Change in intersegmental foot and ankle motion after a high tibial osteotomy in genu varum patients

Kyung, Min Gyu; Cho, Yun Jae; Hwang, Sunghyun; Lee, Dong‐Oh; Lee, Myung Chul; Lee, Dong Yeon

doi:10.1002/jor.24834

Cited by 11 publications

(19 citation statements)

References 23 publications

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“…This foot model consisted of the hindfoot, forefoot, first ray, fifth ray, and hallux. The relationship between segments was calculated in the sagittal, coronal, and axial planes from a ZXY Euler decomposition of the relative orientation of the anatomical coordinate systems, as previously described [ 23 , 24 ]. The general orientation of the coordinate system is as follows: the X-axis, the vertical axis pointing down toward the plantar surface of the foot; the Y-axis, the anterior-posterior axis pointing forward; and the Z-axis, the medial-lateral axis pointing to the segment’s right [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…To compare the position of the foot and ankle segments between groups or states, the ISAs (position) in the middle of eight phases of gait (initial contact (IC) [0–2%], load response (LR) [6–8%], mid-stance (MS) [21–23%], terminal stance (TS) [40–42%], pre-swing (PSw) [55–57%], initial swing (ISw) [67–69%], mid-swing (MSw) [80–82%], and terminal-swing (TSw) [93–95%]) were measured, and the change in intersegmental angle (motion) between phases was calculated as previously described [ 24 , 27 , 28 ].…”

Section: Methodsmentioning

confidence: 99%

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The effect of backpack load on intersegmental motions of the foot and plantar pressure in individuals with mild flatfoot

Kyung

Bak

Lim

et al. 2022

Journal of Foot and Ankle Research

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Background The feet play an essential role in shock absorption, and foot posture is closely related to gait. The compensatory mechanism under heavy-load conditions in individuals with mild flatfoot is poorly understood. In the authors’ country, individuals with mild flatfoot are drafted as active-duty soldiers and participate in military rucking wearing heavy backpacks. This study investigated the effect of backpack load on gait and foot plantar pressure and possible differences in participants with mild flatfoot. The average weight of the backpack during military rucking (approximately 20 kg), was simulated in this study. Methods This study prospectively enrolled 30 healthy young males, divided into a control group (CON, n = 15) and a mild low-arched group (MLA, n = 15), based on the presence of flatfoot. Segmental foot kinematics were evaluated using a three-dimensional multi-segment foot model, and gait data of the temporal and spatial parameters were obtained. The dynamic plantar pressure was simultaneously measured using a pedobarography platform with gait trials. The protocol was repeated with all participants wearing 20 kg backpacks. Comparisons between the baseline and loaded states, as well as comparison between groups, were conducted. Results Although the cadence, gait speed, and stride length decreased in the loaded condition, step time and proportion of the stance phase increased in both groups. Although the MLA group showed more supinated and abducted positions of the forefoot and more pronated positions of the hindfoot than the CON group, the change in intersegmental foot and ankle motion in each group after backpack loading was minimal. However, the former showed a larger step width and a greater increase in contact area in the midfoot region, while the latter demonstrated a greater increase in peak pressure. Conclusions Individuals with mild flatfoot demonstrated significantly different gait curve patterns (waveforms) compared to the controls. In the loaded condition, the CON and MLA groups may have adopted different strategies to maintain balance during gait. We suggest that although individuals with asymptomatic mild flatfoot are drafted as active-duty soldiers, they should be thoroughly investigated under loaded conditions, and orthoses may be helpful.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The effect of backpack load on intersegmental motions of the foot and plantar pressure in individuals with mild flatfoot

Kyung

Bak

Lim

et al. 2022

Journal of Foot and Ankle Research

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“…This work was based on the idea that a change of the weight-bearing line at the knee could alter the coronal orientation of the ankle. Given that a long leg standing X-ray is performed with the knees pointing forward, it can be deduced that the X-ray represents a natural illustration of a standing position of the lower extremity [17][18][19][20]. Therefore, one must understand that for an even foot sole contact with the ground after valgisation or varisation osteotomy around the knee, the joints distal to the talus (mainly the subtalar joint) have to adapt by inversion or eversion.…”

