The influence of foot hyperpronation on pelvic biomechanics during stance phase of the gait: A biomechanical simulation study

Abstract

Despite the theoretical link between foot hyperpronation and biomechanical dysfunction of the pelvis, the literature lacks evidence that confirms this assumption in truly hyperpronated feet subjects during gait. Changes in the kinematic pattern of the pelvic segment were assessed in 15 persons with hyperpronated feet and compared to a control group of 15 persons with normally aligned feet during the stance phase of gait based on biomechanical musculoskeletal simulation. Kinematic and kinetic data were collected while participants walked at a comfortable self-selected speed. A generic OpenSim musculoskeletal model with 23 degrees of freedom and 92 muscles was scaled for each participant. OpenSim inverse kinematic analysis was applied to calculate segment angles in the sagittal, frontal and horizontal planes. Principal component analysis was employed as a data reduction technique, as well as a computational tool to obtain principal component scores. Independent-sample t-test was used to detect group differences. The difference between groups in scores for the first principal component in the sagittal plane was statistically significant (p = 0.01; effect size = 1.06), but differences between principal component scores in the frontal and horizontal planes were not significant. The hyperpronation group had greater anterior pelvic tilt during 20%-80% of the stance phase. In conclusion, in persons with hyperpronation we studied the role of the pelvic segment was mainly to maintain postural balance in the sagittal plane by increasing anterior pelvic inclination. Since anterior pelvic tilt may be associated with low back symptoms, the evaluation of foot posture should be considered in assessing the patients with low back and pelvic dysfunction.

The biomechanical effects of pronated foot function on gait. An experimental study

“…However, the increase in hip adduction in the FPg was not significant, in contrast to Tateuchi et al, who reported a significant increase in hip adduction and internal rotation with FP 35 . Equally, unlike other reports, we did not find increases in FPg anterior pelvic tilt 4,32,36 or pelvic obliquity 33,34 . However, FPg pelvic ROM in the sagittal and transversal planes during stance was slightly, but significantly, greater in the FPg (with a large effect size in the sagittal plane, and a small effect size in the transverse plane), supporting our hypothesis and confirming the results of Resende et al 34 that showed an effect of FP on pelvic kinematics 33,34,36 .…”

“…Equally, unlike other reports, we did not find increases in FPg anterior pelvic tilt 4,32,36 or pelvic obliquity 33,34 . However, FPg pelvic ROM in the sagittal and transversal planes during stance was slightly, but significantly, greater in the FPg (with a large effect size in the sagittal plane, and a small effect size in the transverse plane), supporting our hypothesis and confirming the results of Resende et al 34 that showed an effect of FP on pelvic kinematics 33,34,36 . Nevertheless, these results should be interpreted with caution in view of the small differences in angle values between groups.…”

“…33,34 However, FPg pelvic ROM in the sagittal and transversal planes during stance was slightly, but significantly, greater in the FPg (with a large effect size in the sagittal plane, and a small effect size in the transverse plane), supporting our hypothesis and confirming the results of Resende et al 34 that showed an effect of FP on pelvic kinematics. 33,34,36 Nevertheless, these results should be interpreted with caution in view of the small differences in angle values between groups. These differences could be generated by a measurement error but could also represent a difference in the gait pattern due to the small ROM that occur at the pelvis.…”

“…Previous studies of healthy subjects walking with wedges to artificially induce FP have revealed alterations in lower limb kinematics 4,31‐36 ; however, artificial FP may not represent the true effects and adaptations to FP. Peak knee internal rotation, for example, was increased during the whole stance phase in the FPg compared with the CTRg in agreement with previous studies 4,31‐34 and our hypothesis.…”

“…7,10,42 The increased pelvic ROM in the sagittal and transverse planes observed in the FPg could accentuate the lumbar lordosis and increase the risk of low back pain. 36,43 Therefore, although this study did not directly assess the relationship between FP and MSD, it seems reasonable to believe that FP might increase the risk of MSD due to the effects of FP on the whole kinematic chain. However, and despite a large effect size in the sagittal plane ROM, these results should be interpreted with caution in view of the small differences in joint angles between groups.…”