Objective. Ankle-foot problems have a considerable impact on daily functioning in patients with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder (hEDS/HSD). Therefore, the objective of this study was to identify alterations in multisegment ankle and foot kinematics during gait and to assess foot function and pain in these patients.Methods. Twenty-three women with hEDS/HSD and 23 healthy controls participated in this 3-dimensional gait analysis. Multisegment ankle and foot kinematics were collected using the Ghent Foot Model and analyzed with Statistical Parametric Mapping. Foot function and pain were assessed using visual analog scale scores, the Margolis Pain Diagram, and the Foot Function Index.Results. Levels of pain and foot dysfunction were significantly higher in subjects with hEDS/HSD (P < 0.001). Kinematic curve analyses provide evidence for a hypermobile first ray, represented by a significantly increased eversion position of the medial forefoot during stance phase (P < 0.001) in subjects with hEDS/HSD compared to controls. In addition, significantly more dorsiflexion was found in the medial and lateral forefoot and the rearfoot (P < 0.001). At the midfoot, an increased plantar flexion (P < 0.001) and at the level of the hallux a decreased dorsiflexion (P = 0.037) and increased inversion (P < 0.001) and abduction (P = 0.016) were found in subjects with hEDS/HSD.Conclusion. This study is the first to apply a multisegment foot model during gait in hEDS/HSD, which confirms the characteristic hypermobility throughout the foot, especially the hypermobile first ray.
Fatigue has often been considered a risk factor for developing sports injuries, modulating lower extremity jump-landing biomechanics. The impact of fatigue on proximal trunk and pelvic biomechanics has been suggested to play an important role in lower extremity loading and injury risk, yet the available evidence remains ambiguous as the trunk and pelvis were often not the primary focus of research. Therefore, the purpose of this systematic review was to determine how fatigue affects trunk and pelvic three-dimensional jump-landing biomechanics. PubMed (MEDLINE), Web of Science, Embase, CINAHL and SPORTDiscus were consulted up to and including April 2022 for potential studies investigating the effect of fatigue on trunk and pelvic kinematics, kinetics and/or muscular activity during jump-landing tasks in healthy, physically active populations. Methodological quality of the studies was assessed by the modified Downs and Black checklist. Twenty-one studies were included and methodological quality was moderate to high among these studies. The results indicate prevailing evidence for more trunk flexion during standardized jump-landing tasks after lower extremity muscle fatigue. Otherwise, lumbo-pelvic-hip muscle fatigue does not seem to elicit major detrimental changes to these jump-landing biomechanics. Although a wide variability of trunk and pelvic jump-landing strategies was observed, the results provide evidence for increased trunk flexion after lower extremity muscle fatigue. This proximal strategy is suggested to help unload fatigued lower extremity structures and lack of this compensation might increase knee injury risk.
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