an investigation into the relationship between rocker sole designs and alteration to lower limb ...

423 Pages·2014·23.11 MB·English

by  Andrey Aksenov

AN INVESTIGATION INTO THE
RELATIONSHIP BETWEEN ROCKER SOLE
DESIGNS AND ALTERATION TO LOWER LIMB
KINETICS, KINEMATICS AND MUSCLE

FUNCTION DURING ADULT GAIT

ANDREY AKSENOV

Ph.D. Thesis 2014
AN INVESTIGATION INTO THE
RELATIONSHIP BETWEEN ROCKER SOLE
DESIGNS AND ALTERATION TO LOWER LIMB
KINETICS, KINEMATICS AND MUSCLE

FUNCTION DURING ADULT GAIT

Andrey Aksenov

Centre for Health Research
School of Health Sciences
University of Salford
Salford UK

Submitted in fulfilment of the requirements of the Degree of Doctor of
Philosophy, February 2014
I TABLE OF CONTENTS I
II LIST OF FIGURES VIII
III LIST OF TABLES XVIII
IV ACKNOWLEDGMENTS XXVIII
V ABSTRACT XXIX
VI LIST OF ABBREVIATIONS XXXI

CHAPTER 1 ........................................................................................................................ 1
1 INTRODUCTION ................................................................................................................... 1
1.1 Rocker-soled shoes ...................................................................................................... 1
1.2 Thesis content .............................................................................................................. 7
CHAPTER 2 .................................................................................................................................. 9
2 INTERMITTENT CLAUDICATION (IC) ................................................................................... 9
2.1 Chapter overview ......................................................................................................... 9
2.2 Intermittent Claudication (IC) ...................................................................................... 9
2.3 Treatment regimes .................................................................................................... 11
2.3.1 Walking exercise therapy in the treatment of IC ............................................... 11
2.3.2 Progressive resistance training (PRT) ................................................................. 15
2.4 Drug therapy .............................................................................................................. 16
2.5 Discussion .................................................................................................................. 16
2.6 Orthotic intervention ................................................................................................. 17
2.6.1 Rocker-soled shoes ............................................................................................. 17
2.6.2 Raised heels ........................................................................................................ 18
2.6.3 Specifically-designed rocker profiles .................................................................. 19
2.6.4 Chapter summary ............................................................................................... 21
CHAPTER 3 ................................................................................................................................ 23
3 ABLE-BODIED ADULT GAIT AND CLAUDICANT PATHOLOGICAL GAIT ............................ 23
3.1 Phases of able-bodied adult gait ............................................................................... 23
3.2 Muscles of lower limb ................................................................................................ 24
3.3 The role of the ankle plantarflexor muscles .............................................................. 25
I
3.4 The effect of IC on gait parameters and muscle strength in older people - a review
of the literature regarding its effect and possible treatment regimes .................................... 26
3.4.1 The effect of PAD severity and ABPI values on gait parameters and ambulatory
function. 26
3.4.2 The effect of increasing age and PAD ................................................................. 26
3.4.3 The effects of a PAD-IC ....................................................................................... 27
3.4.4 The effect of exercise, drug therapy on claudicant gait parameters ................. 30
3.4.5 Overall analysis regarding gait parameters associated with PAD-IC.................. 31
3.5 The effect of walking with shoes adapted with rocker sole profiles ......................... 32
3.5.1 Reduction of plantar foot pressures ................................................................... 32
3.6 Alteration to lower limb joint kinetics and kinematics .............................................. 34
3.6.1 Joint Rotation...................................................................................................... 34
3.7 Alteration to externally-applied sagittal plane lower limb joint moments ............... 37
3.7.1 Sagittal plane knee joint moments ..................................................................... 37
3.7.2 Sagittal plane ankle powers ................................................................................ 38
3.7.3 Alteration to EMG activity .................................................................................. 38
3.8 Comment ................................................................................................................... 39
3.9 Alteration to oxygen consumption ............................................................................ 40
3.10 Overall chapter analysis ............................................................................................. 40
CHAPTER 4 ................................................................................................................................ 42
4 MUSCLE PHYSIOLOGY AND RELATED BIOMECHANICS ................................................... 42
4.1 Chapter overview ....................................................................................................... 42
4.2 Basic terminology used in this thesis for muscle biomechanics and gait analysis .... 42
