Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Peripheral arterial disease affects ground reaction forces during walking.
Scott-Pandorf MM, Stergiou N, Johanning JM, Robinson L, Lynch TG, Pipinos II. J Vasc Surg. 2007 Sep;46(3):491-9.
Quote:
OBJECTIVE: Claudication is the most common manifestation of peripheral arterial disease (PAD), producing significant ambulatory compromise. The gait of claudicating patients has been evaluated using primarily temporal and spatial parameters. With the present study, we used advanced biomechanical measures to further delineate the ambulatory impairment of claudicating patients. We hypothesized that the claudicating legs of PAD patients have an altered kinetic gait pattern compared with normal legs from control subjects.
METHODS: Ambulation kinetics (ground reaction forces) were evaluated in claudicating patients and compared with age-matched healthy controls. Forces were analyzed in the vertical, anterior-posterior, and medial-lateral directions. Time from heel touch-down to toe-off (stance time) and time spent in double-limb support were also evaluated.
RESULTS: The study recruited 14 PAD patients (age, 58 +/- 3.4 years; weight, 80.99 +/- 15.64 kg) with femoropopliteal occlusive disease (ankle-brachial index [ABI], 0.56 +/- 0.03) and five controls (age, 53 +/- 3.4 years; weight, 87.38 +/- 12.75 kg; ABI, >/=1.00). Vertical force curve evaluation demonstrated significant flattening in claudicating patients resulting in a lower and less fluctuant center of mass when ambulating. In the anterior-posterior direction, claudicating patients demonstrated significantly decreased propulsion forces. In the medial-lateral direction, they had significantly increased forces consistent with wider steps and an inability to swing their legs straight through. Claudicating patients demonstrated a greater stance time and time in double limb support compared with healthy controls. Most importantly, gait abnormalities were present before the onset of claudication, with gait worsening after the onset of claudication.
CONCLUSION: Claudicating patients demonstrate significant gait impairments that are present even before they experience any limb discomfort. These alterations may make them feel more stable and secure while attempting to minimize use of the affected limb. Advanced biomechanical analysis, using ambulation kinetics, permits objective and quantitative evaluation of the gaits of claudicating patients. Such evaluation may point to new rehabilitation strategies and provide objective measurement of functional outcomes after medical and surgical therapy.
Intralimb coordination variability in peripheral arterial disease
Robert G. Crowther, Warwick L. Spinks, Anthony S. Leicht, Frank Quigley, Jonathan Golledge Clinical Biomechanics (Articles in Press)
Quote:
Background
Increased variability has been traditionally associated with decreased movement performance due to disease and aging. However, recent research indicates that variability may be of functional importance in motor control. Thus the purpose of this study was to determine whether individuals with peripheral arterial disease and suffering from intermittent claudication have reduced intralimb joint coordination variability compared to individuals without peripheral arterial disease. A further aim was to examine the efficacy of various techniques used to describe intralimb joint coordination variability.
Methods
Participants with peripheral arterial disease and suffering from intermittent claudication (n=28) were selected based on an appropriate history of peripheral arterial disease and intermittent claudication, ankle brachial pressure index <0.9 in at least 1 leg and a positive Edinburgh claudication questionnaire response. A further group of participants (n=25) free of peripheral arterial disease (ankle brachial pressure index >0.9) and who were non-regular exercisers were recruited from the community to act as age and mass matched controls. All participants underwent 2D angular kinematics analysis during normal walking. Intralimb coordination variability was measured using parameterization, vector coding and normalized root mean square techniques applied to relative motion plots of various joint couplings. Differences between groups were examined by one-way ANOVA.
Findings
Participants with peripheral arterial disease and suffering from intermittent claudication displayed significantly greater intralimb joint coordination variability than age and mass matched controls participants for all joint couplings using all intralimb joint coordination variability techniques.
Interpretation
These findings suggest that higher levels of intralimb joint coordination variability of the lower limbs in participants with peripheral arterial disease and suffering from intermittent claudication may be an adaptation of the motor control system to deal with perturbations associated with the gradual onset of claudication pain.
Lower limb movement variability in patients with peripheral arterial disease
Robert G. Crowther, Warwick L. Spinks, Anthony S. Leicht, Frank Quigley, Jonathan Golledge Clinical Biomechanics (in press)
Quote:
Background
Peripheral arterial disease is a chronic obstructive disease of the arteries of the lower limb caused by atherosclerosis. The resultant decrease in blood flow can result in symptoms of pain in the lower limb on exercise known as intermittent claudication. Exercise induced pain is experienced in the calves, thigh or buttocks restricting activities of daily living and thus reducing quality of life.
Methods
This study investigated lower limb movement variability in individuals with peripheral arterial disease-intermittent claudication (n=28) compared to individuals without peripheral arterial disease-intermittent claudication (control, n=25). A further aim was to examine the efficacy of various techniques used to describe single joint movement variability. All participants underwent two-dimensional angular kinematics analysis of the lower limb during normal walking. Single joint movement variability was measured using linear (spanning set and coefficient of variation) techniques. Between group differences were examined by one-way ANOVA.