Section: Discussionmentioning

confidence: 99%

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Konrads

Eis

Ahmad

et al. 2021

Eur J Orthop Surg Traumatol

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Introduction Despite the fact that osteotomies around the knee represent well-established treatment options for the redistribution of loads and forces within and around the knee joint, unforeseen effects of these osteotomies on the ankle are still to be better understood. It was therefore the aim of this study to determine the influence of osteotomies around the knee on the coronal alignment of the ankle. We hypothesize that osteotomies around the knee for correction of genu varum or valgum lead to a change of the ankle orientation in the frontal plane by valgisation or varisation. Materials and methods Long-leg standing radiographs of 154 consecutive patients undergoing valgisation or varisation osteotomy around the knee in 2017 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy site. The hip knee ankle angle (HKA), the mechanical lateral distal femur angle (mLDFA), the mechanical medial proximal tibia angle (mMPTA) and five angles around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann–Whitney test. Results One hundred fifty-four patients (96 males, 58 females) underwent osteotomies around the knee for coronal realignment. The mean age was 51 ± 11 years. Correction osteotomies consisted of 73 HTO, 54 DFOs, and 27 double level osteotomies. Of all osteotomies, 118 were for valgisation and 36 for varisation. For valgisation osteotomies, the mean HKA changed from 5.8° ± 2.9° preoperatively to − 0.9° ± 2.5° postoperatively, whereas the mMPTA changed from 85.9° ± 2.7° to 90.7° ± 3.1° and the malleolar-horizontal-orientation-angle (MHA) changed from 16.4° ± 4.2° to 10.9° ± 4.2°. For varisation osteotomies, the mean HKA changed from − 4.3° ± 3.7° to 1.1° ± 2.2° postoperatively, whereas the mLDFA changed from 85.7° ± 2.2° to 89.3° ± 2.3° and the MHA changed from 8.8° ± 5.1° to 11.2° ± 3.2°. Conclusion Osteotomies around the knee for correction of coronal limb alignment not only lead to lateralization or medialization of the weight-bearing line at the knee but also lead to a coronal reorientation of the ankle. This can be measured at the ankle using the MHA. When planning an osteotomy around the knee for correction of genu varum or valgum, the ankle should also be appreciated—especially in patients with preexisting deformities, ligament instabilities, or joint degeneration around the ankle.

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“…We used the DuPont foot model for the evaluation of intersegmental foot and ankle motion. 13 14 15) We conducted the experimental procedures with the same method as our former studies, including the placement of skin markers, definition of coordinate systems, and method of calculating joint rotation. 14 16 17) …”

Section: Methodsmentioning

confidence: 99%

“… 17) The foot model was defined as consisting of the hindfoot, forefoot, first ray, fifth ray, and hallux. 17) As described previously, 14 18) a ZXY Euler decomposition of the relative orientation of the anatomical coordinate systems was utilized to calculate the relationships between segments in the sagittal, coronal, and axial planes.…”

Section: Methodsmentioning

confidence: 99%

Foot and Ankle Motion after Tibiotalocalcaneal Arthrodesis: Comparison with Tibiotalar Arthrodesis Using a Multi-Segment Foot Model

et al. 2022

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Background Tibiotalocalcaneal arthrodesis is an established surgical procedure for treating patients with end-stage ankle joint arthritis and subtalar joint arthritis. Although it greatly relives pain, a major drawback is loss of range of motion. Although it is known to restrict an additional subtalar joint compared to tibiotalar arthrodesis, there is a lack of gait analysis studies comparing the two methods. This study aimed to evaluate the differences in kinematics of the foot and ankle joints between tibiotalar and tibiotalocalcaneal arthrodesis. We also compared preoperative and postoperative statuses for each surgical method. Methods The study included 12 and 9 patients who underwent tibiotalar and tibiotalocalcaneal arthrodesis, respectively, and 40 healthy participants were included in the control group. The DuPont foot model was used to analyze intersegmental foot and ankle kinematics during gait. Results Compared to controls, both tibiotalar and tibiotalocalcaneal arthrodesis resulted in slow gait speed with reduced stride length, increased step width, and decreased range of sagittal plane motion. Both fusion methods showed similar range of motion in all segments and planes following surgery. Coronal positions showed more supination of the forefoot and pronation of the hindfoot segment after each operation, particularly tibiotalocalcaneal arthrodesis. Gait after tibiotalocalcaneal arthrodesis did not significantly differ from that after tibiotalar arthrodesis, but there was a tendency of more pronation in the hindfoot segment. Conclusions Both fusion methods limited foot and ankle motion in similar ways. Comparing tibiotalar and tibiotalocalcaneal arthrodesis suggests that additionally fusing the subtalar joint does not cause greater movement restriction in patients. Objectively comparing tibiotalar and tibiotalocalcaneal arthrodesis will facilitate further understanding of the effect of tibiotalocalcaneal arthrodesis on movement and the value of subtalar joint motion for improved preoperative counselling.

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Change in intersegmental foot and ankle motion after a high tibial osteotomy in genu varum patients

Cited by 11 publications

References 23 publications

The effect of backpack load on intersegmental motions of the foot and plantar pressure in individuals with mild flatfoot

The effect of backpack load on intersegmental motions of the foot and plantar pressure in individuals with mild flatfoot

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Foot and Ankle Motion after Tibiotalocalcaneal Arthrodesis: Comparison with Tibiotalar Arthrodesis Using a Multi-Segment Foot Model

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