Introduction: Involvement of the forefoot is common among patients with Rheumatoid Arthritis. It results in severe deformities with significant disabilities. Aim: The aim of this study was to compare and assess in patients with Rheumatoid Arthritis in a South African population the outcomes of severe forefoot deformity reconstruction surgery in the short- to medium-term and in particular focusing on radiological, clinical, and functional outcomes. Patients and Methods: A retrospective review of 19 patients who received reconstructive forefoot surgery for forefoot deformities resulting from Rheumatoid Arthritis was undertaken. They all underwent Modified Hoffman Surgical Reconstruction (first MTPJ fusion and lesser toe resection arthroplasty). The patient records between 2013 and 2016 were reviewed. Pre-operative and post-operative outcome scores were collected. Final postoperative radiographs were analyzed. Patients completed Short Form 36 and AOFAS forefoot scores. Post-operative scores were collected 6 months post-op. Results: There were 19 patients in the study with a minimum 6 months follow up. Of the 19 patients 17 (89.5%) were females and 2 (10.5%) males. The mean age was 54.9 ± 9.6 years (range: 34 – 69 years). Most patient outcomes (SF36, AOS alignment, VAS Pain percentage, and VAS Disability percentage) significantly improved with a p value < 0.05, when comparing the pre-operative versus post-operative variable scores. However, only AOS Alignments showed no significant difference between pre-operative and post-operative scores (p>0.05). Conclusion: Reconstructive forefoot surgery with the Modified Hoffman Surgical Reconstruction provides marked radiological correction, with significant improvements in the quality of life of the cohort of patients.

OBJECTIVES:: Evaluate effects of a new off-the-shelf insert on frontal plane foot biomechanics and compare effectiveness of the new and an existing off-the-shelf insert and a motion-control shoe in neutralizing frontal plane foot biomechanics. Design: Descriptive. Setting: Biomechanics laboratory. Participants: Fifteen uninjured subjects with a flexible flatfoot secondary to forefoot varus. Assessment of risk factors: Three-dimensional kinematic and kinetic data were collected as subjects walked and jogged at their self-selected speed while wearing a motion-control running shoe, the shoe with a new off-the-shelf insert, and the shoe with an existing off-the-shelf insert. Main outcome measures: Frontal plane kinematics and rearfoot kinetics were evaluated during stance. Statistical analysis was performed using a repeated measures analysis of variance and Student-Newman-Keuls post hoc tests (α ≤ 0.05). Results: The new insert and motion-control shoe placed the forefoot in a less-everted position than the existing off-the-shelf insert during walking. There were no differences in forefoot kinematics during jogging, nor were there differences in rearfoot motion during walking or jogging. The rearfoot eversion moment was significantly lower with the new off-the-shelf insert compared with the motion-control shoe and the existing insert during walking and jogging. Conclusions: A new off-the-shelf device is available that promotes more neutral frontal plane biomechanics, thus providing a theoretical rationale for using this device for injury prevention and treatment. The comparative biomechanical effectiveness of a motion-control shoe and the orthotic inserts may assist health care professionals in selecting a device to correct the flatfoot structure.

No / The purpose of this article is determining if and how the kinematic relationship between adjacent body segments changes when an individual’s gait pattern is experimentally manipulated can yield insight into the robustness of the kinematic coupling across the associated joint(s). The aim of this study was to assess the effects on the kinematic coupling between the forefoot, rearfoot and shank during ground contact of running with alteration in foot strike pattern. Twelve subjects ran over-ground using three different foot strike patterns (heel strike, forefoot strike, toe running). Kinematic data were collected of the forefoot, rearfoot and shank, which were modelled as rigid segments. Coupling at the ankle-complex and midfoot joints was assessed using cross-correlation and vector coding techniques. In general good coupling was found between rearfoot frontal plane motion and transverse plane shank rotation regardless of foot strike pattern. Forefoot motion was also strongly coupled with rearfoot frontal plane motion. Subtle differences were noted in the amount of rearfoot eversion transferred into shank internal rotation in the first 10–15% of stance during heel strike running compared to forefoot and toe running, and this was accompanied by small alterations in forefoot kinematics. These findings indicate that during ground contact in running there is strong coupling between the rearfoot and shank via the action of the joints in the ankle-complex. In addition, there was good coupling of both sagittal and transverse plane forefoot with rearfoot frontal plane motion via the action of the midfoot joints.

