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Footwear may moderate the transiently heightened asymmetry in lower limb loading associated with peak growth in adolescence during running. This repeated-measures study compared the magnitude and symmetry of peak vertical ground reaction force and instantaneous loading rates (VILRs) in adolescents during barefoot and shod running. Ten adolescents (age, 10.6 ± 1.7 years) ran at self-selected speed (1.7 ± 0.3 m/s) on an instrumented treadmill under three counter-balanced conditions; barefoot and shod with partial-minimal and conventional running shoes. All participants were within one year of their estimated peak height velocity based on sex-specific regression equations. Foot-strike patterns, peak vertical ground reaction force and VILRs were recorded during 20 seconds of steady-state running. Symmetry of ground reaction forces was assessed using the symmetry index. Repeated-measures ANOVAs were used to compare conditions (α=.05). Adolescents used a rearfoot foot-strike pattern during barefoot and shod running. Use of conventional shoes resulted in a lower VILR ( P  < .05, d z  = 0.9), but higher VILR asymmetry ( P  < .05) than running barefoot (d z  = 1.5) or in partial-minimal shoes (d z  = 1.6). Conventional running shoes result in a lower VILR than running unshod or in partial-minimal shoes but may have the unintended consequence of increasing VILR asymmetry. The findings may have implications for performance, musculoskeletal development and injury in adolescents.

Background: Instrumented treadmills that incorporate pressure platforms are increasingly used to characterize gait in children. Although footprint size is known to influence the measurement performance of pressure platforms, published evidence on the reliability of such systems for children's gait is lacking., Research Question: This study evaluated the test-retest reliability of temporospatial gait parameters and vertical ground reaction forces measured in healthy children during barefoot walking and running on a capacitance-based treadmill system., Methods: Temporospatial gait parameters, including cadence, stride length, stride duration, stance and swing phase durations and the magnitude and timing of conventional vertical ground reaction force peaks were determined on two occasions in 17 healthy children (mean age, 11 ± 2 years; height, 148.4 ± 9.3 cm; and mass, 43.3 ± 10 kg) during walking and running at preferred speed on an instrumented treadmill. Reliability was assessed using Intra Class Correlation Coefficients (ICC) and the standard error of measurement (SEM). The minimum detectable change (MDC95%) was also calculated., Results: ICC values ranged from 0.91-0.99 for all variables. When expressed as a percentage of the mean, the SEM was <5% for all gait parameters assessed during walking and running. The MDC95% values for gait parameters were typically higher during running than walking, and were ±4% of the gait cycle for temporal parameters, ±55 cm for stride length and ±0.1 bodyweights for peak vertical ground reaction force., Significance: Children's gait parameters varied by <5% between test occasions and were more consistent during walking than running. These findings provide clinicians and researchers with an index of the reliability and sensitivity of the treadmill to detect changes in common spatiotemporal gait parameters and vertical ground reaction forces in children., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Abnormalities in gait have been associated with high plantar pressures and diabetes-related plantar foot ulcers. Whether these are a transient response to the ulcer or are representative of long-term lower limb biomechanical abnormalities is currently unknown., Objective: The aim of this study was to examine whether 12 gait parameters identified as being associated with nonhealing diabetes-related plantar foot ulcers at baseline remained associated during a 6-month follow-up period., Design: This was a longitudinal observational case-control study., Methods: Gait assessments were performed at entry and twice during follow-up over a 6-month period in 12 participants with nonhealing diabetes-related plantar foot ulcers (case participants) and 62 people with diabetes and no history of foot ulcers (control participants) using a standardized protocol. Linear mixed-effects random-intercept models were used to identify gait parameters that consistently differed between case participants and control participants at all assessments after adjustment for age, sex, body mass index, presence of peripheral neuropathy, and follow-up time. Standardized mean differences (SMD) were used to measure effect sizes., Results: Five of the 12 gait parameters were significantly different between case participants and control participants at all 3 time points. Case participants had a more abducted foot progression angle (SMD = 0.37), a higher pelvic obliquity at toe-off (SMD = -0.46), a greater minimum pelvic obliquity (SMD = -0.52), a lower walking speed (SMD = -0.46), and a smaller step length (SMD = -0.46) than control participants., Limitations: The limitations included a small sample size, the observational nature of the study, and the inability to evaluate the impact of gait on wound healing., Conclusions: This study identified abnormal gait parameters consistently associated with nonhealing diabetes-related plantar foot ulcers. Further research is needed to test the clinical importance of these gait characteristics., (© 2019 American Physical Therapy Association.)

