Ikeda Andrea J, Fergason John R, Wilken Jason M
1 Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA.
2 Extremity Trauma and Amputation Center of Excellence, Brooke Army Medical Center, San Antonio, TX, USA.
Prosthet Orthot Int. 2018 Jun;42(3):265-274. doi: 10.1177/0309364617728116. Epub 2017 Sep 4.
The Intrepid Dynamic Exoskeletal Orthosis is a custom-made dynamic response carbon fiber device. A heel wedge, which sits in the shoe, is an integral part of the orthosis-heel wedge-shoe system. Because the device restricts ankle movement, the system must compensate to simulate plantarflexion and allow smooth forward progression during gait.
To determine the influence of wedge height and durometer on the walking gait of individuals using the Intrepid Dynamic Exoskeletal Orthosis.
Repeated measures.
Twelve individuals walked over level ground with their Intrepid Dynamic Exoskeletal Orthosis and six different heel wedges of soft or firm durometer and 1, 2, or 3 cm height. Center of pressure velocity, joint moments, and roll-over shape were calculated for each wedge.
Height and durometer significantly affected time to peak center of pressure velocity, time to peak internal dorsiflexion and knee extension moments, time to ankle moment zero crossing, and roll-over shape center of curvature anterior-posterior position. Wedge height had a significant influence on peak center of pressure velocity, peak dorsiflexion moment, time to peak knee extension moment, and roll-over shape radius and vertical center of curvature.
Changes in wedge height and durometer systematically affected foot loading. Participants preferred wedges which produced ankle moment zero crossing timing, peak internal knee extension moment timing, and roll-over shape center of curvature anterior-posterior position close to that of able-bodied individuals. Clinical relevance Adjusting the heel wedge is a simple, straightforward way to adjust the orthosis-heel wedge-shoe system. Changing wedge height and durometer significantly alters loading of the foot and has great potential to improve an individual's gait.
无畏动态外骨骼矫形器是一种定制的动态响应碳纤维装置。置于鞋内的足跟楔形垫是矫形器 - 足跟楔形垫 - 鞋系统的一个组成部分。由于该装置限制了踝关节的活动，该系统必须进行补偿以模拟跖屈，并在步态中实现平稳向前推进。
确定楔形垫高度和硬度对使用无畏动态外骨骼矫形器的个体步行步态的影响。
重复测量。
12名个体穿着他们的无畏动态外骨骼矫形器，搭配六种不同的足跟楔形垫行走在平坦地面上，这些楔形垫的硬度为软质或硬质，高度分别为1厘米、2厘米或3厘米。计算每个楔形垫的压力中心速度、关节力矩和翻转形状。
高度和硬度显著影响压力中心速度峰值时间、背屈内力矩和膝关节伸展力矩峰值时间、踝关节力矩过零点时间以及翻转形状前后曲率中心位置。楔形垫高度对压力中心速度峰值、背屈力矩峰值、膝关节伸展力矩峰值时间以及翻转形状半径和垂直曲率中心有显著影响。
楔形垫高度和硬度的变化会系统性地影响足部负荷。参与者更喜欢那些能使踝关节力矩过零点时间、膝关节伸展内力矩峰值时间以及翻转形状前后曲率中心位置接近健全个体的楔形垫。临床相关性调整足跟楔形垫是调整矫形器 - 足跟楔形垫 - 鞋系统的一种简单、直接的方法。改变楔形垫高度和硬度会显著改变足部负荷，并且有很大潜力改善个体的步态。
