 degrees of freedom model by fixing the marker set Department of Industrial and Management Engineering, Hanbat National
directly to the shoes and the lower limb was modelled using the calibrated University, Yusung, Daejeon, 305-719, South Korea
anatomical systems technique. E-mail: tbryu75@gmail.com
Results: Significant differences were seen between the healthy subjects Journal of Foot and Ankle Research 2014, 7(Suppl 1):A71
and the patellofemoral pain patients during both tasks at the midfoot
and rearfoot movement in the sagittal and coronal planes (p=0.003 to Soft tissue artifact (STA), the deformation of skin and muscle during motion,
0.016); at the knee joint significant differences were seen in the sagittal, is known to be one of the important sources of errors in human motion
coronal and transverse plane movement (p=0.001 to 0.01); and in the analysis using stereophotogrammetry. As a way to reduce the STA errors,
moments about the ankle and knee joints in the sagittal and coronal methods estimating positions of anatomical landmarks (AL) have been
planes (p=0.012 to 0.035). The orthoses produced statistically significant proposed that keep them rigidly related to the underlying bone. The
differences in the movement in the forefoot, midfoot and rearfoot across previous methods [1,2] used intermediate variables such as joint angles or
all three planes for both tasks (p=0.001 to 0.032). The orthoses showed motion time to adjust AL positions which were calculated from position data
no change in the knee kinematics, although a significant reduction in the of skin markers. The present study proposes a method to estimate AL
knee coronal plane moments during step descent was seen in both the positions with skin marker positions directly, thereby removing the
¾ and full length foot orthoses (p=0.019, p=0.028). intermediate variables of the previous methods. The proposed method
Conclusions: Despite placing markers on the shoes this study was able identifies a systematic relationship between the displacements of ALs and
to detect significant differences within the foot segments and identified skin markers relative to a technical coordinate frame defined by skin markers
potentially clinically important differences between patellofemoral pain in ad hoc motions(Figure 1). Then, AL positions are calibrated directly by
patients and normal subjects and was able to determine clinical using the displacement relationship with skin markers. The proposed method
important changes due to treatment. was applied to analyze three lower extremity motions (walking, sit-to-stand/
Figure 1(abstract A71) Scatter plot of AL and skin marker displacement in the thigh of a participant
Figure 2(abstract A71) Statistical comparison of compensation methods
stand-to-sit and step up/down) of ten healthy males. Its performance was A hierarchical cluster (HC) technique was adopted [3] using TimeClust1.1.
compared with the transformation error minimization method (TEM) of [3] In the present work kinematics, kinetics and PP data estimated as in [2]
and the AL estimation method with joint angle (ALJ) of [2]. The proposed were used as input. Peak value and its position in term of stance phase
method considerably reduced STA errors relative to the TEM (by 30 – 80% ) of gait’s percentage was extract from each variable. HC was performed
and was also slightly more effective than the ALJ, showing 25 – 40% error either using each type of variable and putting them all together as input
reductions for seven of 18 kinematic variables (Figure 2). or by using each type of variable separately (3D kinematics, kinetics, PP).
Trial registration: Current Controlled Trials ISCRTN73824458. In order to explore how the subjects were distributed in the proposed
References cluster, descriptive statistics was used. Statistical differences of both
1. Cappello A, Cappozzo A, Palombara PFL, Lucchetti L, Leardini A: Multiple biomechanics and clinical variables between the obtained clusters were
anatomical landmark calibration for optimal bone pose estimation. investigated using Student T-test and Pearson correlation (MatlabR2011b).
Human Movement Science 1997, 16:259-274. After 5 years follow up 3 subjects ulcerated.
2. Lucchetti L, Cappozo A, Cappello A, Croce UD: Skin movement artefact Results: Results of HC analysis (see Table 1 and Figure 1) performed either
assessment and compensation in the estimation of knee-joint using only 3D subsegments kinematics or kinetics defined two groups, one
kinematics. Journal of Biomechanics 1998, 31:977-984. including PU subjects and one not. The cluster containing PU subjects was
3. Soderkvist I, Wedin P: Determining the movements of the skeleton using characterized by larger number of diabetes complications and higher
well-configured markers. Journal of Biomechanics 1993, 26:1473-1477. values of biomechanics variables.
Conclusions: In conclusion, our work highlighted the presence of warning
signs of neuropathy even in diabetic subjects without a clinical diagnosis
A72 of PN. Furthermore 2 type of variables were able to correctly identify the
Biomechanical evaluation of diabetic foot through hierarchical cluster 3 subjects who developed PU within the 5 years (e.g. 3D foot kinematics
analysis and kinetics).
Zimi Sawacha1*, Fabiola Spolaor1, Gabriella Guarneri2, Annamaria Guiotto1, References
Angelo Avogaro2, Claudio Cobelli1 1. American Diabetes Association, American Academy of Neurology:
1
Department of Information Engineering, University of Padova, Italy; Consensus Statement. Report and Recommendations of the San Antonio
2
Department of Clinical Medicine and Metabolic Disease, University Conference on Diabetic Neuropathy. Diabetes Care 1988, 11:592-597.
Polyclinic, Padova, Italy 2. Sawacha Z, Guarneri G, Cristoferi G, Guiotto A, Avogaro A, Cobelli C:
E-mail: zimi.sawacha@dei.unipd.it Integrated kinematics–kinetics–plantar pressure data analysis: A useful
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A72 tool for characterizing diabetic foot biomechanics. Gait & Posture 2012,
36:20-26.
Introduction: Type 2 diabetes is predicted to become the 7 th leading 3. Magni P, Ferrazzi F, Sacchi L, Bellazzi R: TimeClust: a clustering tool for
cause of death in the world by the year 2030 [1]. Diabetic foot is the most gene expression time series. Bioinformatics 2008, 24(3):430-2.
common long-term diabetic complication, and it is a major risk factor for
plantar ulceration (PU), it is determined by peripheral neuropathy (PN),
vascular disease, increased foot pressures, foot trauma, deformity and A73
callus [1]. 2-Dimensional foot FE models for clinical application in gait analysis
The aim of this study is to develop a methodology for automatic detection Alessandra Scarton1*, Annamaria Guiotto1, Zimi Sawacha1, Gabriella Guarneri2,
of patients at risk for PU based on 3 dimensional (3D) multisegment foot Angelo Avogaro2, Claudio Cobelli1
1
biomechanics through cluster analysis. Department of Information Engineering, University of Padova, Padova,
Methods: For this purpose 44 subjects, 20 with (PN) and 24 without PN 35131, Italy; 2Department of Clinical Medicine and Metabolic Disease,
(noPN) were enrolled. Simultaneous kinematic, kinetic and plantar pressure University Polyclinic, Padova, 35131, Italy
(PP) data were acquired during gait with a BTS motion capture system E-mail: alessandra.scarton@dei.unipd.it
(6 cameras, 60-120 Hz) synchronized with 2 Bertec force plate (FP4060-10) Journal of Foot and Ankle Research 2014, 7(Suppl 1):A73
and 2 Winpod pressure plate as in [2]. After gait analysis 5 years clinical
follow up was performed on each subject including: neuropathy diagnosis Background: Foot ulcerations are one of the most common and
following ADA recommendation as in [2,3], electroneurophysiological invalidating complications which affect the diabetic patients [1,2]. Several
study; Index of Winsor, cardiovascular autonomic tests, HbA1c values, two-dimensional (2D) finite element (FE) models of the foot have been
micro-macroalbuminuria values, a carotid artery Doppler ultrasound developed in the last decades in order to understand what are the
examination. causes and to decrease their progress [3-5].
Table 1(abstract A72) Clinical data of subjects for each cluster. In the upper part of table are collected data of cluster using
Ground Reaction Force (GRF) input; in the lower part are collected data of luster using kinematics input.
GRF CL 1 CL 2 p Value
Subjects per Cluster 11 32
Mean and St. Dev
Year of Disease 16,73 10,80 20,68 12,61
HbA1c 7,97 1,26 7,96 1,14
Presence of Complications
Vasculopathy 3 (27.27%) 5 (15.625%)
microalbuminuria 2 (18.18%) 4 (12.5%)
Neuropathy 3 (27.27%) 17 (53.125%)
Autonomic Neuropathy 2 (18.18%) 7 (21.875%)
Finger Deformity 1 (9.09%) 13 (40.625%)
Callosity 2 (18.18%) 18 (56.25%) 0,02926
Ulcer 0 3(9.37%)
KINEMATICS CL 1 CL 2 p Value
Subjects per Cluster 18 26
Mean and St. Dev
Year of Disease 23,67 11,82 16,44 11,56
HbA1c 7,95 1,27 7,97 1,11
Presence of Complications
Vasculopathy 3 (16.67%) 5 (19.23%)
microalbuminuria 3 (16.67%) 3 (11.54%)
Neuropathy 6 (33.33%) 8 (30.77%)
Autonomic Neuropathy 10 (55.56%) 10 (38.46%)
Finger Deformity 12 (66.67%) 9 (34.62%) 0,03662
Callosity 5 (27.78%) 4 (15.39%)
Ulcer 0 3(11.5%)
The aim of this work was to create four 2D FE models of an healthy and of a Conclusions: Even under the restrictive assumptions of 2D representation,
diabetic neuropathic subject integrating kinematic, kinetic and pressure data which is inadequate for a complete model of the complex mechanics of
and to validate them by means of a comparison between experimental and the foot, it is possible to run fast computational simulations that provide
simulated pressure values. These models could represent a tool for clinical useful information for the clinicians towards a prevention of plantar ulcer
applications in order to prevent the development of the diabetic ulcers. formation.
Methods: Foot biomechanical analysis was carried out as in [6,7] on 10 References
healthy (age 58.7±10 years, BMI 24.5±2.6 kg/m2) and 10 diabetic subjects 1. Boulton AJM, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J: The global
with neuropathy (age 63.2±6.4 years, BMI 24.3±2.9 kg/m2). The experimental burden of diabetic foot disease. Lancet 2005, 366:1719-24.
setup included a 60 Hz 6 cameras stereophotogrammetric system (BTS S.r.l, 2. Cavanagh P, Erdemir A, Petre M, Owings T, Botek G, Chokhandre S, Bafna R:
Padova), 2 force plates (FP4060-10, Bertec Corporation, USA) and 2 plantar Biomechanical factors in diabetic foot disease. Journal of Foot and Ankle
pressure systems (Imagortesi, Piacenza). The signals coming from all systems Research 2008, 1:K4.
were synchronized as in [6,7]. 3. Wu L: Nonlinear finite element analysis for musculoskeletal
Four 2D FE models of the foot were developed from MRI images of a biomechanics of medial and lateral plantar longitudinal arch of Virtual
healthy and a diabetic subject (Figure 1). The modeled section were Chinese Human after plantar ligamentous structure failures. Clinical
chosen as typical areas of ulcers development and according to the Biomechanics 2007, 22:221-229.
position of the marker in the gait analysis protocol: the slice passing 4. Scarton A, Guiotto A, Sawacha Z, Guarneri G, Avogaro A, Cobelli C: Gait
through the first and the fifth metatarsal heads, the slice passing through analysis driven 2d finite element model of the neuropathic hindfoot.
the malleoli, the slice passing through the calcaneus and the second Proceedings ISB Natal, Brasil 2013.
metatarsal head and the slice passing through the calcaneus and the first 5. Gefen A, Megido-Ravid M, Itzchack Y, Arcan M: Biomechanical analysis of
metatarsal head. the three-dimensional foot structure during gait: a basic tool for clinical
The displacements of the markers determined from the gait analysis data applications. ASME 2000, 122.
for each patient in four instances of the stance phase of gait (initial 6. Sawacha Z, Guarneri G, Cristoferi G, Guiotto A, Avogaro A, Cobelli C:
contact, loading response, midstance and push-off) were used as input Integrated kinematics–kinetics–plantar pressure data analysis: A useful
for the simulations. The validations of the models have been performed tool for characterizing diabetic foot biomechanics. Gait & Posture 2012,
computing the RMSE between the experimental and the simulated 36:20-26.
plantar pressures in percentage of the experimental peak value. 7. Sawacha Z, Cristoferi G, Guarneri G, Corazza S, Donà G, Denti P,
Results: Results for the diabetic subjects are shown in Table 1. No Facchinetti A, Avogaro A, Cobelli C: Characterizing multisegment foot
significant differences were found between the healthy subjects kinematics during gait in diabetic foot patients. Journal of
experimental and simulated pressures. NeuroEngineering and Rehabilitation 2009, 6:37.
Figure 1(abstract A72) Peak of Medio Lateral, Vertical and Anterior Posterior Force of Midfoot in each cluster (in blu Cluster 1, in red Cluster 2).
Figure 1(abstract A73) The figure shows the four models developed for the diabetic subject. A) 1st-5th metatarsal head model; B) Through malleoli
model; C) 1st metatarsal -calcaneus model; D) 2st metatarsal -calcaneus model.
Table 1(abstract A73) RMSE between the experimental and the simulated plantar pressures in percentage of the
experimental peak value, in four instances of the stance phase of gait and for the four models.
Initial contact Loading response Midstance Push-off
1st metatarsal -calcaneus model 25.08 20.43 33.26 24.69
2st metatarsal -calcaneus model 22.20 24.68 37.82 41.67
1st-5th metatarsal head model - 45.77 46.34 46.25
Through malleoli model 35.36 42.12 46.58 -
Twenty healthy adults mean aged 28.9 years (10 males and 10 females)
A74 were tested. Eight markers of 15-marker set were placed in foot to
Repeatability of a multi-segment foot model with 15-marker set in evaluate segmental foot motion. Three representative strides from five
normal adults separate trials were used for analysis from each session. Kinematic data of
Sang Gyo Seo1*, Dong Yeon Lee1, Ji-Beom Kim1, Seong Hyun Kim1, foot segmental motion was collected and tracked using the Foot3D Multi-
Hye Sun Park1, Hyo Jeong Yoo1, Sung Ju Kim2, Jihyeung Kim3, Segment Software (Motion Analysis Co., Santa Rosa. CA). Retests were
Kyoung Min Lee4, Chin Youb Chung4, In Ho Choi1 performed in the same manner with an interval of 4 weeks. Coefficients of
1
Department of Orthopedic Surgery, Seoul National University Hospital, multiple correlation (CMC) and intra-class correlation (ICC) were calculated
Seoul, Korea; 2Department of Statistics, Korea University, Seoul, Korea; in order to assess the inter-trial and inter-session repeatability. Inter-
3
Department of Orthopedic Surgery, Seoul National University Boramae segment foot angles from healthy adults from a MFM with 15-marker set
Medical Center, Seoul, Korea; 4Department of Orthopedic Surgery, Seoul showed a narrow range of variability during the whole gait cycle.
National University Bundang Hospital, Seongnam, Korea The mean inter-trial ICC (± Standard deviation) was 0.981 (± 0.010), which
E-mail: sporter99@naver.com was interpreted as excellent. The mean inter-trial CMC (± Standard deviation
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A74 ) was 0.948 (± 0.027), which was interpreted as excellent or very good
repeatability. The mean inter-session ICC (±SD) was 0.886 (± 0.047) and the
Several 3D multi-segment foot models (MFMs) have been introduced for mean inter-session CMC (±SD) was 0.801 (± 0.077), which were interpreted
the in vivo analysis of dynamic foot kinematics [1,2]. However, there is as excellent or very good repeatability. The lowest repeatability was in the
scanty evidence available to support their clinical use. Considering the transverse plane at the forefoot and the most consistent finding was
potential of MFM to assess the function in foot pathology, there is a need observed at the sagittal plane of the hallux and hindfoot (Table 1, Figure 1).
for simple, reproducible and reliable multi-segment foot models. The We demonstrated a MFM with 15-marker set had high inter-trial and
purpose of this study was to assess the reliability of a simple MFM with inter-session repeatability, especially in sagittal plane motion. We thought
15-marker set. this MFM would be applicable to evaluation of the motion of the foot
segment during gait.
References
1. Simon J, Doederlein L, McIntosh AS, Metaxiotis D, Bock HG, Wolf SI: The
Table 1(abstract A74) Repeatability of foot kinematics Heidelberg foot measurement method: development, description and
Inter-trial Inter-session assessment. Gait Posture 2006, 23:411-424.
2. Carson MC, Harrington ME, Thompson N, O’Connor JJ, Theologis TN:
CMC ICC CMC ICC Kinematic analysis of a multi-segment foot model for research and clinical
Hallux applications: a repeatability analysis. J Biomech 2001, 34:1299-1307.
Flex/Ext 0.971 0.990 0.796 0.880
Rotation 0.970 0.990 0.951 0.974 A75
Hindfoot Gender differences in segmental foot motions during gait using 3D
multi-segment foot model
Flex/Ext 0.931 0.976 0.837 0.911
Sang Gyo Seo1*, Dong Yeon Lee1, Ji-Beom Kim1, Seong Hyun Kim1,
Pro/Sup 0.890 0.961 0.697 0.838 Hye Sun Park1, Hyo Jeong Yoo1, Sung Ju Kim2, Jihyeung Kim3,
Rotation 0.927 0.974 0.728 0.820 Kyoung Min Lee4, Chin Youb Chung4, In Ho Choi1
1
Department of Orthopedic Surgery, Seoul National University Hospital,
Arch
Seoul, Korea; 2Department of statistics, Korea University, Seoul, Korea;
Height 0.959 0.992 0.798 0.883 3
Department of Orthopedic Surgery, Seoul National University Boramae
Length 0.909 0.998 0.980 0.840 Medical Center, Seoul, Korea; 4Department of Orthopedic Surgery, Seoul
National University Bundang Hospital, Seongnam, Korea
Index* 0.952 0.972 0.729 0.989
E-mail: sporter99@naver.com
Forefoot Journal of Foot and Ankle Research 2014, 7(Suppl 1):A75
Flex/Ext 0.978 0.986 0.840 0.913
There might be gender differences in segmental foot motion considering the
Pro/Sup 0.993 0.968 0.687 0.814
gender differences in the foot shape and the prevalence of pathologies [1,2].
Rotation 0.972 0.983 0.813 0.890 The objectives of this study were 1) to obtain reference data of segmental
Medial forefoot motion of the foot using a multi-segment foot model (MFM) with 15-marker
set from healthy adults; 2) to find gender differences in segmental foot
Flex/Ext 0.956 0.984 0.834 0.909
motion during gait. One hundred feet of 100 healthy adults (50 males, 50
Pro/Sup 0.916 0.975 0.808 0.892 females) with 20-35 years old were tested by Cleveland Clinic marker set and
Rotation 0.949 0.985 0.808 0.893 six additional foot markers. We presented demographic data of participating
subjects. Females were shorter, both in height and length. Hallux valgus
Lateral forefoot
angle on static status was significantly higher in female. Talo-1st metatarsal
Flex/Ext 0.957 0.985 0.765 0.866 angle was not significantly different. The cadence (steps/min) was
Pro/Sup 0.929 0.970 0.763 0.865 significantly more frequent in female than in male. The stride length, the
step width, and the step time were significantly longer in male. The speed
Rotation 0.954 0.983 0.790 0.877
and the proportion of stance phase were not significantly different (Table 1).
Figure 1(abstract A74) Walking kinematics for the 1st and 2nd visit (average with a range representing 2 standard deviations). Each row shows the
motion of each segment: hallux, hindfoot, arch, forefoot, medial forefoot, lateral forefoot motion. Each column represents motion in each of the three
planes (sagittal, coronal, transverse plane). Horizontal axis represents gait cycle, and vertical axis represents range of motion.
The range of segmental motion (hallux, forefoot, hindfoot) and arch data were 2. Murray MP, Kory RC, Sepic SB: Walking patterns of normal women. Arch
recorded during the gait and compared between male and female. The both Phys Med Rehabil 1970, 51(11):637-650.
genders had similar patterns of segmental foot motions. The range of sagittal
motion and coronal angulation of the hallux was greater during gait in
females. The range of motion on the hindfoot was also greater in females. The A76
male had higher adjusted arch height and arch index. However, the range of Temporal pattern in segmental motions of the foot in healthy senile
adjusted arch height was larger in females (Figure 1). We demonstrated that adults: comparison between young and senile healthy adults
there was a substantial temporal pattern of the foot segmental motion in Sang Gyo Seo1*, Dong Yeon Lee1, Ji-Beom Kim1, Seong Hyun Kim1,
normal adults. We also presented that there was a significant gender Hye Sun Park1, Hyo Jeong Yoo1, Sung Ju Kim2, Jihyeung Kim3,
difference the motion of specific foot segment. We believe that data from this Kyoung Min Lee4, Chin Youb Chung4, In Ho Choi1
1
study might be used as a reference data to evaluate the effect of certain Department of Orthopedic Surgery, Seoul National University Hospital,
condition on the segmental motion of the foot and to reveal the gender Seoul, Korea; 2Department of statistics, Korea University, Seoul, Korea;
3
difference in prevalence and prognosis of foot and ankle pathologies. Department of Orthopedic Surgery, Seoul National University Boramae
References Medical Center, Seoul, Korea; 4Department of Orthopedic Surgery, Seoul
1. Cho SH, Park JM, Kwon OY: Gender differences in three dimensional gait National University Bundang Hospital, Seongnam, Korea
analysis data from 98 healthy Korean adults. Clin Biomech Bristol, Avon E-mail: sporter99@naver.com
2004, 19(2):145-152. Journal of Foot and Ankle Research 2014, 7(Suppl 1):A76
Table 1(abstract A75) Basic gait parameters Hallux valgus of male and female was more severe in senior during gait.
Arch height was no difference (Figure 3). In 3D foot gait analysis, the
Male (mean ± SD) Female p- value differences between senior and young adults were apparent. In summary,
(mean ± SD) foot motion in senior had limited range of motion during gait. And hallux
Cadence (cm) 110.3 ± 5.7 116.4 ± 6.5 < 0.001 valgus in senior was more severe. But arch height was not diminished. The
Speed (cm/sec) 123.3± 8.9 124.9± 7.5 0.445 understanding about changes of foot segmental motion depending on age
will suggest more correct approach in degenerative foot and ankle disease.
Stride length (cm) 133.9± 7.3 128.3± 7.1 < 0.001 References
Step width (cm) 66.9 ± 3.7 64.1 ± 3.6 < 0.001 1. Ostrosky KM, VanSwearingen JM, Burdett RG, Gee Z: A comparison of gait
characteristics in young and old subjects. Phys Ther 1994, 74:637-644,
Proportion of stance 59.7 ± 1.2 59.3 ± 0.8 0.123
discussion 644-636.
phase (%)
2. Lee JH, Chun MH, Jang DH, Ahn JS, Yoo JY: A comparison of young and
old using three-dimensional motion analyses of gait, sit-to-stand and
The incidence of foot and ankle disease increases as the age increases [1,2]. upper extremity performance. Aging Clin Exp Res 2007, 19:451-456.
However, there was no report about differences of foot motion between
senile person and young adults. The purpose of this study is to analyze
distinctions according to age in segmental foot motion using 3D multi-foot A77
model from healthy senior and young adults. Dynamic barefoot plantar pressure in gait and foot type biomechanics
One hundred senile (50 males, 50 females) and young adults (50 males, Jinsup Song1*, Howard J Hillstrom2, Michael Neary3, Kersti Choe1,
50 females) were tested by 3D multi-foot model with 15-markers. The William Brechue3, Rebecca A Zifchock3, Steve Svoboda3, Jim Furmato1,
cadence, speed, stride length, step width, step time, and stance phase Mandy Gibbons2, Ibadete Thaqi2, Jocelyn Hafer2, Siobhan Mangan2,
were analyzed. The maximum and minimal values and motions of 3- Stephen Bartalini2, Marian T Hannan4
1
planes of hallux, forefoot, hindfoot, and arch were compared between Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania,
senile and young adults. USA; 2Hospital for Special Surgery, New York, New York, USA; 3United States
The cadence, speed, stride length, and step width were lower in senior. The Military Academy, West Point, New York, USA; 4Hebrew Senior Life, Harvard
stance phase was longer (Table1). In female, sagittal motion of all segment Medical School, Boston, USA
were more limited and hindfoot was more unstable in senior (Figure 1). In E-mail: jsong@temple.edu
male, sagittal motion of hallux and forefoot were lower in senior (Figure 2). Journal of Foot and Ankle Research 2014, 7(Suppl 1):A77
Figure 1(abstract A75) Comparison of the mean foot segmental motion between two genders. The both gender had similar patterns of segmental foot
motions in spite of the gender differences in the specific motion of some segments.
Table 1(abstract A76) Basic gait parameters in senile adults 1.1 years, 24.5±3.0 kg/m 2 ) [2]. Five trials of barefoot dynamic planar
pressure were obtained for each foot with the Novel emed-x (novel
Male (mean ± SD) Female p- value GmbH, Munich) using the two-step method for walking data
(mean ± SD) acquisition. The Center of Pressure Excursion Index (CPEI, %) and
Cadence (cm) 109.3 ± 6.6 114.6 ± 6.9 < 0.001 the peak pressure (PP, in kiloPascal) were calculated for each trial.
Speed (cm/sec) 114.0 ± 9.2 111.5 ± 7.9 0.147 Analysis of Variance was performed across the foot type groups on the
left foot.
Stride length (cm) 124.5 ± 7.3 116.3 ± 7.4 < 0.001 The cavus group exhibited the largest CPEI while the planus group
Step width (cm) 62.4 ± 4.5 58.3 ± 4.1 < 0.001 demonstrated the smallest CPEI. The neutral group demonstrated the
Step time (sec) 0.55 ± 0.04 0.53 ± 0.03 < 0.001 lowest peak pressure, which was significantly lower than the planus
group. Results of this study provide additional evidence which support
Proportion of stance 61.1 ± 1.1 60.6 ± 1.1 0.046 the link between the dynamic plantar pressure in gait and foot type
phase (%) biomechanics.
Acknowledgement: Volunteers from the New York College of Podiatric
Medicine, Temple University School of Podiatric Medicine, the Hospital for
Song et al demonstrated that healthy subjects with planus and neutral Special Surgery, and Novel GmbH were instrumental in the collection of
foot type exhibited a distinguishable foot posture and dynamic foot these data. We appreciate the study participants and support of the
function [1]. However, such a relationship has not been demonstrated in United States Military Academy.
a large sample study. References
Foot structure was categorized into one of three foot types (cavus, 1. Song J, Hillstrom HJ, Secord D, Levitt J: Foot type biomechanics:
neutral, and planus) based on the standing arch height index (AHI) in comparison of planus and rectus foot types. J Am Podiatri Med Assoc
1,054 incoming cadets at the US Military Academy (172 female, 18.5 ± 1996, 86:16-23.
Figure 1(abstract A76) Comparison of the mean foot segmental motion between senile and young adults in female.
Figure 2(abstract A76) Comparison of the mean foot segmental motion between senile and young adults in male.
2. Hillstrom HJ, Song J, Kraszewski AP, Hafer JF, Moontanah R, Dufour AB, measurements of internal strains and stresses of the foot are inconceivable
Chow BS, Deland JT: Foot type biomechanics part 1: structure and or invasive [3]. In this research the comparison of the effect of 3 different
function of the asymptomatic foot. Gait Posture 2013, 37:445-51. sizes of height of high-heeled shoes on foot bones and plantar fascia is the
main objective. Von-Misses stresses, strain, and arch deformation of the
foot during balanced standing in women are the parameters which are
investigated in this research. The output of this research is describing the
A78 effect of increasing of heel height on foot bones stresses.
The effect of various heights of high-heeled shoes on foot arch Mimics and ABAQUS software are employed to create a finite element
deformation: Finite element analysis (FE) model of the human ankle. MIMICS used as the segmentation
Amir Ahmady1, Ehsan Soodmand2*, Iman Soodmand3, Thomas L Milani2 software and ABAQUS used for finite element analysis (FEA). A CT
1
Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, (Computed Topography) scan images from the right foot of a normal
Malaysia; 2Technische Universität Chemnitz, Chemnitz, Germany; 3Department female subject was imported into MIMICS. The segmented surfaces were
of Mechanical Engineering, Jondishapour University of Technology, Dezful, Iran then imported into SolidWorks CAD (Computer aided design) system to
E-mail: ehsan.soodmand@s2013.tu-chemnitz.de create model assembly. In order to creating tetrahedral finite element
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A78 meshes the solid models of foot bones and encapsulated soft tissue
structures models established in MIMICS software is imported into
Women are interested to wear high-heeled shoes to increase their ABAQUS. Contact interactions among the major joints were prescribed to
attractiveness. High-heeled shoes might create harmful effects on the allow relative bone movements.
musculoskeletal system. Besides earlier studies proved that the function of The soft tissue and orthotic material were defined as hyper elastic while
foot and lower extremity will change due to wearing high-heeled shoes other tissues were idealized as homogeneous, isotropic, and linearly
[1,2]. Because of limitations of the experimental methods, direct elastic. The ground reaction and extrinsic muscles forces for simulating
Figure 3(abstract A76) Comparison of the mean foot segmental motion between male and female in senior.
the stance phase of gait were applied at the inferior ground support as a strain and the total tensional force in the plantar fascia was minimum
boundary condition and at their corresponding points of insertion by (Figure 3).
defining contraction forces via axial connector elements. During the References
balance standing condition, on half of body weight is transferred from 1. Esenyel M, et al: Kinetics of high-heeled gait. Journal of the American
each foot to the ground [4]. Podiatric Medical Association 2003, 93(1):27-32.
The result of this study on the shoes with heel height 1.5 inches, 2.5 2. Yu J, et al: Biomechanical simulation of high-heeled shoe donning and
inches, and 3.5 inches shows that an increase in shoe heel height walking. Journal of Biomechanics 2013, 46(12):2067-2074.
resulted in a decrease in arch deformation (Figure 1). There was a 3. Yu J, et al: Development of a finite element model of female
common rise in a peak Von-Mises stress of foot bones with increasing foot for high-heeled shoe design. Clinical Biomechanics 2008, 23:
shoe heel height (Figure 2). With 2.5 inches high-heeled shoe, the S31-S38.
Table 1(abstract A77) The mean Center of Pressure Excursion Index and the Peak Pressure are shown for three foot
type groups. The analysis was limited to left foot only.
Cavus Neutral Planus P-value
N (female) 53 (5) 184 (29) 711 (121)
a
CPEI (%) 23.07 ± 7.46 21.01 ± 6.53 20.39 ± 6.82 0.0168
c
PP (kN) 578.5 ± 140.6 552.8 ± 139.2 600.4 ± 168.2 <0.0001
a c
A significant difference (P<0.05) was observed between the cavus and planus foot types and between neutral and planus foot types.
Figure 1(abstract A78) Foot arch deformations during balanced standing
Figure 2(abstract A78) Von-Mises stress of foot bones for 3 different sizes of shoe heel heights
4. Franciosa P, Gerbino S: From CT scan to plantar pressure map Background: It is becoming increasingly common for pedobarography to
distribution of a 3D anatomic human foot. COMSOL Conference 2010. be used to aid treatment planning. While there is some consensus on use of
this data in specific populations (for example diabetes in adults) there is
little information on how it should be interpreted in those with paediatric
A79 orthopaedic conditions, such as clubfoot. This is due in part to a scarcity in
Measurement of plantar pressure data in children with clubfoot the literature of “normal” reference data for children, as well as a lack of
Julie Stebbins1*, Louise Way1, Claudia Giacomozzi2 consensus on the clinical interpretation of deviations from normal data. The
1
Oxford Gait Laboratory, Oxford University Hospitals NHS Trust, Oxford, Oxon, aim of this study was to determine if the plantar pressure distribution in
OX3 7HE, UK; 2Department of Technology and Health, Istituto Superiore di children with clubfeet can reliably be distinguished from an age-matched,
Sanità, Rome, Italy typically developing population.
E-mail: julie.stebbins@ouh.nhs.uk Patients/materials and methods: 73 typically developing (TD) children
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A79 (age 6-16 years) with no known pathology and 10 children with
Figure 3(abstract A78) Average of strain in plantar fascia
treated clubfoot (CF) (age 5-16 years) participated. Plantar pressure a reduction in pressure in the hindfoot region, and a mixed response at
data (emed-m, novel, Germany) were obtained while walking at self- the forefoot.
selected speed. Synchronous trajectory data were collected from Conclusion: Substantial variation in pressure distribution was found in the
reflective markers placed on the feet according to the Oxford Foot TD population. Despite this, almost all CF subjects demonstrated significant
Model [1] using a 12 camera system (Vicon, Oxford, UK). Pressure differences to age-matched TD data. This suggests that pedobarography
images were masked into 5 areas using projected marker co-ordinates provides adequate sensitivity for assessing this population. “Normal”
(Figure 1) [2]. The TD children were grouped into 6 age bands. Data reference data may be used as a comparison (similar to other gait data) but
from each CF subject was compared to age-matched data from the TD care should be taken that this is appropriately age-matched. Markers placed
population. on the foot were used to automatically mask the footprint for this study,
Results: Differences were found across the age groups in the TD allowing accuracy of masking to be maintained, even in the presence of
population (Figure 2) with a progressive increase in peak pressure with abnormal foot shapes. This needs to be taken into consideration when
age in most areas. 9/10 CF subjects demonstrated significant assessing data from a clubfoot population.
differences to the TD population in at least one sub-area of the foot. References
The most frequent differences were found in the mid-foot region, with 1. Stebbins, et al: Gait Posture 2006, 23:401-411.
11/20 feet having increased pressure in this region. There was generally 2. Giacomozzi et al: Med.Biol.Eng.Comp 2000, 38:156-63.
Figure 1(abstract A79) CF footprint masked based on marker co-ordinates