The capacity of foot-strike running patterns to influence the functional properties of the Achilles tendon is controversial. This study used transmission-mode ultrasound to investigate the influence of habitual running foot-strike pattern on Achilles tendon properties during barefoot walking and running. Fifteen runners with rearfoot (RFS) and 10 with a forefoot (FFS) foot-strike running pattern had ultrasound transmission velocity measured in the right Achilles tendon during barefoot walking (≈1.1 ms -1 ) and running (≈2.0 ms -1 ). Temporospatial gait parameters, ankle kinematics and vertical ground reaction force were simultaneously recorded. Statistical comparisons between foot-strike patterns were made using repeated measure ANOVAs. FFS was characterised by a significantly shorter stance duration (-4%), greater ankle dorsiflexion (+2°), and higher peak vertical ground reaction force (+20% bodyweight) than RFS running (P < .05). Both groups adopted a RFS pattern during walking, with only the relative timing of peak dorsiflexion (3%), ground reaction force (1-2%) and peak vertical force loading rates (22-23%) differing between groups (P < .05). Peak ultrasound transmission velocity in the Achilles tendon was significantly higher in FFS during walking (≈100 ms -1 ) and running (≈130 ms -1 ) than RFS (P < .05). Functional Achilles tendon properties differ with habitual footfall patterns in recreational runners.

Background: Heightened vertical load beneath the foot has been anecdotally implicated in the development of activity-related heel pain of the calcaneal apophysis in children but is supported by limited evidence., Research Question: This study investigated whether vertical loading patterns during walking and running differed in children with and without calcaneal apophysitis., Methods: Vertical ground reaction force, peak plantar pressure (forefoot, midfoot, heel) and temporospatial gait parameters (cadence, step length, stride, stance and swing phase durations) were determined in children with (n = 14) and without (n = 14) calcaneal apophysitis. Measures were acquired during barefoot walking and running at matched and self-selected speed using an instrumented treadmill, sampling at 120 Hz. Statistical comparisons between groups were made using repeated measure ANOVAs., Results: There were no significant between group differences in vertical ground reaction force peaks or regional peak plantar pressures. However, when normalised to stature, cadence was significantly higher (≈ 5%) and step length shorter (≈ 5%) in children with calcaneal apophysitis than those without, but only during running (P <.05). Maximum pressure beneath the rearfoot during running was significantly correlated with self-reported pain in children with calcaneal apophysitis., Significance: Peak vertical force and plantar pressures did not differ significantly in children with and without calcaneal apophysitis during walking or running. However, children with calcaneal apophysitis adopted a higher cadence than children without heel pain during running. While the findings suggest that children with calcaneal apophysitis may alter their cadence to lower pressure beneath the heel and, hence pain, they also highlight the benefit of evaluating running rather than walking gait in children with calcaneal apophysitis., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: This cross-sectional study used transmission-mode ultrasound to evaluate dynamic tendon properties during walking in surgically repaired and contralateral Achilles tendon (AT), with a median (range) post-operative period of 22 (4-58) months. It was hypothesised that the axial transmission speed of ultrasound (TSOU) during walking would be slower, indicating lower material stiffness in repaired compared with contralateral AT., Methods: Ten patients [median (range) age 47 (37-69) years; height 180 (170-189) cm; weight 93 (62-119) kg], who had undergone open surgical repair of the AT and were clinically recovered according to their treating clinicians, walked barefoot on a treadmill at self-selected speed (1.0 ± 0.2 m/s). Synchronous measures of TSOU, sagittal ankle motion, vertical ground reaction force (GRF), and spatiotemporal gait parameters were recorded during 20 s of steady-state walking. Paired t tests were used to evaluate potential between-limb differences in TSOU, GRF, ankle motion, and spatiotemporal gait parameters., Results: TSOU was significantly lower (≈175 m/s) in the repaired than in the contralateral AT over the entire gait cycle (P < 0.05). Sagittal ankle motion was significantly greater (≈3°) in the repaired than in the contralateral limb (P = 0.036). There were no significant differences in GRF or spatiotemporal parameters between limbs., Conclusions: Repaired AT was characterised by a lower TSOU, reflecting a lower material stiffness in the repaired tendon than in the contralateral tendon. A lower material stiffness may underpin greater ankle joint motion of the repaired limb during walking and long-term deficits in the muscle-tendon unit reported with AT repair. Treatment and rehabilitation approaches that focus on increasing the material stiffness of the repaired AT may be clinically beneficial. Transmission-mode ultrasound would seem useful for quantifying tendon properties post AT rupture repair and may have the potential to individually guide rehabilitation programmes, thereby aiding safer return to physical activity., Level of Evidence: II.

