Osteotomy Clinical Trial
Official title:
Gait Analysis During Level and Uphill Walking After Lengthening Osteotomy of the Lateral Column
A common surgical treatment for posterior tibial tendon dysfunction (and the resulting flat
foot) is the correction through a calcaneal lengthening osteotomy of the lateral column
(LLC). Clinical studies showed pain relief and functional improvements through different
scores. However, according to clinical experience, some patients complain about a limited
ankle dorsiflexion after LLC surgery. Several joints of the foot (talocrural, subtalar,
talonavicular, calcaneocuboid) contribute to the overall range of motion in foot
plantarflexion/dorsiflexion and pronation/supination. Changes in the range of motion in one
joint can affect all the other joints. For instance, it was shown that a fusion of the
talonavicular joint removes most of the residual hindfoot motion in
plantarflexion/dorsiflexion and pronation/supination. Because the lengthening of the lateral
column presumably decreases the mobility of the medial column and thus of the talonavicular
joint, this surgery can influence the range of motion of the other joints, and hence
contribute to the reported decreased ankle dorsiflexion motion.
Patients after LLC have less plantarflexion of the first metatarsal throughout stance of
level walking and less inversion of the hindfoot during push-off compared to healthy
subjects. Uphill walking requires more ankle plantarflexion and dorsiflexion than level
walking. A limitation of the ankle joint mobility especially in dorsiflexion could therefore
lead to additional or greater changes in gait patterns (hindfoot and forefoot kinematics)
during uphill walking.
The primary objective is:
• To compare differences in hindfoot and forefoot kinematics between level and uphill
treadmill walking in relation to passive range of motion
The secondary objectives are:
- To compare lower leg muscle activation during level and uphill treadmill walking between
patients after LLC and healthy subjects
- To test the association between muscle strength, muscle activation patterns and hindfoot
and forefoot kinematics during level and uphill walking and heel rise
- To relate clinical outcome of LLC surgery by functional scores to passive range of
motion
At the initial assessment, written informed consent will be obtained before participants will undergo a clinical exam (inspection and palpation of the foot, measurement of bilateral passive ankle range of motion). All participants will complete the Short Form (SF)36 and the Foot Function Index20 to obtain pain and functional scores (approximate duration: 30 minutes). Participants will be able to familiarize with treadmill walking at their preferred walking speed. Surface electrodes will be placed bilaterally over the tibialis anterior, gastrocnemius medialis and lateralis, soleus, and peroneus brevis. Isokinetic muscle strength in ankle plantarflexion/ dorsiflexion and inversion/eversion will be tested using the Biodex system 4 Pro (approximate duration: 45 minutes). Reflective surface markers will be placed bilaterally on anatomic landmarks according to the Plug In Gait model and a specific foot model. These markers are seen by 6 Vicon MX cameras. Participants will be asked to stand on the treadmill (h/p cosmos, Zebris), and data for a standing reference trial will be collected. Single-limb heel rise performance with each leg will be tested on the treadmill while kinematic, electromyography (EMG), and pressure data will be measured. Participants will then walk barefoot for 2 minutes at 0% slope while kinematic, EMG, and pressure data will be recorded. Subsequently, the treadmill incline will be increased to 15%, and data for 2 minutes walking at this slope will be recorded followed by three heel rises (approximate duration: 45 minutes). The estimated total time for each participant is 120 minutes. ;
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