Skip to main content

Simulated Ankle Equinus Affects Knee Kinematics During Gait

HSS Journal ® volume 12, pages 39–43 (2016)Cite this article

Abstract

Background

It is critical to distinguish gait compensations from true abnormalities when planning interventions to improve gait in individuals with neuromuscular disorders.

Questions/Purposes

The aim of this study was to determine the effect of isolated ankle equinus on knee kinematics during the initial contact phase of gait.

Methods

Ten healthy subjects (29 + 4.3 years) participated, and testing occurred in a motion analysis laboratory. This cross-sectional study investigated five gait conditions in each subject: shoe alone, shoe with unilateral ankle foot orthosis locked at neutral, 10°, 20°, and 30° of fixed ankle plantar flexion. Gait kinematics were recorded and calculated with 3D motion analysis. The difference between the shoe and each brace condition was analyzed by repeated-measures ANOVA. The primary outcome was knee flexion at initial contact.

Results

With greater than 10° simulated ankle equinus, the primary gait compensation pattern was increased knee flexion at initial contact. A significant degree of knee flexion occurred ranging from 7° to 22°.

Conclusion

Our data suggests that observed knee flexion at initial contact may be a compensation pattern in individuals with >10° ankle equinus. However, in individuals with ≤10° ankle equinus, observed knee flexion may represent a true gait deviation. This has clinical significance in the realm of cerebral palsy for treatment planning to improve gait.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Abel MF, Damiano DL, Blanco JS, et al. Relationships among musculoskeletal impairments and functional health status in ambulatory cerebral palsy. J Pediatr Orthop. 2003; 4: 535-541.

    Google Scholar 

  2. Adolfsen SE, Ounpuu S, Bell KJ, DeLuca PA. Kinematic and kinetic outcomes after identical multilevel soft tissue surgery in children with cerebral palsy. J Pediatr Orthop. 2007; 6: 658-667.

    Article  Google Scholar 

  3. Cook RE, Schneider I, Hazlewood ME, Hillman SJ, Robb JE. Gait analysis alters decision-making in cerebral palsy. J Pediatr Orthop. 2003; 3: 292-295.

    Google Scholar 

  4. DeLuca PA, Ounpuu S, Davis RB, Walsh JH. Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy. J Pediatr Orthop. 1998; 6: 712-718.

    Google Scholar 

  5. Desloovere K, Molenaers G, Feys H, Huenaerts C, Callewaert B, Van de Walle P. Do dynamic and static clinical measurements correlate with gait analysis parameters in children with cerebral palsy? Gait Posture. 2006; 3: 302-313.

    Article  Google Scholar 

  6. Dusing SC, Thorpe DE. A normative sample of temporal and spatial gait parameters in children using the GAITRite electronic walkway. Gait Posture. 2007; 1: 135-139.

    Article  Google Scholar 

  7. Etnyre B, Chambers CS, Scarborough NH, Cain TE. Preoperative and postoperative assessment of surgical intervention for equinus gait in children with cerebral palsy. J Pediatr Orthop. 1993; 1: 24-31.

    Google Scholar 

  8. Feng L, Patrick Do K, Aiona M, Feng J, Pierce R, Sussman M. Comparison of hamstring lengthening with hamstring lengthening plus transfer for the treatment of flexed knee gait in ambulatory patients with cerebral palsy. J Child Orthop. 2012; 3: 229-235.

    Article  Google Scholar 

  9. Gage JR. The role of gait analysis in the treatment of cerebral palsy. J Pediatr Orthop. 1994; 6: 701-702.

    Article  Google Scholar 

  10. Gage JR. The identification and treatment of gait problems in cerebral palsy. London: Mac Keith Press; 2009. Distributed by Wiley-Blackwell.

    Google Scholar 

  11. Gough M, Shortland AP. Can clinical gait analysis guide the management of ambulant children with bilateral spastic cerebral palsy? J Pediatr Orthop. 2008; 8: 879-883.

    Article  Google Scholar 

  12. Grant AD, Feldman R, Lehman WB. Equinus deformity in cerebral palsy: a retrospective analysis of treatment and function in 39 cases. J Pediatr Orthop. 1985; 6: 678-681.

    Article  Google Scholar 

  13. Holm I, Tveter AT, Fredriksen PM, Vollestad N. A normative sample of gait and hopping on one leg parameters in children 7-12 years of age. Gait Posture. 2009; 2: 317-321.

    Article  Google Scholar 

  14. Houx L, Lempereur M, Remy-Neris O, Brochard S. Threshold of equinus which alters biomechanical gait parameters in children. Gait Posture. 2013; 4: 582-589.

    Article  Google Scholar 

  15. Kay RM, Dennis S, Rethlefsen S, Reynolds RA, Skaggs DL, Tolo VT. The effect of preoperative gait analysis on orthopaedic decision making. Clin Orthop Relat Res. 2000; 372: 217-222.