Figure 2(abstract A79) Peak pressure in each sub-area across different ages
Novel, Germany), lower limb kinematics (200 Hz, Vicon Peak, United
A80 Kingdom), and EMG signals of five lower limb muscles (3000 Hz, Telemyo
Running on an unpredictable irregular surface changes lower limb 2400 G2, Noraxon, USA) were recorded. Eight perception items were
biomechanics and subjective perception compared to running on a assessed subjectively (9-point Likert Scale). Biomechanical parameter
regular surface mean magnitudes and mean standard deviations, as variability measure,
Thorsten Sterzing1*, Charlotte Apps1,2, Rui Ding1, Jason Tak-Man Cheung1 of 16 steps were calculated. Variables were compared between surfaces
1
Sports Science Research Center, Li Ning (China) Sports Goods Co Ltd, by Wilcoxon signed rank tests (p<.05).
Beijing 101111, China; 2School of Sport and Exercise Sciences, Liverpool John Results: Step length decreased while step frequency increased on UIS
Moores University, Liverpool, L3 3AF, UK (p<.05). In-shoe pressure relative load magnitudes on UIS were increased at
E-mail: thorsten@li-ning.com.cn medial midfoot (p<.05), and decreased at lateral forefoot (p<.05). Relative
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A80 load variability increased for all regions (p<.05). Runners had a flatter and
less dorsiflexed foot strike (Table 1), alongside increased knee and hip
Background: Irregular surface conditions, for instance, are present during flexion on UIS (p<.05). Whereas all sagittal joint angle magnitudes differed
trail running. Modified treadmills can be used to produce such surface significantly, only knee and hip angles varied significantly more. Touchdown
conditions in a laboratory environment [1]. Gait variability on uneven shoe- ankle inversion remained unchanged, whereas maximum eversion was
surface interfaces is increased in walking [2,3], hence the same may apply to significantly higher on UIS, and both were more variable (p<.05). Tibialis
running. This study examined the effects of an unpredictable irregular anterior and gastrocnemius medialis muscle activity magnitude and
surface (UIS) on lower limb biomechanics, locomotion variability, and variability was similar, whereas peroneus longus activity was significantly
subjective perception during treadmill running. increased, while not being more variable on UIS (Table 1). Subjectively,
Methods: Seventeen young, male, active participants ran at 8 km/h on a running on UIS was more challenging (p<.05).
treadmill with predictable regular surface (PRS) and with UIS. The UIS was Conclusion: Runners consciously applied a more alert kinematic lower
created by randomly attaching EVA dome shaped inserts (‫ﻁ‬: 140 mm) of limb posture at touchdown on UIS, with lower limb position more
different height (10 mm and 15 mm) and hardness (40 and 70 Asker C) consistent for distal sagittal joint angles. Similar muscular activity of
to the treadmill. In-shoe plantar pressures (200 Hz, Pedar X System, tibialis anterior and gastrocnemius medialis indicates that general muscle
Table 1(abstract A80) Magnitude (Mag) and variability (Var) of kinematic and EMG parameters, significant surface
comparisons (PRS vs. UIS) indicated in bold.
Sagittal plane angles [deg] Normalized muscle activity during stance [%]
Shoe to Surface Shoe to Shank Tibialis Anterior Gastrocnemius Med Peroneus Longus
Mag Var Mag Var Mag Var Mag Var Mag Var
PRS 20.8 2.1 9.7 1.3 24.4 3.3 42.1 5.6 42.7 5.8
UIS 17.0 2.7 7.1 1.9 22.8 3.5 43.5 5.4 46.8 7.7
p-value .001 .102 .001 .055 .149 .492 .831 .586 .025 .068
activity applied was sufficient to compensate the perturbation level in this gastrocnemius medialis on UIS, whereas it was similar for peroneus longus
study regarding sagittal plane ankle motion. Running on UIS increased (Table 1). Subjectively, walking on UIS was more challenging (p<.05).
gait variability, thus stimulating enhancement of motor control patterns, Conclusion: On UIS, muscle specific motor control strategies were applied.
resembling a positive training mechanism [4]. Frontal plane stabilization effort of the ankle joint was consistently increased
References throughout all ground contacts. Sagittal ankle joint mobilization and/or
1. Voloshina AS, Kuo AD, Daley MA, Ferris DP: Biomechanics and energetics stabilization depended on specific perturbation effects of single ground
of walking on uneven terrain. J Exp Biol 2013, 216:3963-3970. contacts. Walking on UIS induced a more variable gait, thus stimulating
2. Gates DH, Wilken JM, Scott SJ, Sinitski EH, Dingwell JB: Kinematic strategies enhancement of motor control patterns, resembling a positive training
for walking across a destabilizing rock surface. Gait Posture 2012, 35:36-42. mechanism [4].
3. Stöggl T, Müller E: Magnitude and variation in muscle activity during References
walking before and after a 10-week adaptation period using unstable 1. Voloshina AS, Kuo AD, Daley MA, Ferris DP: Biomechanics and energetics
(MBT) shoes. Footwear Sci 2012, 4(2):131-143. of walking on uneven terrain. J Exp Biol 2013, 216:3963-3970.
4. Latash ML: The bliss of motor abundance. Exp Brain Res 2012, 217(1):1-5. 2. Gates DH, Wilken JM, Scott SJ, Sinitski EH, Dingwell JB: Kinematic strategies
for walking across a destabilizing rock surface. Gait Posture 2012,
35:36-42.
A81 3. Stöggl T, Müller E: Magnitude and variation in muscle activity during
Walking on an unpredictable irregular surface changes lower limb walking before and after a 10-week adaptation period using unstable
biomechanics and subjective perception compared to walking on a (MBT) shoes. Footwear Sci 2012, 4(2):131-143.
regular surface 4. Latash ML: The bliss of motor abundance. Exp Brain Res 2012, 217(1):1-5.
Thorsten Sterzing1*, Charlotte Apps1,2, Rui Ding1, Jason Tak-Man Cheung1
1
Sports Science Research Center, Li Ning (China) Sports Goods Co Ltd,
Beijing 101111, China; 2School of Sport and Exercise Sciences, Liverpool John A82
Moores University, Liverpool, L3 3AF, UK What have studies using finite element analysis taught us about the
E-mail: thorsten@li-ning.com.cn diabetic foot? A systematic review
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A81 Scott Telfer1,2*, Ahmet Erdemir3, James Woodburn1, Peter R Cavanagh2
1
Institute for Applied Health Research, Glasgow Caledonian University,
Background: Irregular surface conditions, for instance, are present during Glasgow, UK; 2Department of Orthopaedics and Sports Medicine, University of
trail walking. Modified treadmills can be used to produce such surface Washington, Seattle, WA, USA; 3Computational Biomodeling (CoBi) Core and
conditions in a laboratory environment [1]. Walking on an irregular surface Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
showed increased gait variability [2], which is regarded as a beneficial E-mail: scott.telfer@gcu.ac.uk
training stimulus [3]. Thus, this study examined the effects of an Journal of Foot and Ankle Research 2014, 7(Suppl 1):A82
unpredictable irregular surface (UIS) on lower limb biomechanics, locomotion
variability, and subjective perception during treadmill walking. Background: Over the past two decades finite element (FE) analysis has
Methods: Seventeen young, male, active participants walked at 5 km/h on become a popular tool for researchers looking to simulate the
a treadmill with predictable regular surface (PRS) and with UIS. The UIS was biomechanics of the foot in people with diabetes. The ultimate aims of
created by randomly attaching EVA dome shaped inserts (‫ﻁ‬: 140 mm) of these simulations have been to improve understanding of the
different height (10 mm and 15 mm) and hardness (40 and 70 Asker C) to complicated nature of mechanical loading and to inform interventions
the treadmill. In-shoe plantar pressures (200 Hz, Pedar X System, Novel, designed to prevent plantar ulceration. This review is intended to provide
Germany), lower limb kinematics (200 Hz, Vicon Peak, United Kingdom), and a systematic review of these FE analysis based computational simulations.
EMG signals of five lower limb muscles (3000 Hz, Telemyo 2400 G2, Methods: PUBMED, ScienceDirect and Web of Science databases were
Noraxon, USA) were recorded. Eight perception items were assessed searched for relevant peer reviewed articles using the keywords “diabetic
subjectively (9-point Likert Scale). Biomechanical parameter mean foot”, “finite element” and related synonyms. This review considered
magnitudes and mean standard deviations, as variability measure, of 16 original research studies that utilised FE models of the foot or part of the
steps were calculated. Variables were compared between surfaces by foot to simulate function, tissue behaviour, or structural deformities
Wilcoxon signed rank tests (p<.05). associated with the diabetic foot. In addition, studies using FE to study
Results: Step length increased, while step frequency decreased on UIS footwear, insoles or surgical interventions intended to reduce ulceration
(p<.05). In-shoe pressure relative load magnitudes were consistent risk in the diabetic foot were eligible for inclusion.
between conditions for five out of six masks, with only the medial midfoot Results: Thirty relevant articles were found covering three primary
loaded higher on UIS (p<.05). Relative load variability increased on UIS for themes: investigations of the characteristics of the diabetic foot (10
all masks (p<.05). Small but significant kinematic differences at touchdown articles); design of interventions to reduce ulceration risk (17 articles); and
were found, with markedly greater variability on UIS: Reduced shoe-surface methodological aspects for modeling the diabetic foot (3 articles). Several
angle and ankle dorsiflexion, increased knee and hip flexion. The ankle FE studies have provided estimates of external and internal soft tissue
joint showed decreased inversion at touchdown and increased maximum loading, and suggested that internal stresses may often be considerably
eversion on UIS, alongside higher variability (Table 1). Whereas muscle larger than those measured at the plantar surface and are proportionally
activity magnitude was similar for tibialis anterior and gastrocnemius greater in the diabetic foot compared to controls. A series of results that
medialis on both surfaces, it was increased for peroneus longus on UIS. In inform the design of insoles, footwear and corrective surgery have been
contrast, muscle activity variability was increased for tibialis anterior and presented with the goal of defining the modes of action for these
Table 1(abstract A81) Magnitude (Mag) and variability (Var) of kinematic and EMG parameters, significant surface
comparisons (PRS vs. UIS) indicated in bold.
Frontal plane ankle angle [deg] Normalized muscle activity during stance [%]
Inversion touchdown Eversion maximum Tibialis Anterior Gastrocnemius Med Peroneus Longus
Mag Var Mag Var Mag Var Mag Var Mag Var
PRS -2.8 1.5 7.7 0.9 19.1 2.6 31.3 4.9 38.8 9.7
UIS -1.5 1.9 9.3 3.4 19.6 3.4 31.9 5.5 48.5 11.3
p-value .006 .002 .001 001 .435 .013 .831 .049 .006 .163
intervention strategies. FE analysis has also been applied to simulate the Results: Tissue responses are compared (Fig. 1 A&B). Old subjects show
effect of changes associated with the diabetic foot on factors such as significantly higher tissue stiffness in all foot sites tested with p<0.05. Diabetes
blood supply to local tissues. subjects are found to have stiffer plantar tissue in foot regions tested.
Discussion: Existing models have not yet adequately captured the Both natural and accelerated tissue glycation stiffen plantar soft tissue
complexity of foot anatomy or the changes in tissue properties and resulting in stiffer and weaker tissue property. This study successfully
structural factors associated with diabetes. Further work is required to demonstrates the ability of proposed indentation technique to quantify
improve the validity and credibility, of FE models and to standardize positive relationship between tissue glycation and plantar soft tissue stiffness.
reporting. The development of patient-specific models is an extremely time- References
consuming process and reported run times are long. Progress in these areas 1. Bai P, et al: Glycation alters collagen fibril organization. Connective Tissue
is needed to ultimately move the technique beyond the research domain to Research 1992, 28(1-2):1-12.
allow it to become a clinically relevant tool at the patient level. 2. Larsson J: Lower extremity amputation in diabetic patients. Lund
Acknowledgment: ST is funded through the People Programme (Marie University: Lund University 1994.
Curie Actions) of the European Union’s Seventh Framework Programme 3. Chen W, et al: An instrumented tissue tester for measuring soft tissue
(FP7 2007-2013) under REA Grant Agreement No. PIOF-GA-2012-329133. property under the metatarsal heads in relation to metatarsophalangeal
joint angle. Journal of Biomechanics 2011, 44:1804-1804.
4. Cavanagh PR: Plantar soft tissue thickness during ground contact in
A83 walking. Journal of Biomechanics 1999, 32(6):623-628.
Assessment of tissue glycation on plantar soft tissue stiffness
Jee Chin Teoh, Taeyong Lee*
Department of Biomedical Engineering, National University of Singapore, A84
Singapore Effect of deformation depth on plantar soft tissue behavior
E-mail: bielt@nus.edu.sg Jee Chin Teoh, Bena Lim, Taeyong Lee*
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A83 Department of Biomedical Engineering, National University of Singapore,
Singapore
Introduction: Tissue glycation, that occurs naturally through ageing and E-mail: bielt@nus.edu.sg
can be sometimes accelerated by disease such as diabetes mellitus, is Journal of Foot and Ankle Research 2014, 7(Suppl 1):A84
clinically claimed to have induced irregular collagen alignment and
increased collagen fibril density in patients [1]. This hence increases tissue Introduction: Most in vivo indentation techniques are limited by the lack
stiffness and leads to plantar injury, i.e. ulcer. In the USA, 85% of all non- of adequate indentation on the plantar tissue. Without sufficient
traumatic amputations in diabetes patients arise from non-healing ulcers [2]. indentation into the soft tissue, only very little and less representative
This tells the need to assess and to detect tissue abnormality early, in order information can be obtained. The purpose of this study is hence to assess
to prevent problematic tissue rupture especially in elderly and diabetes the effect of deformation depth on plantar tissue behavior and to
subjects. Currently, there are several existing tools used by clinicians like establish a set rule of optimum indentation depth that is sufficient to
monofilament, tuning forks, biothesiometers, neurothesiometers etc. quantify the critical plantar soft tissue behavior.
However, majority of them only measure subjective sensing ability but not Methods: 20 young subjects (20-25 years) participated. During the
the mechanical property of the plantar tissue. The objective of this study is testing, the indenter [1] probed the second metatarsal head (MTH 2) and
to investigate the effects of (i) natural tissue glycation (ageing) and (ii) heel pad tissue with constant rate of 12mm/s. Experiment was done
accelerated tissue glycation (diabetes mellitus) on plantar soft tissue stiffness under load bearing (50% BW on foot tested) condition. Maximum tissue
using the proposed indenter [3]. deformation induced was varied from 1.2mm to 6.0mm in steps of
Methods: First experiment investigates the plantar tissue stiffness as a 1.2mm. Tissue stiffness obtained from tissue response curve was
consequence of natural ageing. 25 young (22±1.6 yrs) and 25 old subjects compared.
(67±5.8 yrs) of similar physical attributes are recruited. Second experiment Results: All 20 subjects showed similar force response as demonstrated
involves 35 normal and 5 diabetic subjects of similar physical attributes in Fig. 1, at both sites. The soft tissue response was fitted to the
and ages. It assesses the effect of accelerated tissue glycation due to viscoelastic model proposed [2], represented by Equation (1).
diabetes on plantar tissue stiffening. During stiffness measurement,
indentor tip probes the plantar soft tissue to obtain localized force
 K1 X , 0  X  Xs
response underneath the 2nd metatarsal head pad at 3 different F  (1)
dorsiflexion angles of 0°, 20°, 40° and the hallux and heel at 0°. Maximum
tissue deformation is fixed at 5.6mm (close to literature data) [4].
 K1 X  K 2 ( X  X s )  CX , X s  X  X max
Figure 1(abstract A83) Comparison of plantar STS between (A) young and elderly; (B) diabetic and non diabetic subjects. *p < 0.05
Figure 1(abstract A84) Typical force response of plantar soft tissue to the variable indentation depth.
As the indenter tip goes deeper into the soft tissue beyond a threshold
depth, the force gradient will increase notably. K 1 and K 2 depict the A85
elastic components of soft tissue at the initial and subsequent phases of The effect of gender, age, bodyweight, height and body mass index on
indentation. C characterizes the viscous behavior of tissue which is only plantar soft tissue stiffness
prominent at the latter stage of indentation. X s is the minimum Jee Chin Teoh, Taeyong Lee*
indentation depth required for the tissue to exhibit nonlinear viscoelastic Department of Biomedical Engineering, National University of Singapore,
behavior. The parameters are listed in Table 1. Singapore
Discussion: As the indentation gets deeper, the stiffer the soft tissue E-mail: bielt@nus.edu.sg
becomes. We found that indentation depth which is less than the Journal of Foot and Ankle Research 2014, 7(Suppl 1):A85
threshold depth might not be representative of the nature of plantar soft
tissue. This small tissue deformation does not reflect the critical condition Introduction: Foot abnormality has become a public health concern.
of soft tissue during physical activities that will expose the tissue to risk Early detection of pathological soft tissue is hence an important
of ulceration. The threshold depth is subject dependent and is very likely preventive measure, especially to the elderly who generally have a higher
to be caused by the difference in tissue composition. The next key step is risk of foot pathology (i.e. ulceration). However, the management of
to further investigate how the tissue composition will affect the threshold plantar tissue stiffness data is questionable.
thickness in each subject. The objective of this study is to assess the influence of gender and
The study successfully indicated the necessity to induce sufficient physical attributes such as height, weight and BMI on plantar soft tissue
indentation to the soft tissue tested, in order to describe its true nature. stiffness. It is also to evaluate whether it is necessary to isolate the
This will eventually provide a more useful stiffness values in identification differences in gender, age, bodyweight, height and body mass index in
of potentially abnormal soft tissue. the data analysis procedure.
References Methods: 100 healthy subjects were recruited from National Seoul
1. Chen W, et al: An instrumented tissue tester for measuring soft tissue University (SNU) hospital for the experiment. During stiffness measurement
property under the metatarsal heads in relation to metatarsophalangeal [1], indentor tip probes the plantar soft tissue to obtain localized force
joint angle. Journal of Biomechanics 2011, 44:1804-1804. response underneath the 2nd metatarsal head pad at 3 different
2. Klaesner JW, et al: Accuracy and reliability testing of a portable soft dorsiflexion angles of 0°, 20°, 40° and the hallux and heel at 0° Maximum
tissue indentor. Neural Systems and Rehabilitation Engineering 2001, tissue deformation is fixed at 5.6mm (close to literature data) [2].
9(2):232-240, IEEE Transactions on. Tissue behavior was characterized via K, stiffness constant.
Indentation force ( N )
K ( N / mm) 
Indentation depth (mm)
Table 1(abstract A84) Tissue properties of 2nd MTH and heel
2nd MTH Heel p-value T-tests were used to identify significant stiffness differences between left
and right foot, as well as between male and female subjects on hallux
Average Tissue 13.80 ± 1.76 18.04 ± 2.42 < 0.01* and heel pad. Two-way ANOVA was used to analyze the data obtained
Thickness (mm) from sub-MTH pad as the stiffness of the forefoot region. The level of
K1 (% tissue -0.230 ± 0.122 -0.492 ± 0.151 < 0.01* significance was set at p<0.05. Pearson correlation was used to assess the
thickness/mm) relationship between bodyweight and BMI with plantar soft tissue
stiffness.
K2(% tissue thickness / -0.477 ± 0.168 -1.015 ± 0.406 < 0.01* Results: The male and female participants were significantly varied in
mm) weight, height and BMI, but similar in age. There was a weak correlation
Xs (% tissue thickness) 16.177 ± 1.909 11.845 ± 1.284 < 0.01* for both the BW and BMI with plantar tissue stiffness (Table 1a and 1b).
This showed that BW and BMI are unlikely the cause for the variation in
C 0.767 ± 0.667 1.803 ± 0.651 0.03* stiffness data. Gender difference also did not show influence on stiffness
*significant at 95% confidence level measurement of plantar tissue at zero MTPJ flexion (Table 2).
Table 1(abstract A85) Pearson correlation for (a) body the 5MtF in football players occur frequently in their non-dominant limb
weight and (b) body mass index with plantar soft tissue [2]. Since different playing positions requires different physical demands
in match-play [3], the aim of this study was to examine the hypothesis
stiffness that the limb dominance for 5MtF is position-specific. Using a publicly-
(a) available injured reserve list in Japan professional football league (J-
League) during 2008-2013 seasons, we collected a total of 82 cases of
Plantar location Left Right
5MtF. Positions (forward players: FW, midfielders: MF, and defenders: DF)
Hallux -0.1 -0.06 and limb dominance in each player was also identified by officially-
Heel 0.12 0.13 released profile in their team. To test whether the percentage of limb
dominance of 5MtF differed from chance, we used a binomial test to
2nd MTH 0° 0.08 0.08 compare reported incidence of 5MtF in non-dominant limb out of all
20° 0.17 0.16 cases to the theoretical probability of 50%. In the present study, 24
30° 0.15 0.19 (29.3%), 33 (40.2%) and 25 (30.5%) cases of 82 cases were classified into
FW, MF and DF, respectively (Figure 1-A). There were no significant
(b) differences in the incidence of 5MtF among three groups (p=0.41, Chi-
Hallux -0.09 0.02 square test). Overall, the 5MtF tended to be occurred in non-dominant
limb (Figure 1-B; p<0.01). However, as shown in Figure 1-B, the trend was
Heel -0.06 -0.16 more pronounced in DF (p<0.01), and not in FW (p=0.15) and MF
2nd MTH 0° -0.08 -0.08 (p=0.24). These results suggest that limb dominance for5MtF is position-
20° -0.13 -0.14 specific in football players.
References
30° -0.19 -0.12 1. Ekstrand J, van Dijk CN: Fifth metatarsal fractures among male
professional footballers: a potential career-ending disease. Br J Sports
Med 2013, 47:754-758.
2. Ekstrand J, Torstveit MK: Stress fractures in elite male football players.
Table 2(abstract A85) T-test results of plantar tissue Scand J Med Sci Sports 2012, 22:341-346.
stiffness due to gender difference 3. Bloomfield J, Polman R, O’Donoghue P: Physical demands of different
positions in FA Premier League soccer. J Sports Sci Med 2007, 6:63-70.
Plantar tissue stiffness p
Left
Hallux 0.72570177 A87
A neuromusculoskeletal model to simulate the isokinetic ankle
Heel 0.21899688 dorsiflexion test of spasticity
2nd MTH 0° 0.48993505 Ruoli Wang1*, Örjan Ekeberg1, Anders Fagergren2, Johan Gäverth3,
20° 0.05168678 Hans Forssberg3
1
Department of Computational Biology, KTH Royal Institute of Technology,
40° 0.01657689 Stockholm, Sweden; 2AggeroMedtech AB, Stockholm, Sweden; 3Department
Right of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
Hallux 0.74204251 Journal of Foot and Ankle Research 2014, 7(Suppl 1):A87
Heel 0.08408934 Introduction: Spasticity is a motor disorder characterized by a velocity-
2nd MTH 0° 0.52305598 dependent increase in tonic stretch reflexes [1], commonly seen in many
20° 0.05769349 neurological disorders. Clinically, spasticity is measured by an examiner
rotating a joint and simultaneously estimating the resistance according to
40° 0.02280329 an ordinal scale. However, the limited reliability of the measurement and
the impossibility to discriminate between the underlying neural (stretch
reflex) and non-neural (i.e. muscle mechanics) contributions have been
Discussion: From the experimental results, it can be deduced that BW the motivation to develop methods describing resistance joint torque
and BMI are weakly associated with plantar tissue stiffness and there was quantitatively. The aim of this preliminary study is to develop a forward
no significant difference in stiffness between male and female neuromusculoskeletal model consisting of the explicit musculotendon,
participants. No difference is found between left and right feet muscle spindle, and motoneuron pool, which can simulate the passive
measurement. This suggests that normalizing of plantar tissue stiffness by isokinetic ankle dorsiflexion test of spasticity.
either variable is not necessary. The data can be pooled and treated Material and methods: In the model, the plantarflexors were considered
equally regardless of gender. as a lumped representation of all the muscles. Dorsiflexors were not
References included in the model. The musculoskeletal geometry was based on the
1. Chen W, et al: An instrumented tissue tester for measuring soft tissue anthropometrical data from a healthy female (height: 1.62m, weight:
property under the metatarsal heads in relation to metatarsophalangeal 53kg). The hill-type musculotendon model was used to simulate the
joint angle. Journal of Biomechanics 2011, 44:1804-1804. musculotendon dynamics of the lumped plantarflexors. Activation
2. Cavanagh PR: Plantar soft tissue thickness during ground contact in dynamics were modeled as a first order differential equation. The hybrid
walking. Journal of Biomechanics 1999, 32(6):623-628. v 0.6 model was used to model the firing characteristics of the muscle
spindle [2]. The input-output relation of the a-motoneuron pool can be
simplified as a sigmoid function. The contributions of the moment from
A86 the passive muscle properties and the stretch reflex to the total
Limb dominance for fifth metatarsal fracture in football players is resistance torque were computed from 0° to 40° ankle dorsiflexion at two
position-specific constant angular velocities (5°s-1 vs. 236°s-1).
Tomoya Ueda1,2*, Hiroaki Hobara1, Yoshiyuki Kobayashi1, Masaaki Mochimaru1, Results and discussions: Compared to the fast ankle rotation, there was
Hiroshi Mizoguchi2 almost no stretch reflex-induced moment in the slow ankle rotation
1
National Institute of Advanced Industrial Science and Technology, Tokyo, (Figure 1), which agrees to the definition of the spasticity. It indicates that
135-0064, Japan; 2Tokyo University of Science, Chiba, 278-8510, Japan the current neuromusculoskeletal model can describe the individual
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A86 contributions to the total resistance moment. In the future, by comparing
the experimental measurements and the predicted moment, the
Fifth metatarsal fractures (5MtF) are one of the most common traumatic important spasticity related parameters e.g. a-motoneuron pool
foot injuries in football player [1,2]. A previous study demonstrated that properties may be identified individually.
Figure 1(abstract A86) A: Incidence of fifth metatarsal fracture in three groups. B: Percentage of non-dominant limb (%NDL) for fifth metatarsal fracture
in each group.
References Background: Charcot-Marie-Tooth disease (CMT) is the most common

