A Pilot Study of Musculoskeletal Abnormalities in Patients in Recovery from a Unilateral Rupture-Repaired Achilles Tendon

Sun, Dong; Fekete, Gusztáv; Baker, Julien S.; Mei, Qichang; Bíró, István; Zhang, Yan; Gu, Yaodong

doi:10.3390/ijerph17134642

Cited by 15 publications

(20 citation statements)

References 55 publications

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“…Musculoskeletal modeling represents a valuable non-invasive tool to estimate the internal body loads, which could not be directly measured otherwise ( Vigotsky et al, 2019 ; Imani Nejad et al, 2020 ). Modeling estimates showed good agreement with experimentally measured quantities, such as joint loads from instrumented prostheses and muscle activations from EMGs ( Lund et al, 2012 ; Marra et al, 2014 ; De Pieri et al, 2018 , 2019 ; Lunn et al, 2020 ; Sun et al, 2020 ). Through conventional gait analysis and inverse dynamics, we are able to compute kinetic parameters such as net joint moments and joint powers, which provide us insight into the function of various muscle groups in healthy and pathological gait patterns ( Sloot and van der Krogt, 2018 ).…”

Section: Introductionmentioning

confidence: 58%

Altered Muscle Contributions are Required to Support the Stance Limb During Voluntary Toe-Walking

Pieri

Romkes

Wyss

et al. 2022

Front. Bioeng. Biotechnol.

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Toe-walking characterizes several neuromuscular conditions and is associated with a reduction in gait stability and efficiency, as well as in life quality. The optimal choice of treatment depends on a correct understanding of the underlying pathology and on the individual biomechanics of walking. The objective of this study was to describe gait deviations occurring in a cohort of healthy adult subjects when mimicking a unilateral toe-walking pattern compared to their normal heel-to-toe gait pattern. The focus was to characterize the functional adaptations of the major lower-limb muscles which are required in order to toe walk. Musculoskeletal modeling was used to estimate the required muscle contributions to the joint sagittal moments. The support moment, defined as the sum of the sagittal extensive moments at the ankle, knee, and hip joints, was used to evaluate the overall muscular effort necessary to maintain stance limb stability and prevent the collapse of the knee. Compared to a normal heel-to-toe gait pattern, toe-walking was characterized by significantly different lower-limb kinematics and kinetics. The altered kinetic demands at each joint translated into different necessary moment contributions from most muscles. In particular, an earlier and prolonged ankle plantarflexion contribution was required from the soleus and gastrocnemius during most of the stance phase. The hip extensors had to provide a higher extensive moment during loading response, while a significantly higher knee extension contribution from the vasti was necessary during mid-stance. Compensatory muscular activations are therefore functionally required at every joint level in order to toe walk. A higher support moment during toe-walking indicates an overall higher muscular effort necessary to maintain stance limb stability and prevent the collapse of the knee. Higher muscular demands during gait may lead to fatigue, pain, and reduced quality of life. Toe-walking is indeed associated with significantly larger muscle forces exerted by the quadriceps to the patella and prolonged force transmission through the Achilles tendon during stance phase. Optimal treatment options should therefore account for muscular demands and potential overloads associated with specific compensatory mechanisms.

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Section: Introductionmentioning

confidence: 58%

Altered Muscle Contributions are Required to Support the Stance Limb During Voluntary Toe-Walking

Pieri

Romkes

Wyss

et al. 2022

Front. Bioeng. Biotechnol.

