Academic journal article Journal of Rehabilitation Research & Development

Influence of Marker Models on Ankle Kinematics in Persons with Partial Foot Amputation: An Investigation Using a Mechanical Model

Academic journal article Journal of Rehabilitation Research & Development

Influence of Marker Models on Ankle Kinematics in Persons with Partial Foot Amputation: An Investigation Using a Mechanical Model

Article excerpt

INTRODUCTION

A systematic review on the biomechanics of gait in persons with partial foot amputation (PFA) concluded that there was a high level of evidence that PFA affects the temporospatial, external force, kinematic, kinetic, and plantar pressure aspects of PFA gait, but there was less confidence in the evidence regarding exactly how these aspects of gait were affected [1]. Dillon et al. suggested that a number of methodological problems endemic in this body of literature reduced confidence in the evidence [1]. For example, with the exception of two studies [2-3], marker placement was not explicitly described [4-6], which is problematic because marker placement defines the kinematic measurements. Since most authors reported using commercially available systems to collect these data [4-6], one can only assume that they followed the standard marker placement procedures required of those systems. However, most of the studies did not describe how certain markers were placed in the presence of a prosthesis or the absence of the forefoot landmarks typically used to locate some of the markers defining the foot local coordinate system. Given these sorts of methodological issues, it is not surprising that the ankle kinematic data vary markedly between investigations. Concerns have been raised regarding the accuracy of these data, especially with respect to discrepancies between barefoot and shod/ device investigations [1].

Previous studies of barefoot walking in PFA suggest that ankle dorsiflexion range is either reduced or similar to that observed in persons without amputation. Garabolsa et al. observed significantly less dorsiflexion of the residuum during gait compared with the sound limb in a group of persons with dysvascular transmetatarsal (TMT) amputation [3]. Boyd et al. investigated groups of persons with dysvascular amputation with either toe, metatarsophalangeal (MTP), or ray amputations, but how many toes or rays were affected in these groups was unclear [5]. No significant differences existed in ankle dorsiflexion between groups of subjects with amputation and a control group of nondisabled subjects who walked more quickly. Unclear descriptions of amputation level [5] make comparison between these studies difficult and walking velocity was either not reported [3] or expressed as a proportion of a laboratory normal database [5]. Hence, accounting for the influence of walking speed between investigations was not possible. Tang et al. reported barefoot kinematics for a group of individuals with "mostly traumatic" TMT amputation as part of an experimental study comparing gait in several conditions, including barefoot, shoe only, or shoe plus prosthesis (insole with carbon fiber footplate) [4]. The dorsiflexion peak observed in the control group was similar to that seen in the PFA barefoot walking condition despite some dorsiflexion bias in the PFA group. Such bias of the kinematic data raises concerns about the modeling and changing of markers between experimental conditions. When the total ankle range from initial plantar flexion peak to dorsiflexion peak is considered, the PFA subjects walking barefoot exhibited reduced angular excursion compared with the control group [4].

In contrast to the relatively normal or reduced ankle dorsiflexion observed during barefoot ambulation in PFA, studies measuring ankle motion in shoe or shoe plus prosthesis conditions suggest that ankle dorsiflexion is increased. Tang et al. reported that for a group of individuals with TMT amputation, the shoe and shoe plus prosthesis conditions allowed significantly greater ankle dorsiflexion during stance compared with walking barefoot or a shod control group [4]. An observational study by Dillon reported a similar pattern of ankle movement in persons with Lisfranc and TMT amputation using either toe fillers, slipper sockets, or shoes stuffed with a variety of materials, but the dorsiflexion range and peak were more normal and comparable with the 95 percent confidence interval of the control group [7]. …

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