4.2.1 Planes and axes .................................................................................................. 42
4.2.2 Lower limb skeletal structure and joint motions ............................................... 44
4.3 Muscle anatomy ........................................................................................................ 48
4.3.1 Skeletal muscle structure ................................................................................... 51
4.3.2 Tendons .............................................................................................................. 53
4.3.3 Force generation ................................................................................................ 54
4.3.4 Muscle fibre types .............................................................................................. 55
4.3.5 The pennation angle of muscles ......................................................................... 58
4.3.6 Muscle contraction ............................................................................................. 61
4.3.7 Force-length relationships of muscle fibres ....................................................... 62
4.3.8 Force-length relationships (for the entire muscle) ............................................ 64
II
4.4 Comment ................................................................................................................... 67
4.4.1 Force-velocity relationship ................................................................................. 70
4.4.2 Isometric force .................................................................................................... 71
4.4.3 Development of tension in a muscle .................................................................. 72
4.5 Ankle muscles mechanics and properties for gastrocnemius (GAS), soleus (SOL),
tibialis anterior (TA) .................................................................................................................. 72
4.5.1 The Achilles tendon moment arm ...................................................................... 74
4.5.2 Optimal pennation angle for gastrocnemius and soleus during dynamic
movement ......................................................................................................................... 75
4.6 The effect of footwear features on muscle parameters ........................................... 77
4.6.1 Introduction ........................................................................................................ 77
4.6.2 Rocker sole designs, alteration to heel height and their biomechanical effect . 78
4.6.3 Alteration to heel height .................................................................................... 79
4.6.4 Rocker sole Apex Position (AP) ........................................................................... 89
4.6.5 Shoe forepart flexibility ...................................................................................... 91
4.6.6 Rocker Angle (RA) ............................................................................................... 92
4.6.7 The posterior heel curve (HC) ............................................................................. 93
4.6.8 Hypothesis for curved heeled shoes .................................................................. 95
4.7 Summary .................................................................................................................... 95
4.8 Overarching and specific hypotheses ........................................................................ 99
CHAPTER 5 .............................................................................................................................. 109
5 METHODOLOGY .............................................................................................................. 109
5.1 Chapter overview ..................................................................................................... 109
5.2 The motion analysis system ..................................................................................... 109
5.2.1 Camera setup .................................................................................................... 111
5.2.2 Oqus 3+ Qualisys calibration ............................................................................ 112
5.2.3 Calibration results ............................................................................................. 115
5.3 The force Platforms ................................................................................................. 116
5.3.1 Reflective marker set selection ........................................................................ 118
5.3.2 The Calibration Anatomical System technique (CAST) ..................................... 120
5.3.3 Definition of the segment coordinate systems ................................................ 121
5.4 Electromyography (EMG) data collection ................................................................ 127
5.4.1 Electromyography equipment .......................................................................... 127
5.4.2 Data collection procedure ................................................................................ 128
III
5.4.3 Study Design ..................................................................................................... 131
5.4.4 Participants ....................................................................................................... 131
5.5 Footwear selection criteria ...................................................................................... 132
5.6 Procedure used to adapt shoes with rocker sole profiles ....................................... 134
5.7 Gait laboratory testing procedure ........................................................................... 139
5.7.1 Static tests ........................................................................................................ 142
5.7.2 Dynamic tests ................................................................................................... 142
