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Joint Angle, Range of Motion, Force, and Moment Assessment: Responses of the Lower Limb to Ankle Plantarflexion and Dorsiflexion

Joint Angle, Range of Motion, Force, and Moment Assessment: Responses of the Lower Limb to Ankle... Hindawi Applied Bionics and Biomechanics Volume 2021, Article ID 1232468, 13 pages https://doi.org/10.1155/2021/1232468 Research Article Joint Angle, Range of Motion, Force, and Moment Assessment: Responses of the Lower Limb to Ankle Plantarflexion and Dorsiflexion 1,2 2 2 2 Ukadike Chris Ugbolue , Chloe Robson, Emma Donald, Kerry L. Speirs, 3 1,4 5 1 Frédéric Dutheil , Julien S. Baker , Tilak Dias , and Yaodong Gu Faculty of Sports Science, Ningbo University, China School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire G72 0LH, UK CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, 63000 Clermont-Ferrand, France Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong Advanced Textiles Research Group, School of Art and Design, Bonington Building, Nottingham Trent University, UK Correspondence should be addressed to Ukadike Chris Ugbolue; u.ugbolue@uws.ac.uk Received 8 April 2021; Revised 23 July 2021; Accepted 25 August 2021; Published 20 September 2021 Academic Editor: Weijie Fu Copyright © 2021 Ukadike Chris Ugbolue et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There is limited research on the biomechanical assessment of the lower limb joints in relation to dynamic movements that occur at the hip, knee, and ankle joints when performing dorsiflexion (DF) and plantarflexion (PF) among males and females. This study investigated the differences in joint angles (including range of motion (ROM)) and forces (including moments) between the left and right limbs at the ankle, knee, and hip joints during dynamic DF and PF movements in both males and females. Using a general linear model employing multivariate analysis in relation to the joint angle, ROM, force, and moment datasets, the results revealed significant main effects for gender, sidedness, phases, and foot position with respect to joint angles. Weak correlations were observed between measured biomechanical variables. These results provide insightful information for clinicians and biomechanists that relate to lower limb exercise interventions and modelling efficacy standpoints. 1. Introduction roles in human stability and locomotion [2–4]. There is a definitive need in previous and present research for reliable The Augmented Video-based Portable System and the gold studies focusing upon the differences in ankle, knee, and standard 3D Vicon Motion Analysis System (Vicon-UK, hip kinematics and kinetics with direct association to dorsi- flexion (DF) and plantarflexion (PF). Minns Business Park, West Way, Oxford, UK) are validated motion analyses systems that are useful for evaluating the The ankle and the lower limb joints assist with the trans- motion characteristics of the lower limbs [1]. These systems mission of forces and loads between the leg and foot during can work simultaneously and may be integrated with force weight-bearing activities resulting in effective mobility and plates and electromyographic systems. From an anatomical flexibility [5]. The ankle functionally acts as a talocrural joint with movement controlled by two joints, namely, the distal perspective and in line with the Vicon® Plug-In-Gait model (which is predominantly used to biomechanically evaluate end of the tibia and fibula of the lower leg and proximal joint movement), the lower extremity consists of the foot, end of the talus of the foot. DF and PF are movements ankle, knee, and hip joints. These joints all play important exhibited by the ankle. The subtalar joint along with 2 Applied Bionics and Biomechanics ° ° articulation of the other talar bones facilitates inversion and (40-70 of flexion needed) and sit to stand (104 of flexion eversion motions. From a functionality perspective, the dor- needed) [14]. Arnold et al. suggest that the hip flexors do siflexor muscles aid the body in clearing the foot during the not necessarily directly affect the passive movement of the swing phase as well as controlling plantarflexion of the foot ankle; however, it does facilitate the knee to complete its during a heel strike. Plantarflexor muscles are imperative movement, which can influence the flexibility of the to performance during an abundance of daily tasks, from ankle [15]. stair climbing and walking to rising from a chair [6]. During To date, no research has effectively measured the kine- gait motion, the foot must adapt to uneven surfaces and matics and kinetics of the lower limbs during ankle DF absorb shocks before biomechanically changing to exert and ankle PF in a standing position. Nor has a longitudinal force in the later stages when acting as a lever [7]. This fur- study been completed to incorporate changes over time ther permits