Background: Despite the emerging use of treadmills integrated with pressure platforms as outcome tools in both clinical and research settings, published evidence regarding the measurement properties of these new systems is limited. This study evaluated the within- and between-day repeatability of spatial, temporal and vertical ground reaction force parameters measured by a treadmill system instrumented with a capacitance-based pressure platform., Methods: Thirty three healthy adults (mean age, 21.5 ± 2.8 years; height, 168.4 ± 9.9 cm; and mass, 67.8 ± 18.6 kg), walked barefoot on a treadmill system (FDM-THM-S, Zebris Medical GmbH) on three separate occasions. For each testing session, participants set their preferred pace but were blinded to treadmill speed. Spatial (foot rotation, step width, stride and step length), temporal (stride and step times, duration of stance, swing and single and double support) and peak vertical ground reaction force variables were collected over a 30-second capture period, equating to an average of 52 ± 5 steps of steady-state walking. Testing was repeated one week following the initial trial and again, for a third time, 20 minutes later. Repeated measures ANOVAs within a generalized linear modelling framework were used to assess between-session differences in gait parameters. Agreement between gait parameters measured within the same day (session 2 and 3) and between days (session 1 and 2; 1 and 3) were evaluated using the 95% repeatability coefficient., Results: There were statistically significant differences in the majority (14/16) of temporal, spatial and kinetic gait parameters over the three test sessions (P < .01). The minimum change that could be detected with 95% confidence ranged between 3% and 17% for temporal parameters, 14% and 33% for spatial parameters, and 4% and 20% for kinetic parameters between days. Within-day repeatability was similar to that observed between days. Temporal and kinetic gait parameters were typically more consistent than spatial parameters. The 95% repeatability coefficient for vertical force peaks ranged between ± 53 and ± 63 N., Conclusions: The limits of agreement in spatial parameters and ground reaction forces for the treadmill system encompass previously reported changes with neuromuscular pathology and footwear interventions. These findings provide clinicians and researchers with an indication of the repeatability and sensitivity of the Zebris treadmill system to detect changes in common spatiotemporal gait parameters and vertical ground reaction forces.

Background: Commercially available instrumented treadmill systems that provide continuous measures of temporospatial gait parameters have recently become available for clinical gait analysis. This study evaluated the level of agreement between temporospatial gait parameters derived from a new instrumented treadmill, which incorporated a capacitance-based pressure array, with those measured by a conventional instrumented walkway (criterion standard)., Methods: Temporospatial gait parameters were estimated from 39 healthy adults while walking over an instrumented walkway (GAITRite(®)) and instrumented treadmill system (Zebris) at matched speed. Differences in temporospatial parameters derived from the two systems were evaluated using repeated measures ANOVA models. Pearson-product-moment correlations were used to investigate relationships between variables measured by each system. Agreement was assessed by calculating the bias and 95% limits of agreement., Results: All temporospatial parameters measured via the instrumented walkway were significantly different from those obtained from the instrumented treadmill (P<.01). Temporospatial parameters derived from the two systems were highly correlated (r, 0.79-0.95). The 95% limits of agreement for temporal parameters were typically less than ±2% of gait cycle duration. However, 95% limits of agreement for spatial measures were as much as ±5cm., Conclusions: Differences in temporospatial parameters between systems were small but statistically significant and of similar magnitude to changes reported between shod and unshod gait in healthy young adults. Temporospatial parameters derived from an instrumented treadmill, therefore, are not representative of those obtained from an instrumented walkway and should not be interpreted with reference to literature on overground walking., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Altered mechanical properties of the heel pad have been implicated in the development of plantar heel pain. However, the in vivo properties of the heel pad during gait remain largely unexplored in this cohort. The aim of the current study was to characterise the bulk compressive properties of the heel pad in individuals with and without plantar heel pain while walking., Methods: The sagittal thickness and axial compressive strain of the heel pad were estimated in vivo from dynamic lateral foot radiographs acquired from nine subjects with unilateral plantar heel pain and an equivalent number of matched controls, while walking at their preferred speed. Compressive stress was derived from simultaneously acquired plantar pressure data. Principal viscoelastic parameters of the heel pad, including peak strain, secant modulus and energy dissipation (hysteresis), were estimated from subsequent stress-strain curves., Findings: There was no significant difference in loaded and unloaded heel pad thickness, peak stress, peak strain, or secant and tangent modulus in subjects with and without heel pain. However, the fat pad of symptomatic feet had a significantly lower energy dissipation ratio (0.55+/-0.17 vs. 0.69+/-0.08) when compared to asymptomatic feet (P<.05)., Interpretation: Plantar heel pain is characterised by reduced energy dissipation ratio of the heel pad when measured in vivo and under physiologically relevant strain rates.