No / Background - Although there is a wealth of research into the kinematic coupling between the foot and shank, it remains unclear whether the relationship is stable across speed and mode of gait. The aim of this study was to determine whether the coupling relationship between the forefoot, rearfoot and shank differed between walking and running, and across different running speeds. Methods Twelve subjects walked/ran barefoot over-ground at one walking and three running speeds. The shank, rearfoot and forefoot were modelled as rigid segments and three-dimensional joint kinematics were determined using a seven camera ProReflex system. Coupling between the forefoot, rearfoot and shank was assessed using cross-correlation and vector coding techniques. Findings Cross-correlation of rearfoot eversion/inversion with shank internal/external rotation was lower in walking (r=0.49) compared to running (r>0.95). This was also the case between rearfoot frontal plane and forefoot sagittal plane motion (walking, r=¿0.80; running, r=¿0.96). Rearfoot frontal plane and forefoot transverse plane cross-correlation was high in both running and walking (r>0.90), but there was little evidence of any coupling between rearfoot frontal plane and forefoot frontal plane motion in any condition. No differences in cross-correlations were found between the three running speeds. Interpretation Kinematic coupling between the forefoot, rearfoot and shank was weak during walking relative to running. In particular, the low cross-correlation between rearfoot eversion/inversion and shank internal/external rotation during walking implies the two motions are not rigidly linked, as has been assumed in previous injury models.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

There has been much debate on the benefits of a forefoot versus rearfoot strike pattern in distance running in terms of performance and injury prevalence. Shock attenuation occurs more prominently in soft tissues at impact in forefoot runners compared to the passive skeletal loading in rearfoot runners. Recent studies indicate that a forefoot strike pattern may not be maintainable over long distance efforts. Therefore, this study tested the hypothesis that habitual forefoot runners could not maintain their strike pattern throughout a prolonged, intensive run. Fourteen forefoot runners ran to voluntary exhaustion on an instrumented force treadmill (average run duration: 15.4±2.2 minutes). Kinematic and kinetic data were sampled each minute at 200Hz and 1000Hz, respectively. Ankle plantar-flexor torque was measured during pre- and post-run isometric contractions, during which electromyographic activity was measured in the soleus, lateral, and medial gastrocnemius. Loading rate (49.95±14.83 to 57.40±22.53 BW*s-1, p=0.0311) and impact peak (1.35±0.43 to 1.50±0.51, p=0.0207) increased significantly throughout the run. Both peak knee flexion (-33.93±3.67º to -36.21±3.48º, p=<0.0000) and sagittal ankle angle at touchdown (-11.83±5.33º to -9.33±6.29º, p =0.0202) increased significantly. Ankle torque decreased significantly from pre- to post-run (120.57±33.57 to 110.76±32.91 Nm, p = 0.0154). This was accompanied by a decrease in medial and lateral gastrocnemius integrated electromyographic activity (iEMG) (p=0.0387 and 0.0186, respectively). The results indicated that there were significant changes in landing mechanics in the habitual forefoot runners with increased levels of exertion, as they shifted towards strike patterns more similar to rearfoot runners throughout the run. These changes are in line with metabolic findings of other studies. There is increased eccentric loading of the ankle plantar-flexor muscles at touchdown in forefoot runners that may contribute to a decreased torque output by the end of the run. The decline in iEMG may indicate altered central drive of the system and a decline in the impact attenuation ability of the triceps surae, leading to the changes exhibited up the kinematic chain. These findings suggest that while forefoot strike patterns are good for speed, the onset of fatigue may affect the ability to maintain this pattern during a prolonged, intensive effort.

Introduktion: Fotisättningstyper (FST) vid löpning är associerat med prestation och löprelaterade skador. Tidigare studier har undersökt prevalensen av olika FST hos amerikanska och asiatiska löpare, men däremot inte hos svenska löpare. Syfte: Att undersöka och jämföra prevalensen av olika FST (RFS = hälisättning; MFS = mittfotisättning; FFS = framfotaisättning) hos svenska löpare mellan olika löptävlingar, distanser och med avseende på prestation. Metod: Fotisättningar spelades in i 100 bilder per sekund (fps), vid tre olika platser för både Stockholm maraton (1.2, 25, 42 km) och Göteborgs halv-maraton (7.5, 15, 20 km), baserat på 2071 personer per mätpunkt. FST bedömdes genom en frame-by-frame analys. Resultat: 12’426 observationer av fotisättningar analyserades. Den totala prevalensen av FST var 92.3% (n=11’465), 4.5% (n=559), och 3.2% (n=402), för RFS, MFS, respektive FFS, och skiljde sig mellan maraton och halv-maraton (p &lt; .001, φc = 0.069), där det förekom högre andel RFS i det sistnämnda. FST var associerat med distans, där MFS och FFS var mer vanligt förekommande på kortare distanser jämfört med RFS (p &lt; .001, df = 2; H = 71.524). Stratifierade analyser baserade på löptävling visade att associationen mellan FST och distans inom respektive lopp försvann för halv-maratontävlingen, men kvarstod för maratontävlingen. Slutligen så var FST associerat med prestation (p &lt; .001, df = 2, H = 65.419) och denna kvarstod för både halv-maraton (p &lt; .001) och maratontävlingen (p &lt; .001) efter stratifierade analyser baserat på löptävling. Konklusion: Resultaten överenstämmer med tidigare studier på området av andra grupper löpare, och stödjer tidigare fynd att RFS är den vanligaste förekommande FST, och att FST är associerat med distans och prestation, vid hel- och halvmaraton. / Foot strike type (FST) is associated with performance and running-related injuries. Previous studies have examined the prevalence proportion of FST among predominantly American and Asian cohorts. However, no study has investigated this among a predominantly Swedish cohort. Aim: To examine and compare the prevalence proportions of FST between running races, distance and performance, among a predominantly Swedish cohort of runners. Method: FST was recorded in 100 frames per second (fps), at three different points of measure for both the Stockholm Marathon (1.2, 25, 42 km) and the Gothenburg Half-Marathon (7.5, 15, 20 km), based on 2071 individuals per point of measure. FST was assessed using frame-by-frame analysis. Results: 12’426 observations of FST were analyzed. The overall prevalence proportions of FST was 92.3% (n=11’465), 4.5% (n=559), and 3.2% (n=402), for RFS, MFS, and FFS respectively, and differed between the half-marathon and marathon (p &lt; .001, φc = 0.069), with the latter having higher proportion of RFS. FST was associated with distance, with MFS and FFS being more common at shorter distances compared with RFS (p &lt; .001, df = 2; H = 71.524). Stratifying the data by race type revealed that the association between FST and distance within the races disappeared within the half-marathon race, but remained for the marathon. Lastly, FST was associated with performance (p &lt; .001), and this association remained for both the half-marathon (p &lt; .001) and marathon (p &lt; .001) after stratifying by race type. Conclusion: The results are consistent with previous studies on other populations, and add to the body of literature showing that RFS is the most common FST, and that FST is associated with distance and performance, for full- and half-marathon races.

