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Quasi-stiffness of intrinsic foot joints during the mid-stance of gait in a healthy population
Alexandre Naaim, Raphaël Dumas, Laurence Cheze, Jean-Luc Besse, Bernhard Devos Bevernage, Thibaut Leemrijse, Paul-André Deleu
To cite this version:
Alexandre Naaim, Raphaël Dumas, Laurence Cheze, Jean-Luc Besse, Bernhard Devos Bevernage, et al.. Quasi-stiffness of intrinsic foot joints during the mid-stance of gait in a healthy population.
SB'20, 45ème Congrès de la Société de Biomécanique, Oct 2020, Metz (virtuel), France. pp S200-S202, �10.1080/10255842.2020.1813427�. �hal-03171623�
Quasi-stiffness of intrinsic foot joints during the mid-stance of gait in a healthy population
A. Naaima, R. Dumasa, L. Chezea, J. L. Bessea,b, B. Devos Bevernagec, T. Leemrijsec and P. A. Deleuc
aIFSTTAR, LBMC UMR_T9406, Univ Lyon, Universite Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon, France;bCentre Hospitalier Lyon-Sud, Service de Chirurgie Orthopedique et Traumatologique, Hospices Civils de Lyon, Lyon, France;cFoot
& Ankle Institute, Brussels, Belgium
1. Introduction
Quasi-stiffness has been used as a parameter revealing the global mechanical behaviour of lower limb joints during locomotion and more particularly that of the ankle. This parameter has been defined as a linear relation between the intersegmental moment and the joint angle. It represents the resistance that a joint offers to a movement due to both passive and active structures spanning the joint (Latash and Zatsiorsky 1993). As the joint does not act as a real passive spring, the term ‘quasi-stiffness’ is used. In the absence of muscle activation, this parameter can evaluate the behaviour of the ligaments, tendons, muscular and fascia tissues. Recently, multi-segment kinetic foot models have received an increasing atten- tion for evaluating the intrinsic foot joints in both healthy and pathological subjects. An approach com- bining force platform and pressure plate using a dis- tribution scheme (as validated by Saraswat et al.
(2014)) together with an extensive marker set allows to compute intersegmental moments in the ankle, Chopart, Lisfranc and metatarsophalangeal joints. The foot has the ability to function as a mobile adapter to support the entire body weight across different ter- rains, and to act as a rigid lever to propel efficiently the body forward (Mcpoil and Knecht, 1985). Thus, quasi-stiffness of intrinsic foot joints could provide further insights to analyse foot function during gait.
The ankle and the metatarsophalangeal joints provide two pivotal sites for sagittal plane motion and the
subtalar, Chopart and Lisfranc joints are supposed to give flexibility and stability to adapt the foot to all surfaces and direction change. Quasi-stiffness may vary at different foot joints during foot rockers. The aim of this study was to calculate, for an asymptom- atic healthy population, the quasi-stiffness of the intrinsic foot joints during mid-stance. This phase is characterised by a single leg support with low propul- sion as it occurs before heel-off and by a presumed major contribution of the passive foot structures.
2. Methods 2.1. Subject
Twenty asymptomatic subjects were recruited (age 45 ± 12 years, BMI: 24.62 ± 2.5 kg/m2, walking speed 1.39 ± 0.15 m/s). All participants signed an informed consent approved by a local Ethics Committee (B200- 2017-061). For all subjects both feet were studied resulting in 40 feet analysed in total.
2.2. Protocol
The assessment of kinematics and kinetics was done using 8 optoelectronic cameras, a force platform to measure ground reaction forces and moments and a pressure plate to measure foot pressure all synchron- ised at 200 Hz. Thirty-two markers were positioned by the same experienced clinician using the model proposed by Deschamps et al. (2017). This model allows to measure intersegmental angles and moments for ankle (shank-calcaneus), Chopart (calcaneus-mid- foot), Lisfranc (midfoot-metatarsus) and first meta- tarso-phalangeal (MPT1) joints. Participants were asked to walk barefoot at self-selected speed along a 10 m foot path until 5 valid trials (no visual gait adjustment to target pressure plate and clear foot- contact within the plate) were recorded.
