Bilateral ankle deformities affects gait kinematics in chronic stroke patients

Useless. You described how to identify a problem but DID NOTHING to solve it.

Hope you're OK with that when you are the 1 in 4 per WHO that has a stroke, you'll want full recovery, this doesn't get you there.

Bilateral ankle deformities affects gait kinematics in chronic stroke patients

Hogene Kim^1,2*, Ji-Eun Cho², Kyeong-Jun Seo² and Jooyoung Lee³

• ¹Department of Clinical Rehabilitation Research, National Rehabilitation Center, Seoul, Republic of Korea
• ²Translational Research Center on Rehabilitation Robots, National Rehabilitation Center, Seoul, Republic of Korea
• ³Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea

Objectives: Stroke patients suffer from ankle joint deformities due to spastic ankle muscles. This study evaluated the viability of using 3D scanned surface images of the feet of stroke victims to visually assess the deformities of a hemiparetic foot and investigated the influences of deformed ankle joints on gait kinematics.

Methods: A total of 30 subjects with stroke-induced hemiparesis and 11 age-matched healthy controls completed the clinical assessments. We analyzed their feet's morphometric characteristics using a 3D scanner, identified convenient anthropometric measurements, and conducted gait trials on even and uneven terrains. The 3D foot morphometric characteristics were evaluated using the geometric morphometrics method (GMM).

Results: Results showed that there were significant differences in bilateral foot shapes between the chronic stroke patients and healthy controls and between the paretic and non-paretic sides in the chronic stroke patients. In stroke patients, those with the smaller medial malleoli's vertical tilt angles showed significantly different ankle ranges of motion of dorsi-/plantar flexion during gaits on uneven terrains (p = 0.009). In addition, those with the greater medial malleoli's vertical tilt angles showed significantly different ankle ranges of motion of inversion/eversion during gaits on even and uneven terrains (p < 0.05).

Conclusion: Using 3D scanning technology, bilateral morphometric changes in the feet of chronic stroke patients were shown by GMM and the simple anthropometric measurements identified its shape deformities in the feet. Their possible effects on gait kinematics while walking on uneven terrains were investigated. Current methodology can be potentially useful in applying conventional productions of clinically manufactured, patient-fitted ankle-foot-orthosis in orthotics and prosthetics, and in detecting various unidentified pathological deformities in the feet.

Introduction

Most patients with upper motor neuron disorders, such as stroke, multiple sclerosis, and amyotrophic lateral sclerosis, have spastic lower limb muscles (1). Specifically, 30–70% of stroke survivors suffer from spastic or stiff ankle muscles (2). Spastic muscles in the ankle joints significantly increase joint stiffness owing to the dependence of the muscle tone on the rising velocity of the stretch reflex (3). Thus, patients with stroke-induced hemiparesis suffer from several movement disorders. Previous studies have reported that the equinus foot condition significantly disrupts the gait patterns of stroke patients (4, 5). Decreased muscle activity in the ankle plantar flexors of such patients reduces the propulsive forces acting during their gait (5). A patient with equinovarus foot requires more time to recover than one without equinus foot and they have to undergo intense rehabilitation (6).

Chronic stroke victims who have not undergone ankle treatments suffer from a constant inequivalence between their major ankle muscles, i.e., the spastic triceps surae and ankle dorsiflexors. This inequivalence is responsible for the geometric deformities of a foot (7). A spastic equinus foot introduces many functional limitations into the daily activities of patients, namely foot drop during gait (4, 8) and balance impairments (9). Various clinical treatments, such as orthopedic surgeries, toxin injections, and ankle-foot-orthoses (AFOs) (10, 11) have been adopted to treat the spastic equinovarus foot condition. AFO is a popular assistive technology that has been used to treat patients having a hemiparetic foot, both inside and outside clinics.

Recent advances in scanned 3D digital imaging technology have been successfully incorporated into clinical practice to enable the treatment of various pathological deformities. For example, standardized measurements of 3D surface images of breasts and head shapes allow for obtaining objective dimensions in a subjective field and overcoming the deficits of conventional 2D photography in plastic and reconstructive surgery. This enables clinicians to reproduce their results and precisely track the deformities of patients (12). Although 3D surface imaging technology can be used in applying it to many patient-fitted assistive devices in rehabilitation clinics, orthotics and prosthetics, the application of 3D surface imaging technology in detecting hemiparetic foot deformities is limited. In addition, the traditional approach to shape analysis, using numerical quantities such as the distance or angle between a foot's landmarks, employs quantities that are less verified than the actual coordinates of the landmarks, ignoring the foot's precise geometry (13).

This study evaluates the viability of using 3D scanned surface images of the feet of stroke patients to visually assess the deformities of a hemiparetic foot. Anthropometric measurements that can locate typical foot landmarks, characteristic of hemiparetic foot abnormalities, are easier to obtain when using modern 3D scanning technology. First, we hypothesized that there was no difference in the foot and ankle shapes (1) between the paretic and non-paretic sides in chronic stroke patients and (2) between the hemiparetic sides of chronic stroke patients and age- and gender-matched healthy controls using the geometric morphometrics method (GMM); variations in foot shapes were examined based on the coordinates of foot landmarks as well as by using the traditional approach. Secondly, we hypothesized that (3) the effect of the anthropometric difference between paretic and non-paretic feet did not affect the gait parameters of chronic stroke patients.