No / Motion at the midfoot joints can contribute significantly to overall foot motion during gait. However, there is little information regarding the kinematic coupling relationship at the midfoot. The purpose of the present study was to determine whether the coupling relationship at the midfoot and subtalar joints was affected when step width was manipulated during running. Twelve subjects ran over-ground at self-selected speeds using three different step widths (normal, wide, cross-over). Coupling at the midfoot (forefoot relative to rearfoot) and subtalar (rearfoot relative to shank) joints was assessed using cross-correlation techniques. Rearfoot kinematics were significantly different from normal running in cross-over running (P < 0.05) but not in wide running. However, coupling between rearfoot eversion/inversion and shank rotation was consistently high (r > 0.917), regardless of step width. This was also the case for coupling between rearfoot frontal plane motion and forefoot sagittal plane (r < 0.852) and forefoot transverse plane (r > 0.946) motion. There was little evidence of coupling between rearfoot frontal plane motion and forefoot frontal plane motion in any of the conditions. Forefoot frontal plane motion appeared to have little effect on rearfoot frontal plane motion and thus, had no effect on motion at the subtalar joint. The strong coupling of forefoot sagittal and transverse plane motions with rearfoot frontal plane motion suggests that forefoot motion exerts an important influence on subtalar joint kinematics.

This thesis focuses on the evaluation of a conservative approach to the hallux valgus deformity. 21 people took part in the empirical study in which the changes were tracked. I worked with a group of women who exercised regularly and a control group. The regularly exercising group participated in a 3-month therapeutic program led by a physiotherapist. Each of the participants was properly examined at the beginning of the program and after three months, when the program finished. Each examination consisted of a kinesiologic analysis, a plantography footprint, a foot X-ray, a pain evaluation (the numeric scale was used) and filling out a scoring scale questionnaire of American Orthopaedic Foot and Ankle Society (AOFAS). The changes of pain of the MTP or IP toe joint, the development of foot arch, changes of the toe valgus angle according to the X-rays and the overall score achieved in the AOFAS questionnaire were statistically evaluated. The ability to isolate toe abduction, right posture of the foot, stability of the axial joints and other changes were followed as well. After comparing the results the conclusion of the study is that the three-months physiotherapist-led program weaken the pain of MTP/IP toe joint, rise the score achieved in the AOFAS questionnaire, improve the foot posture and the overall...

Title: Quantification of plantar pressure distribution and geometry of forefoot according to the character of shoes Objectives: The main purpose of this thesis is to describe and verify the changes in the sole of the foot according to the style of shoe which are manifested by changes in the values of the maximum pressure, contact area, contact time and changes in pressure time integral. The next object is to verify the changes in forefoot geometry according to the style of shoes. Methodology: The sample consisted of 6 healthy women of average age 25 ± 1 year. All study participants reported wearing high-heeled shoes occasionally which means not more than twice per week. The measurement was realized with the Pedar-X in-shoe pressure measurement system (Novel) and motion capture system Qualisys. Results were analysed statistically using Wilcoxon test. Statistical significance was set at p < 0,05. Results: From the received data we could find out the changes that footwear causes in healthy people. The findings of this study indicate that the use of different style of shoes affect all measured parameters such as maximum pressure, contact area, contact time and pressure time integral.From the experiment evaluation, it is clear that the style of shoes may also affect the geometry of forefoot. Keywords:...