An Innovative Clinical Evaluation Protocol after Total Ankle Arthroplasty: A Pilot Study Using Inertial Sensors and Baropodometric Platforms
<p>Ankle Lunge Test (ALT). The patient positions their foot perpendicular to the wall and brings their knee towards it. The foot is then gradually moved away from the wall until the maximum ankle dorsiflexion is achieved without lifting the heel. The distance between the foot and the wall, reported in cm, and the angle of the tibial shaft from the vertical, reported in degrees (°), was then measured.</p> "> Figure 2
<p>Graphical visualization of plantar pressure parameters shown in software.</p> "> Figure 3
<p>Graphical representation of the trunk and pelvis movement during gait.</p> "> Figure 4
<p>Visual plantar pressure distribution before (<b>left</b>) and after surgery (<b>right</b>). The software used a color code based on specific pressure levels, indicating the varying loads as strong (red), medium-strong (green) and medium (blue).</p> ">
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Patient Selection
2.3. Clinical Evaluation
2.4. Physical Examination
2.5. Plantar Pressure and Gait Analysis
2.5.1. Baropodometric Platform
- Load distribution [%] (Figure 2): indicates the load distribution between the feet.
- Total anteroposterior load distribution [%] (Figure 2): indicates the load distribution between the hindfoot and forefoot of both feet. Normal reference values: 40–45% in forefoot; 55–60% in hindfoot.
- Mean pressure [kPa] (Figure 2): indicates the average plantar pressure recorded in each foot. This parameter is improved with the reduction in the difference between the mean pressure values of the operated foot and the non-operated foot. The reference scale considered ranges from 0 to 500 kPa.
- Peak pressure [position, kPa]: indicates the point on the foot where the maximum pressure value is recorded, with the maximum value associated.
- Ellipse area of the body’s barycenter [mm2] (Figure 2): indicates the movement of the barycenter and center of pressure (C.O.P.) of the two feet. The ellipse represents 90% of it.
- Ellipse area of the foot’s barycenter [mm2] (Figure 2): indicates the movement of the barycenter and center of pressure (C.O.P.) of the foot. The ellipse contains 90% of it.
- C.O.P. distance [mm] (Figure 2): indicates the average distance of the C.O.P. trajectory from the central point of the trajectory itself. The reduction of the elliptical surface of the body’s barycenter, elliptical surface of the foot’s barycenter and C.O.P. distance indicates a lower movement of the center of pressure and, therefore, a greater stability of the barycenter of the patient examined.
- Mean pressure [kPa]: indicates the average plantar pressure recorded in each foot. This parameter is improved with the reduction in the difference among the mean pressure values between the operated and non-operated foot. The reference scale considered ranges from 0 to 500 kPa.
- Peak pressure during gait [position, kPa]: indicates the point of the foot where the maximum pressure value is recorded at each step stage (contact phase, intermediate support phase, propulsion phase), with maximum associated value.
- Maximum load points curve: connects all the maximum load points at every moment of the step, in both feet. The normal course of this curve is represented by the normal pronation–supination movements that the foot performed during the gait.
2.5.2. Inertial Sensors
- Walking speed [m/min], normal values: 77.4 m/min for men; 71.4 m/min for women [32].
- Cadence [steps/min]—number of steps per minute, normal values: 52.8 steps/min for men; 55.8 steps/min for women [32].
- Stride length [m]—distance between two consecutive heels strikes of the same foot, normal values: 1.46 m for men; 1.28 m for women [32].
- Stride duration [s]—the time between two consecutive heel strikes of the same foot, normal values: 1.14 (±0.08) s for men; 1.08 (±0.08) s for women [32].
- Step length [m]—between the ipsilateral and contralateral heel strikes. The parameter is expressed as a percentage value considering the stride length; normal values: 50% left; 50% right [32].
- Step duration [s]—the time between ipsilateral and contralateral heel strikes. The parameter is expressed as a percentage value considering the duration of the step cycle (symmetry ratio); normal values: 50% left; 50% right [32].
