Research Papers

Foot and Ankle Joint Biomechanical Adaptations to an Unpredictable Coronally Uneven Surface

[+] Author and Article Information
Ava D. Segal

Center for Limb Loss and Mobility,
Department of Veterans Affairs,
1660 S. Columbian Way, MS-151,
Seattle, WA 98108
e-mail: avasegal@gmail.com

Kyle H. Yeates

Center for Limb Loss and Mobility,
Department of Veterans Affairs,
1660 S. Columbian Way, MS-151,
Seattle, WA 98108;
Department of Mechanical Engineering,
University of Washington,
Seattle, WA 98195
e-mail: kyle.yeates@gmail.com

Richard R. Neptune

Department of Mechanical Engineering,
The University of Texas at Austin,
Austin, TX 78712
e-mail: rneptune@mail.utexas.edu

Glenn K. Klute

Center for Limb Loss and Mobility,
Department of Veterans Affairs,
1660 S. Columbian Way, MS-151,
Seattle, WA 98108;
Department of Mechanical Engineering,
University of Washington,
Seattle, WA 98195
e-mail: gklute@u.washington.edu

Manuscript received March 13, 2017; final manuscript received August 1, 2017; published online January 17, 2018. Assoc. Editor: Pasquale Vena.

J Biomech Eng 140(3), 031004 (Jan 17, 2018) (9 pages) Paper No: BIO-17-1103; doi: 10.1115/1.4037563 History: Received March 13, 2017; Revised August 01, 2017

Coronally uneven terrain, a common yet challenging feature encountered in daily ambulation, exposes individuals to an increased risk of falling. The foot-ankle complex may adapt to improve balance on uneven terrains, a recovery strategy which may be more challenging in patients with foot-ankle pathologies. A multisegment foot model (MSFM) was used to study the biomechanical adaptations of the foot and ankle joints during a step on a visually obscured, coronally uneven surface. Kinematic, kinetic and in-shoe pressure data were collected as ten participants walked on an instrumented walkway with a surface randomly positioned ±15 deg or 0 deg in the coronal plane. Coronally uneven surfaces altered hindfoot–tibia loading, with more conformation to the surface in early than late stance. Distinct loading changes occurred for the forefoot–hindfoot joint in early and late stance, despite smaller surface conformations. Hindfoot–tibia power at opposite heel contact (@OHC) was generated and increased on both uneven surfaces, whereas forefoot–hindfoot power was absorbed and remained consistent across surfaces. Push-off work increased for the hindfoot–tibia joint on the everted surface and for the forefoot–hindfoot joint on the inverted surface. Net work across joints was generated for both uneven surfaces, while absorbed on flat terrain. The partial decoupling and joint-specific biomechanical adaptations on uneven surfaces suggest that multi-articulating interventions such as prosthetic devices and arthroplasty may improve ambulation for mobility-impaired individuals on coronally uneven terrain.

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Grahic Jump Location
Fig. 2

Average vertical GRF normalized to body mass (N/kg) across the disturbed step stance phase for three surface conditions: flush, blinded (B.) inversion and B. eversion. The average timing of peak GRF in early stance and late stance, displayed with vertical dashed lines, were similar in timing across conditions. For each trial, the corresponding joint angles and moments at these peak loading events were also extracted (see Fig. 3).

Grahic Jump Location
Fig. 1

Foot and sensor static marker placement with shoe cutouts to accommodate the in-shoe MSFM. The static sensor markers (red circles) were used to locate the position of the insoles relative to the location of the foot markers. All foot tracking markers were attached directly to the skin. The cuboid and navicular bony landmarks were palpated before subjects donned the shoes. Then markers (white circles) were attached to the shoe upper above the palpated location for the static trial only to define the MTJ center.

Grahic Jump Location
Fig. 3

Average coronal plane angles (deg, inversion+) and moments normalized by body mass (N·m/kg, eversion+) across the disturbed step stance phase (%) for three surface conditions: flush, blinded (B.) inversion and B. eversion and three joints: whole foot ankle (AJCWF), hindfoot ankle (AJCHF) and MTJ. The MPJ was modeled with two degrees-of-freedom (2DOF); therefore, only MPJ coronal moments were shown. Vertical dashed lines identify the average timing of peak vertical GRF in early stance and late stance, as shown in Fig. 2.

Grahic Jump Location
Fig. 4

Average total power normalized by body mass (W/kg, generated+) across the disturbed step stance phase (%) for three surface conditions: flush, blinded (B.) inversion and B. eversion and four joints: whole foot ankle (AJCWF), hindfoot ankle (AJCHF), midtarsal (MTJ), and metatarsophalangeal (MPJ). A vertical dashed line portrays the average percent stance time of the OHC (OHC 79 ± 2%).



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