2.3. Data analysis
Data analysis was identical with that described by Deleu et al. (2020). Point trajectory and force plat- form data were filtered using a low-pass zero-lag, 4th order, Butterworth filter with a cut-off frequency of 10 Hz. The force data were distributed using a pro- portional distribution scheme (Saraswat et al. 2014).
Inertia effects of the foot were considered negligible
ß2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING 2020, VOL. 23, NO. S1, S200–S202
https://doi.org/10.1080/10255842.2020.1813427
compared to the ground reaction force. The mid- stance phase was defined from the contralateral foot- off to the ipsilateral heel-off. For each joint of inter- est, the intersegmental flexion extension moment was plotted against the flexion extension angle. The quasi- stiffness was then calculated using a linear regression on the portion corresponding to the mid-stance sampled instants of time. For each joint, a boxplot was used to show the distribution of the quasi-stiff- ness for the complete population (median value and the interquartile range (IQR) were calculated).
3. Results and discussion
Figure 1illustrates for each joint the mean flexion exten- sion moment for all subjects plotted against the mean flexion extension angle with the corresponding linear regression allowing to compute the quasi-stiffness dur- ing mid-stance.
During mid-stance, Chopart and Lisfranc joints had the highest quasi-stiffness and the ankle and the MTP1 the lowest value (Figure 2). Moreover, a higher IQR for Chopart and Lisfranc joints was found. The higher quasi-stiffness was expected as, during mid- stance, Chopart and Lisfranc joints are supposed to be locked to avoid the collapsing of the longitudinal foot arch during the loading of the foot. The mid- stance of gait occurs during the ankle rocker where the ankle joint is supposed to control the rotation of the shank above while the MTP1 joint is still playing a limited role, both resulting in a lower quasi-stiff- ness. The quasi-stiffness results seem to be in accord- ance with earlier findings describing foot biomechanics (Farris et al.2019).
To the authors’ knowledge, the main novelties of this study was to calculate the quasi-stiffness of intrinsic foot joints using proper inverse dynamics methods in addition to integrate Chopart and Lisfranc joints in the analysis. Previous studies who calculated quasi-stiffness for intrinsic foot joints used only a pressure platform, neglecting all non-vertical forces and moments (Sanchis et al. 2019), or com- puted MTP1 moments only after heel-off (Day and Hahn2019).
The higher variability found for Chopart and Lisfranc joints might be due to the lower range of motion of these two joints. Errors in the kinematics and kinetics may also arise due to the soft tissue artefact. It was chosen to focus in this study on mid-stance where the stability of the foot is not only provided by passive structures but also by isometric contraction of the plan- tar intrinsic muscles. Still, during mid-stance, it can be supposed that passive structures are responsible for a large portion of the quasi-stiffness, especially in Chopart and Lisfranc joints, as reported using foot musculo-skel- etal models (Kim et al.2018).
4. Conclusions
During this study, the quasi-stiffness of the intrinsic foot joints has been quantified in asymptomatic sub- jects and the different roles played by the joints dur- ing mid-stance illustrated. As expected, Chopart and Lisfranc joints showed higher quasi-stiffness than ankle and MTP1 in agreement with the described foot biomechanics. Further research is required to analyze in a systematic and automatic manner the other sub- phases of the gait cycle for diagnosis and follow-up of pathological subjects.
Figure 1. Mean intersegmental moment vs. mean joint angle during stance phase from all trials and subjects.
Figure 2. Boxplot of the quasi-stiffness of intrinsic foot joints for the complete population.
COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING S201
Acknowledgements
We would like to thank Vincent Ballesio for his tech- nical support.
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KEYWORDSInverse dynamics; intersegmental moment; quasi-stiffness;
multi-segment foot model; walking
alexandre.naaim@univ-lyon1.fr
S202 ABSTRACT