1. Lance J: The control of muscle tone, reflexes, and movement. Neurology hereditary peripheral neuropathy, with an incidence of 1 in 2,500 [1]. CMT
1980, 30:1301. is characterised by the progressive weakening of the distal muscles and
2. Prochazka A, Gorassini M: Models of ensemble firing of muscle spindle sensory loss of the limbs, particularly around the foot and ankle resulting
afferents recorded during normal locomotion of cats. J Physiol 1998, in balance, walking impairments, cavus foot deformity and lateral
27:21-34. instability [2,3]. Clinical anecdotes suggest foot orthoses designed on the
‘sensorimotor’ paradigm proposed by Lothar Jahrling are beneficial at
improving lateral stability during gait in patients with CMT. The purpose
of this study was to investigate the effect of sensorimotor orthoses on
A88 frontal plane ankle motion in people with CMT.
Effect of sensorimotor orthoses on rearfoot motion in patients with Methods: Four males and one female with CMT aged 31 to 64 years
Charcot-Marie-Tooth disease: a pilot study volunteered for the study. Each participant were fitted with an extra
Caleb Wegener1*, Katrin Wegener2, Karl-Heinz Schott2, Joshua Burns3 depth prefabricated pedorthic shoe (Gadean Walker Stretch, Malaga, WA,
1
Discipline of Exercise and Sports Science, Faculty of Health Sciences, The Australia) and a custom made orthoses prescribed according to the
University of Sydney, NSW, 1825, Australia; 2Shoe Tech Pty. Ltd, Pedorthic sensorimotor paradigm. Participants completed five walking trials at a
Clinic, Dee Why, NSW, 2099, Australia; 3Faculty of Health Sciences, The self-selected velocity while wearing the shoe and shoe with orthoses in a
University of Sydney/ Institute for Neuroscience and Muscle Research, The randomised order. Three-dimensional ankle joint complex motion was
Children’s Hospital at Westmead, Sydney, NSW, 2145, Australia measured using a motion-analysis system. Rearfoot motion was attained
E-mail: caleb.wegener@sydney.edu.au by detachable wand triad-marker through a window in the heel counter
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A88 of the shoe. Data were time-normalised by linear interpolation to the
Figure 1(abstract A87) The contributions of the moment from passive muscle properties and the stretch reflex to the total resistance moment when a-
motoneuron pool properties were specified. The angular velocities and the position of the ankle joint were prescribed in the simulation.
stance phase and ensemble-averaged across trials and participants.

Maximum and mean frontal plane motion from initial contact until 50% A90
of stance was calculated. Paired sample t-tests were undertaken to assess The effect of cognitive task on ankle movement variability in athletes
significance between conditions. Participants were asked to nominate with Functional Ankle Instability
which condition felt more stable during walking. Sanam Tavakoli1, Saeed Forghany1,2*, Christopher Nester2, Akram Jamali1,
Results: Gait velocity was not altered between the shoe (1.16m/s (0.13)) Khadijeh Bapirzadeh1
1
and orthoses (1.7m/s (0.12), p=0.537). Mean ankle eversion increased Musculoskeletal Research Centre, Isfahan University of Medical Sciences,
during loading while wearing orthoses (mean change 3.7° (2.8), p=0.041). Iran; 2Centre for Health Sciences Research, University of Salford, UK
Maximum ankle eversion increased during loading while wearing orthoses E-mail: Saeed_forghany@rehab.mui.ac.ir
(mean change 3.6° (2.9), p=0.051). All five participants reported a sense of Journal of Foot and Ankle Research 2014, 7(Suppl 1):A90
increased stability while walking with the orthoses.
Conclusions: Sensorimotor orthoses increase ankle eversion in people Background: Gait has been generally viewed as a largely automated
with CMT and may provide increased gait stability during the loading motor task, requiring minimal higher-level cognitive input. Increasing
phase of gait. evidence, however, suggest that attention demanding cognitive tasks to
References disturb gait[1,2]. Movement variability may influence joint stability and
1. Skre H: Genetic and clinical aspects of Charcot-Marie-Tooth disease. Clin increase the risk of “giving way” at the ankle in individuals with functional
Genet 1974, 6:98-118. ankle instability (FAI)[3]. The purpose of this study was to investigate the
2. Sabir M, Lyttle D: Pathogenesis of Charcot-Marie-Tooth disease. Gait effect of dual-tasking on ankle movement variability in athletes with FAI.
analysis and electrophysiologic, genetic, histopathologic, and enzyme Methods: 21 athletes (age 25.57±4.77 years) with clinically diagnosed FAI
studies in a kinship. Clin Orthop Relat Res 1984, 223-35. were recruited. All participants completed 5 trials of normal walking and 5
3. Vinci P, Perelli SL: Footdrop, foot rotation, and plantarflexor failure in trials of normal walking while performing a cognitive task. The cognitive
Charcot-Marie-Tooth disease. Arch Phys Med Rehabil 2002, 83:513-516. task consisted of subtracting seven from a randomly selected number
between 11 and 99 repeatedly whilst walking. Three dimensional rotations
of the affected ankle (measured by an eight-camera motion capture system
A89 at 100 Hz) were calculated by visual3D during gait cycles. Between trials
Correlation between foot type and posture for the elderly variability of ankle rotations time curves during stance phase and during
Kyungock Yi1*, Namhee Kim2 200ms before and after heel strike were calculated using the coefficient of
1
Human Movement Study, Ewha Womans University, Seoul, Korea, 120750; multiple correlations (CMC) and intraclass correlation (ICC).
2
Hanbuk University, Donduchun,Kyuggido, 473777, Korea Results: The results indicate that mean CMC was decreased during dual
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A89 task condition in the sagittal and frontal planes. This was statistically
significant in frontal plane during 200ms before and after heel strike
The purpose of this study was to identify the correlation between foot type (p<0.05) (Table 1). There was reduction in ICC magnitude in dual-task
and posture. Subjects were 49 elderly people from a Catholic Church in the condition compared to single task in 200ms before heel strike (Table 2).
Seoul area. 13 subjects were men, and 36 were women. Questionnaire was Conclusion: The athletes with FAI demonstrated greater ankle movement
used to identify injuries, blood pressure, history and location of pain, wallet variability during dual task condition which may indicate diminished
carrying habits for men (left or right side). Resting Calcanel Stance Position neuromotor control. Cognitive load may increase episodes of ankle
(RCSP) was used to identify foot type (pes planus, pes rectus, pes cavus), F/F instability in these athletes.
to R/F and three-dimensional pelvic deviation were also measured,grip Competing interests: Nester declares a personal commercial interest in
strength and posture (sagittal plane & coronal plane). SPSS 18 was used for the insoles tested in this study.
statistical analysis, along x² (with Scheffe for post-hoc), and Kenndall’s tau_b References
for the correlation. 1. Abbud GA, Li KZ, DeMont RG: Attentional requirements of walking
1. Foot Deformity according to the gait phase and onset of auditory stimuli. Gait & posture
a) 65% of test subjects had normal feet. 69% of elderly men and 64% of 2009, 30(2):227-32.
elderly women were normal. 2. Al-Yahya E, Dawes H, Smith L, Dennis A, Howells K, Cockburn J: Cognitive
b) 21% of elderly women had pes cavus. motor interference while walking: a systematic review and meta-
c) There was a higher incidence of pes cavus and F/F to R/F angle in the analysis. Neuroscience and biobehavioral reviews 2011, 35(3):715-28.
right foot compared to the left. 3. Brown CN, Padua DA, Marshall SW, Guskiewicz KM: Variability of motion in
2. Correlation between foot type and posture individuals with mechanical or functional ankle instability during a stop
There was a correlation between left foot type and both sagittal postural jump maneuver. Clinical biomechanics Bristol, Avon 2009, 24(9):762-8.
deviation and coronal shoulder deviation. Subjects with left foot pes
planus also exhibited a rearward postural deviation and a left downward
sloping shoulder deviation. A91
There were correlation between deviation in the shoulder, shoulder blade, Simplified finite model based evaluation of tissue stress distribution on
and pelvis. Thus, subjects with one type of deviation are likely to have anesthetic feet of Leprosy patients for 3 dimensional orthosis
corresponding deviations in the other two areas. fabrication
For men, shoulders and shoulder blades tilted in the same direction as Sathish K Paul1*, Sudesh Sivarasu2
1
the pelvis: e.g. Right downward sloping shoulders / shoulder blades VIT University, Vellore - 632014, Tamil Nadu, India; 2Lecturer & Project leader,
corresponded to a right downward sloping pelvis. Biomechanics, University of Cape Town, Cape Town 7925, South Africa
Men’s pelvis deviated towards their wallet-carrying side in the transverse E-mail: sathishpaul77@gmail.com
plane: e.g. men who habitually carried their wallet in their left pocket had Journal of Foot and Ankle Research 2014, 7(Suppl 1):A91
a rearward deviation in their left pelvis and vice versa.
There was a negative correlation between grip strength and injury history. Background: The Subtalar joint position during static stance is a crucial
Subjects with stronger grip strength had less injuries and vice versa. determinant of the peak plantar pressures and forms a base for any
There was a positive correlation between injury history and sagittal intervention in foot related problems for leprosy affected patients[1].
postural deviation. Studies have stated that the subtalar joint when in neutral position is more
References ideal for orthotic fabrication. In this study a hypothesis was formulated and
1. Kyungock Yi, Kim N, Kim Y: The Differences in Foot Type According to pursued [2,3]. Central to the hypothesis is that the stress will be minimal in
Major in Left and Right Foot for Female College Students. Korean Journal the distal joints of the foot when the subtalar joint is neutral at static
of Sport Biomechanics 2012, 22(2):229-236. stance position.
2. Kyungsook Kim, et al: The Effects of Exercise on Physical and Rear Foot Results: The Computed Tomography (CT) images of the feet for 5 patients
Deformities in Gifted Youth Athletes. Journal of Korean Education suffering from Hansen’s disease having no muscle weakness and joint
Association for Girls and. Woman 2011, 2:181-193. restriction were acquired. The gray intensities corresponding to the bones
Table 1(abstract A90) Mean CMC during different conditions and periods of time.
Single-Task Dual-Task
200ms before and after HSa Frontal plane 0.9529±0.029 0.9270±0.044 *
Sagittal plane 0.9505±0.042 0.9373±0.046
Transverse plane 0.8530±0.150 0.8539±0.140
HS-TOb Frontal plane 0.9396±0.042 0.91150.092
Sagittal plane 0.9842±0.019 0.9825±0.022
Transverse plane 0.9228±0.092 0.9274±0.072
a b
Heel strike. Toe off. * P <0.05
Table 2(abstract A90) ICC in 3planes during different - 531230, India; 3Head, Sustainable Livelihoods, The Leprosy Mission Trust
India-110001, New Delhi, India
conditions E-mail: sathishpaul77@gmail.com
Single-Task Dual-Task Journal of Foot and Ankle Research 2014, 7(Suppl 1):A92
a
200ms before HS Frontal plane 0.964 0.960
Background: The Micro Cellular Rubber (MCR) unit established in
Sagittal plane 0.943 0.710 Vizinagaram, Andhra Pradesh in India by The Leprosy Mission Trust India
(TLMTI) caters to the need of poor Leprosy affected patients with
Transverse plane 0.934 0.914
neuropathic feet within India and to countries nearby India. The MCR
HS Frontal plane 0.968 0.975 Unit till date has provided over a million pairs of MCR insoles to all with
Sagittal plane 0.879 0.907 anaesthetic feet and still continues to do so.
Results: The MCR sheets manufactured with a shore hardness of 15’
Transverse plane 0.756 0.908 Shore ‘A’, has helped prevent high pressure points and thus avoid plantar
200ms after HS Frontal plane 0.958 0.909 ulcers in anaesthetic feet. Natural Rubber along with several other
chemicals is used in optimum quantities to manufacture MCR. The unique
Sagittal plane 0.950 0.949 manufacturing process gives MCR the ability to spring back to original
Transverse plane 0.809 0.973 shape when pressure is released while walking.
b
The larger size (24” X 20”) coloured MCR sheets with 10mm thickness has
TO Frontal plane 0.911 0.930 become an ideal rubber to prevent stigma for deformed anaesthetic feet.
Sagittal plane 0.882 0.898 The cost effectiveness in the production of the MCR rubber has helped
the poor leprosy patients afford and use the MCR insoles for their
Transverse plane 0.924 0.903 footwear. Association and constant interaction with various shoe and
a
Heel strike. b *
Toe off. P <0.05 footwear companies have led to experimentation and development of
newer designs in MCR sandals. High quality and standards of the MCR
insoles are maintained through periodic standardised quality tests carried
of the foot from the CT images were 3 dimensionally reconstructed. The out both within and outside the organisation.
three dimensional model of the human foot, incorporating the realistic Although the initial purpose of the MCR unit was to cater to the needs of
geometry and the material properties of the hard tissues were then Leprosy affected people, in course of time, various Orthotic & Prosthetic
analyzed using a finite element solver. Stress distribution on bones of the centres realized the value and have started using MCR in their products,
foot while on static stance with the subtalar joint in neutral position were especially for Diabetic foot care. Since patients use and prefer protective
acquired. The results demonstrate that the weight of the patient and the MCR footwear to prevent ulcers, protect and cover their anaesthetic and
position of the calcaneum in the static stance position contribute to the deformed feet, it is essential for MCR production units to constantly
high stresses in the foot. The stresses in the bones of the foot are minimal upgrade and develop newer designs and give the patients and
when the subtalar is in neutral position, suggesting that this position is an opportunity to choose. At present TLMTI uses 50% of its annual MCR
optimal aim for foot orthotic fabrication. production and the rest is used by other NGOs and Orthotic centres.
Conclusion: The automating process of designing a customized orthosis Conclusion: With time there has been a rapid change and development
with the impression got from the 3 dimensionally modeled feet reduced in the design and manufacture of footwear, however there has been no
the modeling time considerably. The simple technique used will help in alternative to MCR insole footwear. The constant strive of introducing and
giving comfort and stability to the patient’s feet while walking. making use of MCR footwear in other general disabilities have reduced
References the stigma of MCR’s in leprosy to a great extent.
1. Abbud GA, Li KZ, DeMont RG: Attentional requirements of walking
according to the gait phase and onset of auditory stimuli. Gait & posture
2009, 30(2):227-32.
2. Al-Yahya E, Dawes H, Smith L, Dennis A, Howells K, Cockburn J: Cognitive A93
motor interference while walking: a systematic review and meta- Rearfoot strikers have smaller resultant tibial accelerations at foot
analysis. Neuroscience and biobehavioral reviews 2011, 35(3):715-28. contact than non-rearfoot strikers
3. Brown CN, Padua DA, Marshall SW, Guskiewicz KM: Variability of motion in Molly D Glauberman, Peter R Cavanagh*
individuals with mechanical or functional ankle instability during a stop Deparment of Orthopaedics and Sports Medicine, University of Washington,
jump maneuver. Clinical biomechanics Bristol, Avon 2009, 24(9):762-8. Seattle, WA, 98195, USA
E-mail: cavanagh@uw.edu
A92
Micro Cellular Rubber (MCR) - a boon for leprosy affected patients with Purpose: Overuse injuries are common in recreational runners. Recent
anesthetic feet in preventing secondary impairments reports have implicated the characteristics of the footstrike in the
Sathish K Paul1*, Edward Rajkumar2, Tina Mendis3 etiology of stress responses in the tibia. This has motivated efforts to
1
Prevention of Impairment and Disability, The Leprosy Mission Trust India, modify the loading at footstrike by altering the orientation of the foot at
New Delhi-110001, India; 2Manager, MCR Unit, Vizinagaram, Andhra Pradesh first contact. The present study aimed to: 1) report typical magnitudes of
Figure 1(abstract A93) Peak tibial acceleration in rearfoot (n=13) and non-rearfoot (n=7) strikers in Brooks Adrenaline shoes.
Figure 2(abstract A93) Peak resultant tibial acceleration in runners who ran with an altered footstrike (n=18) while wearing their own shoes.
resultant tibial acceleration (TA) in women distance runners; 2) contrast strikers decreased to 9.5g from 13.2g when switching to rearfoot striking
TA in rearfoot and non-rearfoot striking runners; and 3) examine TA (Figure 2).
during non-natural footstrike patterns in runners. Conclusions: It is not advantageous for rearfoot strikers to transition to non-
Method: We used a leg-mounted tri-axial acceleration monitoring unit to rearfoot striking if PTA is the criterion measure. Previous studies that have
measure TA and angular velocities. Twenty injury-free women distance only examined the axial component of tibial acceleration may have reached
runners (age 27.8±3.7 years, height 168.1±6.2 cm, body mass 59.2±7.3 kg, the wrong conclusion because the A-P component is the larger component
weekly mileage >20) participated in the study. The sensor was positioned in non-rearfoot strikers. Our findings suggest that a transition away from
5cm above the medial malleolus along the medial tibial border and rearfoot striking is likely to increase tibial acceleration at footstrike. Thus, if
tensioned to 22N with a Velcro strap. Multiple 60-second running trials at tibial stress injuries are indeed related to resultant tibial acceleration at
3.13 m/s on a force-measuring treadmill (Kistler 9287 plate) were collected. footstrike, a change to non-rearfoot striking may increase the risk of injury.
Results: The range of values for axial peak tibial acceleration (PTA) in the
group was 4.6g to 10.9g. Axial PTA in 7 non-rearfoot strikers (6.3±1.1g) was
not significantly different from that in rearfoot strikers (7.4± 0.8g; p=0.15). A94
However, the anterior-posterior acceleration component and the resultant Distal foot segment joint coupling patterns during walking gait
PTA in non-rearfoot strikers (10.0±1.9g) were significantly greater than that Stephen C Cobb1*, Robin L Bauer2, Mukta N Joshi1
1
in rearfoot strikers (5.2±1.6g; p=<0.001) (Figure 1). In a second part of the Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee,
study, twelve natural rearfoot runners were instructed to change their WI 53201, USA; 2Robin Bauer was a graduate student in the MS Kinesiology
strike pattern to a non-rearfoot strike while 6 non-rearfoot strikers changed program at the University of Wisconsin-Milwaukee at the time of the study
to a rearfoot pattern. The average resultant PTA for the natural rearfoot E-mail: cobbsc@uwm.edu
strikers increased from 9.4g to 11.3g, whereas 6 natural non-rearfoot Journal of Foot and Ankle Research 2014, 7(Suppl 1):A94
Background: Several surface based multi-segment foot models have been 3. Bruening D, Cooney K, Buczek F: Analysis of a kinetic multi-segment foot
developed to investigate distal foot function during gait [1,2]. However, model. Part I: Model repeatability and kinematic validity. Gait Posture
the majority of the models have not defined medial and lateral forefoot or 2012, 35(4):529-34.
midfoot segments. In addition very little, is currently known regarding the 4. Rankine L, Long J, et al: Multisegmental foot modeling: a review. Critical
coupling of the distal foot segments [3,4]. The purpose of the current Reviews in Biomedical Engineering 2008, 36(2-3):127-181.
study, therefore, was to utilize a six foot segment model that includes both
medial and lateral forefoot and midfoot segments to quantify the coupling
between the distal foot segments during walking gait. A95
Methods: Ten participants (5 m, 5 f; mean age 22.7 ± 3.3 y) participated in Development for generating electric power shoes having a vibrating
the study. A 10 camera Motion Analysis system was used to capture three- sheet generator assembly
dimensional positions of marker clusters located on the leg and six foot Jia Hroung Wu1*, Wen Lan Wu2
1
segments of interest (calcaneus, navicular, 1st and 2nd metatarsals, hallux, 4th Department of Industrial Management, Hsiuping University of Science and
and 5th metatarsals, cuboid). Following completion of 10 successful walking Technology, Taichung City, Taiwan; 2Department of Sports Medicine,
trials, joint coupling between adjacent segments of interest were Kaohsiung Medical University, Kaohsiung City, Taiwan
investigated using vector coding. Repeated measures ANOVAs with one E-mail: wujia@hust.edu.tw
within-subject variable (stance subphase) were performed for each joint Journal of Foot and Ankle Research 2014, 7(Suppl 1):A95
couple of interest to investigate joint coupling between stance subphases.
Dependent t-tests were performed to investigate significant omnibus It is often seen an object move or vibrate repeatedly. Some phenomenons
F ratios (a = 0.05). are useful, but another is unavailable motion. The unavailable motion makes
Results: Significant joint coupling differences were revealed between a lot of energy dissipation. In order to utilize the energy unavailable motion
stance subphases for the: calcaneonavicular complex sagittal plane and makes, the research will use the energy to generate electric power for
rearfoot complex sagittal plane; calcaneocuboid transverse plane and solving the deficient personal energy sources problems. In general, the
rearfoot complex transverse plane; medial forefoot sagittal plane and generator coil sweeps the magnetic field line to generate the electric power
calcaneonavicular complex frontal plane; and lateral forefoot sagittal these days. The revolving spindle will abrasion and the energy will loss.
plane and calcaneocuboid frontal plane (Table 1). Therefore, the generating efficiency of electric power will decrease [1-4].
Conclusions: These results are clinically relevant due to the fact that a The research utilizes a structure of sheet generator to generate electric
number of previous studies investigating joint coupling have only calculated power. The present research relates to a method for manufacturing a sheet
a single coupling angle between the segments of interest. The single generator having a flat coil assembly, and more particularly to a method
coupling angle has then been assumed to represent the coupling comprising the steps of placing a flat coil into an injecting mold; forming a
relationship throughout the stance phase. The results of the current study, locating section to secure the flat coil; and assembling the sheet generator.
however, suggest that this assumption may not be valid for all the coupling The relative motion between coil and magnet will generate electric power in
relationships between the distal foot segments during walking gait. accordance with the Fleming’s right-hand rule.
Acknowledgements: This study was supported by grants from the In order to assess the efficiency of generating electric power, the research
UW-Milwaukee College of Health Sciences and the Wisconsin Athletic will design an experimental device to simulate the sheet generator. First,
Trainers’ Association. two plastic diaphragms be used to laminate the coil. Then, place the
References laminate diaphragm on the inverted U-shape structure of experimental
1. Nigg B, Cole G, et al: Effects of arch height of the foot on angular motion of device. Because the inverted U-shape structure and magnet move relatively,
the lower extremities in running. Journal of Biomechanics 1993, 26(8):909-916. so the electric power will be produce by cutting magnetic field line.
2. Williams D, McClay I, et al: Lower extremity kinematics and kinetic The server motor drives the cam to press the inverted U-shape structure.
differences in runners with high and low arches. J Appl Biomech 2001, When the motor rotational speed is 120 r.p.m. (2Hz), then the voltage of
17:153-163. generating electric power can obtain exceeds respectively 1.5V, 2.0V and
Table 1(abstract A94) Coupling angles