- Stance duration [% of gait cycle]—the foot support phase, i.e., from heel strike to toe off of the same foot, duration as percentage of gait cycle, normal values: 60.31 (±1.7)% [32].
- Swing duration [% of gait cycle]—the foot swing phase, i.e., from toe-off to heel strike of the same foot, duration as percentage of gait cycle, normal values: 39.6 (±1.9)% [32].
- Double support duration [%]—the duration of the phase of support on both feet as percentage of gait cycle, normal values: 9.4 (±2.3)% for men; 9.6 (±4.6)% for women [32].
- Variability [% of the affected foot gait duration]—the coefficient variation in the duration of the gait of the foot considered. Indicates the reproducibility/repeatability of a step-in time; the lower the value, the more the step is repeatable. Therefore, it undergoes fewer variations during the cycle of the walk.
- Symmetry—the ratio between the swing duration of the right foot and the swing duration of the left foot. It is an index used to evaluate the difference between the two steps during the gait. The ratio of maximum symmetry is when the index is equal to 1.
- TILT (sagittal plane) [°] (Figure 3) is defined as the rotation of the pelvis around its transverse axis. The angle is defined as positive of anterior bending and negative the rear bending.
- OBLIQUITY (frontal plane) [°] (Figure 3): on the frontal plane each “hemi-pelvis” rises during the support phase (stance) and descends in the swing phase of the corresponding leg. Positive angle values (Up) are defined with the lifting of the right pelvis during foot support of the corresponding foot, while negative angle values (Down) are defined with the lowering of the right pelvis resulting in lifting the left pelvis during support of the corresponding foot.
- ROTATION (transverse plane) [°] (Figure 3): each “hemi-pelvis” rotates internally to the side of the dominant leg. Observing the pelvis from above and from the point of view of the analyzed subject, the angle of rotation provided by Biomech is defined as a positive rotation when the right side of the body advances (right internal rotation) and the left side retreats (left outer rotation); it is negative when the left side of the body advances (left internal rotation) and the right side retreats (right external rotation).
2.6. Surgical Technique and Postoperative Management
2.7. Statistical Analysis
3. Results
3.1. Population
3.2. Clinical Evaluation
3.3. Physical Examination
3.4. Baropodometric Platform
3.5. Inertial Sensors
4. Discussion
Limitations and Future Direction
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
List of Abbreviations
17-IFFI | 17-Italian Foot Function Index |
AA | Ankle arthrodesis |
ALT | Ankle Lunge Test |
AOFAS-AHES | American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score |
BMI | Body Mass Index |
C.O.P. | Barycenter and center of pressure |
FPI | Foot Posture Index |
IMUs | Inertial measurement units |
MOxFQ | Manchester–Oxford Foot Questionnaire |
OA | Osteoarthritis |
PROM | Patient-related outcome measure |
ROM | Range of motion |
SF-36 | Short-Form Health Survey |
