Khan Soobia Saad, Khan Saad Jawaid, Usman Juliana
Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia.
Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia; Centre for Applied Biomechanics, University of Malaya, Malaysia.
Gait Posture. 2017 Mar;53:185-192. doi: 10.1016/j.gaitpost.2017.01.022. Epub 2017 Jan 27.
Toe-out/-in gait has been prescribed in reducing knee joint load to medial knee osteoarthritis patients. This study focused on the effects of toe-out/-in at different walking speeds on first peak knee adduction moment (fKAM), second peak KAM (sKAM), knee adduction angular impulse (KAAI), net mechanical work by lower limb as well as joint-level contribution to the total limb work during level walking. Gait analysis of 20 healthy young adults was done walking at pre-defined normal (1.18m/s), slow (0.85m/s) and fast (1.43m/s) walking speeds with straight-toe (natural), toe-out (15°>natural) and toe-in (15°<natural). Repeated measure ANOVA (p<0.05) with post-hoc Tukey's test was applied for statistical analysis. Toe-out gait increased fKAM at all walking speeds (highest at normal speed) while toe-in gait reduced fKAM at all speeds (highest at fast walking speed). Toeing-in reduced KAAI at all speeds while toeing-out affected KAAI only at normal speed. Increasing walking speed generally increased fKAM for all foot positions, but it did not affect sKAM considerably. Slowing down the speed, increased KAAI significantly at all foot positions except for toe-in. At slow walking speed, hip and knee joints were found to be major energy contributors for toe-in and toe-out respectively. At higher walking speeds, these contributions were switched. The ankle joint remained unaffected by changing walking speeds and foot progression angles. Toe-out/-in gait modifications affected knee joint kinetics and lower limb energetics at all walking speeds. However, their effects were inconsistent at different speeds. Therefore, walking speed should be taken into account when prescribing toe-out/-in gait.
已建议采用外八字/内八字步态来减轻膝关节骨关节炎患者的膝关节内侧负荷。本研究聚焦于不同步行速度下的外八字/内八字步态对首次峰值膝关节内收力矩（fKAM）、第二次峰值膝关节内收力矩（sKAM）、膝关节内收角冲量（KAAI）、下肢净机械功以及平地上行走时关节对整个肢体功的贡献。对20名健康年轻成年人进行了步态分析，他们分别以预先设定的正常（1.18米/秒）、慢速（0.85米/秒）和快速（1.43米/秒）的步行速度，以直脚尖（自然）、外八字（比自然状态大15°）和内八字（比自然状态小15°）的方式行走。采用重复测量方差分析（p<0.05）并结合事后的Tukey检验进行统计分析。外八字步态在所有步行速度下都会增加fKAM（在正常速度下最高），而内八字步态在所有速度下都会降低fKAM（在快速步行速度下最高）。内八字在所有速度下都会降低KAAI，而外八字仅在正常速度下会影响KAAI。提高步行速度通常会使所有足部姿势的fKAM增加，但对sKAM影响不大。减慢速度会使除内八字外的所有足部姿势的KAAI显著增加。在慢速步行时，发现髋关节和膝关节分别是内八字和外八字步态的主要能量贡献者。在较高步行速度下，这些贡献会发生转换。踝关节不受步行速度和足部前进角度变化的影响。外八字/内八字步态改变在所有步行速度下都会影响膝关节动力学和下肢能量学。然而，它们在不同速度下的影响并不一致。因此，在规定外八字/内八字步态时应考虑步行速度。