Background and Purpose: Although plantar fascial thickening is a sonographic criterion for the diagnosis of plantar fasciitis, the effect of local loading and structural factors on fascial morphology are unknown. The purposes of this study were to compare sonographic measures of fascial thickness and radiographic measures of arch shape and regional loading of the foot during gait in individuals with and without unilateral plantar fasciitis and to investigate potential relationships between these loading and structural factors and the morphology of the plantar fascia in individuals with and without heel pain., Subjects: The participants were 10 subjects with unilateral plantar fasciitis and 10 matched asymptomatic controls., Methods: Heel pain on weight bearing was measured by a visual analog scale. Fascial thickness and static arch angle were determined from bilateral sagittal sonograms and weight-bearing lateral foot roentgenograms. Regional plantar loading was estimated from a pressure plate., Results: On average, the plantar fascia of the symptomatic limb was thicker than the plantar fascia of the asymptomatic limb (6.1+/-1.4 mm versus 4.2+/-0.5 mm), which, in turn, was thicker than the fascia of the matched control limbs (3.4+/-0.5 mm and 3.5+/-0.6 mm). Pain was correlated with fascial thickness, arch angle, and midfoot loading in the symptomatic foot. Fascial thickness, in turn, was positively correlated with arch angle in symptomatic and asymptomatic feet and with peak regional loading of the midfoot in the symptomatic limb., Discussion and Conclusion: The findings indicate that fascial thickness and pain in plantar fasciitis are associated with the regional loading and static shape of the arch.

Background: Although a lowered medial longitudinal arch has been cited as a causal factor in plantar fasciitis, there is little experimental evidence linking arch motion to the pathogenesis of the condition. This study investigated the sagittal movement of the arch in subjects with and without plantar fasciitis during gait., Methods: Digital fluoroscopy was used to acquire dynamic lateral radiographs from 10 subjects with unilateral plantar fasciitis and 10 matched control subjects. The arch angle and the first metatarsophalangeal joint angle were digitized and their respective maxima recorded. Sagittal movement of the arch was defined as the angular change between heel strike and the maximum arch angle observed during the stance phase of gait. The thickness of the proximal plantar fascia was determined from sagittal sonograms of both feet. ANOVA models were used to identify differences between limbs with respect to each dependent variable. Relationships between arch movement and fascial thickness were investigated using correlations., Results: There was no significant difference in either the movement or maximum arch angle between limbs. However, subjects with plantar fasciitis were found to have a larger metatarsophalangeal joint angle than controls (P < 0.05). Whereas the symptomatic and asymptomatic plantar fascia were thicker than those of control feet (P < 0.05), significant correlations were noted between fascial thickness and peak arch and metatarsophalangeal joint angles (P < 0.05) in the symptomatic limb only., Conclusions: Neither abnormal shape nor movement of the arch are associated with chronic plantar fasciitis. However, arch mechanics may influence the severity of plantar fasciitis, once the condition is present. Digital flexion, in contrast, has a protective role in what might be a bilateral disease process.

