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ABSTRACT: We investigated the biomechanical changes that occur in the lower limb following total knee arthroplasty (TKA). Lower limb joint kinematics and kinetics were evaluated in 32 patients before and 12months following TKA and 28 age-matched controls. Analysis of variance with Bonferroni-adjusted post-hoc tests showed no significant changes in knee joint kinematics and kinetics following TKA despite significant improvements in pain and function. Significant increases in peak ankle plantarflexion and dorsiflexion moments and ankle power generation were observed which may be a compensatory response to impaired knee function to allow sufficient power generation for propulsion. Differences in knee gait parameters may arise as a result of the presence of osteoarthritis and mechanical changes associated with TKA as well as retention of the pre-surgery gait pattern.
The Journal of arthroplasty 03/2013; · 1.79 Impact Factor
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ABSTRACT: Variations in foot posture, such as pes planus (low-arched foot) or pes cavus (high-arched foot), are thought to be an intrinsic risk factor for injury due to altered motion of the lower extremity. Hence, the aim of this systematic review was to investigate the relationship between foot posture and lower limb kinematics during walking. A systematic database search of MEDLINE, CINAHL, SPORTDiscus, Embase and Inspec was undertaken in March 2012. Two independent reviewers applied predetermined inclusion criteria to selected articles for review and selected articles were assessed for quality. Articles were then grouped into two broad categories: (i) those comparing mean kinematic parameters between different foot postures, and (ii) those examining associations between foot posture and kinematics using correlation analysis. A final selection of 12 articles was reviewed. Meta-analysis was not conducted due to heterogeneity between studies. Selected articles primarily focused on comparing planus and normal foot postures. Five articles compared kinematic parameters between different foot postures - there was some evidence for increased motion in planus feet, but this was limited by small effect sizes. Seven articles investigated associations between foot posture and kinematics - there was evidence that increasing planus foot posture was positively associated with increased frontal plane motion of the rearfoot. The body of literature provides some evidence of a relationship between pes planus and increased lower limb motion during gait, however this was not conclusive due to heterogeneity between studies and small effect sizes.
Gait & posture 02/2013; · 2.58 Impact Factor
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ABSTRACT: PURPOSE: To identify the demographic factors, impairments and activity limitations that contribute to health-related quality of life (HRQOL) in people with idiopathic Parkinson's disease (PD). METHOD: Two hundred and ten individuals with idiopathic PD who participated in the baseline assessment of a randomized clinical trial were included. The Parkinson's Disease Questionnaire-39 summary index was used to quantify HRQOL. In order to provide greater clarity regarding the determinants of HRQOL, path analysis was used to explore the relationships between the various predictors in relation to the functioning and disability framework of the International Classification of Functioning model. RESULTS: The two models of HRQOL that were examined in this study had a reasonable fit with the data. Activity limitations were found to be the strongest predictor of HRQOL. Limitations in performing self-care activities contributed the most to HRQOL in Model 1 (β = 0.38; p < 0.05), while limitations in functional mobility had the largest contribution in Model 2 (β = -0.31; p < 0.0005). Self-reported history of falls was also found to have a significant and direct relationship with HRQOL in both models (Model 1 β = -0.11; p < 0.05; Model 2 β = -0.21; p < 0.05). CONCLUSIONS: Health-related quality of life in PD is associated with self-care limitations, mobility limitations, self-reported history of falls and disease duration. Understanding how these factors are inter-related may assist clinicians focus their assessments and develop strategies that aim to minimize the negative functional and social sequelae of this debilitating disease.