Findings
The peripheral arterial disease-intermittent claudication participants displayed significantly higher levels of lower limb movement variability in all joints when assessed using the coefficient of variation technique. There were no significant between group differences using the spanning set technique.
Interpretation
Individuals with peripheral arterial disease-intermittent claudication have higher levels of lower limb movement variability and reduced walking speed compared to healthy age and mass matched controls. This variability may be an adaptation to the gradual onset of ischaemic pain in this population.
Bilateral claudication results in alterations in the gait biomechanics at the hip and ankle joints
Shing-Jye Chen, Iraklis Pipinos, Jason Johanning, Matija Radovic, Jessie M. Huisinga, Sara A. Myers, Nick Stergioua Journal of Biomechanics (in press)
Quote:
Claudication is the most common symptomatic manifestation of peripheral arterial disease (PAD), producing significant ambulatory compromise. The purpose of this study was to use advanced biomechanical gait analysis to determine the gait alterations occurring in claudicating patients both before and after onset of claudication pain in their legs. Hip, knee, and ankle joint moments were measured in claudicating patients (age: 64.46±8.47 years; body mass: 80.70±12.64kg; body height: 1.72±0.08m) and were compared to gender–age–body mass–height-matched healthy controls (age 66.27±9.22 years; body mass: 77.89±10.65kg; body height: 1.74±0.08m). The claudicating patients were evaluated both before (pain-free (PF) condition) and after (pain condition) onset of claudication pain in their legs. Thirteen symptomatic PAD patients (26 claudicating limbs) with bilateral intermittent claudication (IC) and 11 healthy controls (22 control limbs) were tested during level walking at their self-selected speed. Compared to controls, PAD hip and ankle joints demonstrated significant angular kinematics and net internal moment changes. Alterations were present both in PF and pain conditions with several of them becoming worse in the pain condition. Both PF and pain conditions resulted in significantly reduced peak hip extensor moment (5.62±1.40 and 5.63±1.33% BW×BH, respectively) during early stance as compared to controls (7.53±1.16% BW×BH). In the pain condition, PAD patients had a significantly reduced ankle plantar flexor moment (7.56±1.41% BW×BH) during late stance as compared to controls (8.65±1.27% BW×BH). Furthermore, when comparing PF to pain conditions, there was a decreased peak plantar flexor moment (PF condition: 8.23±1.37 vs. pain condition: 7.56±1.41% BW×BH) during late stance. The findings point to a weakness in the posterior compartment muscles of the hip and calf as being the key factor underlying the PAD gait adaptations.
Our findings establish a detailed baseline description of the changes present in PAD patient's joint angles and moments during walking. Since IC is primarily a gait disability, better understanding of the abnormalities in joint and muscle function will enhance our understanding of the gait impairment and may lead to novel, gait-specific treatments.
Peripheral arterial disease affects kinematics during walking.
Celis R, Pipinos II, Scott-Pandorf MM, Myers SA, Stergiou N, Johanning JM. J Vasc Surg. 2009 Jan;49(1):127-32
Quote:
OBJECTIVE: Claudication is the most common manifestation of peripheral arterial disease (PAD) producing significant ambulatory compromise. The purpose of this study was to use advanced biomechanical analysis to characterize the kinematic ambulatory pattern of claudicating patients. We hypothesized that compared with control subjects, claudicating patients have altered kinematic gait patterns that can be fully characterized utilizing advanced biomechanical analysis.
METHODS: The study examined fourteen PAD patients (age: 58 +/- 3.4 years; weight: 80.99 +/- 15.64 kg) with clinically diagnosed femoro-popliteal occlusive disease (Ankle Brachial Index (ABI): 0.56 +/- 0.03, range 0.45 to 0.65) and five healthy controls (age: 53 +/- 3.4 years; weight: 87.38 +/- 12.75 kg; ABI >or= 1). Kinematic parameters (hip, knee, and ankle joint angles in the sagittal plane) were evaluated during gait in patients before and after the onset of claudication pain and compared with healthy controls. Joint angles were calculated during stance time. Dependent variables were assessed (maximum and minimum flexion and extension angles and ranges of motion) and mean ensemble curves were generated. Time to occurrence of the discrete variables was also identified.
RESULTS: Significantly greater ankle plantar flexion in early stance and ankle range of motion during stance was observed in PAD patients (P < .05). Time to maximum ankle plantar flexion was shorter and time to maximum ankle dorsiflexion was longer in PAD patients (P < .05). These differences were noted when comparing PAD patients prior to and after the onset of claudication with healthy controls. The analysis of the kinematic parameters of the knee and the hip joints revealed no significant differences between PAD patients and controls.
CONCLUSION: PAD patients with claudication demonstrate significant gait alterations in the ankle joint that are present prior to the onset of claudication pain. In contrast, the joint motion of the hip and knee did not differ in PAD patients when compared with controls. Further research is needed to verify our findings and assess the impact of more proximal disease in PAD patients as well as the effect of revascularization on joint kinematics.
PVD and lower limb biomechanics
Linear Mode