Couple Stance Subphase Coupling Direction (°)
Distal joint complex Proximal joint complex Loading response Midstance Terminal stance Pre-swing
Motion Plane Motion Plane
Calcaneonavicular Rearfoot 149.45±30.98 234.34±50.18 232.74±72.60 243.19±134.42
Frontal Frontal
Calcaneonavicular Rearfoot 36.54±34.37 33.01±4.16 33.18±9.40 40.42±14.61
Transverse Transverse
Calcaneocuboid Rearfoot 149.67±44.46 214.90±107.08 225.71±108.97 211.40±41.84
Sagittal Sagittal
Calcaneocuboid Rearfoot 213.83±22.85 172.10±68.40 131.86±98.60 190.87±126.79
Frontal Frontal
Calcaneocuboid Rearfoot 287.89±98.31a 169.05±32.07a 150.01±19.73 160.40±45.48
Transverse Transverse
Medial forefoot Calcaneonavicular 129.19±113.93 129.38±41.21b 182.49±43.12bc 256.82±19.86c
Sagittal Frontal
Lateral forefoot Calcaneocuboid 170.25±43.90 133.17±72.88 88.87±71.84c 230.62±90.23c
Sagittal Frontal
First MTP Sagittal Medial forefoot 262.83±77.59 184.36±125.82 129.68±83.16 112.24±7.60
Sagittal
a
Significantly different loading response and midstance subphase coupling angles
b
Signficantly different midstance and terminal stance subphase coupling angles
c
Signficantly different terminal stance and pre-swing subphase coupling angles
Table 1(abstract A95) The table of relationship between purpose of this study was to investigate the perturbation recovery of five
number of coil layers and voltage minutes of plantar-flexor static stretching (PSS) in the elderly.
Materials and methods: Thirty-one participants aged over 65 years
Layers 1 2 3 performed 5 min-PSS in the form of wedge board standing. The sway length
Resistance (Ω) 29.2 62.5 92.2 of each subject’s COM (center of mass) was measured to examine the
subject’s static balance. It was measured for one minute in quiet standing
Voltage (V) 1.5 2.5 3.0 with the eyes closed. Sway length was measured for 1 minute which was
divided in three 20-second-sections before and after stretching.
Results: The result showed significant decreases in sway length before
2.5V without assembling the bridge circuit at the coil of 1 layer, 2 layers stretching between 0-20s and 21-40s, 0-20s and 41-60s separately. However,
and 3 layers, as shown in Table 1. Actually, the voltages of generating the results between 21-40s and 41-60s did not show any significant changes.
electric power shoes exceed respectively 1V and 2V without assembling The result showed significant decreases in sway length after stretching
the bridge circuit under the human walking motion and running motion, between 0-20s and 41-60s, 21-40s and 41-60s. However, the results between
as shown in Figure 1. The basic goal of the research has achieved. And 0-20s and 21-40s did not show any significant changes (Table 1).
the design parameters can easily provide the industry of electric power Conclusion: Stabilization time of sway length became stable from 21s
shoes. The industry of storage energy will be developed and established. before stretching with the eyes closed, but unstable duration lasted to
Acknowledgments: This work is sponsored by the Ministry of Education, 40s after stretching, and then sway length was started to decrease from
Taiwan, Republic of China under grant number 99G-55-050. that time(Figure 1). These results suggest that the elderly subjects
References temporarily experienced difficulties in maintaining balance immediately
1. 2008 [http://www.singtao.ca/tor/2008-10-17/1224228745d1364178.html]. after the PSS. Therefore, to prevent falls and perform exercises in a safe
2. 2008 [http://big5.xinhuanet.com/gate/big5/www.nx.xinhuanet.com/misc/ way, it is recommended to allow patients to rest after performing PSS.
2008-11/10/content_14874736.htm]. Trial registration: Current Controlled Trials ISCRTN73824458.
3. Chen XH: Improvement of Power generation shoes. Patent of R.O.C 2000, References
Patent No.:488214. 1. Johnson G, Bradley D, Witkowski R, et al: Effect of a static calf muscle-
4. Kymissis J, Kendall C, Paradiso J, Gershenfeld N: Parasitic power harvesting in tendon unit stretching program on ankle dorsiflexion range of motion
shoes. Proc. IEEE International conference on wearable computing 1998, 132-139. of older women. Journal of geriatric physical therapy 2007, 30:49.
2. Blazevich J, Kay D, Waugh C, et al: Plantarflexor stretch training increases
reciprocal inhibition measured during voluntary dorsiflexion. Journal of
A96 Neurophysiology 2012, 107:250-256.
The effects of plantar-flexor static stretching on perturbation recovery 3. Gajdosik L, Vander Linden W, McNair J, et al: Viscoelastic properties of
in the elderly short calf muscle-tendon units of older women: effects of slow and fast
Seong-gil Kim1, Goonchang Yuk2, Hwangbo Gak1* passive dorsiflexion stretches in vivo. European journal of applied
1
Department of Physical Therapy, College of Rehabilitation Science, Daegu physiology 2005, 95:131-139.
University, Jilyang, Gyeongsan-si, Kyeongbuk, 712-714, Republic of Korea; 4. Weir E, Tingley J, Elder C: Acute passive stretching alters the mechanical
2
Department of Physical Therapy, Yeungnam University Hospital, 170 properties of human plantar flexors and the optimal angle for maximal
Hyeonchung-ro, Namgu, Daegu 705-703, Republic of Korea voluntary contraction. European Journal of applied physiology 2005, 93:614-623.
E-mail: hbgak@daegu.ac.kr 5. Ryan D, Herda J, Costa B, et al: Viscoelastic creep in the human skeletal
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A96 muscle–tendon unit. European journal of applied physiology 2010, 108:207-211.
Background: It is important to improve the routine ADL(activities of daily

