Kinesiology Laboratory, Geneva University Hospitals and Geneva University, Switzerland; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland.
Kinesiology Laboratory, Geneva University Hospitals and Geneva University, Switzerland.
Gait Posture. 2023 Sep;105:104-109. doi: 10.1016/j.gaitpost.2023.07.285. Epub 2023 Jul 27.
Toe-walking is one of the most common gait deviations (due to soleus and/or gastrocnemius muscle contractures), compromising the first (heel rocker) and second (ankle rocker) of the foot during walking. The aim of this study is to evaluate the effect of emulated artificially gastrocnemius and soleus contractures on the first and second rocker during walking.
An exoskeleton was built to emulate contractures of the bilateral gastrocnemius and soleus muscles. Ten healthy participants were recruited to walk under the following conditions: without emulated contractures or with bilateral emulated contractures at 0°,10°, 20° and 30° of plantarflexion of the soleus or gastrocnemius in order to create an artificial restriction of dorsiflexion ankle movement. A linear regression from the ankle plantar-dorsiflexion angle pattern was performed on 0-5 % of the gait cycle (first rocker) and on 12-31 % of the gait cycle (second rocker) to compute the slope of the curve. The proportion of participants with the presence of the first and second rocker was then computed. A Statistical Parametric Mapping (SPM) analysis assessed the kinematic variations among different degrees of emulated contractures.
The first and second rockers are completely absent from 10° of plantarflexion emulated contracture. The data indicate there was a non-linear shift of the gait pattern of the ankle kinematics and an important shift toward plantarflexion values with the loss of the rockers.
This study suggests that toe-walking in the experimental simulation situation is not necessarily due to a high emulated contracture level and can occur with a small emulated contracture by an adaptation choice. This study may improve interpretation of clinical gait analysis and shows that the link between the level of gastrocnemius/soleus emulated contracture and progression of toe-walking (increased plantarflexion during gait) is not linear.
足尖行走是最常见的步态偏差之一（由于比目鱼肌和/或腓肠肌挛缩），在行走过程中会影响足的第一（足跟摆动）和第二（踝关节摆动）阶段。本研究旨在评估模拟的比目鱼肌和腓肠肌挛缩对行走时第一和第二阶段的影响。
构建了一个外骨骼来模拟双侧比目鱼肌和腓肠肌的挛缩。招募了 10 名健康参与者，让他们在以下条件下行走：不模拟挛缩，或在比目鱼肌或腓肠肌跖屈 0°、10°、20°和 30°时模拟双侧挛缩，以限制踝关节背屈运动。对踝关节跖屈-背屈角度模式进行线性回归，在步态周期的 0-5%（第一阶段）和 12-31%（第二阶段）计算曲线斜率。然后计算存在第一和第二阶段的参与者比例。统计参数映射（SPM）分析评估了不同模拟挛缩程度的运动学变化。
模拟跖屈 10°挛缩时，第一和第二阶段完全缺失。数据表明，踝关节运动学的步态模式发生了非线性变化，并且随着阶段的丧失，向跖屈值发生了重要的变化。
本研究表明，实验模拟情况下的足尖行走不一定是由于高度模拟挛缩，而是可能由于适应选择而出现较小的模拟挛缩。本研究可以提高对临床步态分析的解释，并表明比目鱼肌/腓肠肌模拟挛缩程度与足尖行走进展（步态中跖屈增加）之间的关系并非线性。