    Article  PubMed  Google Scholar 

  16. Kendall FP, Kendall FP. Muscles: testing and function with posture and pain. 5th ed. Baltimore: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  17. Lofterod B, Terjesen T. Results of treatment when orthopaedic surgeons follow gait-analysis recommendations in children with CP. Dev Med Child Neurol. 2008; 7: 503-509.

    Article  Google Scholar 

  18. Lofterod B, Terjesen T, Skaaret I, Huse AB, Jahnsen R. Preoperative gait analysis has a substantial effect on orthopedic decision making in children with cerebral palsy: comparison between clinical evaluation and gait analysis in 60 patients. Acta Orthop. 2007; 1: 74-80.

    Article  Google Scholar 

  19. Maas JC, Huijing PA, Dallmeijer AJ, Harlaar J, Jaspers RT, Becher JG. Decrease in ankle-foot dorsiflexion range of motion is related to increased knee flexion during gait in children with spastic cerebral palsy. J Electromyogr Kinesiol. 2015; 2: 339-346.

    Article  Google Scholar 

  20. Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. 4th ed. Philadelphia: F.A. Davis; 2009.

    Google Scholar 

  21. Perry J, Burnfield JM, Cabico LM. Gait analysis : normal and pathological function. Thorofare: SLACK; 2010.

    Google Scholar 

  22. Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol. 2001; 98–108.

  23. Rose SA, DeLuca PA, Davis RB 3rd, Ounpuu S, Gage JR. Kinematic and kinetic evaluation of the ankle after lengthening of the gastrocnemius fascia in children with cerebral palsy. J Pediatr Orthop. 1993; 6: 727-732.

    Article  Google Scholar 

  24. Sutherland DH, Olshen RA, Biden EN, Wyatt MP, eds. The development of mature walking. London: MacKeith Press; 1988.

    Google Scholar 

  25. Ten Berge SR, Halbertsma JP, Maathuis PG, Verheij NP, Dijkstra PU, Maathuis KG. Reliability of popliteal angle measurement: a study in cerebral palsy patients and healthy controls. J Pediatr Orthop. 2007; 6: 648-652.

    Article  Google Scholar 

  26. Thompson NS, Baker RJ, Cosgrove AP, Saunders JL, Taylor TC. Relevance of the popliteal angle to hamstring length in cerebral palsy crouch gait. J Pediatr Orthop. 2001; 3: 383-387.

    Google Scholar 

  27. Whitall J, Getchell N. From walking to running: applying a dynamical systems approach to the development of locomotor skills. Child Dev. 1995; 5: 1541-1553.

    Article  Google Scholar 

  28. Wren TA, Gorton GE 3rd, Ounpuu S, Tucker CA. Efficacy of clinical gait analysis: a systematic review. Gait Posture. 2011; 2: 149-153.

    Article  Google Scholar 

  29. Wren TA, Kalisvaart MM, Ghatan CE, et al. Effects of preoperative gait analysis on costs and amount of surgery. J Pediatr Orthop. 2009; 6: 558-563.

    Article  Google Scholar 

  30. Zwick EB, Saraph V, Zwick G, Steinwender C, Linhart WE, Steinwender G. Medial hamstring lengthening in the presence of hip flexor tightness in spastic diplegia. Gait Posture. 2002; 3: 288-296.

    Article  Google Scholar 

Download references

Acknowledgments

The authors acknowledge Howard J. Hillstrom, PhD, for statistics and Andy Tse, CO, for brace fabrication.

Disclosures

ᅟ

Conflict of Interest

Lisa C. Drefus, PT, DPT, Jocelyn F. Hafer, BS, MA, and David M. Scher, MD, have declared that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Required Auhtor Forms

Disclosure forms provided by the authors are available with the online version of this article.

Author information

Authors and Affiliations

  1. Pediatric Rehabilitation, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Lisa C. Drefus PT, DPT

  2. Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Lisa C. Drefus PT, DPT, Jocelyn F. Hafer BS, MA & David M. Scher MD

  3. Pediatric Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    David M. Scher MD

Authors
  1. Lisa C. Drefus PT, DPT
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jocelyn F. Hafer BS, MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David M. Scher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa C. Drefus PT, DPT.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

ESM 1

(PDF 1224 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Drefus, L.C., Hafer, J.F. & Scher, D.M. Simulated Ankle Equinus Affects Knee Kinematics During Gait. HSS Jrnl 12, 39–43 (2016). https://doi.org/10.1007/s11420-015-9474-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11420-015-9474-4

Keywords

  • equinus
  • gait
  • knee kinematics
  • cerebral palsy
  • knee flexion
  • gait compensations