Midfoot and ankle motion during heel rise and gait are related in people with diabetes and peripheral neuropathy

Jeong, Hyo-Jung; Mueller, Michael J.; Zellers, Jennifer A.; Hastings, Mary K.

doi:10.1016/j.gaitpost.2020.11.013

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…These muscles are active during the propulsive phase of walking [35, 36] and a likely source of tension across the arch [24]. As foot and ankle mechanics are similar between push‐off of walking and heel raises [31], these muscles are likely active in a similar manner during heel raises. While we did not see any differences among the three heel raise conditions, this may be due in part to the statistical treatment, where we had numerous pairwise comparisons.…”

Section: Discussionmentioning

confidence: 99%

“…Heel raises were used as a dynamic task because they provide a controlled environment to systematically manipulate the MTP joint. Motion at the midfoot and ankle as well as ankle power during heel raises and push‐off during walking are significantly correlated [31], suggesting that heel raises may serve as an adequate surrogate for the push off phase of gait. These controlled heel raises allowed us to evaluate associated changes in foot kinematics and energetics during a dynamic task where the windlass mechanism is dynamically engaged.…”

Section: Methodsmentioning

confidence: 99%

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The influence of the windlass mechanism on kinematic and kinetic foot joint coupling

Williams

Ridge

Johnson

et al. 2022

Journal of Foot and Ankle Research

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Background Previous research shows kinematic and kinetic coupling between the metatarsophalangeal (MTP) and midtarsal joints during gait. Studying the effects of MTP position as well as foot structure on this coupling may help determine to what extent foot coupling during dynamic and active movement is due to the windlass mechanism. This study’s purpose was to investigate the kinematic and kinetic foot coupling during controlled passive, active, and dynamic movements. Methods After arch height and flexibility were measured, participants performed four conditions: Seated Passive MTP Extension, Seated Active MTP Extension, Standing Passive MTP Extension, and Standing Active MTP Extension. Next, participants performed three heel raise conditions that manipulated the starting position of the MTP joint: Neutral, Toe Extension, and Toe Flexion. A multisegment foot model was created in Visual 3D and used to calculate ankle, midtarsal, and MTP joint kinematics and kinetics. Results Kinematic coupling (ratio of midtarsal to MTP angular displacement) was approximately six times greater in Neutral heel raises compared to Seated Passive MTP Extension, suggesting that the windlass only plays a small kinematic role in dynamic tasks. As the starting position of the MTP joint became increasingly extended during heel raises, the amount of negative work at the MTP joint and positive work at the midtarsal joint increased proportionally, while distal-to-hindfoot work remained unchanged. Correlations suggest that there is not a strong relationship between static arch height/flexibility and kinematic foot coupling. Conclusions Our results show that there is kinematic and kinetic coupling within the distal foot, but this coupling is attributed only in small measure to the windlass mechanism. Additional sources of coupling include foot muscles and elastic energy storage and return within ligaments and tendons. Furthermore, our results suggest that the plantar aponeurosis does not function as a rigid cable but likely has extensibility that affects the effectiveness of the windlass mechanism. Arch structure did not affect foot coupling, suggesting that static arch height or arch flexibility alone may not be adequate predictors of dynamic foot function.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The influence of the windlass mechanism on kinematic and kinetic foot joint coupling

Williams

Ridge

Johnson

et al. 2022

Journal of Foot and Ankle Research

View full text Add to dashboard Cite

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“…Participant inclusion criteria for the parent study included type 2 diabetes mellitus and peripheral neuropathy (full details are reported in previous publications). 6,7 A Zoom (Zoom Video Communications Inc, San Jose, California) video or phone call was scheduled with each participant based on their preference. We queried the participants about (1) technology resources they would need to successfully participate in the telehealth intervention (need for internet connection, a device-iPad/tablet, and/or technical support), (2) level of interest (definitely-, probably-or might be interested; probably not-or definitely not interested), and (3) types of interventions they would find most beneficial (open-ended question) and multiple choices were allowed.…”

Section: Methodsmentioning

confidence: 99%

“…Participant inclusion criteria for the parent study included type 2 diabetes mellitus and peripheral neuropathy (full details are reported in previous publications). 6,7…”

Section: Methodsmentioning

confidence: 99%

Remote Research: Resources, Intervention Needs, and Methods in People with Diabetes and Peripheral Neuropathy