living) in the elderly and then diverse and various therapeutic interventions A97
or exercises are applied for the therapy. Generally, to increase the efficiency Effects of heel height and wearing experience on human standing
of the exercise and prevent the injury, the stretching is commonly used [1]. balance
Indeed, there are many case that the elderly complain of the difficulties to Shuping Xiong*, Vaniessa D Hapsari
control the balance after the stretching [2,3]. However, previous studies Ergonomics and Applied Biomechanics Laboratory, Ulsan National Institute
about the effects of stretching after or during the stretching have focused of Science and Technology, Ulsan, 689-798, South Korea
mainly on the histological or neurological changes and there are few studies E-mail: maverickhkust@unist.ac.kr
that focused on the temporary balance control in the elderly [4,5]. Thus, the Journal of Foot and Ankle Research 2014, 7(Suppl 1):A97
Figure 1(abstract A95) Testers wore shoes for generating voltage measurements
Table 1(abstract A96) Comparison of sway length standing Acknowledgements: This study was funded by the Basic Science
before and after 5 minutes plantar-flexor static stretch. Research Program through the National Research Foundation of Korea
(NRF 2011-0022185).
Condition 0-20sec 21-40sec 41-60sec p References
Pre-stretch 14.00±5.18 11.90±4.05 11.78±5.21 0.00ac 1. Tedeschi FW, Dezzotti NR, Joviliano EE, Moriya T, Piccinato CE: Influence of
high-heeled shoes on venous function in young women. J Vasc Surg
Post-stretch 15.87±6.14 15.32±6.13 13.75±5.41 0.02bc 2012, 56(4):1039-1044.
*p<.05 (Mean±SD) 2. Cronin NJ, Barrett RS, Carty CP: Long-term use of high-heeled shoes alters
a
= 0-20sec * 21-40sec, b
= 21-40sec * 41-60sec, c
= 0-20sec * 41-60sec the neuromechanics of human walking. J Appl Physiol 2012,
112(6):1054-1058.
3. Cowley EE, Chevalier TL, Chockalingam N: The effect of heel height on
Background: High heeled shoes (HHS) are no mere accessories of the gait and posture: A review of the literature. J Am Podiatr Med Assoc 2009,
feet, but an essential part of a woman’s fashion that reflects her 99(6):512-518.
personality. Previous studies have shown that HHS are associated with
various musculoskeletal disorders and an increased risk of falls [1-3]. As
reduced balance control is a primary risk factor for falls, the goal of this A98
study is to examine the effects of heel height and HHS wearing Analysis of vertical ground reaction force variables by Foot scan in
experience on human balance during standing. hemiplegic patients
Materials and methods: Thirty young and healthy female participants HyunDong Kim1*, Geun-Yeol Jo2, NaMi Han1, Mi-Ja Eom1
1
were sorted into two groups, inexperienced and experienced HHS Department of Physical Medicine and Rehabilitation, Inje University, Busan,
wearers. They participated in a series of balance tests to measure their 614-735, South Korea; 2Department of Physical Medicine and Rehabilitation,
postural balance, limits of stability, functional mobility, plantar pressure Inje University, Busan, 612-896, South Korea
distribution and muscle activities when they wore women’s dress shoes E-mail: criskim@korea.com
of four different heel heights: 0cm (flat), 4cm (low), 7cm (medium), and Journal of Foot and Ankle Research 2014, 7(Suppl 1):A98
10cm (high).
Results: Heel height and wearing experience affect standing balance Purpose: Our purpose was to analyze the differences in the vertical
independently. Increasing shoe heel height decreased an individual’s ground reaction force (GFR) records of hemiplegic patients to a normal
balance, as shown by worsened postural balance, limits of stability in healthy control group and between affected and unaffected limbs of
terms of excursions and directional control, and functional mobility. At hemiplegic patients using an F-Scan in-shoe transducer.
the same time, high heels induce more effort on both sides of the calf Material and methods: Twenty patients with hemiplegia due to vascular
muscles (gastrocnemius medialis, gastrocnemius lateralis), tibialis anterior causes underwent gait analysis (by the F-Scan system). All patients had
muscle, and vastus lateralis muscle. Calf muscles play primary roles, while steady neurological status and were able to gait independently more than
the tibialis anterior and vastus lateralis muscles play secondary roles in 8 m. The following vertical ground reaction force variables were measured:
maintaining balance. Increased experience in wearing high heeled shoes the first peak force during early stance(F1Y) and the percent stance at
does not improve overall balance performance, but does provide certain which it occurred(F1X); the second peak force evident through push-off
advantages to stability limits in terms of excursions and directional (F2Y) and the percent stance that it occurred(F2X); loading rate, push-off
control in the forward and back directions. Experienced wearers used rate, vertical force impulse, and stance time. Comparison of the GFR
significantly less effort on most muscles at the cost of higher effort from records was performed between hemiplegic patients and healthy control
the gastrocnemius medialis muscle. group and affected and unaffected limbs of hemiplegics. The group
Conclusions: The heel elevation induces more effort from lower limb control consisted of 20 healthy volunteer subjects.
muscles but results in worse human balance regardless of the wearing Results: F1Y of affected side was significantly less than that of unaffected
experience, especially starting at 7cm heel height. Calf muscles play side and normal control group(p<0.05). There was no difference in the F2Y
primary roles and the vastus lateralis & tibialis anterior muscles play between affected side and control group but that of unaffected side was
secondary roles in maintaining standing balance when wearing HHS. significantly less than the other groups(p<0.05). F1X of both affected and
Experienced wearers do not show significantly better overall balance unaffected side of patients was greater and F2X was less than the control
performances, even though they have better excursions and directional group(p<0.05). Loading rate and push-off rate were significantly less on
control in the forward & back directions. the both affected and unaffected sides of patients when compared to the
Figure 1(abstract A96) Comparison of sway length changes over the sections of 0-20, 21-40, 41-60s before and after stretch. *p<.05 (Mean±SD).
control group(p<0.05). Greater impulse and stance time were recorded in gait parameter on applying metatarsal-bar showed no significantly
both sides of patients than the control group(p<0.05). difference, we suggest that metatarsal-bar is helpful to foot diseases patients.
Conclusions: Measuring vertical ground reaction force variables using a References
F-scan system is an objective and useful way to analyze hemiplegic gait 1. Hetherington V, Johnson R, Albritton J: Necessary dorsiflextion of the first
after stroke. From this study, we identified abnormal GFR variables in metatarsophalangeal joint during gait. The journal of foot surgery 1990,
affected limb and even on unaffected limb of hemiplegic patients. 29(3):218.
Abnormalities in GFR variables of the unaffected limb in hemiplegic 2. Hopson M, McPoil T, Cornwall M: Motion of the first metatarsophalangeal
patients may not be the principle target of rehabilitation programs joint. Reliability and validity of four measurement techniques. Journal of
aiming at restoring gait pattern. Instead it is suggested that more the american podiatric medical association 1995, 85(4):198-204.
account should be taken to the unaffected limb 3. Voloshin A, Wosk J: An in vivo study of low back pain and shock absorption
in the human locomotor system. Journal of biomechanics 1982, 15(1):21-27.
4. Nyska M, McCabe C, Linge K, et al: Plantar foot pressures during treadmill
A99 walking with high-heel and low-heel shoes. Foot & ankle international
The change of gait analysis on applying metatarsal-bar used 3D motion 1996, 17(11):662-666.
analysis 5. Yoon MC: The effect of metatarsal pad on peak plantar pressures of the
Se won Yoon1*, Jeong woo Lee1, Soo ji Park2, Woong sik Park3, forefoot during walking. Kyonggi university 2007, Master’s degree.
Moon jeong Kim4
1
Department of physical therapy, Kwangju women’s university, Kwangju,
506-713, Korea; 2Department of physical therapy, Graduate school, Kwangju A100
women’s university, Kwangju, 506-713, Korea; 3Department of occupational The change of gait on shoes sole form
therapy, Kwangju women’s university, Kwangju, 506-713, Korea; 4Department Se won Yoon1*, Jeong woo Lee1, Soo ji Park2, Woong sik Park3,
of physical therapy, Shinhwa rehabilitation clinic, Busan, Korea Woon su Cho4
1
E-mail: ptyoon2000@mail.kwu.ac.kr Department of physical therapy, Kwangju women’s university, Kwangju,
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A99 506-713, Korea; 2Department of physical therapy, Graduate school, Kwangju
women’s university, Kwangju, 506-713, Korea; 3Department of occupational
Introduction: Enough dorsiflexion angle of the first metatarsophalangeal therapy, Kwangju women’s university, Kwangju, 506-713, Korea; 4Department
joint is needed to ensure thrust and stability [1], and if the range of motion of physical therapy, Nambu university, Kwangju, Korea
of the first metatarsophalangeal joint decreases, normal foot function during E-mail: ptyoon2000@mail.kwu.ac.kr
gait is under severe restriction [2]. Wearing shoes with high heels during Journal of Foot and Ankle Research 2014, 7(Suppl 1):A100
gait makes weight leaning forward and wearing them for long may cause
deformation of hallux valgus [3,4]. General therapeutic concepts of foot Background: Preceding studies reported that differences in pressure
diseases focus on reducing or eliminating plantar tissue stress. Recently, distribution according to shoe type [1] and there were many comparative
studies on treatment to solve these problems have been conducted, but analyses of motor mechanics between travel shoes and general running
there have been a few studies on orthotic devices such as metatarsal pad, shoes [2], but they were confined to research on pressure distribution of
dome and wedge [5]. foot and studies on muscle activity and gait cycle depending on shoes heel
Therefore, this study applied bar metatars ophalangeal area of normal were rare.
persons and examined if any change occurs of spatio-temporal indices Therefore, the purpose of this study was to examine change of gait (gait
and kinematic parameters by using 3D motion analysis system. parameter) on shoes sloe form through gait analyzer.
Method: This study selected 40 female university students in their Method: This study selected 12 normal female in their twenties. Gait
twenties and conducted the experiment with them before and after analyzer is composed of two sending and receiving bars of 5cm long and
applying metatarsal bar. Spatio-temporal indices including stance phase, webcam and the width of both bars was 1m. The subject’s gait was
swing phase, double phase, cadence, stride time, stance phase time, sensed between sending and receiving bars and information of temporal
swing phase time, double stance phase time, step length, stride length, and spatial variables was collected. Webcam was used to save image
velocity, stride velocity, and swing phase velocity were measured through information and synchronize the subject’s gait exactly.
3D motion analysis system and kinematic parameters such as pelvic tilt All subjects of this study put three kinds of shoes including high heel,
angle, hip joint flexion-extension angle, knee joint flexion-extension MBT shoes and house shoes and were measured once respectively.
angle, foot progression angle, and ankle joint flexion-extension angle Experiment was made of the following procedures. The researcher
were also measured through 3D motion analysis system. demonstrated 5m gait personally before subjects gait. And then the
After attaching metatarsal bar to the subjects on bare foot, they had researcher said to subjects “walk please”, subjects were put on three
enough practice in laboratory to make them accustomed to gait. Before kinds of shoes once and walk 5m on gait analyzer. Subjects were
experiment, calibration was conducted, gait space was measured and measured by putting a pair of shoes and allowed to take a rest for 2 min.
then subsequent experiment was carried out. Result: As result of change of gait parameter of left and ring lower
Marker was at attached to joint and photographing was made at the extremity on shoes sole form, step, single support, load response were
condition that reflective materials except marker were eliminated within showed significantly difference (p<0.05). But stance phase, swing phase,
the camera view. Marker was at attached to sacrum (1), anterior superior gait time were showed no significantly difference. As result of change of
iliac spine (left, right), greater trochanter (left, right), femur ½ location (left, gait parameter of double support phase on shoes sole form, stride,
right), lateral epicondyle of femur (left, right), fibular head (left, right), tibia double support were showed significantly difference (p<0.05). But gait
½ location (left, right), lateral malleolus (left, right), 5th metatarsal head cycle, gait rate were showed no significantly difference.
(left, right), and heel (left, right). Marker should be attached to be seen in a Conclusion: Step and stride of gait parameter showed shorten when
straight line from side to measure the accurate angle and the subjects wearing high heel. We think that because our subjects were normal
were made to stand in the middle of gait path and look at the front. female in their twenties adaptive high heel height, step and stride of gait
The subjects are made to stand at the starting point of the path to parameter were shorten. MBT shoes showed the highest load response of
measure the dynamic gait and their gaits were measured after comfortable gait parameter in three type shoes, because MBT shoes activate tibialis
walking by measurer’s instruction. The subjects wore shorts to prevent the anterior and gastrocnemius. Therefore we suggest that lower limb
sway of marker during gait and preferred walking velocity was used as gait diseases patients consider gait parameter when helpful shoes select.
velocity. References
Result: As a result of analyzing gait, knee joint angle showed significant 1. Yi KO, Kwon BY: Differences in pressure distribution according to shoe
difference and remaining variables showed no significant difference. type. Journal of Korean physical education association for women 2006,
Conclusion: This study was showed significantly decreased that change of 20(4):161-168.
knee joint angle on applying metatarsal-bar. It was the same change when 2. Choi KJ, Kwon HJ: Sport biomechanical comparative analysis between
wearing high heel appears that general knee joint decreased. We think that general sporting shoe and functional walking shoe. Korean journal of
applying metatarsal-bar wasn’t influence on change of knee joint angle. Also sport biomechanics 2003, 13(2):161-173.
injury is still existed, the leg alignment and foot types might be an
A101 important factor that mainly causes the muscular injury after an appropriate
The effect of foot pressure on applying metatarsal-bar bike fitting. [1-3]The purpose of this study was to investigate the efficacy of
Se won Yoon1*, Jeong woo Lee1, Soo ji Park2, Woong sik Park3, an arch support insole with/o forefoot wedge in muscle activities and joint
Seong kwan Jeong4 loads in order to mimic the musculoskeletal sport injury in cycling and to
1
Department of physical therapy, Kwangju women’s university, Kwangju, enhance the performance.
506-713, Korea; 2Department of physical therapy, Graduate school, Kwangju Eleven amateur cyclists were recruited for this study. Vicon motion analysis
women’s university, Kwangju, 506-713, Korea; 3Department of occupational system, Pedar in-sole foot pressure sensor and Delsys EMG system were
therapy, Kwangju women’s university, Kwangju, 506-713, Korea; 4Department used to measure the three-dimensional lower extremity kinematics, kinetics,
of physical therapy, Orthopedic medicine, Seoul EMG signal. Each subject was randomly shot four different insoles (Bikepro,
E-mail: ptyoon2000@mail.kwu.ac.kr off-counter insole with/o arch support and forefoot wedge) with his own
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A101 bike shoes and bike mounted on a cycle ergometer set to a fixed power of
150W in 75rpm. An One-way ANOVA repeated measurement was used to
Introduction: Several methods to decrease foot pressure applying foot discriminate the effect of insole material, arch, and forefoot wedge. The
orthosis wedge or gait strategies by evaluating foot pressure increased results showed that the BikePro significantly increased the ankle varus angle
abnormally by various foot diseases are under investigation [1]. Recently, (0.4°, p=0.029), the knee internal rotation (1.4°, p=0.030), and it significantly
studies on foot orthosis, diabetic shoes and old people footwear have decreased the ankle abduction angle (1.2°, p=0.047)at the bottom dead
been conducted, but there have been a few studies on orthotic devices center (BDC); reduced the knee sway area by (10.4% , p=0.037). Combined
such as metatarsal pad, dome and wedge [2]. with forefoot wedge, it significantly decreased the ankle varus(0.5°, p=0.005),
Therefore, this study applied bar metatarsophalangeal area of normal and increased the ankle abduction angle (1.2°, p=0.005) but without
persons and examined by using foot analysis system (pressure of changing the knee trajectory patterns.
forefoot, midfoot and rearfoot). The muscle activation time reduced for the biceps femoris(6.8% , p=0.005)
Method: This study selected 40 female university students in their in comparision with the off-counter insoles. Combined with wedge it
twenties and conducted the experiment with them before and after significantly increased the tibialis anterior EMG peak(32% , p=0.015) as
applying metatarsal bar. Dynamic and static foot regions were divided into well as the EMG integral (33%, p=0.019), and the integral of biceps
forefoot, midfoot and rearfoot and then maximum, average and low femoris was also increased (12.5% , p=0.048) when vs. without the
pressure at each region were measure and static foot pressure distribution wedge. The arch support decreased the peak knee sagittal plane moment
ratio was also measured. on the same performance, increased efficiency during cycling. With the
1) Static Foot Pressure: The tips of both feet are aligned to match on wedge, the high forces found the hallux region and first metatarsal head
vertical and horizontal lines of foot pressure measuring plate. Subject’s region which increased the peak knee and ankle moment (Figure 1).
eyes are arranged to look at the front and not to wear shoes. This study suggests the cyclist shall wear proper sports orthotic with arch
2) Dynamic Foot Pressure: Subjects are made to step foot pressure plate support and forefoot wedge according to one’s limb alignment, foot type
by left foot first to measure changes of foot pressure during gait. They as well as the forefoot angle, in addition to the bike fitting to reduce the
are made to walk, looking at the front at the same velocity as usual, overused musculoskeletal related injury.
provided that they are not allowed to wear shoes. Then measured value Acknowledgment: This study was supported by National Science
of left foot was excluded because it may affect the result of gait. Council, ROC through the grant NSC 95-2622-B-010-001, NSC96 -2622-
3) Distribution Ratio: Distribution ratio is measured at four regions of E010- 001-CC3, NSC 100-2622-E-010 -002 -CC3.
front, back, left and right with the same method as that of static foot References
pressure measurement. 1. Bini RR, Diefenthaeler F, Mota CB: Fatigue effects on the coordinative
Results: The results of this study showed that maximum, average and pattern during cycling: kinetics and kinematics evaluation. J Electromyogr
low pressure of static and dynamic conditions in forefoot were Kinesiol 2010, 20(1):102-7.
significantly decreased (p<0.05). Static low pressure in midfoot was 2. Callaghan M: Lower body problems and injury in cycling. Bodywork and
significantly increased and the remaining showed significantly decreased Movement Therapies 2005, 9:226-236.
(p<0.05). Static maximum and average pressure and dynamic low 3. Sanner W, O’Halloran W: The Biomechanics, Etiology, and Treatment of
pressure of rearfoot were significantly decreased (p<0.05). Cycling Injuries. American Podiatric Medical Association 2000, 90(7):354-376.
Conclusion: As reduction of foot pressure by using metatarsal-bar results
in lowering of arch and increasing contact surface, pressure to the foot
was dispersed. These results suggest that wearing shoes with bar which A103
can decrease foot pressure for the patients with diabetic foot lesion and The effects of the aeroball on plantar pressure during isometric hip
rheumatoid arthritis was therapeutically helpful. contractions
References Kyungock Yi*, Haelee Moon, Namjeong Son, Jaewon Choi, Haeryoung Won,
1. Kwon OY, Jung DY, Park KH: The effect of rear foot wedge angle on peak Kyungsun Kim, Chanmi Kim, Jihee Yi, Hwalee Kim
plantar pressures on the forefoot during walking. Journal of the Korean Division of Human Movement Studies, College of Health Science, Ewha
academy of university trained physical 2002, 9(3):11-22. Womans University
2. Yoon MC: The effect of metatarsal pad on peak plantar pressures of the E-mail: yikok@ewha.ac.kr
forefoot during walking. Kyonggi university 2007, Master’s degree. Journal of Foot and Ankle Research 2014, 7(Suppl 1):A103
Many female college students in South Corea suffer from postural problems
A102 and deformities in their lower extremities. In particular, many females exhibit
Cycling performance enhancement and injury prevention use an arch knee valgus or varus. These problems can arise from a variety of causes, from
support insole with forefoot wedge the use of elevated heels, to years of carrying heavy backpacks, and muscle
Sai-Wei Yang1*, Po-Hsun Li1, Keh-Tao Liu2 imbalance. There are many different types of exercises to address these
1
Department of Biomedical Engineering, National Yang-Ming University, problems, but isometric hip contractions are a simple movement that can be
Taipei, Taiwan; 2Global Action Inc- Footdisc®, Taiwan done anywhere at any time. This study tested whether foot pressure
E-mail: swyang@ym.edu.tw variables of isometric hip contractions could be improved through the use of
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A102 an aeroball in order to correct knee deformities.
The purpose of this study was to evaluate the effects of the aeroball on
Bicycle riding is an increasingly popular recreational and competitive activity, plantar pressure during isometric hip contractions. Subjects for this study
however, the more popular the more biking-related injuries. Most of cycling were 39 female college students. Subjects’ plantar pressure was gauged
injuries are musculoskeletal related and caused by a combination of with a Zebris (Germany) pressure plate while they performed 30 second
inadequate preparation, inappropriate bike fitting, poor technique, and isometric hip contractions with and without an aeroball (maker, diameter).
overuse of prolonged uphill biking. However, after well bike fitting, the Independent variables for the study were isometric hip contractions with
Figure 1(abstract A102) Change of Muscle activities and joint moment in different arch support and wedges
and without the aeroball. Dependent variables were plantar pressure “Keep your eye on the ball,” is an old sports adage. This is especially true in
variables, such as length of x and y axis, path area, path length, and average sports like volleyball, tennis, American football, and basketball. Among these
velocity. All dependent variables were significantly higher with the aeroball. sports, basketball is one of the few sports where airborne athletes cannot
The increased length of the x and y axis, and the larger path area, and visually reestablish their relationship to the ground because they are
path length all demonstrate greater movement during contractions. Thus, focused on the ball. This typically happens when athletes are attempting to
with the aeroball, subjects pushed their hips forward more with greater rebound a missed shot. Basketball players are expected to sacrifice their
exterior rotation at the thigh, resulting in greater movement of pressure bodies in order to secure the ball, thus grabbing the ball is a greater priority
at the feet. In addition, the higher velocity for the aeroball demonstrates than landing safely. As a result of this game-logic, athletes are unable to
that subjects contracted their muscles more forcefully during the 30- utilize their Vestibulo-Ocular Reflex (VOR) for landing. Does this create a
second contraction interval. higher risk for landing-related injuries? How does this altered line of sight
In conclusion, pressure plate analysis revealed that isometric hip affect landing strategies? What types of exercises can be implemented to
contractions were more effective with an aeroball. Future studies will build minimize injury risk during these types of landings?
upon these results to evaluate the corrective effects of isometric hip The purpose of this study was to evaluate the effects of line of sight on
contractions, especially on knee varus and valgus. Furthermore additional ground reaction force and pressure during landing. Subjects for this study
studies will investigate the relationship between diminished muscle function were ten female university physical education majors. Subjects all jumped in
in the inner thighs, hips, and posterior chain, and postural problems. bare feet to negate the effects of shoes. The independent variable for this
References study was line of sight during landing (forwards or upwards). Subjects
1. Krackow KA: The Technique of Total Knee Arthroplasty. St. Louis; C.V. focused on a vertical visual cue while jumping, and either continued to look
Mosby Company 1990. upwards or changed their line of sight to a horizontal cue during landing.
2. Chao EY, Neluheni EV, Hsu RW, Paley D: Biomechanics of alignment. Dependent variables were ground reaction force (passive and active force via
Orthop Clin N Am 1994, 25:379-86. Kistler 9287BA, Switzerland) and pressure (area of center of pressure
trajectory, path length, average velocity, forefoot and rear foot average force
via the Zebris, Germany). Statistical analysis was performed using SPSS for
the dependent t-test. Passive force variables (maximum passive force and
A104 number of passive force peaks) were significantly larger for subjects with an
The effects of line of sight on ground reaction force and pressure upward line of sight. Landing velocity for upward line of sight was also
during landing higher, although this difference was not statistically significant. In contrast
Kyungock Yi there was no significant difference for active force regardless of line of sight.
Division of Human Movement Studies, College of Health Science, Ewha. For forward line of sight, there were significantly higher lengths for the x axis
Womans University and path length. Subjects with an upwards line of sight had a significantly
E-mail: yikok@ewha.ac.kr higher amount of forefoot force. These results show that different landing
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A104 strategies are employed according to line of sight during landing.
Table 1(abstract A103) The differences in pressure variables according to aeroball usage
dependent variable N Mean(±SD) mean diff. t P
wob_Length_of_x_axis 39 8.79(±2.28) -1.49 -3.680 .001**
aeroball_Length_of_x_axis 10.27(±2.62)
wobl_Length_of_y_axis 39 15.15(±6.90) -2.46 -2.130 .040*
aeroball_Length_of_y_axis 17.61(±6.06)
wob_Path area 39 111.77(±73.44) -36.32 -2.619 .013*
aeroball_Path area 148.09(±77.24)
wob_Path_length 39 297.01(±108.37) -83.05 -3.804 .001**
aeroball_Path_length 380.07(±150.65)
wob_Average_Velocity 39 10.09(±3.67) -2.82 -3.803 .001**
aeroball_Average_Velocity 12.91(±5.12)
*p<.05, **p<.01
wob; without ball
Normally, athletes are able to adjust their line of sight while airborne in morphofunctional roles of the human foot structure that mechanically
order to land safely. This mechanism was reflected in the forward line of interacts with the ground in a favourable manner to maintain stable gait. In
sight. With a forward line of sight, subjects leaned forward during landing, the present study, we constructed a dynamic gait simulator to load and
utilizing greater hip flexion to cushion their impact. In addition, subjects mobilize the cadaver foot and directly measured the three-dimensional
made contact with both their toes and heels during landing, allowing the kinematics of foot bones using a biplane X-ray fluoroscopy.
foot arch to flex and dissipate landing force. The greater use of the foot A robotic gait simulator was developed to load and mobilize the cadaver
during landing resulted in greater x axis length and higher path length for foot in a manner similar to the way human foot actually moves and
forward line of sight. interacts with the ground during walking. The simulator has three legs, fore,
In contrast, an upwards line of sight required a more upright spinal middle and hind legs, with the cadaver foot fixed to the middle leg (Figure
alignment, restricting hip movement when landing. This clearly illustrates 1A). After the middle cadaver foot contacts the ground, the hind leg departs
the inter-relationship between the hip and neck during landing. As a from the ground. The fore leg replicates the foot-contact with the ground in
result, subjects with an upward line of sight were far more dependent on the next step and toe-off of the middle cadaver foot follows afterward.
flexion in the ankles to cushion their landing. Thus, subjects with an Tendons of tibialis anterior and soleus were connected to pneumatic
upward line of sight tended to land almost exclusively on their forefeet. actuators to apply forces at the appropriate moment to reproduce how the
Athletes in jumping sports should practice landing with an upward line of foot would function during walking.
sight in order to safely master this movement. Furthermore, in order to A biplanar dynamic X-ray fluoroscopic system was developed with
accommodate the forefoot landing strategy, basketball players should Shimadzu Corporation, Kyoto, Japan. The system consists of two sets of x-
increase both their ankle and forefoot dorsi flexibility. ray sources and flat panels with a resolution of 2688 x 2208 pixels. We
This study focused on line of sight and its influence on landing variables recorded biplanar X-ray videos of foot movement using the system using
such as ground reaction force and center of pressure. However, dynamic the dynamic cadaver model at 15 fps. For direct measurement of 3D
balance incorporates many other variables including the visual, vestibular, kinematics of the foot bones, we developed an automatic method to
and proprioceptive systems in addition to muscle strength, flexibility, and register bone surface models with the two fluoroscopic images (Figure 1B).
mobility. Future studies should investigate all of these variables in Specifically, the 3D surface models of the foot were generated based on
relation to landing with an upward line of sight in order to access which computed tomography (CT), and a similarity measure between occluding
variable has the greatest influence on dynamic balance under these contours of the bone surface models with edge-enhanced fluoroscopic
conditions. Furthermore, future studies should incorporate kinematic images was evaluated to reconstruct the position and orientation of each
variables in addition to utilizing a downward line of sight. bone model in a 3D space. Collisions among the reconstructed bones were
References also evaluated to avoid penetration.
1. Dufek JS, Bates BT: Biomechanical factors associated with injury during Using the biplanar X-ray fluoroscopic images and the proposed
landing in jump sports. Sports Med 1991, 12(5):326-37. reconstruction methodology based on CT, we reconstructed 3D movements
2. Yu B, Lin CF, Garrett WE: Lower extremity biomechanics during the of the calcaneus, talus, navicular and cuboid when a human cadaveric foot
landing of a stop-jump task. Clin Biomech 2006, 21(3):297-305. walked on a flat surface using the simulator. The surface models of the four
bones were successfully matched with the corresponding fluoroscopic
images and the joint movements were quantified and visualized. The
A105 present methodology must be undergone further evaluation, but the
Direct assessment of foot kinematics during human gait using a proposed framework may serve as an effective tool for understanding the
dynamic cadaver simulator and a biplane X-ray fluoroscopy morphofunctional roles of the human foot structure during walking.
Kohta Ito1, Naomichi Ogihara1*, Koh Hosoda2, Masahiro Shimizu2,
Shinnosuke Kume2, Takeo Nagura3, Toshiyasu Nakamura3, Nobuaki Imanishi3,
Sadakazu Aiso3, Masahiro Jinzaki4
1
Department of Mechanical Engineering, Keio University, Yokohama 223- A106
8522, Japan; 2Department of Multimedia Engineering, Osaka University, Suita A classification of foot types of high school girls in South Korea
565-0871 Japan; 3School of Medicine, Keio University, Tokyo 160-8582 Japan; Saemi Shin1, Jongsuk Chun2*
1
E-mail: ogihara@mech.keio.ac.jp Symbiotic Life Tech., Yonsei University, Seodaemun-gu, Seoul, 120-749,
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A105 Korea; 2Dept. of Clothing and Textiles, Yonsei University, Seodaemun-gu,
Seoul, 120-749, Korea
Direct measurement of detailed kinematics of individual anatomical E-mail: jschun@yonsei.ac.kr
structures in the foot during human locomotion is crucial for understanding Journal of Foot and Ankle Research 2014, 7(Suppl 1):A106
Figure 1(abstract A105) A robotic gait simulator to load and mobilize the cadaver foot in a manner similar to the way human foot moves and interacts
with the ground during walking (A). Automatic method to register bone surface models with the two fluoroscopic images recorded by a biplanar
dynamic X-ray fluoroscopic system (B).
Wearing uncomfortable shoes for a long time may cause pains by blisters Background: There are many cases of working in the stands for a long
or corns in the foot. It may lead to weaken ligaments and muscles of time by form or by industry on the manufacturing sites and service
lower limbs and feet. The previous researchers claimed that a pain in the industries, and in many cases, working in the stands happened in the spot
foot may be prone to a backache [1]. High school girls feel discomfort in of education and at home. There arose many body changes and a lot of
their foot for wearing shoes, especially the heel, toes, or sole, caused by loads to the lower limb and lumbar in a standing posture for a long time.
the shape, height of heel, or ball girth of the shoe [2]. The aim of this Method: In order to identify the changes in the body the experiment was
study was to analyze characteristics according to the forms of the foot conducted by maintaining the standing posture for two hours by using
that would be applied to make well-fitted shoes for female South Korean three sorts of shoes state and four sorts of mats as an object of 9 test
youths. This study classified foot types of South Korean high school girls subjects. The Mat used in the experiment was designed on the basis of
of 17 and 18 years. The three-dimensional foot scan data were collected Elasticity 15% and 35%, Hardness 25Hs and 45Hs. As to the state of shoes,
with a 3D foot scanner. 201 subjects were participated in the experiment. the experiment was progressed by dividing into three sorts of working
Twenty-four dimensions were measured on the right foot: 6 lengths, 9 environment: bare foot, wearing safety shoes and wearing slippers. The
heights, 4 girths, 2 widths and 3 angles. The results of this study were measuring of EMG was executed as an object of Erector Spinae, Rectus
follows; First, five factors were extracted by factor analysis. They were Femoris, Vastus Lateralis, Tibialis Anterior and Gastrocnemius Medialis.
foot length, foot girth and width, lateral foot height, medial foot height, And, the Circumference of Leg, the circumference of crus was measured
and toe flexure factors. Second, four foot types were classified by cluster based on each projecting point of calf, and the circumference of thigh
analysis. Cluster 1 (n=55, 27.4%) referred to the wide and float foot with based on the center point of thigh.
a long foot length and low heights, and have a little prominent Results: The results showed that the elasticity, hardness, and interaction
metatarsale fibulare. Cluster 2 (n=59, S.D.=29.3%) represented the small between elasticity and hardness have significant differences at the Erector
foot with the shortest foot length, the smallest foot girth, and gentle Spinae, Rectus Femoris with barefoot (p<0.05). The elasticity, hardness, and
curves on the forefoot. Cluster 3 (n=41, S.D.=20.4%) represented thick interaction between elasticity and hardness have significant differences at
foot with open toes compared to the other types. Cluster 4 (M=46, S.D. the Rectus Femoris, Vastus Lateralis with safety shoes (p<0.05). The elasticity,
=22.9%) explained the slant foot to the lateral side that has a flat sole hardness, and interaction between elasticity and hardness have significant
and a little prominent metatarsale tibiale. The findings of this study show differences at the Rectus Femoris with slippers (p<0.05).
that female high school girls in South Korea have diverse shapes and
measurements of the foot. The results of this study may be applied for
making shoes with the proper fitness for female South Korean youths. A108
References Effects of ankle and knee braces on leg stiffness during hopping
1. Lim JY: Analysis of foot characteristics according to the classification of Hiroaki Hobara1*, Yoshiyuki Kobayashi1, Tomoya Ueda1,2, Masaaki Mochimaru1
1
foot types of junior high school girls. Journal of the Korean Society for National Institute of Advanced Industrial Science and Technology, Tokyo,
Clothing Industry 2007, 9(3):319-326. 135-0064, Japan; 2Tokyo University of Science, Chiba, 278-8510, Japan
2. Kim JS, Kweon SA, Choi JM: A study on the purchasing practices, wearing E-mail: hobara-hiroaki@aist.go.jp
state and overall satisfaction with shoes for high school students. Journal of Foot and Ankle Research 2014, 7(Suppl 1):A108
Journal of the Korean Society of Clothing and Textiles 2004, 8(2):312-319.
In a spring-mass model (Figure 1-A), the stiffness of the leg spring (leg
stiffness; Kleg) is thought to be an important factor in musculoskeletal
A107 performance in hopping, running and jumping [1]. Despite the fact that
The study on mat with hardness and elasticity for minimizing fatigue at many athletic activities are performed with joint stabilizers, little is
various qork conditions known about the Kleg with ankle and/or knee braces. A previous study
Bo Seong Kim, Su Min Yoon, Hoon Yong Yoon* demonstrated that neither ankle taping nor bracing affected the Kleg during
Department of Industrial and Management Systems Engineering, Dong-A hopping at 3.0 Hz [2]. However, it remains unclear if this constant Kleg exists
University, Busan, Korea or changes at other hopping frequencies. The purpose of this study was to
E-mail: yhyoon@dau.ac.kr more extensively investigate the effect of ankle and knee braces on the Kleg
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A107 over a range of hopping frequencies.
Ten male participants performed one-legged hopping in place, matching
Objective: This study was to investigate the changes by body part that metronome beats at 2.2, 2.6, and 3.0 Hz. Based on a spring-mass model,
occurred in a standing posture for a long time through EMG and we calculated Kleg using an inertial sensor (Myotest ®, Myotest SA,
Circumference of Leg. In addition, this study was to find out Mat that Switzerland). Commercially-available ankle and knee braces (Ankle Guard-
could minimize the degree of fatigue by body part according to the soft and Knee Guard-Ligament3, ALCARE, Japan) were used to constrain
Elasticity and Hardness of Anti-Fatigue Mat by workplace circumstances. these joints, respectively.
Figure 1(abstract A108) A: Spring-mass model for hopping. This model consists of a body mass and a massless linear spring supporting the body mass.
The model is shown at the beginning of the ground contact phase (left), the middle of ground contact phase (middle), and at the end of ground
contact phase (right). B: Comparison of Kleg among brace conditions in three hopping frequencies.
Statistical analysis revealed the existence of a significant main effect of judged that in the future, multifaceted research on performance
hopping frequency (F(1.22, 10.97)= 48.16, p< 0.01; Figure 1-B) on Kleg but no evaluation specifications and test methods of work shoes suitable for the
significant main effect of brace conditions (F(3.00, 27.00)= 0.15, p= 0.926), nor farm work environment will be necessary.
a significant interaction between hopping frequency and brace conditions
(F(6.00, 54.00)= 0.94, p= 0.472) on Kleg. These results indicate that neither
ankle nor knee bracing affects the Kleg in a range of hopping frequency. A110
References The foot plantar pressures for patients with hallux valgus combines
1. Butler RJ, et al: Lower extremity stiffness: Implication for performance with or without claw toe
and injury. Clin Biomech 2003, 18:511-517. Wen-Lan Wu1*, Jina-Min Liang1, Yuh-Min Cheng2, Peng-Ju Huang2,
2. Williams S, Riemann BL: Vertical leg stiffness following ankle taping and Jia-Hroung Wu3
1
bracing. Int J Sports Med 2009, 30:383-386. Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan; 2Department of Orthopaedic Surgery, Kaohsiung Medical University
Hospital, Kaohsiung, Taiwan; 3Department of Industrial Engineering &
A109 Management, Hsiuping University of Science and Technology, Taiwan
Development and performance evaluation of slip-resistant agricultural E-mail: wenlanwu@kmu.edu.tw
work shoes Journal of Foot and Ankle Research 2014, 7(Suppl 1):A110
Kyung-suk Lee*, Young-soon Oh, Do-hee Kim, Hye-seon Chae, Kyung-ran Kim
National Academy of Agricultural Science, Rural Development Background: Hallux valgus and claw toe remains the most common and
Administration, Suwon, 441-707, Korea disabling pathologies of the foot. The goal was to assess the difference
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A109 between the patients suffered hallux valgus combine with claw toe and
the patients without any complications.
Recently, the burden of farm work and the occurrence of negligent Methods: 7 severe HV patients (2 male and 5 female, 14 foot) and 7
accident increase with aging and feminization in rural areas in South patients suffered HV combine with claw toe (HVC) (1 male and 6 female, 14
Korea. Especially, accidents like slip or falling occur as the most frequent foot) were recruited in this study. The F-Scan in-shoe system (Tekscan, Inc.)
farm work accidents, and a half of female farmers have experienced an were used to record the data of plantar pressure at a sampling frequency of
accident by slip. The Korea’s agricultural environment is poor with bumpy 50 Hz. Subjects were instructed to wear the custom shoes with F-Scan
ground and slippery ground with water, which may cause farmers get a sensor pad and perform a 5 meter walking task on their self speed. For
heavy load on the feet: e.g. squatting, and accordingly deformation or plantar pressure assessment, each footprint is divided into 12 regions (MH,
damage to the foot is frequently observed, but there are no development LH, MF, M1, M2, M3, M4, M5, T1, T2, T3, T45) to enable analysis of the instant
and research on agricultural work shoes to improve the problems. Thus, of peak pressure (kg/cm2) and maximum force that were normalized with
this study develops agricultural work shoes with enhanced slip-resistant body weight (MxF(%BW)). The independent t test was used to determine
performance and attempts to look into the performance of the developed the differences of foot regions for two groups. Results were considered
agricultural work shoes through a comparison with existing products. statistically significant when the p<0.05.
Agricultural work shoes were produced based on the results of research Results: The result of anthropometric feature of the individuals recruited for
on the conditions of work shoes put on for dry-field farming, referring to the study was showed in Table 1. It showed that HVC group had significantly
the outsole of mountaineering boots put on in environments most similar larger degree between M1and M2. The Table 2 showed the MxF (%BW) and
to agricultural field, which are light and have a performance similar to peak pressure (kg/cm2) that had significant difference from two groups. It
that of existing products. They were in a form of 6-inch safety shoes that
could prevent twisting of the ankles and a last reflecting morphological
characteristic of the farmers’ feet were applied, and a mesh material was Table 1(abstract A110) Anthropometric feature of the
used to enhance their thermal comfort. individuals recruited for the study (mean ± SD)
For a performance evaluation, a slip-resistance evaluation and a gait stability
evaluation according to the plantar foot weight dispersion were conducted HV HVC
on 4 existing products and 1 developed product. For the slip-resistance Age (year) #
38.42±13.54 67.86±9.14
evaluation, an AVIT measurement (detergent solution, glycerin solution) and
an HSL ramp test were carried out, and the work shoes used in the test had Height (cm) 165.29±9.72 159.14±6.20
the irregular roughness of the outsole surface and since the actual slip Weight (kg) 63.86±10.17 65.28±4.89
accidents occurred in old work shoes rather than in new ones, the outsole Degree of HV (°) 33.26±7.81 38.72±10.68
of the work shoes was brushed with sandpaper 400 times before the test. #
For the plantar foot pressure evaluation, the distribution of the plantar foot Degree of M1M2 (°) 12.28±2.08 15.61±3.39
pressure was measured using Novel Padar-x System for two men who had Foot width (mm) 91.29±9.56 95.84±4.23
not experienced any pain or illness at the lower part of the body or foot and
# means p<0.05
had a normal gait form.
1. As a result of a slip resistance evaluation, all work shoes including the
developed product showed excellent performance in detergent solution
while in glycerol, most of them were below Grade 2. It turned out that
mountaineering boots had the highest risk of slipping, but the developed Table 2(abstract A110) Peak pressure and MxF(%BW) for
agricultural work shoes had a relatively lower risk of slip except in walking are expressed as mean ± SD.
glycerol.
HV HVC
2. As a result of a plantar foot pressure evaluation, the contact area was
2
in the order of mountaineering boots (136.5cm 2 ), new model rubber Peak pressure (kg/cm )
shoes (121.3cm 2 ) and development product (120.0cm 2 ), and the M2 4.45±1.91 5.78±3.36
maximum pressure was relatively higher in mountaineering boots than
that of new model rubber shoes and the developed product. The M3 3.64±1.60 4.73±1.57
developed agricultural work shoes had a weaker weight dispersion effect T1# 4.06±2.07 2.74±1.60
compared to new model rubber shoes while they substantially induced a MxF (%BW)
wide contact area and evenly dispersed plantar foot pressure.
Through the above results, the developed agricultural work shoes had a M2# 24.58±8.48 32.16±11.29
better performance than mountaineering boots put on in similar M3# 19.92±5.69 25.12±7.17
environments. Yet, it is somewhat impractical to evaluate them as a T1# 23.74±15.02 11.41±7.29
standard for the performance evaluation of industrial safety shoes with
which the main task is carried out on the relatively flat ground, and it is # means p<0.05
showed that the HVC group had lower PP and MxF than HV group at the T1 5. Gribble PA, Hertel J: Effect of hip and ankle muscle fatigue on unipedal
region; conversely, it showed higher MxF at the M2 and M3 regions. postural control. Journal of Electromyography and Kinesiology 2004a,
Conclusion: In past study, Plank found a medial shift in peak pressure in 14:641-646.
most of the hallux valgus group, with a significant decrease in pressure 6. Gribble PA, Hertel J: Effect of lower-extremity muscle fatigue on postural
beneath the fourth and fifth metatarsal heads and this finding was also control. Archives of Physical Medicine and Rehabilitation 2004b,
be found from HV and HVC group. In the present study, when patients 85(4):589-592.
suffered HV combined with claw toe represented high peak pressure and 7. Yaggie JA, McGregor SJ: Effects of isokinetic ankle fatigue on the
MxF at the M2and M3 regions. It would result in the metatarsal heads maintenance of balance and postural limits. Archives of physical Medicine
bear more weight and become painful during walking. and Rehabilitation 2002, 83(2):224-228.
Acknowledgements: This work was supported by a grant from the 8. Bellew JW, Fenter PC: Control of balance differs after knee or ankle
Kaohsiung Medical University Hospital, Taiwan (KMUH100-0M24). fatigue in older women. Archives of Physical Medicine and Rehabilitation
Reference 2006, 87:1486-1489.
1. Plank MJ: The pattern of forefoot pressure distribution in hallux valgus. 9. Salavati M, Moghadam M, Ebrahimi I, Arab AM: Changes in postural
The Foot 1995, 5:8-14. stability with fatigue of lower extremity frontal and sagittal plane
movers. Gait & Posture 2007, 26:214-218.
10. Gerodimos V, Mandou V, Zafeiridis A, Loakimidis P, Stavropoulos N, Kellis S:
A111 Isokinetic peak torque and hamstring/quadriceps ratios in young
Effects of muscle fatigue on ankle and the fatigue protocols of postural basketball players. effects of age, velocity, and contraction mode. The
control Journal of Sports Medicine and Physical Fitness 2003, 43:444-452.
YH Shin, CH Youm*, YK Kim
Sport Biomechanics Laboratory, University of Dong-A, Busan, Korea
E-mail: chyoum@dau.ac.kr A112
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A111 Analysis on the muscle activity of antebrachial area at the iron swing
of male high school golf players
Postural control is composed of the integration of vision, vestibular system, Oh Cheong Hwan, Hong Soo Young*, Shin Eui Su, Bea Jae Hee
and proprioceptive sense along with the balanced control of the Physical Education, Chungnam National Univ., Gung-dong, Yuseong-gu,
musculoskeletal system [1,2]. Muscle fatigue can be defined as the decrease Daejeon, 305-764, Korea
in the maximum muscular strength production capacity due to high E-mail: hsy34255@hanmail.net
intensity or prolonged exercise during physical activity [3,4]. Most studies Journal of Foot and Ankle Research 2014, 7(Suppl 1):A112
related to muscle fatigue and postural control use isokinetic dynamometers.
Angular speed has mostly been used, being divided into slow [5,6] and fast Introduction: The purpose of this study is to provide systematic as well
angular speeds [7,8]. The fast angular speed is mainly used for low intensity, as scientific foundational data through 3D image analysis and
long-duration exercise and the slow angular speed is used for high intensity, electromyography (EMG) on male high school golf players’ #7 iron swing.
short-duration exercise [9,10]. Hence, an understanding of the change in Methods: The subjects selected for the experiment of this research were
postural control capabilities according to fatigue induction properties of one player who had won in the male high school golf game and seven
various movements such as plantar flexion and dorsiflexion is deemed players whose golf career lasted for over five years. And their age (years)
necessary. was 19.00±0.00, stature (m) was 1.73±3.29, body mass (Kg) was 79.00±13.25,
The purpose of this study was to investigate the effects of muscle fatigue and career (years) was 7.7±1.72. The equipment used for this research for
on ankle joint and the fatigue protocols of postural control during single- photographing was nine infrared high-speed cameras (Motion Master 100,
leg stance. The subjects of this study were 24 healthy adult women. KOR), and the Kwon3d XP program was utilized for 3D motion analysis. And
Fatigue was induced on plantar flexion and dorsiflexion with an isokinetic electromyography (EMG) (Tellemyo 2400 GT, USA) was used to analyze their
dynamometer at angular velocities of 30 °/s and 120 °/s. right and left arms’ radial extensor of wrist and radial flexor of wrist muscle
Among the anteroposterior plane factors, plantar and dorsiflexion resulted in activity. Also, SPSS 21.0 was employed to conduct independent T-test.
decreased postural control during single-leg stance after fatigue induction Results and discussion: Total time consumed for the male high school
using a plantar and dorsiflexion fatigue protocol at an angular velocity of 30 golf players’ #7 iron swing was 0.35±0.01 S. Advanced researches
°/s. No change was observed in the postural control during single-leg stance targeting professional golf players report that total time consumed at #7
postural control on application of the fatigue protocol at an angular velocity iron swing is 0.33±0.01 S; thus, there is 0.02 S difference between
of 120 °/s. Plantar and dorsiflexion did not differ significantly with the amateur and professional golf players. This seems to be resulted from
application of the fatigue protocol at angular velocities of 30 °/s and 120 °/s. difference in the experimental environment, and the result is similar to
Among the mediolateral plane factors, postural control diminished during that of advanced researches.
single-leg stance after fatigue induction on application of the plantar and The displacement of the center of the body was found to be 0.02m in the
dorsiflexion fatigue protocol at an angular velocity of 30 °/s. On application pre- and post-variable X-axis. And averagely, it was 0.01m in the left and
of the fatigue protocol an angular velocity of 120 °/s, however, no change in right variable Y-axis and was 0.08m in the horizontal and vertical variable
the postural control was observed during single-leg stance. Thus, the plantar Z-axis. Therefore, according to the result of comparing them with
and dorsiflexion fatigue protocol applied at an angular velocity of 30 °/s professional golf players in advanced researches, the pre- and post-variable
resulted in decreased single-leg stance postural control compared to that X-axis indicated 0.03m difference, and the left and right variable Y-axis
observed at an angular velocity of 120 °/s. showed 0.01m difference averagely, and next, the horizontal and vertical
In summary, during high-intensity, short-duration exercise involving variable Z-axis had no difference as average 0. This implies that professional
plantar and dorsiflexion at an angular velocity of 30 °/s, fatigue at 50% of golf players tend to hit the ball more efficiently than amateur golf players.
the maximum plantar flexion torque might result in reduced single-leg Kim Jae-sam (2009)’s research reports that at the #7 iron swing of
stance postural control. professional golf players, the club head’s synthetic rate was found to be
References 25.73±0.33 m/s at the impact (E5). But in this research, it was calculated
1. Boyas S, Remaud A, Bisson EJ, Cadieux S, Morel B, Bilodeau M: Impairment as 25.63±1.25 m/s at the impact (E5), so there was 0.1m/s or so
in postural control is greater when ankle plantarflexors and dorsiflexors difference. This means that professional golf players hit the ball slightly
are fatigued simultaneously than when fatigued separately. Gait & faster than amateur golf players.
Posture 2011, 34(2):254-259. Kim Chang-uk and Pak Jong-jin (2001)’s research compares five high
2. Shumway-Cook A, Woollacott MH: Motor control. Theory and practical school players with the club by analyzing the muscle activity of their arms
applications Baltimore, Williams & Wilkins, 2 2000, 163-191. at #7 iron golf swing. And according to the analysis on their left and right
3. Allen DG, Westerblad H: Role of phosphate and calcium stores in muscle muscle groups, there was no statistically significant difference found;
fatigue. Journal of physiology 2001, 536:657-665. however, in this research, at the #7 iron golf swing of male high school
4. Lorist MM, Kernell D, Meijman TF, Zijdewind I: Motor fatigue and cognitive golf players, the right arm’s radial extensor of wrist and radial flexor of
task performance in humans. Journal of Physiology 2002, 545:313-319. wrist were higher than the left arm’s (p>.001).
Conclusion: Therefore, they tend to use their right arm’s radial extensor of
wrist and radial flexor of wrist more at the golf swing. This means that they
use their right arm’s antebrachial area for hitting so that they can hit the ball
more powerfully. If further analysis is done in consideration of each
individual’s characteristics, it will help improve their performance in the
game.
Reference
1. Chang ook Kim, Jong Jin Park: Analysis of EMG distribution or loading of
arm muscle on golf swing. Journal of Sport Biomechanics 2001, 11(1):13-26.
A113
Kinetic analysis on physical segments of forward breakfall of the
martial arts
Oh Cheong Hwan, Shin Eui Su*, Hong Soo Young, Bea Jae Hee
Physical Education, Chungnam National Univ., Gung-dong, Yuseong-gu, Figure 1(abstract A114) Midfoot pressure ratio (mfp) in the 3 arch
Daejeon, 305-764, Korea groups for both bilateral and unilateral stance
E-mail: sin76@cnu.ac.kr
The purpose of this study was to provide basic quantitative data to mean age was 70.7 ± 7.0 years, mean height was 153.1 ± 5.5 cm, and mean
minimize the injury occurring during forward breakfall by the comparative weight was 49.9 ± 4.3 kg. Subjects were first requested to stand on both
analysis of biomechanical factors through 3D motion analysis, analysis of legs with eyes open. When subjects were adjudged stable in the standing
ground reaction force, and EMG analysis of the forward breakfall of the position, digital foot pressure distribution data were obtained by using MAT-
martial arts targeting 10 skilled and 10 unskilled subjects. SCAN (Nitta Corporation, Japan).
In this study, three-dimensional motion analysis, the nine high-speed Subjects were next requested to stand on their right leg only with eyes
camera (Motionmaster 100, KOR) was used, the desired total floor open, and data were obtained as above. Based on our previous study [2],
reaction force device (ATMI, USA) 2 units was measured using an impact mfp under both bilateral and unilateral stance was calculated. Subjects
force. And the floor reaction force and three-dimensional motion analysis were categorized into 3 groups according to data from bilateral stance:
program was used for the Kwon3dXP. Group differences for verification high arch, normal arch, and flat foot. Paired t-test for mfp between the 2
and program SPSS 21.0 was used. The following are the findings. stances was implemented for all 3 groups. The level of significance of the
First, the total time taken for forward breakfall of the martial arts showed test was set at 5%.
1.53±0.04 s for skilled, and 1.41±0.06 s for unskilled subjects (p<.01). Results and discussion: Among 44 subjects, 10 were categorized as
Second, during forward breakfall of the martial arts, the skilled subjects having high arch and 8 as having flat foot according to bilateral stance
came up with significantly faster impact velocity in the primary point of data. Figure 1 shows mfp for both stances. Paired t-test showed a
impact (E2) (p<.001), but the unskilled subjects showed significantly faster significantly higher mfp for unilateral than bilateral stance in the high and
impact velocity in the secondary point of impact (E3) (p<.001). normal arch groups (p = 0.002 and p <0.001, respectively). In the flat foot
Third, the forward breakfall of the martial arts did not show any group, no significant inter-stance difference was seen. Thus, in the normal
difference between left and right side in the reaction force, but unskilled and high arch groups, it is assumed that the foot arch was deformed by
subjects proved a significantly greater forward and backward reaction increased foot arch load in unilateral stance, thus altering mfp. On the
force in the secondary point of impact(E3) both right and left sides(right: other hand, in the flat foot group, it is assumed that foot arch structure
p<.01, left: p<.001). The skilled subjects showed a significantly greater was reduced and foot function consequently weakened.
vertical reaction force in the primary point of impact(E2) (right: p<.001, Acknowledgements: This work was supported by JSPS KAKENHI Grant
left: p<.001), and unskilled subjects showed a larger vertical reaction force Number 2470060022700585, 24700600.
in the secondary point of impact (E3), respectively(right: p<.01, left: p<.05). References
Therefore, in order to reduce the impact force when the forward motion 1. Imaizumi K, Iwakami Y, Yamashita K: Analysis of foot pressure distribution
action Break fall slowly to reduce the impact velocity and the impact of data for the evaluation of foot arch type. Proceedings of 33rd Annual
the hand compared to alleviate elbow seems to be good. International Conference of the IEEE EMBC 2011, 7388-7392.
2. Imaizumi K, Iwakami Y, Yamashita K, Hiejima Y: Development of an
evaluation system for foot arch type of the elderly by using foot
A114 pressure distribution data. Proceedings of 33rd Annual International
Effect of foot load changes on foot arch evaluation using foot pressure Conference of the IEEE EMBC 2012, 4859-4862.
distribution data
Kazuya Imaizumi*, Yumi Iwakami, Kazuhiko Yamashita
Division of Healthcare Informatics, Faculty of Healthcare, Tokyo Healthcare A115
University, Tokyo, 154-8568, Japan The effectiveness of intensive mobilization technique combined with
E-mail: k-imaizumi@thcu.ac.jp capsular distension for adhesive capsulitis of the shoulder
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A114 Sunwook Park, Hansuk Lee*
Department of physical therapy, Eulji University, Seongnam, Gyeonggi, Korea
Background: The foot arch serves important functions in regard to shock E-mail: 2gamilla@eulji.ac.kr
absorption and the action of walking. Simple and quantitative classification Journal of Foot and Ankle Research 2014, 7(Suppl 1):A115
of foot arch types such as flat foot and high arch would be helpful in health
support for the elderly. The present authors have developed a classification Background: The management of Adhesive Capsulitis(AC) is controversal.
system for foot arch type showing high reliability using foot pressure Both capsular distension after intraarticular injection and mobilization
distribution data [1,2]. However, effect of foot load changes on foot arch therapy are known as highly effective treatment of painful and limited
evaluation remains unclear. The aim of this study was to investigate the shoulder joint. The aim of this study was to determine the synergistic
effect of foot load changes on foot arch evaluation using foot pressure effect of intensive mobilization technique combined with capsular
distribution data. distension for patients with adhesive capsulitis in improving shoulder
Method: We conducted a field test involving elderly individuals. Foot ROM, pain and function.
pressure distribution data were obtained by the field test with elderly Method: A total of 28 subjects suffering from AC were randomized into
subjects standing on 1 leg and 2 legs. A total of 44 healthy elderly Japanese two groups. Group A received fluoroscopically guided capsular distension
subjects (2 males, 42 females) attended sessions on foot care in Tokyo. Their with steroid injection followed by intensive mobilization technique twice
per week for 4 weeks and group B only received capsular distension with Methods: Fifteen patients with midfoot arthritis aged between 20 and
steroid injection. 60 years participated in the study. Foot function index (FFI) was assessed to
Results: Patients were assessed using the Shoulder Pain and Disability Index evaluate pain before and after the walking activity. Lower leg muscle
(SPADI), Constant-Murley Shoulder Function Assessment Score (CS), Active activity, GRF and gait cycle time during walking were measured under two
Range of Motion(AROM) and Verbal Numeric Score(VNS). All measurements conditions: “shoe only”, and “shoe with FCF insole”. Electromyography (EMG)
were obtained before injection and mobilization and 4 weeks after the activities of the tibialis anterior (TA), gastrocnemius medialis (GCM) and
procedures in order to compare with effects of the treatments. soleus muscles in the involved leg were assessed by multi-channel telemetry
All measured value was significantly difference in group A and B(P<.05). EMG. Simultaneously, the GRF was measured under both conditions. The
Only external rotation ROM was not significantly difference in group B. gait cycle was divided into four different phases including loading response
The statistical differences were observed between group A and B in (LR), mid-stance (MS), terminal stance (TS), and pre-swing (PS).
SPADI, CS, AROM and VNS (P<.01). Results: With reference to the pain subscale of the FFI, we divided the
Conclusions: Treatment using steroid injection with distension followed patients into “reported pain reduction” and “reported no pain reduction”
by intensive mobilization technique is recommended rather than groups. While walking under the shoe with FCF insole condition, significant
injection treatment alone for the treatment of AC. In order to maximize reductions of the TA muscle activity were observed in the LR phase only in
the effectiveness of the two treatments further studies for optimal the group that reported pain reduction (p = 0.028). Contrastingly, in the
mobilization techniques will be needed. group that reported no pain reduction, the TA muscle activity showed no
difference between both conditions (p = 0.237). As for the measurement of
the GCM muscle activity, under the shoe with FCF insole condition, a
A116 significant reduction was observed in the TS and PS phases only in the
The effect of different high-heel types on muscle activation of the group that reported pain reduction (p = 0.046 and p = 0.046). However, in
paraspinal muscles during standing the group that reported no pain reduction, there was no significant
Dongwook Han reduction of GCM muscle activity in any of the gait phases under either the
Department of Physical Therapy, Silla University, 700 Beon-gil, Baegyang- shoe with FCF insole condition or the shoe only condition (p > 0.05). Neither
daero, Sasang-gu, Busan, 617-736, Republic of Korea group reported any statistically significant reduction in the GRF or gait cycle
E-mail: dwhan@silla.ac.kr time (p > 0.05).
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A116 Conclusion: Symptomatic improvement in patients with midfoot arthritis
during walking with the FCF insole was accompanied by reduced TA muscle
Purpose: This study researched the effects of high heels which are same activity in the LR phase along with reduced GCM muscle activity in the TS
in height that is 8cm, but different in types that are Wedge heel, Setback and PS phases. However, walking with the FCF insole was not effective in
heel and French heel on muscle activation of the paraspinal muscles reducing the GRF or gait cycle time. From a clinical perspective, these
surrounding cervical, thoracic and lumbar spine. findings suggest that prescription of the FCF insole can be a viable alternative
Subject: The 28 subjects of this study were females in their 20s, with a to other non-operative treatments in patients with midfoot arthritis.
foot size of 225~230mm and a normal gait pattern, who had no foot
deformities or muscle problems. They voluntarily signed a consent form
after hearing the experiment methods. A118
Methods: To measure the muscle activations of the C6, T7 and L5 The change of EMG during lifting a object from floor according to foot
paraspinal muscles and lumbar multifidus during standing, EMG (Keypoint, position
Medrtonic, USA) was used. After breathing was calmed down, muscle Lee Han Suk*, Kim Jun Hoo
activation during standing on the ground with bare foot was measured. The Department of Physical Therapy, Eulji University, Jaseng Hospital of
Subsequently, muscle activation during standing wearing shoes with 8cm Korean Eastern Medicine, Korea
Wedge heel, Setback heel and French heel were measured. The average E-mail: leehansuk21@hanmail.net
values of three measurements were used for analysis. Journal of Foot and Ankle Research 2014, 7(Suppl 1):A118
Result: In the result of examining the effects of heel types, muscle
activation of cervical paraspinal muscle induced by Wedge heel, Setback The purpose of this study is to represent a basic data about the comparison
heel and French heel was significantly higher than being on bare foot. between EMG of lumbar and leg by the change of foot position.
However, there was no difference significantly between the heel types. Ten women in their twenties volunteered for this study. They took a
Muscle activation of lumbar paraspinal muscle induced by Wedge heel, measurement change between EMG of lumbar and leg with ‘pick up a
Setback heel and French heel was significantly higher than being on bare object’ according to the change in foot position. Foot position degree was 0
foot. However, there was no difference significantly between the heel types. and 45 degree. We measured 3 times for each person and the order of foot
Conclusions: The height of the heels is a more important variable than the position was random. The EMG measure instrument(TeleMyo DTS
width of the heels about the change of muscle activation of cervical and telementry system; Noraxon, USA) was used in the study.
lumbar paraspinal muscle. So, wearing high-heeled shoes is not The muscle activation of TA(tibialis anterior), VL(vastus lateralis), MG
recommended to those who have pain and dysfunction in cervical and (medial gastrocnemius), IC(iliocostalis) were increased in 45 degree and
lumbar region. there were significant difference in TA, VL, IC of right side between o and
45 degree but only VL of left side has a significant difference between o
and 45 degree (p<0.05).
A117 These finding suggest that muscle activation during pick up a object differs
Full-length carbon fiber insole alters lower leg muscle activity in depending on foot angle. We believe that these difference should be
patients with midfoot arthritis considered when physical therapist educate the proper posture to patient.
Tae Im Yi1*, Ji Hye Hwang2, Tae Hee Yoon2, Ji Yang3, Jung Hyun Kim3
1
Department of Physical and Rehabilitation Medicine, Bundang Jesaeng
General Hospital, Seohyeon-dong, Bundang-gu, Seongnam 463 - 774, Korea;
2
Department of Physical and Rehabilitation Medicine, Sungkyunkwan A119
University School of Medicine, Samsung Medical Center, 50 Irwon-dong, The effects of talus control foot orthosis in children with flexible pes
Gangnam-gu, Seoul 135-710, Korea; 3Center for Clinical Medicine, Samsung planus
Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Bong-Ok Kim, Soo-Kyung Bok*, So-Young Ahn
E-mail: taeim@hanmail.net Department of Rehabilitation Medicine, School of Medicine, Chungnam
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A117 National University
Objective: This study aimed to evaluate the effect of the full-length
carbon fiber (FCF) insole on the lower leg muscle activity and the GRF Objective: To identify the therapeutic effect of the talus control foot
during walking in patients with unilateral midfoot arthritis. orthosis(TCFO) in children with severe flexible flat foot.
Material and methods: TCFO is foot orthosis which combines inverted lateral forefoot (M1), medial forefoot (M2), midfoot (M3), lateral rearfoot
rigid foot orthosis(RFO) with broad upright portion that covers and (M4), and medial rearfoot (M5).
protects the talonavicular joint, rising well above the navicular. Comparison of foot pressure is show in figure 2. In the midfoot (M3) area, a
Fourty children were participated in this study who had been diagnosed as significant different was found between insoles in peak pressure and
flexible pes planus, and had more than two consecutive radiologic studies. maximum mean pressure. The type F and G insoles decreased the peak
The anteroposterior talocalcaneal angles (APTCA) and lateral talocalcaneal pressure and maximum mean pressure.
angles (LTTCA), the lateral talometatarsal angles (LTTMA) and the calcaneal References
pitch (CP) of both feet were measured to evaluate foot alignment. Severe 1. Nigg BM, Hintzen S, Ferber R: Effect of an unstable shoe construction on
flexible pes planus was diagnosed when Beighton hypermobility score was lower extremity gait characteristics. Clinical Biomechanics 2006, 21(1):82-88.
greater than 4 points and when either of the feet had greater than 10 2. Ramanathan AK, Kiran P, Arnold GP, Wang W, Abboud RJ: Repeatability of
degrees valgus of resting calcaneal stance position angle and indicators the Pedar-X in-shoe pressure measuring system. Foot and Ankle Surgery
showed greater than 55 degrees in APTCA and LTTCA, greater than 10 2010, 16:70-73.
degrees in LTTMA, lesser than 10 degrees of CP. 3. Kim EH, Cho HK, Jung TW, Kim SS, Chung JW: The Biomechanical
Twenty children with flexible flat foot were fitted with a pair of RFO and Evaluation of Functional Insoles. Korean Journal of Sport Biomechanics
another 20 children were fitted with TCFO. They were recommended to 2010, 20(3):345-353.
put on orthosis more than 8 hrs a day, to walk with heel strike at initial 4. Ko EH, Choi HS, Kim TH, Roh JS, Lee KS: Effect of the Fatigue to Insole
contact and reciprocal arm swing to normalize gait pattern. The follow up Types During Treadmill Exercise. Physical Therapy Korea 2004, 11(2):17-25.
clinical evaluation with radiologic study was done after 12 months.
Result: With TCFO, all radiologic indicators changed toward corrective
direction than with RFO. There were statistically significant improvements A121
in CP and RCSP in both groups. (p < 0.05) In TCFO group, APTCA, RCSP Biomechanical analysis of smart walking shoe sending movement
improved significantly compared with RFO group. information to display device by radio communication
Conclusion: This study showed that TCFO is effective in the treatment of Seung-Bum Park*, Kyung-Deuk Lee, Dae-Woong Kim, Jung-Hyeon Yoo,
children with severe flexible pes planus than RFO. The evaluation with Kyung-Hun Kim
long term follow up of radiographic study would be necessary to confirm Footwear Biomechanics Team, Footwear Industrial Promotion Center, Busan,
the therapeutic effect of TCFO in children with pes planus. Korea
E-mail: sbpark@shoenet.org
A120
An analysis of functional insole on foot pressure distribution of shape The purpose of this study was to find the difference in foot pressure
memory material combinations patterns when wearing smart walking shoes. Foot pressure measurement
Seung-Bum Park*, Kyung-Deuk Lee, Dae-Woong Kim, Jung-Hyeon Yoo, is an established tool for the evaluation of foot function [1]. These
Kyung-Hun Kim measurements assess the effect of structural changes, which may occur
Footwear Biomechanics Team, Footwear Industrial Promotion Center, Busan, as a complication of pathologies such as diabetes, and therefore have
Korea been suggested as one of the key tools in ulcer risk estimation [2].
E-mail: sbpark@shoenet.org The subjects who took part in the test consist of 5 elderly people and 5
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A120 young people. The physical features of the elderly people that were
recruited for the study are shown below: 5 healthy male subjects (elderly
The purpose of this study was to analyze foot pressure distribution of people) with an average age of 62.0 yrs (S.D 1.0 yrs), weight of 69.4 kg (S.
shape memory materials functional insole. Comfort is an important aspect D 10.0 kg), height of 168.8 cm (S.D 5.3 cm) and a foot size of 270.0 mm
for footwear and insole. Footwear and insole comfort has an influence on (S.D 0.0 mm). 5 healthy male subjects (young people) with an average
injury [1,2]. The development of new materials is considered as the age of 27.2 yrs (S.D 4.1 yrs), weight of 75.2 kg (S.D 4.6 kg), height of
important point for manufacturing functional insole [3,4]. 175.4 cm (S.D 4.0 cm) and a foot size of 270.0 mm (S.D 0.0 mm). Ten
Ten healthy male (mean height: 174.7±4.0 cm, mean body mass: 71.0±8.0 males (5 elderly people, 5 young people) walked on a treadmill wearing
kg, mean age 23.9±0.3 yrs.) were participated in this study. All subjects three different shoes. Foot pressure data (Contact areas, Maximum forece,
were free of lower extremity pain, history of serious injuries or operative Peak pressure, Maximum mean pressure) was collected using a Pedar-X
treatment or subjective symptoms interfering with walking. Each subject’s mobile system (Novel Gmbh., Germany) operating at the 1,000 Hz.
foot was pre-screened by Podoscopy (Alfoots, Korea) to see if they had The results are as follows:
any foot abnormalities. 1. Young people
The subjects were required to normal walking (4.2km/h) for treadmill. Each In comparison with the Type B (control shoes):
subjects was seven different insole type (A ~G type, figure 1) during 1) Type A (development shoes)
walking. The PEDAR®-X insole system (Novel GmbH, Germany) was used to a) The contact area of foot (Total) by increased 8.36%, forefoot (M1) by
measure the foot pressure and force. Pressure distribution data (peak increased 8.95%, midfoot (M2) by increased 12.18% and rearfoot (M3) by
pressure, maximum mean pressure) was collected with pressure device at a increased 4.48%. b)The maximum force of foot (Total) by decreased 4.02%,
sampling rate of 100Hz. The feet were divided into six regions: foot (Total), rearfoot (M3) by decreased 6.39%, while the maximum force of forefoot
Figure 1(abstract A120) Tested seven types insoles (L-R): Type A ~ G. N: normal material, S1: low hardness shape memory material, S2: high hardness
shape memory material, P1: low hardness Poron® material, P2: high hardness Poron® material.
Figure 2(abstract A120) Comparison of foot pressure of the seven types insoles.
Figure 1(abstract A121) Type A: development shoes, Type B: control shoes, Type C: smart walking shoes
(M1) by increased 2.48% and midfoot (M2) by increased 17.52%. c)The peak 2) Type C (smart walking shoes)
pressure of foot (Total) by increased 2.28%, forefoot (M1) by increased a)The contact area of foot (Total) by increased 7.96%, forefoot (M1) by
6.19%, while the peak pressure of midfoot (M2) by decreased 2.91% and increased 8.90%, midfoot (M2) by increased 11.81% and rearfoot (M3) by
rearfoot (M3) by decreased 13.69%. d)The maximum mean pressure of foot increased 3.50%. b)The maximum force of foot (Total) by decreased
(Total) by decreased 12.74%, forefoot (M1) by decreased 6.90%, midfoot 5.27%, forefoot (M1) by decreased 0.67% and rearfoot (M3) by decreased
(M2) by decreased 2.79% and rearfoot (M3) by decreased 11.18%. 5.67%, while the maximum force of midfoot (M2) by increased 23.55%. c)
Table 1(abstract A121) Result of Foot Pressure

