ORCID Profile
0000-0002-4780-225X
Current Organisations
Bern University of Applied Sciences
,
Universität Bern
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-03-2022
DOI: 10.1097/BPO.0000000000002127
Abstract: Slipped capital femoral epiphyses (SCFE) is associated with out-toeing of the foot and external rotation gait. But it is unknown if SCFE patients treated with the modified Dunn procedure have out-toeing at follow up. Therefore, we used instrumented gait analysis and questioned (1) do severe SCFE patients treated with a modified Dunn procedure have symmetrical foot progression angle (FPA) compared with contralateral side and compared with asymptomatic volunteers (2) what is the prevalence of out-toeing gait and what are the outcome socres at follow up. Gait analysis of 22 patients (22 hips) treated with an unilateral modified Dunn procedure for severe SCFE (slip angle degrees, 2002 to 2011) was retrospectively evaluated. Of 38 patients with minimal 5-year follow up, 2 hips (4%) had avascular necrosis of the femoral head and were excluded for gait analysis. Twenty-two patients were available for gait analysis at follow up (mean follow up of 9±2 y). Mean age at follow up was 22±3 years. Mean preoperative slip angle was 64±8 degrees (33% unstable slips) and decreased postoperatively (slip angle of 8±4 degrees). Gait analysis was performed with computer-based instrumented walkway system (GAITRite) to measure FPA with embedded pressure sensors. Patients were compared with control group of 18 healthy asymptomatic volunteers (36 feet, mean age 29±6 y). (1) Mean FPA of SCFE patients (3.6±6.4 degrees) at follow up was not significantly different compared with their contralateral side (5.6±5.5 degrees) and compared with FPA of controls (4.0±4.5 degrees). (2) Of the 22 SCFE patients, most of them (19 hips, 86%) had normal FPA (−5 to 15 degrees), 2 patients had in-toeing (FPA −5 degrees) and 1 had out-toeing (FPA degrees) and was not significantly different compared with control group. (3) Mean modified Harris hip score (mHHS) was 93±11 points, mean Hip Disability and Osteoarthritis Outcome Score (HOOS) score was 91±10 points. Three patients (14%) had mHHS points and walked with normal FPA. The 2 patients with in-toeing and one patient with out-toeing had mHHS points. Patients with severe SCFE treated with modified Dunn procedure had mostly symmetrical FPA and good hip scores at long term follow up. This is in contrast to previous studies. Although 1 patient had out-toeing and 2 patients had in-toeing at follow up, they had good hip scores. Level III—retrospective comparative study.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.GAITPOST.2017.12.029
Abstract: Knee adduction moment (KAM) is often used as a surrogate marker of knee contact force (KCF) during walking. Previous studies have reported potential benefits to reduce KAM in patients with knee osteoarthritis (OA) by foot progression angle adjustment. However, KAM is an external moment and it does not consider any muscle contribution to the joint loading, which should pose a greater influence in running than walking. This study used a computational model to compare KAM and KCF between runners with and without knee OA during running. In addition, we evaluated the KAM and KCF when runners adjusted to an out-toe running style. Kinematic, kinetic, and lower limb EMG data were collected from 9 runners with knee OA and 10 healthy counterparts. They were asked to run at their usual speed with standard shoes on an instrumented treadmill. We found no significant difference in the KAM during running between OA and the healthy group (p > 0.376). However, runners with knee OA exhibited a greater total KCF than the healthy counterparts (p 0.346). Surprisingly, an increase in the longitudinal KCF and total KCF were found with adjustment of foot progression angle (p < 0.046). Unlike the findings reported by the previous walking trials, our findings do not support the notion that foot progression angle adjustment would lead to a lower joint loading during running.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.HUMOV.2019.02.004
Abstract: Foot progression angle adjustment was shown to reduce external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) during level ground walking. However, evidence on effects of foot progression angle adjustment on the above surrogate measures of medial knee loading during stair climbing is limited. Hence, this study examined the effects of toe-in and toe-out gait on EKAM and KAAI during stair ascent and descent. Kinematic and kinetic data were collected from thirty-two healthy adults during stair ascent and descent with toe-in, toe-out and natural gait. A repeated measures ANOVA indicated that toe-in gait significantly reduced the first EKAM peak (P < 0.001) and KAAI (P = 0.002), while toe-out gait significantly increased the first (P < 0.001) and second (P = 0.04) EKAM peaks and KAAI (P < 0.001) when compared with natural gait during stair ascent. During stair descent, toe-in gait significantly reduced the first (P < 0.001) and second (P = 0.032) EKAM peaks and KAAI (P < 0.001), whilst toe-out gait significantly increased the first EKAM peak (P = 0.022) and KAAI (P = 0.028) when compared with natural gait. In conclusion, toe-in gait was found to be a viable strategy in reducing medial knee loading during stair climbing.
Publisher: Oxford University Press (OUP)
Date: 11-04-2022
DOI: 10.1093/JHPS/HNAC001
Abstract: In-toeing of the foot was associated with high femoral version (FV), while Out-toeing was associated with femoral-retroversion. Therefore, we report on (i) foot-progression-angle (FPA), (ii) prevalence of In-toeing and Out-toeing, and (iii) clinical outcome of patients treated with femoral-derotation-osteotomy (FDO). We performed a retrospective analysis involving 20 patients (20 hips) treated with unilateral FDO (2017–18). Of them, 14 patients had increased FV, 6 patients had femoral-retroversion. Follow-up time was mean 1 ± 1 years. All patients had minimal 1-year follow-up and the mean age was 29 ± 8 years. Patients with increased FV (FV & 35°) presented with positive posterior-impingement-test and mean FV was 49 ± 11° (Murphy method). Six patients with femoral-retroversion (FV & 10°) had positive anterior impingement test and mean FV of 5 ± 4°. Instrumented gait analysis was performed preoperatively and at follow-up using the Gaitrite system to measure FPA and was compared to a control group of 18 healthy asymptomatic volunteers (36 feet, mean age 29 ± 6 years). (i) Mean FPA increased significantly (P = 0.006) from preoperative 1.3 ± 7° to 4.5 ± 6° at follow-up for patients with increased FV and was not significantly different compared to the control group (4.0 ± 4.5°). (ii) In-toeing decreased from preoperatively (five patients) to follow-up (two patients) for patients with increased FV. Out-toeing decreased from preoperatively (two patients) to follow-up (no patient) for patients with femoral-retroversion. (iii) Subjective-hip-value of all patients increased significantly (P & 0.001) from preoperative 21 to 78 points at follow-up. WOMAC was 12 ± 8 points at follow-up. Patients with increased FV that underwent FDO walked with less In-toeing. FDO has the potential to reduce In-toeing and Out-toeing and to improve subjective satisfaction at follow-up.
No related grants have been discovered for Heiner Baur.