Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada.
Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada.
Gait Posture. 2024 May;110:10-16. doi: 10.1016/j.gaitpost.2024.03.004. Epub 2024 Mar 7.
Posterior tibialis tendon dysfunction (PTTD) is a chronic degenerative musculoskeletal disorder causing a progressive ankle complex and arch collapse altering lower limb biomechanics. However, biomechanical changes associated with stage 1 and 2 PTTD need to be better characterized during walking to guide clinical recommendations and improve non-operative treatments.
What are the lower limb kinematic and kinetic differences between individuals with stage 1 (PTTD1), individuals with stage 2 PTTD (PTTD2) and healthy counterparts during gait?
Sixteen PTTD1, 11 PTTD2 and 20 healthy controls were included in this multicentric case-control study to compare their lower limb gait biomechanics. Kinematic and kinetic data were recorded using a three-dimensional motion capture system and a force plate. One-dimensional statistical parametric mapping was used to compare lower limb joint motion and moments between groups during the stance phase.
PTTD1 had minimal biomechanical differences compared with the control group. In contrast, PTTD2 presented significant differences compared with controls and PTTD1. At the ankle, PTTD2 exhibited greater plantarflexion and eversion angles and midfoot dorsiflexion and inversion angles throughout stance compared with controls and PTTD1. PTTD2 presented lower midfoot abduction moments compared with controls. These changes led PTTD2 to exhibit knee and hip adaptative biomechanical mechanisms in the frontal and transverse planes in late stance. PTTD2 had greater knee internal rotation angles and smaller knee external rotation moments compared to controls. PTTD2 had smaller hip internal rotation angles compared with PTTD1 and smaller hip adduction moments compared with controls.
PTTD1 showed minimal biomechanical differences compared to controls and important differences compared to PTTD2. The lower limb biomechanical deficits accentuate as the pathology advances from stage 1 to stage 2. PTTD is a progressive condition needing early clinical management at stage 1 to avoid successive biomechanical changes associated with stage 2.
胫骨后肌腱功能障碍(PTTD)是一种慢性退行性肌肉骨骼疾病,导致踝关节复合体和足弓进行性塌陷,改变下肢生物力学。然而,需要更好地描述 1 期和 2 期 PTTD 患者在行走过程中的生物力学变化,以指导临床建议并改善非手术治疗。
在步态中,1 期(PTTD1)、2 期 PTTD(PTTD2)患者与健康对照组之间的下肢运动学和动力学有何差异?
本多中心病例对照研究纳入 16 例 PTTD1、11 例 PTTD2 和 20 例健康对照组,比较其下肢步态生物力学。使用三维运动捕捉系统和测力板记录运动学和动力学数据。在站立阶段,使用一维统计参数映射比较组间下肢关节运动和力矩。
与对照组相比,PTTD1 的生物力学差异较小。相比之下,PTTD2 与对照组和 PTTD1 相比,差异显著。在踝关节处,PTTD2 在整个站立阶段表现出更大的跖屈和外展角度以及中足背屈和内翻角度。PTTD2 的中足外展力矩低于对照组。这些变化导致 PTTD2 在站立后期的额状面和横断面上表现出膝关节和髋关节的适应性生物力学机制。PTTD2 的膝关节内旋角度大于对照组,膝关节外旋力矩小于对照组。与 PTTD1 相比,PTTD2 的髋关节内旋角度较小,与对照组相比,髋关节内收力矩较小。
与对照组相比,PTTD1 的生物力学差异较小,与 PTTD2 相比,差异较大。随着疾病从 1 期进展到 2 期,下肢生物力学缺陷会逐渐加重。PTTD 是一种进行性疾病,需要在 1 期进行早期临床管理,以避免与 2 期相关的连续生物力学变化。