the muscles and ligaments to contribute to under DF and PF conditions. Therefore, further in-depth overall stability, and therefore, a biomechanical evaluation investigation is required. There has been a definitive need, of this function can aid in treatment from injury and notifi- previously and presently for reliable research studies to focus cation of any dysfunctions [5, 8]. on the differences in ankle, knee, and hip kinematics and The normal range of motion (ROM) of the ankle during kinetics with direct association to PF and DF. There are ° ° DF is 10-20 degrees ( research topics on DF and PF during landing and other ) and 25-30 during PF, contributing to inversion and eversion [9]. Among healthy and physically movements; however, there is little information regarding active individuals, greater passive DF ROM is seen to the dynamic movements of the ankle whilst standing in rela- increase the risk of knee displacement and these biomechan- tion to the biomechanical correlates of movement at the ical factors can be associated with further injuries such as knee and hip joints. anterior cruciate ligament injury during landing [10]. Simi- The purpose of this study was to investigate any differ- larly, Flanagan et al. suggest the capabilities of the ankle in ences in joint angles, range of motion (ROM), forces, and relation to the plantarflexors can change as much as 25% moments between the left and right limbs at the ankle, knee, depending on age and gender with respect to torque and and hip joints during dynamic DF and PF movements in ROM. Ankle injuries are the most common injury when par- both male and female subjects. It is hypothesized that (a) ticipating in exercise and sport [4] with the plantarflexors females will have a greater ROM in both DF and PF in com- and dorsiflexors potentially playing a role in reducing the parison to males and (b) the heel raise task will produce likelihood of injury. The ankle plantarflexors can substan- higher ground reaction forces, higher forces at the lower tially change the risk of an anterior cruciate ligament and limb joints, and larger moments at the lower limb joints in knee displacement injury [10]. Conversely, dorsiflexors can- comparison to the fore-foot raise task. not withstand the same volume of shock as their counter- parts. As the ground reaction force applied to the joint increases, the hip, knee, and ankle acquire further strain, 2. Method which would occur during landing from height or pivotal situations. 2.1. Participants. Twenty-two healthy individuals, twelve The knee is able to passively affect the DF and PF angles males and ten females, with a mean ± SD age, height, and at the ankle through the Achilles tendons becoming con- body mass of 23:04 ± 2:8 years, 169:82 ± 5:88 cm, and tracted or relaxed on potentially compromising surfaces 69:83 ± 15:03 kg (males: 23:64 ± 3:26 years, 171:77 ± 8:72 [11]. In doing so, the femoral condyles within the knee are cm, and 72:24 ± 16:89 kg; females: 22:18 ± 2:64 years, appropriately loaded with forces prior to transfer onto the 163:45 ± 5:19 cm, and 62:75 ± 15:14 kg), respectively, volun- tibial plateau. The loads placed upon the medial and lateral teered to participate in the study. All participants were phys- compartments of the tibial plateau are dependent on the ically active and able-bodied whilst being free from any structure of the knee and whether varus and valgus deformi- lower limb injuries at the time of testing. Additional infor- ties are present [9]. If an infirmity becomes apparent such as mation from the participants regarding activity levels and osteoarthritis, this particular link of the process can be com- time of activities before embarking on the experimental pro- promised changing the overall mechanical structure of the tocol was controlled prior to data collection. All participants ankle-subtaler joint complex [12]. The knee also further were required not to have engaged in any physical activity assists in proprioception through complex neuromuscular for 48 hours before commencement of the experiment. All structures allowing stability and motion of the lower limbs. participants were right leg dominant. This was confirmed The hip works as a ball and socket joint with motion by identifying what leg the subjects preferred to kick a foot- occurring in three dimensions. The hip joint has two liga- ball with. All subjects were tested at the same relative time ments which anteriorly stabilise the hip (iliofemoral and (morning testing) to minimize data contamination from pubofemoral) and one ligament which is used for posterior diurnal variation effects. stability (ischiofemoral). This allows the femur to flex Ethical approval was obtained from the University of the ° ° between 120 and 135 (90 when fully extended) and extend West of Scotland (Ethical Approval Number 2017-0967- between 10 and 30 [13]. Females generally have a greater 844). Each