Subjects Mask Contact area (cm2) Maximum force (N)
A B C A B C
Young Total 142.877±6.584 131.852±10.934 142.342±5.754 711.105±59.923 740.921±95.996 701.841±60.198
M1 68.663±1.716 63.023±5.373 68.629±0.584 621.023±89.605 606.018±168.64 601.982±86.053
M2 33.443±5.540 29.811±4.185 33.331±5.175 133.911±8.162 113.943±21.044 140.778±14.482
M3 40.770±0.000 39.019±2.200 40.383±0.753 468.385±42.442 500.382±46.850 471.992±27.290
Elderly Total 139.403±2.996 128.966±5.757 138.099±4.256 592.178±95.362 605.047±81.495 596.161±100.23
M1 68.119±3.213 64.589±5.796 68.221±3.705 526.524±75.498 545.776±74.082 546.801±90.669
M2 30.514±2.751 24.877±5.708 29.140±4.599 110.238±25.983 78.007±31.900 96.843±29.870
M3 40.770±0.000 39.503±1.290 40.736±0.060 386.392±94.017 428.618±84.020 397.017±94.609
Subjects Mask Peak pressure (kPa) Maximum mean pressure (kPa)
A B C A B C
Young Total 270.869±70.830 264.823±50.235 247.067±50.477 86.504±3.965 99.139±8.358 88.268±7.415
M1 258.458±83.422 243.390±75.894 235.239±59.953 94.519±9.360 101.522±19.698 93.791±10.480
M2 84.522±14.058 87.059±19.501 88.965±22.004 46.799±7.466 48.141±11.532 47.585±8.937
M3 184.082±25.588 213.283±16.517 190.809±25.685 115.573±11.070 130.126±11.114 119.693±10.816
Elderly Total 189.973±27.832 213.509±21.026 213.564±45.475 76.358±3.203 85.410±3.122 77.770±7.078
M1 188.168±27.811 212.000±20.270 213.564±45.475 81.126±5.774 87.280±3.075 82.372±8.326
M2 66.064±6.977 67.977±18.067 57.432±9.937 39.860±6.977 38.683±7.441 36.246±6.136
M3 134.086±33.163 165.232±33.123 140.901±30.023 94.773±23.062 110.738±22.902 97.650±23.442
The peak pressure of foot (Total) by decreased 6.70%, forefoot (M1) by

decreased 3.35% and rearfoot (M3) by decreased 10.54%, while the peak A122
pressure of midfoot (M2) by increased 2.19%. d)The maximum mean pressure Biomechanical analysis of marathon shoes applied to NESTFIT technology
of foot (Total) by decreased 10.97%, forefoot (M1) by decreased 7.62%, Seung-Bum Park1*, Kyung-Deuk Lee1, Dae-Woong Kim1, Jung-Hyeon Yoo1,
midfoot (M2) by decreased 1.15% and rearfoot (M3) by decreased 8.02%. Kyung-Hun Kim1, Jin-Hoon Kim2
1
2. Elderly people Footwear Biomechanics Team, Footwear Industrial Promotion Center, Busan,
In comparison with the Type B (control shoes): Korea; 2Design Center, Treksta INC, Busan, Korea
1) Type A (development shoes) E-mail: sbpark@shoenet.org
a) The contact area of foot (Total) by increased 8.09%, forefoot (M1) by Journal of Foot and Ankle Research 2014, 7(Suppl 1):A122
increased 5.47%, midfoot (M2) by increased 22.66% and rearfoot (M3) by
increased 3.21%. b)The maximum force of foot (Total) by decreased The purpose of this study was to analyze foot pressure distribution of
2.13%, forefoot (M1) by decreased 3.53% and rearfoot (M3) by decreased marathon shoes to which NESTFIT Technology was applied. As for
9.85%, while the maximum force of midfoot (M2) by increased 41.32%. c) marathon, shoes play a vital role in shortening records. However, they also
The peak pressure of foot (Total) by decreased 11.02%, forefoot (M1) by might become a main factor of injury during long-distance running. This
decreased 11.24%, midfoot (M2) by decreased 2.81% and rearfoot (M3) study will examine foot pressure distribution effects of marathon shoes
by decreased 18.85%. d)The maximum mean pressure force of foot during long-distance running, which have been developed by measuring
(Total) by decreased 10.60%, forefoot (M1) by decreased 7.05% and Korean shoe lasts.
rearfoot (M3) by decreased 14.42%, while the maximum force of midfoot The methods of this study can be explained as below. Firstly, ten healthy
(M2) by increased 3.04%. males were picked as subjects to participate in this study. 10 healthy male
2) Type C (smart walking shoes) subjects with an average age of 22.3 years (SD=0.5), weight of 71.5 kg
a)The contact area of foot (Total) by increased 7.08%, forefoot (M1) by (SD=6.0) and height of 173.1 cm (SD=4.3) were recruited for this study.
increased 5.62%, midfoot (M2) by increased 17.14% and rearfoot (M3) by Secondly, the one equipment used for the study consist of a foot pressure
increased 3.12%. b)The maximum force of foot (Total) by decreased device from Pedar-X, Germany and a treadmill from Pulse fitness, UK.
1.47%, rearfoot (M3) by decreased 7.37%, while the maximum force of Thirdly, the testing procedures involve each subject to test three different
forefoot (M1) by increased 0.19% and midfoot (M2) by increased shoes by having running trials on a treadmill at a constant speed of
24.15%. c)The peak pressure of foot (Total) by increased 0.03%, forefoot 12.0km/hour.
(M1) by increased 0.74%, while the peak pressure of midfoot (M2) by The pressure distribution data (contact area, maximum force, maximum
decreased 15.51% and rearfoot (M3) by decreased 14.73%. d)The peak pressure, maximum mean pressure) was collected by using a
maximum mean pressure of foot (Total) by decreased 8.95%, forefoot pressure device at a sampling rate of 100Hz. The statistical analysis was
(M1) by decreased 5.62%, midfoot (M2) by decreased 6.30% and carried out by using the MINITAB R15 package, specifically One-way
rearfoot (M3) by decreased 11.82%. ANOVA (a=.05). Type A shoe has the lowest peak pressure at total mask.
As a result of analysis, it has been found that Type A and Type C have Generally, the Type A shoe had overall lower values for the maximum
lower foot pressure (Total, M3) than Type B. Also, Type A and Type C force and maximum mean pressure variables compared to Type B, C shoe
show superior performance compared to Type B in all mask at contact conditions.
area. Type A and Type C shoes will be used to reduce foot pressure and In comparison with the control group: 1)The contact areas of foot (total)
increase comfort and fitting. increased 0.87% than Type B, midfoot increased 5.17% than Type B and
References 0.59% than Type C. 2) The maximum force of foot (total) decreased
1. Jason K Gurney, Uwe G Kersting, Dieter Rosenbaum: SBetween-day 4.39% than Type B and 2.72% than Type C, rearfoot decreased 5.42%
reliability of repeated plantar pressure distribution measurements in a than Type B and 2.72% than Type C. 3)The maximum peak pressure of
normal population. Gait & Posture 2007, 27:706-709. midfoot decreased 6.64% than Type B and 11.46% than Type C, rearfoot
2. Cavanagh PR, Simoneau GG, Ulbrecht JS: Ulceration, unsteadiness, and 4.36% than Type B and 10.66% than Type C. 4)The maximum mean
uncertainty: the biomechanical consequences of diabetes mellitus. pressure of foot (Total) decreased 1.74% than Type B and 1.79% than
Journal of Biomechanics 1993, 26(11):23-40. Type C, rearfoot decreased 36% than Type B and 10.66% than Type C.
Figure 1(abstract A122) Marathon Shoes(NESTFIT Technology)

Table 1(abstract A122) Result of Foot Pressure (Marathon Shoes: Type A)