5.8 Data analysis ............................................................................................................ 148
5.8.1 Data processing overview ................................................................................. 148
5.8.2 Kinematic data processing ................................................................................ 149
5.8.3 Visual3D ............................................................................................................ 150
5.8.4 Signal Processing in Visual3D ........................................................................... 152
5.8.5 Modelling requirements for OpenSim from Visual 3D ..................................... 156
5.8.6 Exporting data to OpenSim .............................................................................. 156
5.8.7 OpenSim ........................................................................................................... 157
5.9 Properties and models of muscles (Muscle-tendon dynamics) .............................. 161
5.10 Calculation of the outcome measures ..................................................................... 165
5.10.1 Introduction ...................................................................................................... 165
5.10.2 Joint angles ....................................................................................................... 165
5.10.3 Kinetic data ....................................................................................................... 166
5.10.4 Muscle-tendon properties ................................................................................ 167
5.10.5 OpenSim algorithm for calculation muscles moment arm, muscle-tendon
length and force .............................................................................................................. 168
5.10.6 Area under the curve (impulse) ........................................................................ 170
5.11 Data normalisation .................................................................................................. 172
5.11.1 Normalisation techniques for the ankle joint .................................................. 179
5.11.2 The first technique analysed for ankle joint normalisation ............................. 182
5.11.3 The second technique for ankle joint normalisation ....................................... 183
5.11.4 Kinetic data normalisation................................................................................ 185
CHAPTER 6 .............................................................................................................................. 186
6 RESULTS AND STATISTICAL ANALISIS: KINEMATICS, KINETICS, ELECTROMYOGRAPHY
AND MUSCLE FUNCTION DATA ............................................................................................. 186
6.1 Subject demographics .............................................................................................. 186
6.2 Trial conditions analysed ......................................................................................... 186
IV
6.3 Gait cycle terms of reference .................................................................................. 187
6.3.1 Ankle, knee and hip kinematics, kinetics, EMG and muscle function results .. 188
6.3.2 Ankle sagittal plane ROM ................................................................................. 193
6.3.3 The effect of altering rocker sole apex position (AP) ....................................... 197
6.3.4 The effect of altering rocker apex angle (toe angle-TA) .................................. 201
6.3.5 The effect of adding heel curves ...................................................................... 205
6.4 The effect of altering rocker sole stiffness at the metatarsal arcade area ............. 208
6.4.1 Alteration to sagittal plane ankle kinematics ................................................... 208
6.4.2 Alteration to ankle ROM produced by different forefoot sole flexibilities ...... 209
6.4.3 Summary of ankle angle results for variation in shoe forefoot flexibility ........ 210
6.5 SAGITTAL PLANE KNEE KINEMATICS ........................................................................ 211
6.5.1 The effect of walking with different heel heights ............................................ 211
6.5.2 Alteration to kinetics of the knee during swing phase whilst walking in different
heel heights ..................................................................................................................... 213
6.5.3 Knee sagittal plane ROM .................................................................................. 214
6.5.4 Summary – sagittal plane knee joint angle for different heel heights ............. 216
6.5.5 The effect of altering rocker sole apex position (AP) ....................................... 217
6.5.6 Toe angle (apex angle) ...................................................................................... 219
6.5.7 Heel curves ....................................................................................................... 221
6.5.8 Rocker profile stiffness at the metatarsal area ................................................ 223
6.6 Hip kinematics .......................................................................................................... 226
6.6.1 The effect of walking with different heel heights ............................................ 226
6.6.2 The effect of altering rocker sole apex position (AP) ....................................... 229
6.6.3 Apex angle (toe angle) ...................................................................................... 230
6.6.4 Curved heels ..................................................................................................... 231
6.6.5 Rocker profile stiffness at metatarsal area ...................................................... 232
6.7 Ankle Moments ........................................................................................................ 233
6.7.1 The effect of heel height alteration.................................................................. 233
