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?Gait kinematics are explored in femoroacetabular impingement syndrome.
?Hip and pelvic mechanics are affected primarily at heel strike.
?In addition to altered hip and pelvic mechanics, hindfoot abnormalities are observed.
?At heel strike, the hindfoot is excessively inverted.
?During stance, maximum hindfoot eversion is reduced with range of motion unchanged.
Gait analysis studies in patients with femoroacetabular impingement syndrome focused until today on alterations in pelvic and hip mechanics, but distal articulations in this syndrome were not explored. Viewing the inter-relationships between foot and hip mechanics and the importance of the subtalar joint in load attenuation at heel strike and during forward propulsion thereafter, alterations in hindfoot mechanics in this syndrome may have clinical significance.
Three-dimensional gait kinematics were explored with emphasis on hindfoot mechanics in a group of 15 men with cam-type femoroacetabular impingement and compared to 15 healthy men.
Subjects with femoroacetabular impingement had decreased pelvic internal rotation (effect size = 0.70) and hip abduction (effect size = 0.86) at heel strike, and increased sagittal pelvic range of motion during the stance (effect size = 0.81), compared to controls. At the hindfoot level, subjects with femoroacetabular impingement had inverted position at heel strike compared to neutral position in controls (effect size = 0.89), and reduced maximum hindfoot eversion during the stance (effect size = 0.72). Range of motion from heel strike to maximum eversion was not different between the groups (effect size = 0.21).
Young adult men with cam-type femoroacetabular impingement syndrome present excessively inverted hindfoot at the moment of heel strike and reduction in maximum eversion during the stance phase. Viewing the deleterious effects of hindfoot malalignment on load attenuation during the stance, custom-designed insoles may be a consideration in this population and this should be investigated further.
Re: Femoroacetabular impingement syndrome and foot function
Hip joint biomechanics during gait in people with and without symptomatic femoroacetabular impingement
Laura E. Diamond, Tim V. Wrigley, Kim L. Bennell, Rana S. Hinman, John O’Donnell, Paul W. Hodges Gait and Posture; Article in Press
•Symptomatic FAI is associated with minimal impairments in gait biomechanics.
•Individuals with symptomatic FAI demonstrate decreased sagittal plane hip ROM.
•The magnitude of the gait changes are small and of unknown clinical relevance.
•Gait assessment/training is unlikely to be beneficial in symptomatic FAI.
•More demanding functional tasks targeting impinging positions should be examined.
Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip/groin pain and impaired function in younger active adults, and may lead to stiffness, muscle weakness, structural damage, and hip osteoarthritis. Understanding the impairments associated with FAI is crucial to guide treatment and rehabilitation strategies. Evidence is limited and conflicting about whether hip biomechanics are impaired during walking in people with symptomatic FAI. The objective of this study was to determine whether kinematics and kinetics during gait differ between people with symptomatic FAI and control participants. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery and 14 age-, and sex-matched disease-free controls underwent three-dimensional gait analysis. Tri-planar hip kinematics and kinetics were compared between the two groups. There were limited significant between-group differences with respect to spatiotemporal variables. Participants with FAI walked with less range of motion in the sagittal plane during a gait cycle, but did not exhibit any significant kinematic differences in the frontal or transverse planes. There were no systematic differences in kinetics between the groups in any plane. Findings suggest that individuals with symptomatic FAI have minimal impairments in gait biomechanics. Although these individuals demonstrate reduced hip joint motion in the sagittal plane, the size of the difference is small and its significance for symptoms and function is unclear. More pronounced deficits in hip kinetics and kinematics may be evident during functional tasks that challenge the hip towards the position of impingement.
Femoral acetabular impingement (FAI) has emerged as one of the more commonly recognized intraarticular hip pathologies and is often accompanied with a labral tear. The understanding of the clinical characteristics of individuals with symptomatic FAI has evolved over the past several years due to emerging research. As research progresses, there is often a gap in translating the current evidence to clinical practice. This manuscript presents the latest evidence underpinning the clinical presentation of FAI and labral tears. Evidence is presented within the context of bridging the latest research and clinical practice.
To determine the efficacy of physical therapy on pain and physical function in patients with femoroacetabular impingement.
Randomized, participant- and assessor blinded controlled trial pilot study
This trial was registered at ClinicalTrials.gov (BLINDED) and reported according to Consolidated Standards of Reporting Trials (CONSORT) requirements. Patients were randomly assigned to receive either a combination of manual therapy and supervised exercise (MTEX), plus advice and home exercise or advice and home exercise alone (Ad + HEP) over six weeks. Primary outcomes were average pain (Visual Analog Scale) and physical function (Hip Outcome Score) at week seven.
Fifteen patients, mean age 33.7(SD 9.5,73% female) satisfied the eligibility criteria and completed week seven measurements. The between group differences for changes in pain or physical function were not significant. Both groups showed statistically significant improvements in pain: the MTEX group improved a mean of 17.6 mm and the Ad + HEP group, 18.0 mm.
The results of this pilot study provide preliminary evidence that symptomatic femoroacetabular impingement may be amenable to conservative treatment strategies however further full-scale randomized controlled trials are required to demonstrate this. In this small pilot study, supervised manual therapy and exercise did not result in greater improvement in pain or function compared to advice and home exercise in patients with symptomatic femoroacetabular impingement.
•Clinicians are encouraged to use clinical examination to identify FAI.
•A comprehensive literature search about physical examination tests for FAI was done.
•Diagnostic accuracy of FAI clinical tests is limited due to its heterogenecity.
•More methodologically sound studies on this topic are needed.
Numerous clinical tests have been proposed to diagnose FAI, but little is known about their diagnostic accuracy.
To summarize and evaluate research on the accuracy of physical examination tests for diagnosis of FAI.
A search of the PubMed, SPORTDiscus and CINAHL databases was performed. Studies were considered eligible if they compared the results of physical examination tests to those of a reference standard. Methodological quality and internal validity assessment was performed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.
The systematic search strategy revealed 298 potential articles, five of which articles met the inclusion criteria. After assessment using the QUADAS score, four of the five articles were of high quality. Clinical tests included were Impingement sign, IROP test (Internal Rotation Over Pressure), FABER test (Flexion-Abduction-External Rotation), Stinchfield/RSRL (Resisted Straight Leg Raise) test, Scour test, Maximal squat test, and the Anterior Impingement test. IROP test, impingement sign, and FABER test showed the most sensitive values to identify FAI.
The diagnostic accuracy of physical examination tests to assess FAI is limited due to its heterogenecity. There is a strong need for sound research of high methodological quality in this area.