Quality of Life Research 10/2012; · 2.30 Impact Factor
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ABSTRACT: Forefoot pain is a common problem in older people. We determined whether plantar pressures during gait and the relative lengths of the lesser metatarsals differ between older people with and without plantar forefoot pain. Dynamic plantar pressure assessment during walking was undertaken using the Tekscan MatScan® system in 118 community-dwelling older people (44 males and 74 females), mean age 74 (standard deviation = 5.9) years, 43 (36%) of whom reported current or previous plantar forefoot pain. The relative lengths of metatarsals 1-5 were determined from weightbearing X-rays. Participants with current or previous plantar forefoot pain exhibited significantly (p = 0.032) greater peak plantar pressure under metatarsal heads 3-5 (1.93 ± 0.41 kg/cm(2) vs. 1.74 ± 0.48 kg/cm(2) ). However, no differences were found in relative metatarsal lengths between the groups. These findings indicate that older people with forefoot pain generate higher peak plantar pressures under the lateral metatarsal heads when walking, but do not exhibit relatively longer lesser metatarsals. Other factors may be responsible for the observed pressure increase, such as reduced range of motion of the metatarsophalangeal joints and increased stiffness of plantar soft tissues. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Journal of Orthopaedic Research 09/2012; · 2.81 Impact Factor
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ABSTRACT: Objectives. Foot orthoses are commonly used in the management of knee OA, although the relationship between foot function and knee OA is still unclear. The purpose of the study was to examine foot function during walking in people with and without medial compartment knee OA.Methods. Motion of the tibia, rearfoot and forefoot in 32 patients with medial compartment knee OA and 28 age-matched control subjects was investigated. Multivariate analysis was used to compare the groups.Results. The knee OA group contacted the ground with a more everted rearfoot, demonstrated greater peak rearfoot eversion and exhibited reduced rearfoot frontal plane range of motion and reduced rearfoot peak inversion. The tibia was more internally rotated and laterally tilted throughout the gait cycle, with reduced peak external rotation.Conclusion. People with medial compartment knee OA exhibit altered foot kinematics during gait that are indicative of a less mobile, more everted foot type. The presence and degree of tibial malalignment and the available rearfoot range of motion during walking may affect individual responses to load-altering interventions, such as foot orthoses and footwear modifications.Trial registration: Australian New Zealand Clinical Trials Registry, www.anzctr.org.au/, ACTRN12608000116325.
Rheumatology (Oxford, England) 08/2012; · 4.24 Impact Factor
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ABSTRACT: The relationship between health-related quality of life (HRQoL) in people with Parkinson's disease and their caregivers is little understood and any effects on caregiver strain remain unclear. This paper examines these relationships in an Australian sample.
Using the generic EuroQol (EQ-5D) and disease-specific Parkinson's Disease Questionnaire-39 Item (PDQ-39), HRQoL was evaluated in a sample of 97 people with PD and their caregivers. Caregiver strain was assessed using the Modified Caregiver Strain Index. Associations were evaluated between: (i) caregiver and care-recipient HRQoL; (ii) caregiver HRQoL and caregiver strain, and; (iii) between caregiver strain and care-recipient HRQoL.
No statistically significant relationships were found between caregiver and care-recipient HRQoL, or between caregiver HRQoL and caregiver strain. Although this Australian sample of caregivers experienced relatively good HRQoL and moderately low strain, a significant correlation was found between HRQoL of people with PD and caregiver strain (rho 0.43, p < .001).
Poor HRQoL in people with PD is associated with higher strain in caregivers. Therapy interventions may target problems reported as most troublesome by people with PD, with potential to reduce strain on the caregiver.
BMC Neurology 07/2012; 12:57. · 2.17 Impact Factor
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Meg E Morris,
Clarissa Martin,
Jennifer L McGinley,
Frances E Huxham, Hylton B Menz,
Nicholas F Taylor,
Mary Danoudis,
Jennifer J Watts,
Sze-Ee Soh,
Andrew H Evans,
Malcolm Horne,
Peter Kempster
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ABSTRACT: The high incidence of falls associated with Parkinson's disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson's has not been convincingly demonstrated.
180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined.
This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD.
The trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381).
BMC Neurology 07/2012; 12:54. · 2.17 Impact Factor
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Journal of Foot and Ankle Research 07/2012; 5(1):16. · 1.33 Impact Factor
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ABSTRACT: BACKGROUND: Individuals with knee osteoarthritis (OA) have flatter/more pronated feet than those without OA, but it is unclear whether altered foot posture and function are a cause or consequence of knee OA. The purpose of this study was to examine whether changes in foot posture and function occur after realignment of the knee following total knee replacement (TKR). MATERIALS AND METHODS: Nineteen patients with predominantly medial compartment knee OA were tested prior to and 12months after TKR. The Foot Posture Index (FPI) and Arch Index (AI) were measured as well as motion of the tibia, rearfoot and forefoot using a 3D motion analysis system incorporating a multisegment foot model. RESULTS: There were no significant changes in FPI or AI following TKR, however gait analysis revealed significant increases in tibial external rotation (-18.7±7.0° vs -22.5±8.7°, p=0.002), tibial transverse plane range of motion (-9.1±4.6° vs -11.4±6.1°, p=0.0028) and rearfoot range of motion in the frontal plane (8.6±2.6° vs 10.4±2.7°, p=0.002), and a decrease in rearfoot transverse plane range of motion (8.7±5.3° vs 5.9±4.1°, p=0.038) following the procedure. CONCLUSIONS: TKR produces no change in static foot posture, but results in significant changes in rearfoot kinematics during gait. These findings suggest that rearfoot motion compensates for changes in the alignment of the knee, highlighting the ability of the foot to accommodate for proximal skeletal malalignment.