6.7.2 The effect of altering rocker sole apex position (AP) ....................................... 239
6.7.3 Apex angle (toe angle-TA) ................................................................................ 242
6.7.4 Heel curves ....................................................................................................... 245
6.7.5 Rocker profile stiffness at metatarsal area ...................................................... 248
6.8 Ankle Power ............................................................................................................. 251
6.8.1 The effect of walking with different heel heights (HH) .................................... 251
V
6.8.2 The effect of altering rocker sole apex position (AP) ....................................... 254
6.8.3 The effect of altering apex angle (toe angle-TA) .............................................. 256
6.8.4 The effect of altering heel curve ...................................................................... 258
6.8.5 The effect of altering rocker profile stiffness at metatarsal area .................... 260
6.9 Electromyography data for ankle joint .................................................................... 261
6.9.1 The effect of walking with different heel heights ............................................ 261
6.9.2 The effect of altering rocker sole apex position (AP) ....................................... 266
6.9.3 The effect of altering apex angle (toe angle-TA) .............................................. 268
6.9.4 The effect of altering heel curves ..................................................................... 271
6.9.5 The effect of altering rocker profile stiffness at metatarsal area .................... 273
6.10 Soleus electromyography results............................................................................. 274
6.10.1 The effect of walking with different heel heights ............................................ 274
6.10.2 The effect of altering rocker sole apex position (AP) ....................................... 279
6.10.3 The effect of altering apex angle (toe angle-TA) .............................................. 281
6.10.4 The effect of altering heel curves ..................................................................... 283
6.10.5 The effect of altering rocker profile stiffness at metatarsal area .................... 285
6.11 Tibialis anterior electromyography results .............................................................. 287
6.11.1 The effect of walking with different heel heights ............................................ 287
6.11.2 The effect of altering rocker sole apex position (AP) ....................................... 290
6.11.3 The effect of altering apex angle (toe angle-TA) .............................................. 290
6.11.4 The effect of altering heel curve ...................................................................... 291
6.11.5 The effect of altering rocker profile stiffness at metatarsal area .................... 293
6.12 Achilles muscle moment arm .................................................................................. 295
6.12.1 The effect of altering heel height of the sole on Achilles muscle moment arm295
6.12.2 The effect of altering rocker sole apex position (AP) on Achilles muscle
moment arm ................................................................................................................... 297
6.12.3 The effect of altering apex toe angle of the sole on Achilles muscle moment
arm 299
6.12.4 The effect of altering heel curve of the sole on Achilles muscle moment arm 301
6.12.5 The effect of altering rocker profile stiffness at metatarsal area on Achilles
muscle moment arm ....................................................................................................... 303
6.13 Gastrocnemius and Soleus fibre length alteration .................................................. 304
6.13.1 Heel Height (HH) ............................................................................................... 304
6.13.2 Apex position (AP) ............................................................................................ 306
6.13.3 Toe angle (TA) ................................................................................................... 309
VI
6.13.4 Heel Curve ........................................................................................................ 311
6.13.5 Flexibility of the sole ......................................................................................... 312
6.13.6 Heel Height (HH) ............................................................................................... 314
6.13.7 Apex position (AP) ............................................................................................ 317
6.13.8 Toe angle (TA) ................................................................................................... 319
6.13.9 Heel Curve ........................................................................................................ 321
6.13.10 Flexibility of the sole ......................................................................................... 323
6.14 Tendon force ............................................................................................................ 323
6.15 Tibialis anterior fibre lengthening/shortening velocity ........................................... 326
6.15.1 Heel Height (HH) ............................................................................................... 326
6.15.2 Curved heels ..................................................................................................... 330
CHAPTER 7 .............................................................................................................................. 335
7 DISCUSSION .................................................................................................................... 335
7.1 Sagittal plane ankle kinematics ............................................................................... 335
