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UDK 616.8
van Zwieten, KoosJaap1; Narain, Faridi H.M.1; Kosten, Lauren1;
Wens, Inez1; Eijnde, Bert O.1; Vandersteen, Marjan1;
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Schmidt, Klaus P. ; Zubova, Irina A. ; Varzin, Sergey A.’ ;
Zinkovsky, Anatoly V.2; Piskun, Oleg E.2
KINEMATICAL ASPECTS OF FOOT MOVEMENTS DURING GAIT IN EARLY MULTIPLE SCLEROSIS PATIENTS
functional Morphology, BioMed Research Institute, University of Hasselt, Diepen-beek, Belgium, koosjaap.vanzwieten@uhasselt.be; Department of Biomechanics and Health Sciences, St. Petersburg State Polytechnical University,
St. Petersburg State University, St. Petersburg, Russia
Renewed interest in gait and balance in Multiple Sclerosis emerges, as the 1 st International Symposium on Gait and Balance in Multiple Sclerosis testifies (International Journal of MS Care, 2011). However, little attention is given to the swing phase of gait in early Multiple Sclerosis patients. As stated by Bethoux& Bennett (2011) “.. .space and time requirements, complexity of data analysis, and prohibitive cost of the equipment and its operation, combined with a comparatively low reimbursement rate, confines the clinical use of ... gait analysis systems.”. These authors suggest using e.g. the GAITrite system to capture gaitcharacteristics. By this system, Yentes and co-workers quantified the medio-lateral sway of the foot as a parameter for Multiple Sclerosis progression (Yentes et al., 2012).
Remarkably, various early Multiple Sclerosis patients produce audible shuffling sounds,caused by the lateral soles of their shod feet over the ground, during the terminal-swing phase of gait (Van Zwieten et al., 2013). It is worthwhile to have a closer look at this almost pathognomonic phenomenon. The common cause seems to be foot-drop including foot-inversion. Foot-inversion is defined as turning the sole of the foot inward, while foot-e version is turning the sole outward (Van Zwieten et al., 2007). In early Multiple Sclerosis, the background of this lateral foot-shuffling seems evident, namely weakness of foot dorsiflexor muscles plus weakness of foot evertor muscles. In early Multiple Sclerosis, however, both muscle-groups may be supported or strengthened - not only by resistance training (Yahia et al., 2011), but also by e.g. Two Degree-of-freedom Ankle-Foot Orthoses(Agrawal et al., 2005) or Functional
Electrical Stimulation Devices (Mount and Dacko, 2006; Esnouf et al., 2010).
Some other aspects must be kept in mind. During the swing phase “...when the foot is in the air and not restricted by ground contact, ...motions are eversion (foot rolls inward while lateral side of foot comes up), dorsiflexion (foot/toes move up), and abduction (foot turns out to the side)” (Dierks, 2011). Recent quantitative data on exercise therapies of ankle weakness patients clearly show that normal foot eversion goes together with simultaneous shank internal rotation (Drewes et al., 2009; Hoch, 2011). This obvious “mechanical coupling” relationship, well-known from the closed kinematic chain concept, thus also holds true for the open kinematic chain, that is: during the swing phase of gait. Its background is the “cardan-like” construction of the human ankle joint (Maestro, 2004; Sheehan Gavelli, 2012).
From a functional-anatomical point of view, normal internal shank rotation during knee flexion is effectuated by the medial hamstring muscles (Lynn and Costigan, 2009). Most authors therefore agree on training Multiple Sclerosis patients. hamstrings (Feys and Van Asch, 2008). Strength training of hamstring muscles appears to have positive effects onmuscular function and gait speed in Multiple Sclerosis patients (Mevellec et al., 2003).
Finally, we presume that abnormal lateral foot shuffling in swing may easily lead to the much-dreaded tripping, stumbling and falling with their far-reaching consequences. This should be avoided as much as possible.