Bohnert

Zellers

Jeong

et al. 2022

J Diabetes Sci Technol

Self Cite

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Background: Stay-at-home orders associated with the SARS-CoV-2 (COVID-19) pandemic were particularly important for older adults with type 2 diabetes, at risk for severe COVID-19 complications. In response, research shifted to remote telehealth methodology. Study participant interests, equipment needs, and ability to adapt methods to the remote/telehealth environment were unknown. Study purposes to assess (1) resource needs (internet/devices accessibility), (2) future telehealth interests, and (3) ability to adapt common research and clinical measures of glycemic control, physical function, activity measures, and quality of life outcomes to a telehealth setting. Method: Twenty-one participants with type 2 diabetes and peripheral neuropathy were recruited from a longitudinal study (11 female; age: 66.3 ± 8.3 years; DM: 15.1 ± 8.7 years). Technology needs and future telehealth interests were assessed. A glycemic measure (HbA1c), a five-times chair rise, a one-week activity monitor, and surveys (self-efficacy, depression, and balance) were collected. All aspects of the study were completed remotely over email and video/phone call. Results: Twelve participants used computers; nine used phones for study completion. Participants had the following resource needs: connectivity (n = 3), devices (n = 6), and technical support (n = 12). Twenty people expressed interest in participating in future telehealth studies related to balance, exercise, and diabetes management. Methodological considerations were primarily the need for assistance for participants to complete the home HbA1c test, five-time chair rise, wearable activity monitoring, and surveys. Conclusions: Older adults with type 2 diabetes and peripheral neuropathy would need technological and personal assistance (connection, device, guidance) to complete a long-term telehealth intervention. Despite technology needs, participants were interested in telehealth interventions. Clinical Trial: Parent study, “Metatarsal Phalangeal Joint Deformity Progression—R01 (NCT02616263) is registered at https://clinicaltrials.gov/ .

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“…Heel raises were used as a dynamic task because they provide a controlled environment to systematically manipulate the MTP joint. Motion at the midfoot and ankle as well as ankle power during heel raises and push-off during walking are signi cantly correlated (32), suggesting that heel raises may serve as an adequate surrogate for the push off phase of gait. These controlled heel raises allowed us to evaluate associated changes in foot kinematics and energetics during a dynamic task where the windlass mechanism is dynamically engaged.…”

Section: Methodsmentioning

confidence: 99%

The Influence of the Windlass Mechanism on Kinematic and Kinetic Foot Joint Coupling

Williams

Ridge

Johnson

et al. 2021

Preprint

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Background: Previous research shows kinematic and kinetic coupling between the metatarsophalangeal (MTP) and midtarsal joints during gait. Studying the effects of MTP position as well as foot structure on this coupling may help determine to what extent foot coupling during dynamic and active movement is due to the windlass mechanism. This study’s purpose was to investigate the kinematic and kinetic foot coupling during controlled passive, active, and dynamic movements. Methods: After arch height and flexibility were measured, participants performed four conditions: Seated Passive MTP Extension, Seated Active MTP Extension, Standing Passive MTP Extension, and Standing Active MTP Extension. Next, participants performed three heel raise conditions that manipulated the starting position of the MTP joint: Neutral, Toe Extension, and Toe Flexion. A multisegment foot model was created in Visual 3D and used to calculate ankle, midtarsal, and MTP joint kinematics and kinetics. Results: Kinematic coupling (ratio of midtarsal to MTP angular displacement) was approximately six times greater in Neutral heel raises compared to Seated Passive MTP Extension, suggesting that the windlass only plays a small kinematic role in dynamic tasks. As the starting position of the MTP joint became increasingly extended during heel raises, the amount of negative work at the MTP joint and positive work at the midtarsal joint increased proportionally, while distal-to-hindfoot work remained unchanged. Correlations suggest that there is not a strong relationship between static arch height/flexibility and kinematic foot coupling. Conclusions: Our results show that there is kinematic and kinetic coupling within the distal foot, but this coupling is attributed only in small measure to the windlass mechanism. Additional sources of coupling include foot muscles and elastic energy storage and return within ligaments and tendons. Furthermore, our results suggest that the plantar aponeurosis does not function as a rigid cable but likely has extensibility that affects the effectiveness of the windlass mechanism. Arch structure did not affect foot coupling, suggesting that static arch height or arch flexibility alone may not be adequate predictors of dynamic foot function.

show abstract

Midfoot and ankle motion during heel rise and gait are related in people with diabetes and peripheral neuropathy

Cited by 10 publications

References 21 publications

The influence of the windlass mechanism on kinematic and kinetic foot joint coupling

The influence of the windlass mechanism on kinematic and kinetic foot joint coupling

Remote Research: Resources, Intervention Needs, and Methods in People with Diabetes and Peripheral Neuropathy

The Influence of the Windlass Mechanism on Kinematic and Kinetic Foot Joint Coupling

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