The Knee 06/2012; · 1.74 Impact Factor
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ABSTRACT: OBJECTIVE.: To determine whether there are differences in the foot-specific and general health-related quality of life (HRQoL) of people with and without first metatarsophalangeal joint (MTPJ) osteoarthritis (OA). METHODS.: The foot-specific and general HRQoL of 43 participants (mean [SD] age = 50.0 [10.8]) with symptomatic radiographically confirmed first MTPJ OA (case group) was compared to an age, sex and body mass index matched control group. Foot-specific HRQoL was assessed using the Foot Health Status Questionnaire (FHSQ) and general HRQoL was assessed using the Short-Form-36 questionnaire (SF-36). Both questionnaires are validated instruments with 0 to 100 point domains. RESULTS.: All domains of the FHSQ were significantly lower in the case group (mean [SD] foot pain = 55.5 [22.3] versus 93.0 [7.8], foot function = 73.8 [20.9] versus 96.9 [11.5], footwear = 39.1 [28.7] versus 76.6 [27.0] and general foot health = 50.2 [27.0] versus 89.7 [16.0]). Further, the SF-36 physical functioning domain was significantly lower (mean [SD] = 82.8 [14.7] versus 95.2 [6.3]) in the case group. CONCLUSION.: People with first MTPJ OA experience more foot pain, have greater difficulty performing functional weightbearing activities, find it more difficult to obtain suitable footwear and perceive their feet to be in a poorer state of health. Additionally, people with symptomatic first MTPJ OA have greater difficulty performing a broad range of physical tasks and activities. © 2012 by the American College of Rheumatology.
Arthritis care & research. 05/2012;
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Journal of Foot and Ankle Research 05/2012; 4:1-1. · 1.33 Impact Factor
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Journal of Foot and Ankle Research 05/2012; 4:1-1. · 1.33 Impact Factor
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Journal of Foot and Ankle Research 05/2012; 4:1-1. · 1.33 Impact Factor
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Journal of Foot and Ankle Research 05/2012; 4:1-1. · 1.33 Impact Factor
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ABSTRACT: Foot posture is considered to be an important component of musculoskeletal assessment in clinical practice and research. However, many measurement approaches are not suitable for routine use as they are time-consuming or require specialised equipment and/or clinical expertise. The objective of this study was therefore to develop and evaluate a simple visual tool for foot posture assessment based on the Arch Index (AI) that could be used in clinical and research settings.
Fully weightbearing footprints from 602 people aged 62 to 96 years were obtained using a carbon paper imprint material, and cut-off AI scores dividing participants into three categories (high, normal and low) were determined using the central limit theorem (i.e. normal = +/- 1 standard deviation from the mean). A visual tool was then created using representative examples for the boundaries of each category. Two examiners were then asked to use the tool to independently grade the footprints of 60 participants (20 for each of the three categories, randomly presented), and then repeat the process two weeks later. Inter- and intra-tester reliability was determined using Spearman's rho, percentage agreement and weighted kappa statistics. The validity of the examiner's assessments was evaluated by comparing their categorisations to the actual AI score using Spearman's rho and analysis of variance (ANOVA), and to the actual AI category using percentage agreement, Spearman's rho and weighted kappa.
Inter- and intra-tester reliability of the examiners was almost perfect (percentage agreement = 93 to 97%; Spearman's rho = 0.91 to 0.95, and weighted kappas = 0.85 to 0.93). Examiner's scores were strongly correlated with actual AI values (Spearman's rho = 0.91 to 0.94 and significant differences between all categories with ANOVA; p < 0.001) and AI categories (percentage agreement = 95 to 98%; Spearman's rho = 0.89 to 0.94, and weighted kappas = 0.87 to 0.94). There was a slight tendency for examiners to categorise participants as having higher arches than their AI scores indicated.
Foot posture can be quickly and reliably categorised as high, normal or low in older people using a simplified visual categorisation tool based on the AI.
Journal of Foot and Ankle Research 04/2012; 5(1):10. · 1.33 Impact Factor
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ABSTRACT: Hintergrund
Körperlich aktive ältere Menschen stürzen häufig bedingt durch größeres Ausgesetztsein von gefährlichen Situationen. Jedoch
sind die meisten Studien zu den Umständen und Charakteristika von Stürzen in einer Population älterer motorisch eingeschränkter
Menschen durchgeführt worden.
Forschungsgegenstand
Beschreiben von Ort, Zeit, Sturzursache, Verletzungen und medizinische Behandlung bei einer aktiven Gruppe älterer Menschen.