participant reviewed the information sheet, com- ROM and flexibility compared to men due to bone structure pleted a medical health questionnaire, and provided written differences, related to childbearing. The hip is able to cope informed consent. There was no obligation from the individ- with day to day physical activities such as ascending stairs uals to complete the study, and participants were given Applied Bionics and Biomechanics 3 freedom to withdraw at any time. A risk assessment was also Prior to commencement of the dynamic trials, a famil- completed prior to experimental testing. iarisation period of ten minutes was permitted to ensure par- ticipants were able to complete the movements at a 2.2. Instrumentation and Laboratory Configuration. Eight controlled speed. They were only allowed five repetitions Vicon Bonita Motion Analysis cameras (Oxford Metrics for each movement to reduce the potential impact and learn- Ltd, Oxford, UK) mounted on scaffolding provided a field ing effects of the protocol as outlined by behavioural learn- of view that allowed the lower limb movements to be cap- ing theory. Although the order of the tasks was tured for analysis. The Vicon Bonita Motion Analysis Sys- randomised, to standardize the test protocol, the number tem was linked to an ultra giganet box which collected the of trials, experimenter, and stance were kept consistent lower limb kinematic data at a rate of 250 Hz. The two throughout each session. Following this, each participant AMTI force plates (1.2 m) (AMTI, Watertown, MA, USA) stood on the AMTI force plates, ensuring that the feet were were connected to the Vicon Bonita Motion System and a shoulder width apart and that the hands were placed on interfaced via the ultra giganet box. Kinetic data were col- the hips. The left and right feet were positioned on two inde- lected at a sampling rate of 1000 Hz. Prior to data capture, pendent force plates. Both feet were placed at the centre and the reset button was activated as data were collected from fully within the boundaries of each force plate. Two static both systems integrated through the Vicon Nexus software. trials were taken in this position whilst the participant stood still, followed by two sets of three dynamic trials—DF and 2.3. Experimental Design. The experimental protocol for this PF (Figure 2). The first dynamic trial involved the comple- pilot study required one visit per participant to the Biome- tion of the DF movement phase. This consisted of three con- chanics Laboratory at the University of the West of Scotland. tinuous phases being held for two seconds each: foot flat, Prior to testing, reflective objects in the laboratory were fore-foot raise, and foot flat. The trial ended after a two- removed or concealed to prevent interference during the second time limit once the second foot flat phase elapsed. data capture session. Cameras positioned within the field On completion, a further two trials of data were collected. of view of the participants were inspected, and any reflec- The second set of dynamic trials followed a similar pattern tions identified were masked using the Vicon Nexus Mask but in a PF movement phase. This consisted of three contin- Cameras software function. The Vicon Bonita Motion Anal- uous phases being held for two seconds each: foot flat, heel ysis system was both statically and dynamically calibrated raise, and foot flat. The trial ended after two seconds of before each session of testing. Prior to testing using the the second foot flat phase. This was repeated twice to Vicon Nexus software, individual participant details, i.e., ensure that three sets of data were collected. Once tasks age (years), and anthropometric measurements, i.e., height were completed, the participant then stepped off the force (cm) and body mass (kg) alongside right and left leg length plates and removed the retroreflective markers and their (mm), right and left knee width (mm), and right and left involvement was complete. ankle width (mm), were obtained. Body mass and height 2.4. Statistical Analysis. Statistical analysis software Jamovi were measured using a calibrated scale (Seca 803, England) (Version 0.9.5.12) was used to determine descriptive and and stadiometer (Seca 213, England). All other measure- inferential statistics. Kinematic (joint angle and ROM) data ments were obtained using a small anthropometer measure- were manually transferred from the Vicon Nexus 2.8.1 into ment instrument-Lafayette (http://ProHealthcareProducts Microsoft Excel 2019 version 16.23 (Microsoft Corporation, .com, Lehi, UT, USA) and clinical measuring tape. All Redmond, Washington, USA). The normality of distribution acquired measurements were imputed into the Vicon Nexus was determined using the Shapiro-Wilk test. Anthropomet- software to define each participant before running the Lower ric statistical differences between gender and sidedness were Limb