References
Agrawal A, Banala SK, Agrawal SK, Binder-Macleod SA. Design of a Two Degree-of-freedom Ankle-Foot Orthosis for Robotic Rehabilitation.Proceedings of the 2005 IEEE 9th International Conference on Rehabilitation Robotics June 28 - July 1, 2005, Chicago, IL, USA.
Bethoux F, Bennett S. Evaluating Walking in Patients with Multiple Sclerosis Which Assessment Tools Are Useful in Clinical Practice? International Journal of MS Care 2011;13:4-14.
Dierks TA. Pronation in runners: Implications for Injury. Lower Extremity Review Magazine, June 2011.
Drewes LK, McKeon PO, Paolini G, Riley P, Kerrigan DC, Ingersoll CD, Hertel J. Altered ankle kinematics and shank-rear-foot coupling in those with chronic ankle instability. Journal of Sport Rehabilitation 2009;18,3:375-88.
Esnouf JE, Taylor PN, Mann GE, Barrett CL. Impact on activities of daily living using a Functional Electrical Stimulation device to improve dropped foot in people with multiple sclerosis, measured by the Canadian Occupational Performance Measure. Multiple Sclerosis 2010;16,9:1141-47.
Feys P, van Asch P. Rehabilitation in spasticity, MS in Focus 2008;12:15-18.
Hoch MC. The effect of joint mobilization on functional outcomes associated with chronic ankle instability. Dissertation, University of Kentucky, Lexington, Kentucky, USA 2011
Poster Abstracts from the First International Symposium on Gait and Balance in Multiple Sclerosis. International Journal of MS Care 2011;13,4:199-204.
Lynn SK, Costigan PA. Changes in the medial-lateral hamstring activation ratio with foot rotation during lower limb exercise. Journal of Electromyography and Kinesiology 2009;19:e197-e205.
Maestro M, 2004, Rappel biomecanique des articulations talo-cruraleet sous-talienne. Medicine et Chirurgie du Pied 2004;20,1:6-10.
Mevellec E, Lamotte D, Cantalloube S, Amarenco G, Thoumie P. Relationship between gait speed and strength parameters in multiple sclerosis. Annals of Physical and Rehabilitation Medicine 2003;46:85-90.
Mount J, Dacko S. Effects of dorsiflexor endurance exercises on foot drop secondary to multiple sclerosis: A pilot study. Department of Physical Therapy Faculty Pa-pers.Paper 1. 2006; http://jdc.jefferson.edu/ptfp/1
Sheehan Gavelli F. Personal communication 2012.
vanZwieten KJ, Robeyns I, Vandersteen M, Lippens PL, Mahabier R, Lamur KS. Foot muscles preventing inversion traumatisms. Medicine and Science in Tennis 2007;12,2: 34-35.
vanZwieten, KJ, Narain FHM, KostenL,Wens I, Eijnde BO, Vandersteen M, Schmidt KP. Reappraisal of gait patterns in minimally impaired Multiple Sclerosis patients reveals characteristic foot shuffling sounds. International Sound and Vibration Digest 2013;14,1: 5-6.
Yahia A, Ghroubi S, Mhiri C, Elleuch MH. Relationship between muscular strength, gait and postural parameters in multiple sclerosis. Annals of Physical and Rehabilitation Medicine 2011;54: 144-155.
Yentes JM, Huisinga JM, Filipi ML, Stergiou N. Clinical and biomechanical measures of balance in multiple sclerosis. For oral presentation at the 17th Annual Gait and Clinical Movement Analysis Society Meeting. Grand Rapids, Michigan, May 2012.
Abstract
Multiple Sclerosis patients sometimes experience their forward swinging feet to catch the floor unintentionally. Minimally impaired Multiple Sclerosis patients, during terminal-swing phases of gait, may even produce shuffling sounds, by the lateral soles of their feet over the ground. To prevent tripping, such patients should train their medial hamstring muscles.
