Repeatability in the assessment of multi-segment foot kinematics
Introduction
Stereophotogrammetry has been used for two decades to represent shank and foot multi-segment kinematics. Review of the literature demonstrates that several 3D multi-segment foot models (3DMFMs) have been published [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], embodying the international consensus that the foot should be modeled as a number of segments [11]. However, a recent review highlighted a lack of standardization as well as adequate repeatability studies [12]. As a consequence, clinical utility of several 3DMFMs still has to be determined.
Leardini et al. [10] recently described an interesting 3D multi-segment foot model (Leardini Foot Model: LFM) protocol. Noteworthy differences with some other 3DMFMs are the specific marker placement at the calcaneus, the indirect calculation of landmarks (by mid-point calculation), the fact that the midfoot is considered as one rigid segment and the calculation of several planar angles. The latter two components enforce the clinical relevance of the LFM, especially with respect to foot pathologies [8], [12].
With respect to the LFM protocol, reference waveforms for the stance phase of gait have been published for a group of 10 subjects, illustrating ‘typical’ patterns for all 3D rotations and planar angles [10]. Furthermore, the effect of walking cadence on the kinematic waveforms [13], as well as repeatability indices from a repeated measure design have been reported [14]. Results of the latter indicated that most of the 3D rotations can be measured in a repeatable way by experienced clinicians.
Although several studies contributed to an improved understanding of the LFM protocol, it should be stressed that a full picture of the clinical features has not yet been provided in literature. Moreover, kinematic waveforms have only been published for the stance phase of gait despite the fact that other studies have demonstrated the relevance to report the swing phase [15], [16], [17]. Still, replication of the study by a group independent from the authors of the LFM protocol is lacking, thereby limiting the strength of the conclusions on the reproducibility of the protocol [18]. Finally, intrinsic and extrinsic errors have only been quantified for the 3D rotations and not for the planar angles. Knowing consistency and variability of these planar angles is helpful, as it may guide the use and interpretation [19].
Consequently, the aim of the present study was to further explore the kinematic waveforms obtained from the LFM [10], to provide further insight in the repeatability of the protocol in the presence of different expertise levels, as well as to quantify the repeatability of all parameters (3D rotations and planar angles).
Section snippets
Participants
Six symptom-free adult volunteers (three men, three women, age range 22–54 years, BMI 22.2 ± 2.5) were recruited through advertisements at the institution's gait laboratory for a period of 3 months. Potential participants were excluded if they had a history of trauma of the foot and lower limbs, if they presented with a foot deformity (screened via standard clinical examination) or with a systemic or neurological disorder.
Design
A repeated measure design was used in which each participant underwent eight
Results
The self-selected speed adopted by the subjects resulted in a mean stance phase duration of 0.69 s (±0.07 s) and a mean cadence of 107.4 steps/min (±10.6). Distinct patterns for all 3D inter-segmental rotations and planar angles were obtained.
Mean inter-trial CMCs were >0.820 for both therapists (Table 1). With respect to the relative angles, within-day CMC values ranged between 0.782 and 0.987 for the senior clinician, whereas for the junior clinician these indices ranged between 0.673 and 0.991.
Discussion
The present study was designed to independently assess the repeatability of the Leardini Foot Model protocol [10]. Measuring the extent to which gait measurements are consistent or free from variation is critical if appropriate clinical use is to be pursued [19], [21]. Several earlier studies have focused on the repeatability of kinematic data from a 3DMFM, though, often with a less meticulous repeated-measure design. In fact, models with the highest level of scientific credibility are
Conclusion
The current study has illustrated the repeatability of the 3DMFM protocol proposed by Leardini et al. [10]. Kinematic data can be estimated in a repeatable way by an individual therapist, hence illustrating its clinical utility for other gait laboratories. The repeatability was found to be adequate for a number of 3D rotations and planar angles, indicating that an adequate normative database can be installed in gait laboratories. However, it should be emphasized that experience seems to play a
Conflict of interest
The authors declare that no financial and personal relationship exist which could have influence (bias) their work.
Acknowledgments
The authors are grateful to the Agency for Innovation by Science and Technology Flanders for funding this project (Grant: 080659). They would also like to thank Christophe Meyer for his technical support during the initiation of the project.
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