Mask Contact area (cm2) Maximum force (N)
A B C p-value A B C p-value
Total 156.62±23.25 155.27±17.25 156.92±12.07 0.98 1,309.43±252.33 1,369.60±183.88 1,345.98±121.75 0.78
Forefoot 60.42±9.02 60.99±7.12 61.03±4.66 0.98 746.65±170.96 792.76±121.39 728.42±101.16 0.55
Midfoot 54.40±9.13 51.73±7.31 54.08±5.67 0.69 436.86±114.82 398.41±105.88 411.33±95.55 0.71
Rearfoot 41.04±5.32 41.80±3.86 41.07±3.22 0.90 501.65±109.75 530.39±96.21 537.09±79.32 0.68
Mask Maximum peak pressure (kPa) Maximum mean pressure (kPa)
A B C p-value A B C p-value
Total 298.03±85.12 256.10±256.10 266.04±266.04 0.31 94.27±18.45 95.94±11.20 95.99±10.74 0.95
Forefoot 289.14±85.26 248.23±41.31 252.43±47.66 0.28 119.79±28.58 127.51±20.42 118.60±16.84 0.63
Midfoot 147.34±43.97 157.82±49.05 166.41±43.38 0.65 77.87±21.35 75.85±19.14 76.45±17.28 0.97
Rearfoot 185.35±68.01 193.80±53.62 207.45±52.65 0.70 120.43±23.54 126.65±22.14 130.28±18.08 0.59
* p<.05
Figure 2(abstract A122) Result of Foot Pressure(Marathon Shoes: Type A)
As a result of analysis, it has been found that Type A has the lower
maximum force (total) and maximum mean pressure (total) than Type B A123
or C. Also, it has been found that Type A has the lower maximum force Plantar pressure distribution during treadmill walking in comfort shoes
(rearfoot) and foot pressure (rearfoot) than Type B and Type C. In with PLA(Poly Lactic Acid) resins
addition, it has been proved that the maximum force and maximum Seung-Bum Park*, Kyung-Deuk Lee, Dae-Woong Kim, Jung-Hyeon Yoo,
mean pressure of Type A is lower than any other control groups so that Kyung-Hun Kim
it provides pressure distribution effects during long-distance running. Footwear Biomechanics Team, Footwear Industrial Promotion Center, Busan,
References Korea
1. Jose AR, Eduardo R: Scaling properties of marathon races. Physica A 2006, E-mail: sbpark@shoenet.org
365:509-520. Journal of Foot and Ankle Research 2014, 7(Suppl 1):A123
2. Karkoulias K, Habeos I, Charokopos N, Tsiamita M, Mazarakis A, Pouli A,
Spiropoulos K: Hormonal responses to marathon running in non-elite In the framework of environmentally friendly processes and products, poly
athletes. European Journal of Internal Medicine 2008, 19:598-601. lactic acid(PLA) represents the best polymeric substitutes for various
Figure 1(abstract A123) The two different shoes conditions: Type A(PLA), Type B(Control), Size 245mm
Figure 2(abstract A123) Comparison of foot pressure.
petropolymers because of its renewability, biodegradability, biocompatibility 3. Ramanathan AK, Kiran P, Arnold GP, Wang W, Abboud RJ: Repeatability of
and good thermomechanical properties [1]. The purpose of this study was the Pedar-X in-shoe pressure measuring system. Foot and Ankle Surgery
to analyze foot pressure distribution of PLA materials in functional shoes. 2010, 16:70-73.
Comfort is an important aspect in footwear. Footwear comfort has an 4. Kim EH, Cho HK, Jung TW, Kim SS, Chung JW: The Biomechanical
influence on injury [2,3]. The development of new materials is considered as Evaluation of Functional Insoles. Korean Journal of Sport Biomechanics
the important point for manufacturing functional shoes [4]. 2010, 20(3):345-353.
Ten healthy female(mean height: 159.8 cm, mean body mass: 54.8 kg, mean
age 20.8 yrs.) participated in this study. All subjects were free of lower
extremity pain, history of serious injuries or operative treatment, or A124
subjective symptoms interfering with walking. Pre-impact fall detection using an inertial sensor unit
The subjects were required to walking(3.2km/h) for treadmill. Each subject Soonjae Ahn, Isu Shin, Youngho Kim*
wore two different shoes, type A(PLA) and Type B(control)(figure 1) Department of Biomedical Engineering and Institute of Medical Engineering,
during walking. The PEDAR®-X insole system(Novel GmbH, Germany) was Yonsei University, Wonju, Gangwon, 220-710, Korea
used to measure the foot pressure and force. Pressure distribution data E-mail: younghokim@yonsei.ac.kr
(contact areas, maximum force, peak pressure, maximum mean pressure) Journal of Foot and Ankle Research 2014, 7(Suppl 1):A124
was collected with pressure device at a sampling rate of 100Hz. The feet
were divided into four regions: foot(Total), forefoot, midfoot, rearfoot. Falls are a major cause of injuries and deaths in older adults [1]. As for
Results of foot pressure distribution date show that (figure 2) contact area intervention strategies, one of the important problems in preventing or
increased by 4% in the type A compared to type B, Also, maximum mean reducing the severity of injury in the elderly is to detect falls in its
pressure decreased by 5%. However, peak force increased by 6%, and descending phase before the impact [2]. If a fall can be detected in its
peak pressure increased by 5% as well. AS a result PLA resins may be earliest stage in the descending phase, more efficient impact reduction
helpful in decreasing overall pressure in foot therefore provide better systems can be implemented with a longer lead-time for minimizing injury
comfort in foot. [3,4]. In this study, we implemented a pre-impact fall detection algorithm
References using an inertial sensor unit.
1. Jean-Marie R, Youssef H, Marius M, Philippe D: Polylactide (PLA)-based Totally, forty male volunteers participated in the experiment (three types of
nanocomposites. Progress in Polymer Science 2013, 38(10-11):1504-1542. falls and seven types of ADLs). An inertia sensor unit, placed at waist, was
2. Nigg BM, Hintzen S, Ferber R: Effect of an unstable shoe construction on used to measure subject’s acceleration, angular velocity and vertical angle
lower extremity gait characteristics. Clinical Biomechanics 2006, during various activities. In order to detect pre-impact, the threshold of
21(1):82-88. acceleration and angular velocity was set to 0.8g and 30°/s, respectively,
Table 1(abstract A124) Peak acceleration, angular velocity and vertical angle during falls and ADLs.
Trials Acceleration (g) Angular velocity (°/s) Angle (°)
Pitch Roll Sagittal Lateral
Falls Backward 4.1 ± 0.6 300.3 ± 59.7 45.7 ± 14.2 94.2 ± 4.7 4.7 ± 3.2
Forward 4.5 ± 0.5 220.6 ± 41.6 75.9 ± 17.2 89.6 ± 9.2 8.4 ± 4.6
Side 4.4 ± 0.6 121.2 ± 13.7 419.4 ± 61.3 6.69 ± 2.7 75.95 ± 12.4
ADLs Sit-Stand 1.4 ± 0.2 110 ± 23.1 8.9 ± 7.6 31.1 ± 6.1 2.6 ± 1.3
Stand-Sit 2.2 ± 0.3 392.3 ± 61.3 11.2 ± 6.1 11.63 ± 3.1 1.12 ± 2.7
Sit-Lying 1.1 ± 0.1 80.7 ± 31.7 15.3 ± 3.8 90.3 ± 8.3 4.3 ± 2.8
Walking 2.1 ± 0.2 50.1 ± 10.9 59.3 ± 14.9 1.4 ± 6.2 2.1 ± 3.1
Jump 7.5 ± 1.1 421.2 ± 149.1 102.3 ± 62.1 27.3 ± 2.1 3.6 ± 3.8
Running 4.2 ± 0.9 132.8 ± 45.7 98.2 ± 34.9 11.5 ± 9.7 2.6 ± 4.1
based on the data from the first twenty subjects. Furthermore, the might change to compensate for the worsening of the loading condition,
threshold of vertical angle was set to 30° because the maximum angle in decreased weight-bearing function of the medial toe, and weight transfer to
the ADL did not exceed 30°. This fall detection algorithm was evaluated for the lateral metatarsals [4-7]. Some researchers have investigated kinematics
another twenty subjects. of the MP joint [8,9]. However, there was rare investigation of the MP joint
The results showed that both acceleration and angular velocity during kinetics. In this study, kinetics of the MP joint was determined during the
three different falls were greater than the threshold during several ADLs entire stance period of the gait cycle using a four-segment foot model.
and the vertical angle did not exceed 30°. The vertical angle exceeded 30° The three-dimensional motion analysis was used with foot pressure
only during sit-lying activity, but the acceleration did not reach 0.8g (Table measurement. Twelve normal subjects and ten HV patients were selected
1). Based on the pre-impact fall detection algorithm, no false detection for this study.
was found (100% sensitivity) for all falls. Results showed that a significant difference in stance time was found
Furthermore, no incorrect detection was found (100% specificity) for all between the normal (60.86 ± 1.21 %) and HV groups (63.75 ± 0.91 %) (p
ADLs. The lead time was 474 ± 38.3ms, 590.3 ± 122.6ms and 527 ± 62.3ms < 0.05). The ankle joint moment for the normal group and the HV group
in the backward, the forward and the side falls, respectively. was not significantly different. However, the peak MP1 moment in the HV
In this study, a pre-impact fall detection algorithm was developed using an group was significantly smaller than in the normal group (p < 0.05).
inertial sensor unit. The present pre-impact fall detection algorithm can be Considerable energy absorption was observed from the terminal stance
implemented with a wearable fall injury minimization system to track a to pre-swing in both groups. However, total energy absorption in all MP
user’s body movement. joints decreased 25% in the HV group (4.59 ± 0.85 J/kg) compared with
Acknowledgement: This research was supported by the Human the normal group (6.09 ± 1.00 J/kg). The energy absorption in the MP1
Resource Training Project for Regional Innovation through the National joint and the MP2 joint were significantly smaller in the HV group than in
Research Foundation of Korea (NRF) funded by the Ministry of Education the normal group (p < 0.05). However, no significant difference in energy
(2013H1B8A2032194). absorption for the MP3−5 joint was observed between the normal group
References and the HV group (p > 0.05).
1. Annekenny R, O’Shea D: Falls and syncope in elderly patients. Clinics in This study had some limitation such as assumption that the MP3−5 joints
Geriatric Medicine 2002, 18:xiii-xiv. act as a single joint and small number of the HV patients. In spite of
2. Bourke AK, O’Donova KJ, O´ Laighin G: The identification of vertical those limitations, our study would be helpful in understanding the
velocity profiles using an inertial sensor to investigate pre-impact mechanical role of the MP joint in patients with foot disease.
detection of falls. Medical Engineering & Physics 2008, 30:937-946. Acknowledgement: This research was supported by the Human Resource
3. Wu G: Distinguishing fall activities from normal activities by velocity Training Project for Regional Innovation through the National Research
characteristics. Journal of Biomechanics 2000, 33:1497-1500. Foundation of Korea (NRF) funded by the Ministry of Education
4. Nyan MN, Tay FE, Tan AW, Seah KH: Distinguishing fall activities from (2013H1B8A2032194).
normal activities by angular rate characteristics and high-speed camera References
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Bionics Engineering 2010, 7:211-218.
2. Miyazaki S, Yamamoto S: Moment acting at the metatarsophalangeal
A125 joints during normal barefoot level walking. Gait & Posture 1993,
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model The foot 1995, 5:8-14.
Bora Jeong, Seunghyeon Kim, Jongsang Son, Youngho Kim* 4. Deschamps K, Birch I, Desloovere K, Matricali GA: The impact of hallux
Yonsei University, Wonju, Gangwon, 220-710, Korea valgus on foot kinematics: A cross sectional, comparative study. Gait &
E-mail: younghokim@yonsei.ac.kr Posture 2010, 32:102-106.
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A125 5. Yavuz M, Botek G, Davis BL: Plantar shear stress distributions: comparing
actual and predicted frictional forces at the foot-ground interface.
The foot plays an important role in human walking [1]. The foot has many Journal of Biomechanics 2007, 40:3045-3049.
essential functions such as shock absorption, weight bearing stability and 6. Blomgren M, Turan I, Agadir M: Gait analysis in hallux valgus. Journal of
push-off. The metatarsophalangeal (MP) joint, positioned between the Foot Surgery 1991, 30:70-71.
metatarsal bones of the foot and the proximal phalanges of the toes, 7. Hutton WC, Dhanendran M: The mechanics of normal and hallux valgus feet
provides a broad area of support across the forefoot. The major role of - a quantitative study. Clinical Orthopaedics and Related Research 1981,
the MP joint is the energy absorption during the terminal stance of the 157:7-13.
gait cycle [2]. 8. Kernozek TW, Elfessi A, Sterriker S: Clinical and biomechanical risk factors
Hallux valgus (HV), the most common great toe disorder, is a deformity of of patients diagnosed with hallux valgus. Journal of the American Podiatric
the first MP joint [3]. In HV patients, the mechanical role of the MP joint Medical Association 2003, 93:97-103.
Figure 1(abstract A125) The MP1, MP2 and MP3−5 joint moments and powers; Normal vs. HV
9. Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR: Gait, balance and Brostrm operation (MBO) is the gold standard surgical procedure. There
plantar pressures in older people with toe deformities. Gait & Posture are various evaluation methods in CAI treatments, such as the interview,
2011, 34:347-351. visual analogue scale (VAS), and the measurement of range of motion
(ROM) and the ankle torque. However, in reality, it is difficult to measure
the maximum ROM and torque. Therefore, some studies measured ankle
A126 ROM and torque with cadaver specimens [2,3]. In this study, both open
Biomechanical analysis of operations for chronic ankle instability and arthroscopic MBO were performed on cadavers, and ankle torque
Jeseong Ryu1*, Jongsang Son1, Youngkoo Lee2, Kyungtai Lee3, Youngho Kim1 and angle were measured during ankle inversion using the axial-torsion
1
Department of Biomedical Engineering, Yonsei University, Wonju, Gangwon, testing system. Ankle stiffness was calculated from measured data, and
220-710, Republic of Korea; 2Department of Orthopedic Surgery, effects of both operations were compared quantitatively.
Soonchunhyang University, Bucheon, Gyeonggi, 420-767, Republic of Korea; For this study, matched pairs of fresh-frozen human cadaver lower leg
3
Foot and Ankle Clinic, KT Lee’s Orthopedic Hospital, Seoul, 135-820, specimens were obtained from seven males and four females (average
Republic of Korea age 71.5 (range 58–98) years). Each specimen consisted of the distal half
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A126 of a leg. The soft tissues were removed from the calcaneus and distal
tibiofibular part, except for the ankle joint and ligament. The anterior
Ankle sprains are one of the most common sports injuries which are talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) were
about 40% of total sports injuries and 20~40% of them would be transected. The specimens for the arthroscopic and open MBO were
progressed to chronic ankle instability (CAI) [1]. Rehabilitation and chosen from the left and right legs alternately. Then, each specimen was
surgical therapy have been used to treat CAI, and the open modified fixed in the specially-designed jig that was mounted on the axial-torsion
Figure 1(abstract A126) Ankle torque and stiffness during inversion test during open and arthroscopic MBO
fatigue testing system (Instron 8874, Norwood, MA, USA). The test eight-channel surface EMG system (MyoSystem 1200, Noraxon Inc., USA).
consisted of a single ramp from 0° to 70° by inverting the ankle at 5°/s, Dynamometer tasks were performed with Biodex System 3 Pro (Biodex
while measuring the angular position and resultant torque. Medical Systems, New York, USA) to measure elbow joint moments. The
There was no statistical difference in torque to failure between open and participant was asked to perform three maximum isometric contractions at
arthroscopic MBO. The maximum torque was 16.3±7.2 N•m at 45° for open 90° (flexed). The subject then generated an elbow flexion moment, rested,
MBO and 19.9±10.8 N•m at 40° for arthroscopic MBO (Figure 1). Ankle and generated an elbow extension moment. To evaluate the effects of NOF
stiffness increased faster in arthroscopic MBO (0.31±0.22 N•m/deg) than in compared to EOF briefly, we focused on the changes in biceps brachii long
open MBO (0.18±0.15 N•m/deg) in initial inversion range (<5°), but no head (BIClong) muscle force and compared the relative root-mean-square
statistically significant differences were observed. The maximum stiffness was error.
0.41±0.18 N•m/deg at 35° in open MBO and 0.50±0.27 N•m/deg at 40° in Results and discussion: Modeled joint moments with no parameter
arthroscopic MBO (Figure 1). calibration (NOT Adjusted) showed undesirable negative offset during the
In this study, biomechanical analysis was performed for operations of CAI 3-second-rest period, but this problem was solved by the parameter
and there was no statistically significance in torque and stiffness. In calibration with EOF or NOF (Figure 1a). Even though EOF provided a
comparison to open MBO, arthroscopic MBO is good alternative good estimation of joint moment, it resulted from a combination of
technique for CAI. unrealistic muscle forces. BIClong muscle generated no force between
References about 5 s and 11 s despite of quite large muscle activity (Figure 1b). In
1. Smith RW, Reischl SF: Treatment of ankle sprains in young athletes. Am J contrast, the parameter calibration module with NOF predicted very
Sports Med 2006, 14:465-71. similar muscle forces to the corresponding muscle activations. NOF
2. Birmingham TB, Chesworth BM, Hartsell HD, Stevenson AL, Lapenskie GL, predicted more desirable muscle forces than EOF, but the accuracy in
Vandervoort AA: Peak passive resistive torque at maximum inversion predicting joint moments was relatively low. This might result from the
range of motion in subjects with recurrent ankle inversion sprains. fact that the number of possible value of model parameters with NOF are
J Orthop Sports Phys Ther 1997, 25:342-8. limited compared to EOF, because muscle forces to determine joint
3. Giza E, Nathe R, Nathe T, Anderson M, Campanelli V: Strength of bone moments are constrained. This might be considered as a trade-off
tunnel versus suture anchor and push-lock construct in brostrm repair. problem.
Am J Sports Med 2012, 40:1419-23. Conclusions: Even though NOF yielded relatively low performance in
joint moment prediction, it estimated muscle forces better, providing
more reasonable kinetic information about human movements such as
A127 walking and running.
Alternative objective function to predict reasonable muscle forces Acknowledgements: This research was supported by the Human
using a Hill-type muscle model Resource Training Project for Regional Innovation through the National
Jongsang Son*, Hoyoon Lee, Jongman Kim, Youngho Kim Research Foundation of Korea (NRF) funded by the Ministry of Education
Department of Biomedical Engineering and Institute of Medical Engineering, (2013H1B8A2032194).
Yonsei University, Wonju, 220-710, Republic of Korea References
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A127 1. Lloyd DG, Besier TF: An EMG-driven musculoskeletal model to estimate
muscle forces and knee joint moments in vivo. J Biomech 2003,
Background: Joint moments modeled from a musculoskeletal tool differ 36:765-776.
from those recorded by a dynamometer. In order to solve the problem, 2. Heine R, Manal K, Buchanan TS: Using Hill-type muscle models and EMG
numerical methods to minimize the variance of the joint moments have data in a forward dynamic analysis of joint moment: Evaluation of
been adopted [1]. The existing objective function (EOF) in the optimization, critical parameters. J Mech Med Biol 2003, 3:169-186.
however, might not be sufficient to estimate reasonable muscle forces
due to a possibility of predicting well-matched joint moments with the
combination of unrealistic individual muscle forces [2]. In this study,
we introduce a new objective function (NOF) for predicting reasonable A128
muscle forces and to compare its performance with EOF. Prediction of plantar soft tissue stiffness based on gender, age,
Methods: NOF was designed to strengthen the linear relationship bodyweight, height and body mass index
between: (1) the recorded and modeled joint moments, and (2) the Jee Chin Teoh, Taeyong Lee*
muscle activations and the muscle forces. One male (age: 18 years; mass: Department of Biomedical Engineering, National University of Singapore,
78 kg; height: 178 cm) participated in the study with the informed Singapore
consent prior to commencing the experimental trials. Surface electrodes E-mail: bielt@nus.edu.sg
were attached to record EMG signals from elbow major muscles using an Journal of Foot and Ankle Research 2014, 7(Suppl 1):A128
Figure 1(abstract A127) (a) Measured and predicted elbow joint moments, and (b) Muscle activation and force of long biceps brachii.
Table 1(abstract A128) Linear regression equation: partial regression coefficients, p values, root mean square errors
(RMSE) and number of participants.Y= b0 + b1 x gender + b2 x weight + b3 x height + b4 x bmi + b5 X age; b0 (n/mm);
b1 (n/mm)/gender, female= -1, male = +1; b2 (n/mm)/weight; b3 (n/mm)/height; b4 (n/mm)/bmi; b5 (n/mm)/age
Plantar location b0 Gender (b1) p Weight (b2) p Height (b3) p BMI (b4) p Age (b5) p RMSE n
Left
Hallux -1.8669817 -0.10225389 -0.0042387 0.01183471 -0.0133015 0.02399122 0.48578 99
Heel 12.3844196 -0.12954317 0.08095755 * -0.0619824 * -0.1717064 * 0.00629858 1.09547 100
2ndMTH 0° 6.46521444 -0.2177458 0.06521518 ** -0.0443825 * -0.152051 ** 0.02342962 0.802866 96
20° 8.58233676 -0.37727232 0.11675474 ** -0.0669571 ** -0.2698104 ** 0.05478136 0.989617 100
40° 12.5772582 -0.15231289 0.12385643 ** -0.0855753 * -0.3131397 ** 0.06469774 1.479414 98
Right
Hallux 0.66899629 0.087890718 -0.0165869 0.00670808 0.03648811 -0.0093199 0.409141 99
Heel 17.6691906 -0.54480677 * 0.14765975 ** -0.0882361 ** -0.3480107 ** -0.0132202 1.147579 100
2ndMTH 0° 4.48332802 -0.17447007 0.04778213 * -0.0271027 -0.1134243 * 0.01582428 0.821476 96
20° 14.2540307 -0.34137115 0.12512617 ** -0.0797136 ** -0.2852428 ** -0.0020648 1.126962 100
40° 16.389124 -0.20310698 0.13467015 ** -0.0842629 * -0.2962142 ** -0.0117724 1.614592 98
Introduction: Stiffened plantar soft tissues break down easily (Cheung

et al., 2005) and these microscopic tears will heap together and develop A129
into a large ulcer. In the USA, 85% of all non-traumatic amputations in High-pass-filter cut-offs optimization of the filter-based fatigue index
diabetes patients arise from non-healing ulcers (Larsson, 1994). In fact, during dynamic contractions
foot ulceration is one of the major causes of hospitalization among Jungyoon Kim, Sunwoo Park, Youngho Kim*
the DM patients. 15% of the DM population are threatened by high Department of Biomedical Engineering and Institute of Medical Engineering,
ulceration risk during their life time (Aziz nather’s book). These findings Yonsei University, Wonju, Gangwon, 220-710, Korea
elucidate the need of early identification of degenerating plantar soft E-mail: younghokim@yonsei.ac.kr
tissue to prevent problematic tissue rupture, especially to diabetic and Journal of Foot and Ankle Research 2014, 7(Suppl 1):A129
elderly patients. Non-invasive in vivo assessment that enables direct
measurement of tissue’s mechanical response is therefore required. In Background: Traditional muscle fatigue indices (Fmean and Fmed) have a
order to differentiate between normal and pathological tissue, a stiffness relatively low sensitivity under dynamic exercise conditions. Various muscle
reference is needed. fatigue indices have been attempted to overcome this problem [1,2].
The objective of this study is to conduct a multivariate analysis on the However, their methods required large amounts of computation and had
data of plantar tissue stiffness to a better understanding on the limitations in time-frequency resolution [3]. Kim et al. introduced the use of
influences and the use of these parameters to predict the healthy tissue a filter-based fatigue index (FIhlrOPT), which the ratio of high-frequency to
stiffness of these individuals. low-frequency components of EMG power [3]. In this study, we optimized
Methods: 100 healthy subjects were recruited from National Seoul the cut-offs of the high-pass-filter (HPF) to maximize the correlation
University (SNU) hospital for the experiment. coefficient between the peak power and the FIhlrOPT in different muscles,
During stiffness measurement [1], indentor tip probes the plantar soft and then to determine the frequency bandwidth of our fatigue index.
tissue to obtain localized force response underneath the 2nd metatarsal Methods: Forty-one healthy males were recruited for this study. Twenty-
head pad at 3 different dorsiflexion angles of 0°, 20°, 40° and the hallux seven subjects performed knee extension/flexion exercises and fourteen
and heel at 0°. Maximum tissue deformation is fixed at 5.6mm (close to subjects performed elbow flexion/extension exercises on an isokinetic
literature data) [2]. dynamometer (Biodex System 3, Biodex Medical Systems, NY, USA).
Tissue behavior was characterized via K, stiffness constant. 10 repetition maximum was used for fatigue exercises. The experimental
protocol was 5 sets of 10 knee extensions and elbow flexion with
2 minutes of rest between sets. EMG signals were obtained from rectus
Indentation force ( N )
K ( N / mm)  femoris (RF), vastus medialis (VM), vastus lateralis (VL) and biceps brachii
Indentation depth (mm) (BB) muscles using the Noraxon EMG System (MyoSystem 1200, Noraxon
Inc., AZ, USA). EMG signals, as well as biomechanical signals (angle,
Multiple linear regression of soft tissue stiffness was performed on several angular velocity and torque) were simultaneously recorded with
plantar locations. The independent variables are gender (-1 for females a sampling rate of 1kHz. FIhlrOPT was calculated and cut-offs of HPF were
and +1 for males), bodyweight, height, BMI and age. Multiple analysis optimized to maximize the correlation between the peak power
was chosen to study the combined effects of the independent variables and FIhlrOPT.
on tissue stiffness. Results: Optimized cut-offs of RF, VM, VL and BB were similar (353.3±
Results: However, moderately strong relationship was found on the 49.5 Hz, 343.9± 34.2 Hz, 353.7± 36.1 Hz and 362.3± 28.2 Hz). RF, VM, VL
combined effects of these independent variables as shown in Table 1. and BB muscles showed good correlation with joint power (correlation
This suggest that the decision to ignore the influence of gender, age, coefficient was 0.81± 0.08, 0.56± 0.23, 0.52± 0.24 and 0.72± 0.08).
bodyweight, height and body mass index on plantar soft tissue stiffness Discussion: Similar to previous study, cut-offs of HPF of muscles were
should be carefully considered. The combined effect of these about 350Hz (RF: 360Hz in previous study). Similar cut-offs of HPF in
independent parameters may subtly influence the accuracy of the study different muscles showed the possibility of general cut-off for muscle
analysis. fatigue estimation. Mills showed that the compound muscle action
References potential spectrum did not change during fatigue above 200Hz [4]. Thus,
1. Chen W, et al: An instrumented tissue tester for measuring soft tissue the high frequency power decreased during fatigue because of the
property under the metatarsal heads in relation to metatarsophalangeal reduced motor unit activation. The low frequency power increased
joint angle. Journal of Biomechanics 2011, 44:1804-1804. during fatigue because of the elevated motor unit action potential areas.
2. Cavanagh PR: Plantar soft tissue thickness during ground contact in FIhlrOPT could reflect the decrease in the peak power during fatigue by
walking. Journal of Biomechanics 1999, 32(6):623-628. these reasons.
Figure 1(abstract A129) Linear representations of peak power output versus various EMG indices for all subjects. Peak power output versus FIhlrOPT of (a)
RF muscle; (b) VM muscle ; (c) VL muscle ; (d) BB muscle
Acknowledgement: This research project was also supported by the unloading and poor muscle function in the ankle joint may increase the
Sports Promotion Fund of Seoul Olympic Sports Promotion Foundation rate and the intensity of the ankle sprain. Various techniques have been
from Ministry of Culture, Sports and Tourism (s07201212022012). applied to maximize the joint’s stability. The objectives of this study was to
References compare the effects of general warming, local warming and taping of the
1. Karlsson S, Yu J, Akay M: Time–frequency analysis of myoelectric signals ankle joint on the electrical activity of few muscles during a sudden
during dynamic contractions. IEEE Trans. Biomed. ENG 2000, 47:229-238. unloading of the base of support during walking.
2. Dimitrov GV, Arabadzhiev TI, Mileva KN, Bowtell JL, Crichton N, Method: Ten healthy volunteer women (age: 25.6±2.7Yrs; height: 163.3
Dimitrova NA: Muscle fatigue during dynamic contractions assessed by ±5.6 cm ; mass: 60.3±7.0 kg ) were selected from local population. Using
new spectral indices. Med. Sci. Sports Exerc 2006, 38:1971-1979. Biometrics Datalog EMG system with eight bipolar surface electrodes the
3. Kim J, Park S, Ahn S, Kim Y: A Novel Approach of Defining Fatigue Indices electrical activity of medial gastrcnemious (MG), proneus longus (PL), vastus
with sEMG Power during Isotonic Contractions. J. Precis. Eng. Manuf 2012, medialis (VM) and erector spina at L3 l3v3l (ESL3) muscles were recorded by
13:977-983. 1500HZ sampling frequency. Then signals were filtered using a bound pass
4. Mills KR: Power spectral analysis of electromyogram and compounded filter of 10-500 HZ as well as a filter of 50HZ to eliminate the noise from the
muscle action potential during muscle fatigue and recovery. J. Physiol city electricity. A 12 meter walkway was made of 24 wooden plates (50cm ×
1982, 326:401-409. 50 cm × 4 cm ). Subjects walked through the walkway during the experi-
mentation while each time one of the plates was randomly removed
to impose unloading to the leg. Plates were covered with a uniform carpet.
Subject was unaware of when and where the unloading will happen. Four
A130 different conditions were performed including a) walking without warming
The effects of general warm up, specific warm up and taping on up, b) walking after a general warming, c) walking after local warming and
electrical activity of lower limb’s muscles in reaction to sudden d) walking with taping of the ankle. Each condition was repeated five times
unloading while walking and its average was used for statistical calculations. The average RMS of
Tolue Sahari1, Nader Farahpour2*, Hamidreza Mokhtarinia3, Leyla bavafa4 every muscle was normalized based on the related maximum RMS obtained
1
Islamic Azad University, Broojerd branch, Broojerd Iran; 2Bu Ali Sina by MVIC test. Repeated measure analysis of variance (a<0.05) was used for
University, Hamedan, Iran; 3Islamic Azad University, Hamedan branch, statistical calculations.
Hamedan, Iran; 4Rehabilitation University of Tehran, Iran Results and discussion: During walking, there was not any significant
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A130 differences on the activity of different muscles (p>0.05). In general unloading
resulted in higher EMG amplitude of muscles. There was a significant
Background: Ability of balance maintenance and postural control is interaction between unloading and muscle factors (p= 0.001). All muscles
important to prevent falling and injuries when balance perturbations except ES L3 were influenced by unloading. Warming did not have any
occurs during walking. Injuries due to unloading of the base of support in significant effects on EMG amplitudes of muscles in both normal and
walking and running such as ankle sprain has high incidence. Poor muscle unloading conditions (p>0.05). Symmetrical muscle activity was observed in
function may put the joint in unstable condition. The association of the all conditions by means of similar activity in both the right and the left side’s
muscles. This study indicates that warming and taping could not reduce the condition. As a result of the analysis, MF, PP and MP of midfoot were
perturbation effects on muscle activity. This could have two implications. increased by increased CA of midfoot on CI condition, so CA and MF of
First, the warming intensity was not enough and/or the time between forefoot and rearfoot were decreased. In addition, PP and MP of rearfoot
warming and testing was relatively long so that the warming effects were were decreased significantly. As a result of the analysis in the view point
disappeared prior to the test. Taping the ankle did not influence the leg and of stance phase, MF, PP and MP in the initial contact and the loading
thigh muscles’ activity. It seems that the perturbation was compensated at response were decreased significantly on CI condition. In the mid stance,
lower limb’s muscle and therefore, loading did not have influence on ESL3 MF, PP and MP were increased significantly by the increased CA of
activity. midfoot on CI condition. MF and PP were also increased significantly in
Conclusion: Unloading increases the lower limb’s muscle activity. Lumbar the terminal stance but MP was decreased (Table 1). In case of EMG, all
erector spinae muscle was not influenced by unloading. Muscle reaction was the muscle activities were decreased significantly on CI condition. An
not benefited from the proposed warming exercises and taping. It seems important contribution of this study is an analysis of all the changes in a
that lower limbs’ muscles could compensate the imposed unloading effects. muscle activities caused by wearing the custom-made insoles. Thus, the
To prevent individuals from ankle sprain due to unloading, it is suggested to result of this study can be applied for designing functional insoles and
examine the interaction between shoe and different warming programs in lower extremity orthoses for individuals with pes cavus.
larger sample size. Trial registration: Current Controlled Trials ISCRTN73824458
References
1. Burns J, Crosbie J, Hunt A, Ouvrier R: The effect of pes cavus on foot pain
and plantar pressure. Clinical Biomechanics 2005, 20:877-882.
A131 2. Kim J, Lee S, Lee H: First metatarsal dorsal close wedge osteotomy
Biomechanical analysis on custom-made insoles in gait of idiopathic combined with medial cuneiform plantar open wedge osteotomy for the
pes cavus treatment of a cavus Foot. The Korean Orthopaedic Association 2010, 45:32-38.
Jungkyu Choi1, Ji Yong Jung1, Yonggwan Won2, Jung-Ja Kim3,4* 3. Sabir M, Lyttle D: Pathogenesis of pes cavus in Charcot-Marie-Tooth
1
Department of Healthcare Engineering, Chonbuk National University, Jeonju, disease. Clin Orthop Relat Res 1983, 175:173-178.
Jeolabuk-do, 561-756, Korea; 2School of Electronics and Computer 4. Kim E, Cho H, Jung T, Kim S, Jung J: The biomechanical evaluation of
Engineering, Chonnam National University, Gwangju, 500-757, Korea; functional insoles. Korean Journal of Sport Biomechanics 2010, 20:345-353.
3
Division of Biomedical Engineering, Chonbuk National University, Jeonju, 5. Jung S, Yoo J, Kim K, Song C, Jo B, Jang I, Kim J, Lee S: Ankle Foot Complex.
Jeolabuk-do, 561-756, Korea; 4Research Center of Healthcare & Welfare Perry’s Gait Analysis Seoul: Yeong Mun Publishing Company: Park B , 1 2006,
Instrument for the Aged, Chonbuk National University, Jeonju, Jeolabuk-do, 57-62.
561-756, Korea 6. Park S, Lee S, Kang H, Kim S: EMG analysis of Lower Limb Muscle
E-mail: jungjakim@jbnu.ac.kr Activation Pattern During Pedaling: Experiments and Computer
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A131 Simulations. International Journal of Precision Engineering and Manufacturing
2012, 13:601-608.
The purpose of this study was to evaluate the effects of custom-made
insoles based on the foot pressures and electromyography (EMG)
activities in a subject group of idiopathic pes cavus which the term used A132
to describe a foot type with an excessively high medial longitudinal arch Correlation between radiography and motions of foot and ankle during
[1-3]. The study was conducted using on 10 persons who were diagnosed gait using 3D multi-segment foot model
idiopathic pes cavus by a podiatrist (an age 22.3±0.08 years, a height Dong Yeon Lee*, Sang Gyo Seo, Ji-Beom Kim, Sung Ju Kim, In Ho Choi
159.9±2.2 cm, a weight 50.8±3.69 kg, a foot size 237.9±3.27 mm, mean Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
±SD) All subjects had no history of injury in the musculoskeletal system E-mail: leedy@snu.ac.kr
of the lower extremities except pes cavus. The subjects walked on a Journal of Foot and Ankle Research 2014, 7(Suppl 1):A132
treadmill under two different experimental conditions: walking with
Normal Shoes (NS) and walking with normal shoes equipped with Background: The purpose of this study was to provide basic quantitative
custom-made insoles (CI) molded with the aim of reducing supination of data to minimize the injury occurring during forward breakfall by the
pes cavus (Figure 1). When walking, plantar foot pressure data such as comparative analysis of biomechanical factors through 3D motion
the maximum force (MF), the contacting area (CA), the peak pressure (PP) analysis, analysis of ground reaction force, and EMG analysis of the
and the mean pressure (MP) were collected using Pedar-X System (Novel forward breakfall of the martial arts targeting 10 skilled and 10 unskilled
Gmbh, Germany) and EMG activity of lower limb muscles such as Rectus subjects.
Femoris (RF), Tibialis Anterior (TA), Musculus Biceps Femoris (MBF) and Methods: In this study, three-dimensional motion analysis, the nine high-
Medial Gastrocnemius (MG) were also gathered using Delsys EMG Work speed camera (Motionmaster 100, KOR) was used, the desired total floor
System (Delsys, USA) [4-6]. Accumulated data was then analyzed using reaction force device (ATMI, USA) 2 units was measured using an impact
paired t-test in order to investigate the effects of each of experimental force. And the floor reaction force and three-dimensional motion analysis
Figure 1(abstract A131) Normal Shoes (NS) and Custom-made Insoles (CI)
Table 1(abstract A131) The results of plantar pressure in stance phase.