TAA | Total ankle arthroplasty |
VAS | Visual Analogue Scale |
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Rearfoot Score | −2 | −1 | 0 | 1 | 2 |
Talar head palpation | Talar head palpable on lateral side/but not on medial side | Talar head palpable on lateral side/slightly palpable on medial side | Talar head equally palpable on lateral and medial side | Talar head slightly palpable on lateral side/palpable on medial side | Talar head not palpable on lateral side/but palpable on medial side |
Curves above and below the malleoli | Curve below the malleolus either straight or convex | Curve below the malleolus concave, but flatter/shallower than the curve above the malleolus | Both infra and supra malleolar curves roughly equal | curve below malleolus more concave than curve above malleolus | Curve below malleolus markedly more concave than curve above malleolus |
Calcaneal inversion/eversion | More than an estimated 5° inverted (varus) | Between vertical and an estimated 5° inverted (varus) | Vertical | Between vertical and an estimated 5° everted (valgus) | More than an estimated 5° everted (valgus) |
Forefoot Score | −2 | −1 | 0 | 1 | 2 |
Talo-navicular congruence | Area of TNJ markedly concave | Area of TNJ slightly, but definitely concave | Area of TNJ flat | Area of TNJ bulging slightly | Area of TNJ bulging markedly |
Medial arch height | Arch high and acutely angled towards the posterior end of the medial arch | Arch moderately high and slightly acute posteriorly | Arch height normal and concentrically curved | Arch lowered with some flattening in the central portion | Arch very low with severe flattening in the central portion—arch making ground contact |
Forefoot ab/adduction | No lateral toes visible. Medial toes clearly visible | Medial toes clearly more visible than lateral | Medial and lateral toes equally visible | Lateral toes clearly more visible than medial | No medial toes visible. Lateral toes clearly visible |
Characteristics | No. (tot = 8) |
---|---|
Sex (M/F) | 7/1 |
Age | 66.4 ± 14.3 (48–81) |
Side (Right/Left) | 6/2 |
BMI | 28.14 kg/m2 |
PROMs | Preop Score | Postop Score | p-Value |
---|---|---|---|
AOFAS | 40.8 ± 15.3 | 63.2 ± 12.1 | 0.005 * |
MOxFQ | 66.9 ± 14.3 | 34.4 ± 14.9 | 0.002 * |
VAS | 4.9 ± 1.8 | 2.5 ± 2.1 | 0.037 * |
SF-36 | 63.6 ± 9.4 | 74.2 ± 10.3 | 0.027 * |
17-IFFI | 50.6 ± 13.2 | 38.6 ± 21.4 | 0.115 |
Preop Mean Value | Postop Mean Value | p-Value | |
---|---|---|---|
FPI | 1.9 ± 3.4 | 1.7 ± 2.4 | 0.871 |
ALT (°) | 2.7 ± 7.6 | 3.6 ± 5.8 | 0.626 |
ALT (cm) | 0.75 ± 2.1 | 1 ± 1.6 | 0.626 |
Preop Operated Foot | Postop Operated Foot | p-Value | Preop Non-Operated Foot | Postop Non-Operated Foot | p-Value | ||
---|---|---|---|---|---|---|---|
STATIC | Load distribution (%) | 50.2 ± 6.1 | 49.9 ± 2.8 | 0.889 | 49.8 ± 6.1 | 50.2 ± 2.7 | 0.889 |
Mean pressure (kPa) | 35.8 ± 5.1 | 34.1 ± 3.2 | 0.386 | 33.1 ± 4.8 | 31.5 ± 4.5 | 0.421 | |
Peak pressure (kPa) | 108.0 ± 28.9 | 115.0 ± 63.9 | 0.770 | ||||
Foot barycenter (mm2) | 21.8 ±17.1 | 17.2 ± 13.9 | 0.232 | ||||
Body barycenter (mm2) | 86.4 ± 78.6 | 42.3 ± 20.2 | 0.191 | ||||