Methoden
Prospektive Sturzerhebung über 12 Monate bei 293 Teilnehmern (163 Männer und 130 Frauen) im Alter von 70 bis 90 Jahren, die
an der randomisierten, kontrollierten Studie Standfest im Alter Erlangen, Deutschland teilnahmen.
Ergebnisse
Während des Erfassungszeitraums wurden 322 Stürze gemeldet. 122 Teilnehmer (42%) stürzten mindestens einmal und 62 (21%) stürzten
mehrmals. Der typische Sturz ereignete sich außer Haus während einer Freizeitaktivität, am Mittag oder Nachmittag und bewirkte
keine Verletzungen oder einer Krankenhauseinweisung. Es gab keinen Unterschied in der Sturzrate zwischen den Männern und Frauen,
jedoch waren der Ort, Zeit des Sturzes Sturzverletzungen und Arztbesuche geschlechtsabhängig.
Diskussion:
Die Resultate dieser Studie geben wertvolle Hinweise über Umstände sowie Charakteristika bei Stürzen in einer aktiven älteren,
selbstständigen Kohorte, die helfen können entsprechende Interventionsprogramme zur Sturzprävention für diese Population zu
entwickeln.
Background
Falls are common in physically active older people due to their increased exposure to hazardous situations. However, most
studies of the characteristics and circumstances of falls are based on frail older people.
Objective
To describe the location, time, cause, injuries and medical treatment associated with falls in a physically active group of
older people.
Methods
Prospective falls data over a 12-month period were obtained from 293 people (163 men and 130 women) aged between 70 and 90
years who took part in the “Standfest im Alter” study, a randomized controlled trial conducted in Erlagen, Germany.
Results
During the study period, there were 322 falls. 122 participants (42%) fell at least once and 62 (21%) fell on multiple occasions.
The typical fall occurred outside the home during leisure activities, at midday or in the afternoon and did not result in
injury or admission to hospital. There were no differences in the rate of falls according to gender; however, fall location,
time of fall, fall injury and visits to the doctor after the fall were all influenced by gender.
Conclusions
The results of this study provide useful insights into the characteristics and circumstances of falls in physically active
older people living in the community, which may assist with the development of future falls prevention activities.
Zeitschrift für Gerontologie + Geriatrie 04/2012; 39(4):261-267. · 0.61 Impact Factor
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ABSTRACT: The chevron and scarf osteotomies are commonly used for the surgical management of hallux valgus (HV). However, there is debate as to whether one osteotomy provides more 1-2 intermetatarsal (1-2 IMA) correction than the other. The objective of this systematic review and meta-analysis was to compare the effectiveness of 3 types of first metatarsal osteotomy for reducing the 1-2 IMA in HV correction: the chevron osteotomy, the long plantar arm (modified) chevron osteotomy, and the scarf osteotomy. A systematic search for eligible studies was performed of the following databases: Medline, Embase (Ovid), CINAHL (EBSCO Host), and The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials. Only English-language studies previous to May 2010 were included in the review. Additional hand and electronic content searches of relevant foot and orthopaedic journals were performed. Criteria for inclusion in this analysis included systematic reviews of randomized controlled trials, prospective and retrospective cohort studies, and case-control studies, as well as case-series studies involving the chevron, scarf, or long plantar arm chevron osteotomy of >20 participants with a minimum of 80% follow-up. Quality of evidence of the included studies was assessed with the Grading of Recommendations Assessment, Development and Evaluation system. All pooled analyses were based on a fixed effects model. There was a total of 1351 participants who underwent either a chevron (n = 1028), scarf (n = 300), or long plantar arm chevron osteotomy (n = 23). Only one study for the long plantar arm chevron group fitted the eligibility criteria for this review; however, it was not amenable to meta-analysis. The chevron osteotomy was associated with a mean reduction of 1-2 IMA from preoperative to postoperative of 5.33° (95% confidence interval, 5.12 to 5.54, p < .001), and the scarf osteotomy was associated with a mean reduction of 6.21° (95% confidence interval, 5.70 to 6.72, p < .001). There was a statistically significant 0.88° increase in the correction of the 1-2 IMA in favor of the scarf osteotomy compared with the chevron osteotomy. The studies included in this review were of very low- to low-quality evidence. Our findings indicate that the scarf osteotomy provides greater correction of the 1-2 IMA when used for HV correction. However, only a weak recommendation in favor of the scarf osteotomy can be made based on the low quality of evidence of the studies included in this analysis.
The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 04/2012; 51(4):437-44.
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ABSTRACT: Excessive rearfoot eversion is thought to be a risk factor for patellofemoral pain syndrome development, based on theoretical rationale linking it to greater tibial internal rotation and hip adduction. This study aimed to establish the relationship of rearfoot eversion with tibial internal rotation and hip adduction during walking in individuals with and without patellofemoral pain syndrome.