Normal shoes (NS) Custom-made Insoles (CI)
mean SD mean SD
Contacting area (cm2) Initial contact 15.82 9.94 17.43 10.78
Loading response 42.25 17.92 40.97 13.7
Mid stance 74.18 4.21 74.9 5.79
Terminal stance 47.17 14.32 57.03* 15.25
Maximum force (N) Initial contact 55.65 44.15 53.66 44.65
Loading response 254.15 125.91 243.16* 120.7
Mid stance 400.55 11.06 425.76* 38.87
Terminal stance 283.42 128.78 335.14* 156.3
Peak pressure (kPa) Initial contact 41.5 28.26 36.75* 28.71
Loading response 115.07 41.63 112.14* 36.38
Mid stance 127.05 17.04 139.61* 19.58
Terminal stance 128.97 45.55 143.57* 41.37
Mean pressure (kPa) Initial contact 25.51 16.58 22.75* 13.69
Loading response 55.42 16.72 54.27 16.15
Mid stance 54.84 4.83 57.71* 5.01
Terminal stance 56.45 15.02 54.83* 15.24
* p < 0.05 significant difference between NS and CI
program was used for the Kwon3dXP. Group differences for verification instability refer to sagittal motion [4],[5], [6],[7]. Increased motion may also
and program SPSS 21.0 was used. be present in the axial plan. However, there is no known way of measuring
Results: The following are the findings. Firstly, the total time taken for motion of axial plan. In this study, we assessed the axial plan mobility by
forward breakfall of the martial arts showed 1.53±0.04 s for skilled, and means of measuring the difference between weight bearing IMA and non-
1.41±0.06s for unskilled subjects (p<.01). weight bearing IMA from foot AP radiograph. This study investigated the
Second, during forward breakfall of the martial arts, the skilled subjects difference between the axial motion of the first ray of the symptomatic
came up with significantly faster impact velocity in the primary point of hallux valgus patients group and that of the normal group.
impact (E2) (p<.001), but the unskilled subjects showed significantly faster Methods: A group of 108 women with symptomatic hallux valgus and 37
impact velocity in the secondary point of impact (E3) (p<.001). control women, age 21 to 84 years were measured weight bearing and
Third, the forward breakfall of the martial arts did not show any difference non-weight bearing IMA and calculated the difference. We measured the
between left and right side in the reaction force, but unskilled subjects 1st ray sagittal range of motion by the EMC device [4]. We moved the
proved a significantly greater forward and backward reaction force in the first ray up and down and recorded the distance (d). We also measured
secondary point of impact(E3) both right and left sides(right: p<.01, left: the first metatarsal length (l) on the AP foot x-ray film. Finally, we
p<.001). The skilled subjects showed a significantly greater vertical reaction calculated the 1st ray range of motion (A) using the above data. There
force in the primary point of impact (E2) (right: p<.001, left: p<.001), and data was statistically annalize with correlation with HV angle, IM angle
unskilled subjects showed a larger vertical reaction force in the secondary and each other.
point of impact (E3), respectively (right: p<.01, left: p<.05). Result: The average of the difference weight bearing and non-weight
Conclusion: Therefore, in order to reduce the impact force when the bearing IMA in the control group was 1.16 and 3.20 in the hallux vallgus
forward motion action Break fall slowly to reduce the impact velocity and group. If we defined 3.6(95 percentile in the normal group) as having axial
the impact of the hand compared to alleviate elbow seems to be good. hypermobility, 42% of hallux valgus patients had first ray axial plan
hypermobility (Table 1). The axial plan mobility had no correlation with
sagittal plan mobility(Correlation coefficient : 0.25) and also no significant
A133 correlation with hallux valgus angle or IMA(Correlation coefficient : 0.5)
Sagittal and axial mobility of 1st ray in hallux valgus (Figure 1).
Kiwon Young*, Jin Su Kim, Hun ki Cho, Hyoung Suk Kim Conclusion: 1st ray axial hypermobility is another disease group in hallux
Dept. of Orthopaedic Foot & Ankle Eulji Medical College Hospital Nowon, valgus, so should be considered in treatment of hallux valgus.
Seoul, Korea Trial registration: Clinical experimental study.
E-mail: youngkw1@hanmail.net References
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A133 1. Lapidus PW: Operative correction of metatarsus varus primus in hallux
valgus. SurgGynecolObstet 1934, 58:183-191.
Introduction: Hypermobility of the first ray is one causative factor in 2. Lapidus PW: A quarter of a century of experience with the operative
development and recurrence of Hallux valgus[1],[2],[3]. so treated as an correction of the metatarsus varus primus in hallux valgus. Bull Hosp
important factor in hallux valgus. While most discussions of 1st ray Joint Dis 1956, 17(2):404-421.
Table 1(abstract A133)

Difference between weight bearing IMA and non-weight bearing IMA Sagittal mobility
Hallux valgus group 3.2° (range 0°to 14°) 10.1° (range 7°to 16)
Control group 1.2° (range 0°to 8°) 7.8° (range 6°to 11)
3. Coughlin MJ, Grebing BR, Jones CP: Arthrodesis of the first ankle-hindfoot scale and SF-36. We described radiologic parameters
metatarsophalangeal joint for idiopathic hallux valgus: intermediate around the hindfoot and ankle joint including talar tilt, tibial-ankle surface
results. Foot Ankle Int 2005, 26(10):783-792. angle, medial clear space, frontal tibial ground angle, frontal talar gound
4. Lee KT, Young K: Measurement of first-ray mobility in normal vs. hallux angle, hindfoot alignment view angle and measured the amount of
valgus patients. Foot Ankle Int 2001, 22(12):960-964. change of knee alignment by comparing preoperative and postoperative
5. Morton DJ: Hypermobility of the first metatarsal bone: the interlinking X-rays. We divided cases into 4 groups, two with increased ankle pain
factor between matarsalgia and longitudinal arch strains. J Bone Joint postoperatively in previous ankle pain group and newly developed pain
Surg 1928. postoperatively. Pain was aggrevated compared preoperatively was other
6. Klaue K, Hansen ST, Masquelet AC: Clinical, quantitative assessment of subgroup, and the other had no change. We compared 4 groups in each
first tarsometatarsal mobility in the sagittal plane and its relation to parameter and analyzed statistically (SPSS v13.0).
hallux valgus deformity. Foot Ankle Int 1994, 15(1):9-13. Results: There was change of ankle pain in 15 cases of 71 patients (80
7. Voellmicke KV, Deland JT: Manual examination technique to assess dorsal cases) with over 6 months of follow-up period. Twelve patients had ankle
instability of the first ray. Foot Ankle Int 2002, 23(11):1040-1041. pain before surgery. In 3 cases of them, ankle pain was decreased post-
8. Coughlin MJ, Jones CP, Viladot R, Glano P, Grebing BR, Kennedy MJ, operatively, however, pain of the others was increased postoperatively.
Shurnas PS, Alvarez F: Hallux valgus and first ray mobility: a cadaveric Eight cases had newly developed ankle pain postoperatively. In 60 cases,
study. Foot Ankle Int 2004, 25(8):537-544. ankle pain had no change. The effect of clinical ankle pain by amount of
9. Faber FW, Kleinrensink GJ, Verhoog MW, Vijn AH, Snijders CJ, Mulder PG, varus angle correction by total knee arthroplasty showed significant
Verhaar JA: Mobility of the first tarsometatarsal joint in relation to hallux difference between 4 subgroups. There was no significant difference in
valgus deformity: anatomical and biomechanical aspects. Foot Ankle Int each parameter between 4 subgroups.
1999, 20(10):651-656. Conclusion: Change of alignment of lower extremity after total knee
10. Rush SM, Christensen JC, Johnson CH: Biomechanics of the first ray. Part arthroplasty can affect on ankle pain.
II: metatarsus primus varus as a cause of hypermobility. A three-
dimensional kinematic analysis in a cadaver model. J Foot Ankle Surg
2000, 39(2):68-77. A135
11. Bednarz PA, Manoli A 2nd: Modified lapidus procedure for the treatment Effects of the upright body type exercise program on foot balance in
of hypermobile hallux valgus. Foot Ankle Int 2000, 21(10):816-821. female high school students
12. Kim JY, Park JS, Hwang SK, Young KW, Sung IH: Mobility changes of the Nam-Young Son1, Joong-Sook Lee1*, Jeong-Ok Yang1, Bom-Jin Lee1,
first ray after hallux valgus surgery: clinical results after proximal Dong-Wook Han2
1
metatarsal chevron osteotomy and distal soft tissue procedure. Foot Department of Physical Education, College of Medical and Life Sciences,
Ankle Int 2008, 29(5):468-472. Silla University, Busan, Korea; 2Department of Physical Therapy, College of
Medical and Life Sciences, Silla University, Busan, Korea
E-mail: jslee@silla.ac.kr
A134 Journal of Foot and Ankle Research 2014, 7(Suppl 1):A135
Change of ankle pain after total knee replacement arthroplasty
Heui-Chul Gwak Background: The foot balance is strongly associated with the body
Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, posture which in turn, contributes to musculoskeletal functioning.
Inje University, 633-165 Gaegeum-dong, Busan Jin-gu, Busan 614-735, South Unfortunately, children and adolescents in these day often encounter
Korea some problems with spinal alignment such as scoliosis, due to the
E-mail: ortho1@hanmail.net sedentary lifestyle. Conversely, An exercise program specially designed for
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A134 body posture and balance may be the key to solve these programs.
However, not much research has been conducted to determine the
Background: We aimed to analyze the change of ankle pain by benefits of exercise in relation to correct the body posture, as well as
realignment of the lower extremity after total knee arthroplasty. foot balance.
Methods: We performed prospective analysis and followed up 76 patients Materials and methods: The purpose of this study was to investigate
enrolled from January 2012 to December. 2013 for at least 6 months the effects of an upright body-type exercise program on the foot balance
excepting the 5 patients who were lost follow-up, 71 patients (bilateral: 9, in female high school students. Forteen female high school students
unilateral: 62, total 80 cases) were analyzed. There were 8 men, 63 women were selected and grouped into an experiment(n=7) and control(n=7)
and the average age were 69.6 years old (56-79). All surgery were group. The research varibles included foot balance and body posture
performed by one operator and posterior cruciate ligament stabilized knee which were measured by Shesei Innovation System (PA 200, Japan). A
arthroplasty was done in all cases. Subjective ankle pain was evaluated by specially designed exercise program called the upright body-type exercise
visual analogue scale (VAS) and clinical results were evaluated by AO-FAS was developed and implemented for 12 weeks (2 times per week).
Figure 1(abstract A135) An example of changes in the foot balance of participant 1.
Figure 2(abstract A135) An example of changes in the foot balance of participant 3.
Results: Results revealed that the left balance was changed to almost foot balance was somewhat increaed from 50.03±2.67 to 50.92±1.41.
the perfect balance (50%) from 48.93±3.87 to 48.97±2.95; whreas, the Figures 1 and 2.
right foot balance was from 51.07±3.87 to 50.26±2.95 in experimental Conclusions: As a conclusion, the upright body-type exercise program
group which were also near to the perfect balance (50%). However, may have positive impact on the foot balance and body posture in
the mean score of the left foot balance in the control group was female high school students. This program may also be utilized for
decreased from 49.97±2.67 to 49.08±1.41; whereas, that of the right people with spinal conditions, as a means of rehabilitation.
References injuries to feet in hiking and aggravating fatigability of foot when people
1. Gong WD, Ma SR, Kim TH: Effect of balance ability on ankle joint hike for a long time [2], so hiking boots which are specially functioned
operation for supination foot. Korean Data and Information Science Society are encouraged because walking on the rough surface has latent
2009, 20(3):527-539. dangerousness of injury [3]. Trail walking shoes generally provide more
2. Ko DS, Lee CG, Kim GY, Lee KI, Kim MH, Jeong DI: The Effect of lumbar stability and support than regular walking shoes. Trail walking shoes are for
stabilization exercise on motor capacity and pain in chronic low back natural trails. In rocky, rooted, dusty and muddy trails, a trail walking shoe
pain workers. Journal of Sport and Leisure Studies 2009, 35:1021-1028. gives added traction and support.
Ten healthy males participated in this study. All subjects were free of lower
extremity pain, history of serious injuries or operative treatment or
A136 subjective symptoms interfering with walking. Each subject wore four
A biomechanical research of foot pressure for lower extremity in gait different shoe types during walking trials on a treadmill at a constant
wearing trail walking shoes speed of 4.2km/hour. Pressure distribution data (contact area, maximum
Seung-Bum Park1*, Sae-Yeon Lee2, Seong-Mi Kim2, Yu-Jin Hwang2, force, peak pressure, maximum mean pressure) were collected with
Kyoung-Youl Yoo2 pressure device at a sampling rate of 100Hz. Shoes used in the experiment
1
Footwear Biomechanics Team, Footwear Industrial Promotion Center, Busan, are which developed in four shoes. Developed trail walking shoes (Type A),
Korea; 2Busanil Science High School, Busan, Korea first developed trail walking shoes (Type B) and other company’s trail
E-mail: sbpark@shoenet.org walking shoes (Type C, Type D) are selected for the experiment. Tested
Journal of Foot and Ankle Research 2014, 7(Suppl 1):A136 about ‘Comparison in Lightweightedness’ among the shoes (Figure 1).
‘Comparison in Lightweightedness’s result is Type A (324.92 g) < Type B
The aim of this study is to analyze foot pressure distribution of trail walking (350.70 g) < Type C (374.67 g) < Type D (397.16 g).
shoes while walking. Hiking, a recreational activity which is able to exercise Contact area of functional shoes (Type A) increased in comparison to
whole body in the nature without any cost, has compositive effects which general shoes (Type C, Type D). At the same time, foot pressure decreased
can reduce stress, strengthen muscles of entire body and improve in comparison to general shoes (Type C, Type D). It is expected that Type A
cardiopulmonary function [1]. The Topography is hard near the surface and Functional shoes give more comfort and fit by increasing the contact area
has rough characteristic because of rocks. These condition can lead to and decreasing peak pressure.
Figure 1(abstract A136) Type A: developed trail walking shoes, Type B: first developed trail walking shoes, Type C, D: other company’s trail wxalking
shoes
Table 1 Result of Foot Pressure

Mask Contact Area(cm2) Maximum Force(N)
A CA B C D A CA B C D
Total 142.187 142.739 142.049 146.076 139.403 677.276 703.008 708.275 715.217 690.800
M1 58.507 58.046 57.975 57.618 58.474 558.903 552.363 568.875 539.680 565.046
M2 42.356 44.444 42.660 47.957 40.930 152.873 194.191 168.769 215.201 173.182
M3 40.664 39.659 40.782 39.834 39.483 402.950 412.355 436.040 407.802 416.908
Mask Peak Pressure(kPa) Maximum Mean Pressure(kPa)
A CA B C D A CA B C D
Total 237.516 272.143 256.418 273.346 270.940 78.084 79.048 79.767 76.533 81.563
M1 235.927 268.839 256.130 272.763 264.915 95.864 95.639 98.354 94.568 96.709
M2 87.566 111.221 98.818 126.280 96.161 44.034 50.660 47.934 53.151 48.168
M3 166.622 177.161 171.323 162.103 192.218 99.827 104.309 107.090 102.840 105.777
* CA: Control Average = (Type C + Type D)/2
In the result of the analysis of plantar pressure, Type A reported higher References
than other shoes on the forefoot. At the maximum force, Type A is 1. Lee HS, Jung GS, Yoo HH: Slope Analysis of Mountain Trail Using
observed as the smallest maximum force in almost part. These results, Mobile GPS. The Korean Society for GeoSpatial Information System 2009,
which is similar to Park (2009)’s research [3], decreased the confining 17(2):81-90.
pressure which can lead the deformation of forefoot’s toe. In the 2. Park SB, Lee JS: Analyses of GRF & Insole Foot-Pressure Distribution: Gait
maximum pressure result, the outcome is similar to maximum force, Patterns and Types of Trekking Boots. Korean Journal of Sport
which the smallest is Type A < Type D < Type B < Type C. This can Biomechanics 2007, 17(4):190-200.
decline the impulse which occurs in heel strike section, as a result, this 3. Hettinga BA, Stefayshyn DJ, Fairbairn JC, Worobets JT: Biomechanical
can decrease the fatigability of foot in long-time walking. In addition, effects of hiking on a non-uniform surface. Proceeding. of the 7th
similar to Oh and Lee (2009)’s research [4], it can lighten the impulse Symposium Footwear Biomechanics, Cleveland, OH, USA 2005, 41-42.
force delivered to the body, as being the important factor which can 4. Park JJ: A Comparative Analysis on Changes of Foot Pressure by Shoe
decrease the weight to the leg joint. As examining the result of the Heel Height during Walking. Korean Journal of Sport Biomechanics 2009,
average pressure, Type A < Type C < Type D < Type B is observed. 19(4):771-778.
In this thesis, we analyzed the contact area of plantar pressure, maximum 5. Oh YJ, Lee CM: The Study on 3-Axes Acceleration Impact of Lower Limbs
force, maximum pressure, average pressure. Through this result, we can Joint during Gait. Journal of the Ergonomics Society of Korea 2009,
know impact force alleviation for foot and physical fatigue, too. 28(3):33-39.
When considering the pressure change of the foot, Type A’s contact area
of foot is wider than the others. So, its wearing feeling will be better than
the others. In case of maximum pressure, it is lower than the others and
mid foot, hind foot’s result is similar. So, we expect ‘shockproof and to
disperse pressure’ will be good. Also, with foot and shoe contact area’s
increase, there may be amaximum force and maximum pressure decrease. Cite abstracts in this supplement using the relevant abstract number,
e.g.: Park et al.: A biomechanical research of foot pressure for lower
So, it can decrease the foot’s and pelvic limb’s fatigue.
extremity in gait wearing trail walking shoes. Journal of Foot and Ankle
We offer the data of the dispersing pressure functionality of walking hiking Research 2014, 7(Suppl 1):A136
shoes, so it can be of help to a product’s functionality improvement.

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Journal of Foot and Ankle Research 2014, Volume 7 Suppl 1

http://www.jfootankleres.com/supplements/7/S1 JOURNAL OF FOOT

MEETING ABSTRACTS Open Access

4th Congress of the International Foot and Ankle

These abstracts are available online at http://www.jfootankleres.com/supplements/7/S1

8. Heiderscheit B, Hamill J, Tiberio D: A biomechanical perspective: do foot

Table 1(abstract A5) Mean ± SD inversion/eversion

Background: Studies describe subtalar and ankle arthrodesis as a factor

Figure 1(abstract A12) LMAI at 100ms and VAS

Figure 2(abstract A12) LMFI at 100ms and VAS

Figure 1(abstract A13) CoP Area in mm2

Figure 2(abstract A13) CoP Movement in mm

Figure 3(abstract A13) Mean Velocity in mm/s

6. McPoil TG, et al: Effect of foot orthoses contour on pain perception in

area decreased significantly compared with all other insoles conditions

Figure 1(abstract A28) Profile of joint orientation. Joint orientation

Figure 2(abstract A28) Profile of angular velocities. Joint velocity

Aim: The aim of this study was to determine whether anticipation of an

Table 1(abstract A34) Mean arch height flexibility and

functional ankle instability (FAI); however the effect of balance training on

2. Dixon SJ: Application of Centre-of-Pressure Data to Indicate Rear foot

Figure 2(abstract A58) Fascia stiffness effects

Figure 1(abstract A59) Flow chart of method

Figure 2(abstract A59) Equivalent Stress Distribution

Table 1(abstract A62) HEE and MID placement error and

Purpose: To examine acute alterations in lower-extremity sagittal plane

Background: In-shoe pressure measurement devices are commonly used A68

Figure 1(abstract A69)

Figure 2(abstract A69)

Figure 2(abstract A71) Statistical comparison of compensation methods

Figure 1(abstract A78) Foot arch deformations during balanced standing

Figure 3(abstract A78) Average of strain in plantar fascia

Figure 1(abstract A79) CF footprint masked based on marker co-ordinates

References Background: Charcot-Marie-Tooth disease (CMT) is the most common

stance phase and ensemble-averaged across trials and participants.

Table 1(abstract A94) Coupling angles

Background: It is important to improve the routine ADL(activities of daily

Table 1(abstract A121) Result of Foot Pressure

The peak pressure of foot (Total) by decreased 6.70%, forefoot (M1) by

Figure 1(abstract A122) Marathon Shoes(NESTFIT Technology)

Table 1(abstract A122) Result of Foot Pressure (Marathon Shoes: Type A)

Figure 2(abstract A122) Result of Foot Pressure(Marathon Shoes: Type A)

Figure 2(abstract A123) Comparison of foot pressure.

Introduction: Stiffened plantar soft tissues break down easily (Cheung

Table 1(abstract A131) The results of plantar pressure in stance phase.

Table 1(abstract A133)

Figure 1(abstract A133)

Figure 1(abstract A135) An example of changes in the foot balance of participant 1.

Figure 2(abstract A135) An example of changes in the foot balance of participant 3.

Table 1 Result of Foot Pressure

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