static and dynamic Plug-In-Gait models. The Plug-In- examined. Both PF ROM and DF ROM were calculated as Gait model is the Vicon Nexus’ implementation of the con- follows: ventional gait model. Using a direct (nonoptimal) pose esti- mation, the Plug-In-Gait computes and defines the position ROM = unloaded phase – loaded phase and orientation of each segment based on a set of three ðÞ ðÞ ankle,knee,hip tracking markers. + unloaded phase – reloaded phase : ðÞ Individuals were required to wear dark, figure-fitting ð1Þ clothing and remove shoes during the session. A technical assistant with experience using the Plug-In-Gait marker instrumentation then placed sixteen (14 mm) retroreflective The ROM represented the lower limb range of motion markers accurately on each individuals’ lower limbs accord- (range of forces and moments was also calculated similarly). ing to the Plug-In-Gait marker placement guide. A double- The loaded phase represented the joint angle/force/moment sided tape was used to ensure adherence of retroreflective at the initial foot flat position, unloaded phase represented markers to the skin and fitted clothing of the limb joints the joint angle/force/moment at the fore-foot raise (or heel and segments. The placements on both the left and right raise) position, and reloaded phase represented the joint limbs were as follows: anterior superior iliac spine (ASIS), angle/force/moment at the final foot flat position. posterior superior iliac spine (PSIS), lateral midthigh, lateral General linear model multivariate analyses were applied knee, lateral midtibia, lateral malleolus, and calcaneus and to the joint angle, joint force, joint moment, and ROM data- nd metatarsal head. See Figure 1 for visual representation. sets using IBM SPSS Statistics for Windows, Version 25.0. 4 Applied Bionics and Biomechanics Figure 1: Visual representation of marker placement—positioning of sixteen retroreflective markers on the lower limbs of a participant. tistic (η ) in relation to multivariate analyses was calculated. The values of 0.0099, 0.0588, and 0.1379 were considered small, medium, and large effect sizes, respectively [18]. A Bonferroni post hoc test was applied to test for multiple comparisons in the dependent variables for observed means with respect to gender, sidedness, phases, and foot position. p <0:05 was considered significant. 3. Results The leg length (mm), anterior superior iliac spine trochanter distance (mm), knee width (mm), and ankle width (mm) anthropometric measurements showed no statistical differ- A BC D F ences between the left and right limbs (p >0:05) or between genders (p >0:05). The anthropometric measurements in Dorsiflexion task Plantarflexion task terms of gender and sidedness are displayed in (Figure 3). The ROM at the ankle, knee, and hip joints (Table 1) Figure 2: Pictorial description of the plantarflexion (PF) and together with the range of forces (Table 2) over the antero- dorsiflexion (DF) tasks showing (a) loaded phase (foot flat), (b) posterior (X), mediolateral (Y), and longitudinal (Z) axes unloaded phase (during PF), (c) reloading of the heel (foot flat), and resultant datasets are displayed in (Table 3). (d) loaded phase (foot flat), (e) unloaded phase (during DF), and In terms of DF movement, the female ankle ROM on the (f) reloaded phase (foot flat). Note both tasks were performed as X-and Y-axes for both limbs were higher in comparison to two independent sessions and were randomised. ° ° the males (left female: X =20:610 ±5:409, Y =0:320 ± ° ° 1:606; left male: X =20:067 ±6:204, Y = –0:995 ±0:571; ° ° right female: X =23:030 ±7:604, Y =1:400 ±6:511;right ° ° (IBM Corp., Armonk, New York). The within subject vari- male: X =21:989 ±6:782, Y = –0:346 ±0:332). Females dis- ables (dependent variables) were joint angle position, joint played a decreased ROM compared to males in the X-and Z force position, joint moment position, and joint angle -axes of the knee joints (left female: X =2:420 ±2:615, Z = ° ° ° ROM in the anterior/posterior (X), medial/lateral (Y), and 6:890 ±1:262; left male: X =9:276 ±2:658, Z =13:957 ± ° ° vertical (Z) directions at the ankle, knee, and hip joints. 4:875; right female: X =1:200 ±2:408, Z =3:810 ±3:016; ° ° External moments were reported and together with the force right male: X =2:958 ±3:111, Z =4:378 ±14:776)and on outputs were extracted from the Plug-in-Gait model. The the X-axis of the hip joint for both limbs (left female: X = ° ° between subject factors (independent variable) included gen- 23:880 ±4:229;leftmale: X =30:176 ±13:597; right female: ° ° der, sidedness, phases, and foot position. The Pearson corre- X =22:850 ±4:558; right male: X =26:775 ±7:242). lation (r) was performed to establish the level of interaction Similar to the DF trials, females produced a higher ROM between the foot position independent variable and the joint at the ankle over the X and Y components for