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“…46 A combined subject-specific musculoskeletal and foot-ankle complex finite element model was developed to provide potential information for the study purposes and clinical application. 47 The late stance phase of walking (60%-100%) was selected for the finite element analysis, the 60% of the stance phase was defined as initial push-off and the heel start to arise. The 80% moment during the push-off phase was selected as the target point for finite element analysis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Workflow assessing the effect of Achilles tendon rupture on gait function and metatarsal stress: Combined musculoskeletal modeling and finite element analysis

Sun

Song

Cen

et al. 2022

Proc Inst Mech Eng H

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Achilles tendon rupture (ATR) incidence has increased among badminton players in recent years. The foot internal stress was hard to obtain through experimental testing. The purpose of the current research is to develop a methodology that could improve the finite element model derived foot internal stress prediction for ATR clinical and rehabilitation applications. A subject-specific musculoskeletal model was combined with a 3D finite element model to predict the metatarsal stress. The 80% point during the push-off phase of walking was selected for the comparing between injured and uninjured sides. The surgical repaired Achilles tendon (AT) after 12 months was elongated by 5.5% than the uninjured tendon. At 80% point of stance phase, the ankle plantarflexion angle and AT force decreased by 39.6% and 21.9% on the injured side, respectively. The foot inversion degree increased by 22.9% and was accompanied by the redistribution of metatarsals von Mises stress. The stresses on the fourth and fifth metatarsals were increased by 59.5% and 85.9% on the injured side. The workflow is available to assess musculoskeletal disorders and obtain foot internal stress after ATR. The decreased ankle plantar flexor force may be affected by triceps surae muscle atrophy and weakened force transmission ability of elongated AT. The increased von Mises stress on fourth and fifth metatarsals accompanied by higher foot inversion may increase the ankle lateral sprain injury risk.

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“…Sun et al (2020) conducted a study of gait analysis in patients 2 years following the surgical suturing of AT. The authors found that a restraint of plantar flexion of the foot along with a greater deficit in muscle strength is responsible for plantar flexion of the foot on the operated side, resulting in the increased risk in knee injury during gait [ 23 ]. Jadacka et al (2017) [ 24 ] had similar conclusions as Sun et al (2020) [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Supervised Physiotherapy Improves Three-Dimensional (3D) Gait Parameters in Patients after Surgical Suturing of the Achilles Tendon Using an Open Method (SSATOM)

Czamara

Sikorski

2022

JCM

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Background: The aim of this study was to assess the effectiveness of 38 supervised postoperative physiotherapy (SVPh) visits conducted between 1 and 20 weeks after SSATOM on the values of 3D gait parameters measured at 10 and 20 weeks after surgery. Material: Group I comprised male patients (n = 22) after SSATOM (SVPh x = 38 visits) and Group II comprised male patients (n = 22) from the control group. Methods: A non-randomized, open-label, controlled clinical trial was performed in the two groups to obtain the following values: Step length (cm), stride length (cm), step width (cm), next stance phase (%), swing phase (%), double support (%), gait velocity (m/s), and walking frequency (step/min). The measurements were carried out using the BTS SMART system (Italy). Results: Orthopedic examination showed no pain, a negative result of Thompson and Matles tests, and proper healing of Achilles tendon (ultrasound image). In Group I, between 10 and 20 weeks after SSATOM, there was a statistically significant improvement in all tested gait parameter values (p ≤ 0.001 to 0.009). Conclusions: Conducting 38 SVPh visits significantly improved the values of the analyzed kinematic and spatiotemporal gait parameters in patients in the twentieth week after SSATOM, which were mostly close to the non-operated side and the results of the control group. However, the gait speed and stride length were not close to the results of the control group.

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A Pilot Study of Musculoskeletal Abnormalities in Patients in Recovery from a Unilateral Rupture-Repaired Achilles Tendon

Cited by 15 publications

References 55 publications

Altered Muscle Contributions are Required to Support the Stance Limb During Voluntary Toe-Walking

Altered Muscle Contributions are Required to Support the Stance Limb During Voluntary Toe-Walking

Workflow assessing the effect of Achilles tendon rupture on gait function and metatarsal stress: Combined musculoskeletal modeling and finite element analysis

Supervised Physiotherapy Improves Three-Dimensional (3D) Gait Parameters in Patients after Surgical Suturing of the Achilles Tendon Using an Open Method (SSATOM)

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