7.1.1 The effect of walking with rocker soles incorporating different heel heights . 336
7.2 The effect of altering footwear on calf muscle functioning .................................... 339
7.2.1 Introduction ...................................................................................................... 339
7.2.2 The effect of heel height alteration.................................................................. 341
7.2.3 Conclusion ........................................................................................................ 345
7.3 The effect of walking with rocker soles incorporating different apex positions ..... 345
7.4 The effect of different rocker apex positions (APs) on muscle function. ................ 346
7.4.1 Conclusion ........................................................................................................ 350
7.5 The effect of different toe apex angles on muscle function ................................... 351
7.6 The effect of different curved heels on muscle function ........................................ 353
7.7 Limitations to the methodology and the approach adopted .................................. 356
7.7.1 The walking trials .............................................................................................. 356
7.7.2 Kinetic and Kinematic data ............................................................................... 357
7.7.3 OpenSim limitation ........................................................................................... 358
7.7.4 The OpenSim velocity of muscle-tendon length calculation limitations ......... 359
7.7.5 External foot marker placement and rigid foot model .................................... 359
7.7.6 The walking speed limitation ............................................................................ 360
7.7.7 Conclusion and future work ............................................................................. 360
REFERENCES ........................................................................................................................... 365
APENDICES ............................................................................................................................. 385
VII
LIST OF FIGURES
Figure 3.1: The determinants of gait (Cuccurullo, 2004). ....................................................................... 23
Figure 3.2: Increase in EMG activity when walking with a negative heel rocker soled shoe [Adapted
from (Li and Hong, 2007)]. ...................................................................................................................... 39
Figure 3.3: A negative-heel rocker soled shoe [adapted from Yamamoto et al. (2000)]. ....................... 39
Figure 4.1: The anatomical position, with three reference planes and six directions............................. 43
Figure 4.2: An example of a shank segment for medial/lateral aspects and proximal/distal ends of the
segments. ............................................................................................................................................... 44
Figure 4.3: Basic anatomical points for lower limb bones, segments and joints for gait analysis. .......... 45
Figure 4.4: Osseous structure of the foot. .............................................................................................. 46
Figure 4.5: Motion of the lower limb joints. ........................................................................................... 46
Figure 4.6: Linear and angular movements for foot segment movement in all planes and directions. .. 47
Figure 4.7: The major muscles of the lower limbs. ................................................................................. 49
Figure 4.8: The main ankle plantar/dorsiflexion muscles which were investigated to seek further
understanding of their mutual relationships in performing muscle work whilst wearing different
footwear features in this research, (a) - posterior view of gastrocnemius muscles, (b) posterior view of
soleus muscle, (c) – anterior view of tibialis anterior muscle [picture adapted from (Palastanga and
Soames, 2012)]. ...................................................................................................................................... 50
Figure 4.9: basic muscle structure. ......................................................................................................... 51
Figure 4.10: Diagram representing thick and thin filaments during two stages of contraction [adapted
from (Tözeren, 2000)]............................................................................................................................. 52
Figure 4.11: Typical normalised force-length relationships for a tendon. .............................................. 54
Figure 4.12: Muscle fibre composition and maximum oxygen uptake rates in athletes representing
different sports (Katch et al., 2011). ....................................................................................................... 57
Figure 4.13: Skeletal muscle fibre recruitment during a physical workout [adapted from (Abernethy et
al., 2013)]. ............................................................................................................................................... 57
Figure 4.14: Muscle architecture of fibres: (A) fusiform, (B) sheet, (C) pennate (Palastanga and Soames,
2012). ..................................................................................................................................................... 59
Figure 4.15: The muscle-tendon actuator principle model where 𝐹𝑀 – muscle force, , 𝐹𝑇 – tendon
force, α – pennation angle of the muscle, (𝑙𝑇) – tendon length, (𝑙𝑀) – muscle length (Zajac, 1989,
Delp, 1990, Hoy et al., 1990a, Abernethy et al., 2013). .......................................................................... 60
Figure 4.16: Medial gastrocnemius pennation angle relationship with fibre length at rest (Narici et al.,
1996). ..................................................................................................................................................... 61
VIII