Despite the implication that mechanical overload is fundamental to the development of plantar fasciitis, gait analysis has revealed inconsistent findings regarding its effect on lower limb loading. The aim of the current study was to evaluate the regional vertical ground reaction force in patients with and without plantar fasciitis. A pressure platform was used to determine the vertical ground reaction force beneath the feet of 16 patients with, and an equivalent number of patients without, unilateral plantar fasciitis while completing 10 gait trials at a self-selected walking speed. The magnitude and timing of ground reaction force for the entire foot and for the regions of the rearfoot, midfoot, forefoot, and digits were measured for each limb. The findings indicate that patients with plantar fasciitis make gait adjustments that result in reduced force beneath the rearfoot and forefoot of the symptomatic foot. In addition, increased digital loading was observed in patients with plantar fasciitis suggesting that digital function plays an important, and previously unidentified, protective role.

The heel pad (HP) which is located below the calcaneus comprises a composition of morphometrical and morphological arrangements of soft tissues that are influenced by factors such as gender, age and obesity. It is well known that HP pain and Achilles tendonitis consist of discomfort, pain and swelling symptoms that usually develop from excessive physical activities such as walking, jumping and running. The purpose of this study was to develop biomechanical techniques to evaluate the function and characteristics of the HP. Ten healthy participants (five males and five females) participated in this laboratory-based study, each performing a two-footed heel raise to mimic the toe-off phase during human locomotion. Twenty-six (3 mm) retroreflective markers were attached to the left and right heels (thirteen markers on each heel). Kinematic data was captured using three-dimensional motion analysis cameras synchronised with force plates. Descriptive and multivariate statistical tests were used in this study. In addition, a biomechanical technique that utilises only six markers from 26 markers to assess HP deformation and function has been developed and used in this study. Overall HP displacement was significantly higher in males on the most lateral part of the right heel (p < 0.05). No significant differences were evident when comparing the non-dominant and dominant heels during the baseline, unloading and loading phases (p > 0.05). Findings from this study suggested that biomechanical outputs expressed as derivatives from tracked HP marker movements can morphologically and morphometrically characterise HP soft tissue deformation changes. The outcome of this study highlights the importance of 3D motion analysis being used as a potential prospective intervention to quantify the function / characteristics of the heel pad soft tissues. [ABSTRACT FROM AUTHOR]

This study used transmission-mode ultrasound (US) to evaluate the effect of footwear, with differing heel elevation, on Achilles tendon loading and basic gait parameters. Axial transmission velocity of US was measured in the right Achilles tendon of 20 healthy adults (10 male and 10 female; age: 31 ± 9 years; height: 1.72 ± 0.04 m; weight: 67.8 ± 14.2 kg) while walking barefoot (BF) and in four prototype athletic shoes (S1–S4) on an instrumented treadmill. Shoes were constructed from identical materials and differed only in heel elevation (S1: 0.4 mm; S2: 5 mm, S3: 9.9 mm, S4: 14.8 mm), which was achieved by varying the graded thickness of the midsole beneath the rearfoot. Temporospatial gait parameters, sagittal ankle movement, and vertical ground reaction force were simultaneously recorded at rate of 120 Hz. Shod walking conditions were characterized by a significantly lower cadence, longer stance duration, greater ankle dorsiflexion, larger peak vertical ground reaction force, and higher US transmission velocity in the Achilles tendon than BF walking (P< .05). Incremental heel elevation in footwear resulted in a progressive increase in peak vertical force, a reduction in peak external loading rate, and a small but progressive reduction in US transmission velocity in the Achilles tendon (P< .05). Simple regression modelling predicted that a shoe with 58 mm of heel elevation would effectively replicate values observed during BF walking. Peak US transmission velocity, and hence tensile load, in the Achilles tendon was higher during shod than BF walking and was partially countered by increasing the heel elevation of the shoe. These findings have important clinical implications for the use of footwear in performance applications and in the prevention and rehabilitation of Achilles tendon disorders. [ABSTRACT FROM PUBLISHER]

With this research, we sought to establish the accuracy of stride velocity data collected by the s3 Stride Sensor. Participants walked along a GAITRite mat at self-selected slow, preferred, and fast velocities, with two s3 Stride Sensors attached to their right foot. The start position was systematically varied such that the GAITRite system would record the second through sixth strides at each walking velocity. Both slow and preferred walking velocities were underestimated by 14% relative to the GAITRite (p < .05), while independent of walking velocity, Strides 2 and 3 were underestimated by 26% and 9% (p < .05), respectively. Researchers should use caution when interpreting data collected at slow and preferred walking velocities and during the first three strides. [ABSTRACT FROM AUTHOR]