Twenty-six individuals with patellofemoral pain syndrome and 20 controls (18-35years) participated. Each underwent instrumented three-dimensional motion analysis during over-ground walking. Pearson's correlation coefficients (r) were calculated to establish the relationship of rearfoot eversion with tibial internal rotation and hip adduction (peak and range of motion).
Greater peak rearfoot eversion was associated with greater peak tibial internal rotation in the patellofemoral pain syndrome group (r=0.394, P=0.046). Greater rearfoot eversion range of motion was associated with greater hip adduction range of motion in the patellofemoral pain syndrome (r=0.573, P=0.002) and control (r=0.460, P=0.041) groups; and greater peak hip adduction in the control group (r=0.477, P=0.033).
Associations between greater rearfoot eversion and greater hip adduction indicate that interventions targeted at the foot or hip in individuals with patellofemoral pain syndrome may have similar overall effects on lower limb motion and clinical outcomes. The relationship between rearfoot eversion and tibial internal rotation identified in the patellofemoral pain syndrome group may be related to aetiology. However, additional prospective research is needed to confirm this.
Clinical biomechanics (Bristol, Avon) 03/2012; 27(7):702-5. · 1.76 Impact Factor
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ABSTRACT: Knee osteoarthritis (OA) has been shown to be a risk factor for falls. Reductions in foot clearance during the swing phase of walking can cause a trip and potentially lead to a fall. This study examined the swing phase mechanics of people with and without knee OA during walking.
Minimum toe clearance (MTC) height, joint angles at the time of MTC and the influence of the angular changes of the hip, knee and ankle of the swing leg on foot clearance using sensitivity analysis were investigated in 50 knee OA participants and 28 age-matched asymptomatic controls.
Although both groups had a similar MTC height (controls: 12.8±6.7 mm, knee OA: 13.4±7.0 mm), the knee OA group used a different strategy to achieve the same foot clearance, as evidenced by greater knee flexion (52.5±5.3° vs 49.4±4.8°, p=0.007), greater hip abduction (-3.6±3.3° vs -1.8±3.3°, p=0.03) and less ankle adduction (2.8±1.9° vs 4.2±2.1°, p=0.01).
MTC height was comparable between the groups, however a different swing phase mechanism was used by the knee OA. Although adequate MTC is an important component of safe locomotion, it does not appear to be impaired in people with knee OA. Other factors, such as inadequate responses to postural perturbation, may be responsible for falls in this group.
Gait & posture 02/2012; 35(2):277-81. · 2.58 Impact Factor
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ABSTRACT: To investigate the effectiveness of ultrasound guided corticosteroid injection in the treatment of plantar fasciitis.
Randomised, investigator and participant blinded, placebo controlled trial.
University clinic in Melbourne, Australia.
82 people with a clinical and ultrasound diagnosis of plantar fasciitis unrelated to systemic inflammatory disease.
Participants were randomly allocated to ultrasound guided injection of the plantar fascia with either 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group) or 1 mL normal saline (placebo). Before injection the participants were given an ultrasound guided posterior tibial nerve block with 2% lidocaine (lignocaine).
Primary outcomes were pain, as measured by the foot health status questionnaire (0-100 point scale), and plantar fascia thickness, measured by ultrasound at 4, 8, and 12 weeks.
Reduction in pain at four weeks favoured the dexamethasone group by 10.9 points (95% confidence interval 1.4 to 20.4, P=0.03). Between group differences for pain scores at eight and 12 weeks were not statistically significant. Plantar fascia thickness measured at four weeks favoured the dexamethasone group by -0.35 mm (95% confidence interval -0.67 to -0.03, P=0.03). At eight and 12 weeks, between group differences for plantar fascia thickness also favoured dexamethasone, at -0.39 mm (-0.73 to -0.05, P=0.02) and -0.43 mm (-0.85 to -0.01, P=0.04), respectively. The number needed to treat with dexamethasone for one successful outcome for pain at four weeks was 2.93 (95% confidence interval 2.76 to 3.12). There were no reported adverse events associated with the intervention.
A single ultrasound guided dexamethasone injection is a safe and effective short term treatment for plantar fasciitis. It provides greater pain relief than placebo at four weeks and reduces abnormal swelling of the plantar fascia for up to three months. However, clinicians offering this treatment should also note that significant pain relief did not continue beyond four weeks.
Australian New Zealand Clinical Trials Registry ACTRN12610000239066.
BMJ (Clinical research ed.). 01/2012; 344:e3260.