C.O.P. distance (mm) | 169.9 ± 86.1 | 126.4 ± 30.9 | 0.282 | ||||
DYNAMIC | Mean pressure (kPa) | 64.3 ± 7.2 | 68.9 ± 11.1 | 0.301 | 60.4 ± 6.1 | 70.6 ± 7.2 | 0.036 * |
Peak pressure in contact phase | 145.3 ± 23.7 | 165.5 ± 29.1 | 0.211 | ||||
Peak pressure in intermediate phase | 143.5 ± 9.5 | 139.4 ± 30.2 | 0.728 | ||||
Peak pressure in propulsion phase | 181.9 ± 49.2 | 169.2 ± 59.7 | 0.658 |
Preop Both Feet | Postop Both Feet | p-Value | Preop Operated Foot | Postop Operated Foot | p-Value | Preop Non-Operated Foot | Postop Non-Operated Foot | p-Value | |
---|---|---|---|---|---|---|---|---|---|
Walking speed (m/min) | 56.6 ± 10.8 | 52.3 ± 13.3 | 0.114 | ||||||
Cadence (steps/min) | 45.3 ± 4.6 | 47.7 ± 11.2 | 0.544 | ||||||
Stride length (m) | 1.25 ± 0.1 | 1.10 ± 0.1 | 0.031 * | ||||||
Stride duration (s) | 1.33 ± 0.1 | 1.32 ± 0.3 | 0.911 | ||||||
Step length (m) | 0.63 ± 0.1 | 0.54 ± 0.1 | 0.003 * | 0.61 ± 0.1 | 0.56 ± 0.1 | 0.206 | |||
Step duration (s) | 0.65 ± 0.1 | 0.61 ± 0.2 | 0.581 | 0.68 ± 0.1 | 0.71 ± 0.2 | 0.635 | |||
Stance duration (%) | 60.8 ± 1.9 | 62.0 ± 5.4 | 0.564 | 62.3 ± 2.6 | 65.8 ± 6.7 | 0.195 | |||
Swing duration (%) | 37.0 ± 2.1 | 36.5 ± 4.9 | 0.812 | 35.9 ± 2.6 | 32.4 ± 6.5 | 0.189 | |||
Double support duration (%) | 12.6 ± 1.1 | 14.5 ± 2.6 | 0.089 | ||||||
Gait variability (%) | 4.9 ± 0.9 | 6.4 ± 4.7 | 0.423 | 5.9 ± 2.2 | 6.6 ± 2.9 | 0.499 | |||
Symmetry index | 0.9 ± 0.1 | 1.1 ± 0.3 | 0.265 |
Preop | Postop | p-Value | |
---|---|---|---|
Tilt (°) | 0.87 ± 0.8 | 0.35 ± 0.3 | 0.139 |
Obliquity (°) | 0.17 ± 0.1 | 0.61 ± 0.9 | 0.198 |
Rotation (°) | 0.28 ± 0.2 | 0.48 ± 0.4 | 0.283 |
Preop Operated Foot Mean Value | Postop Operated Foot Mean Value | p-Value | |
---|---|---|---|
Active dorsal flexion (°) | 14.4 ± 7.9 | 11.6 ± 4.9 | 0.417 |
Passive dorsal flexion (°) | 13.8 ± 9.2 | 14.3 ± 5.6 | 0.898 |
Active plantar flexion (°) | 21.4 ± 6.2 | 11.6 ± 4.8 | 0.014 * |
Passive plantar flexion (°) | 21.5 ± 8.4 | 16.5 ± 4.2 | 0.044 * |
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Mazzotti, A.; Arceri, A.; Abdi, P.; Artioli, E.; Zielli, S.O.; Langone, L.; Ramponi, L.; Ridolfi, A.; Faldini, C.; Brognara, L. An Innovative Clinical Evaluation Protocol after Total Ankle Arthroplasty: A Pilot Study Using Inertial Sensors and Baropodometric Platforms. Appl. Sci. 2024, 14, 1964. https://doi.org/10.3390/app14051964
Mazzotti A, Arceri A, Abdi P, Artioli E, Zielli SO, Langone L, Ramponi L, Ridolfi A, Faldini C, Brognara L. An Innovative Clinical Evaluation Protocol after Total Ankle Arthroplasty: A Pilot Study Using Inertial Sensors and Baropodometric Platforms. Applied Sciences. 2024; 14(5):1964. https://doi.org/10.3390/app14051964
Chicago/Turabian StyleMazzotti, Antonio, Alberto Arceri, Pejman Abdi, Elena Artioli, Simone Ottavio Zielli, Laura Langone, Laura Ramponi, Arianna Ridolfi, Cesare Faldini, and Lorenzo Brognara. 2024. "An Innovative Clinical Evaluation Protocol after Total Ankle Arthroplasty: A Pilot Study Using Inertial Sensors and Baropodometric Platforms" Applied Sciences 14, no. 5: 1964. https://doi.org/10.3390/app14051964