both the left angle position, joint force position, joint moment position, and right limbs during PF (left female: X = –57:42 ±3:505, ° ° and joint angle ROM-dependent variables. When imple- Y = –2:79 ±7:245; left male: X = –46:238 ±5:932, Y = – ° ° menting the Pearson correlation, the r values obtained var- 1:853 ±2:0493; right female: X = –57:47 ±2:888, Y = – ° ° ° ied between −1 and +1 where 1 is a perfect correlation and 1:68 ±0:356; right male: X = –42:586 ±2:652, Y =0:317 0 represents no correlation. Further interpretations of r ±0:406). Females displayed an increased ROM compared include the following: 1> r ≥ 0:8 (very strong), 0:8> r ≥ 0:6 to males at the Y-axis for knee joints (left female: X = – ° ° (moderate), 0:6> r ≥ 0:3 (fair), and 0:3> r ≥ 0:1 (poor) [16, 0:77 ±0:561; left male: X =0:822 ±1:806; right female: X ° ° 17]. To determine the effect size, the partial eta squared sta- =0:77 ±1:6304; right male: X =0:696 ±1:645) and at the Applied Bionics and Biomechanics 5 Leg length Knee width 1500 150 1000 100 Le limb Right limb Le limb Right limb ASIS trochanter dista Ankle width 100 100 60 60 40 40 Le limb Right limb Le limb Right limb Male Female Figure 3: Grouped bar chart representation of the anthropometric datasets with respect to sidedness and gender. X-axis of the hip joint for both limbs (left female: X = – The between-subjects effect yielded a significant effect ° ° 3:13 ±5:01; left male: X = –0:253 ±2:436; right female: X for gender with respect to the ankle joint angle in the Y ° 2 = –3:2 ±1:541; right male: X = –0:356 ±7:242). Bar chart direction (F =12:522, p <0:001, η =0:050, small); hip displays for males and females in terms of differences in sid- joint angle in the Y direction (F =17:339, p <0:001, η = edness with respect to DF and PF are shown in Figures 4 and 0:067, medium); knee joint angle in the X direction 5, respectively. (F =17:025, p <0:001, η =0:066, medium); and knee joint The multivariate analysis for the joint angle results angle in the Y direction (F =16:250, p <0:001, η =0:063, showed that there was a significant main effect for gender p medium). Sidedness also yielded a significant effect for the (F =18:273, p <0:001, η =0:415, large), sidedness ankle joint angle in the Y direction (F =5:542, p =0:019, (F =2:681, p =0:006, η =0:094, medium), phases p 2 η = 0.023, small) and hip joint angle in the Z direction (F =5:031, p <0:001, η =0:163, large), and foot position (F =6:884, p =0:009, η =0:028, small). Significant effects (F =22:112, p <0:001, η =0:462, large). There were also were observed for phases regarding the ankle joint angle significant main effects for gender and sidedness interactions in the X direction (F =17:785, p <0:001, η =0:129, (F =3:931, p <0:001, η =0:132, medium), as well as medium) and hip joint angle in the X direction phases and foot position interactions (F =11:787, p <0:001 2 (F =10:190, p <0:001, η =0:078, medium). The foot , η =0:313, large). No significant differences were observed position also produced significant effects with respect to for interaction effects between gender and phases (F =0:298, the ankle joint angle in the X direction (F = 103:015, p < p =0:998, η =0:011, medium); gender and foot position 0:001, η =0:300, large); and hip joint angle in the X (F =1:025, p =0:421, η =0:038, small); sidedness and direction (F =23:412, p <0:001, η =0:089, medium). phases (F =1:000, p =1:000, η =0:007, small); sidedness Apart from the gender and sidedness interaction (for the and foot position (F =0:197, p =0:994, η =0:008, small); p knee in the X direction (F =10:482, p =0:001, η = gender, sidedness, and phases (F =0:029, p =1:000, η = p 0:042, small) and hip joint angle in the Y direction 0:001, small); gender, sidedness, and foot position (F =6:649, p =0:011, η =0:027, small)); and phases and (F =0:085, p =1:000, η =0:003, small); gender, phases, foot position interaction (for the ankle joint angle in the 2 2 and foot position (F =0:243, p =1:000, η =0:009, small); X direction (F = 105:157, p <0:001, η =0:467, large) p p sidedness, phases, and foot position (F =0:151, p =1:000, and hip joint angle in the X direction (F =13:271, p > 2 2 η =0:006, small); and gender, sidedness, phases, and foot 0:001, η =0:100, medium)); no significant effects were p p observed for all other interactions. position (F =0:047, p =1:000, η =0:002, small). Leg length (mm) ASIS tronchanter distance (mm) Ankle width (mm) Knee width (mm) 6 Applied Bionics and Biomechanics Table 1: X, Y and Z ROM joint angle output at the ankle, knee and hip joints for both left and right limbs during the dynamic phases of the trial ( ). Female DF Female PF Male DF Male PF All participants DF All participants PF Limb sidedness Joints Joint co-ordinates ° ° ° ° ° ° (mean ± SD) ( ) (mean ± SD) ( ) (mean ± SD) ( ) (mean ± SD) ( ) (mean ± SD) ( ) (mean ± SD) ( ) X 20.610 ±5.409 -57.420 ±3.505 20.067 ±6.204 -46.238 ±5.932 20.310 ± 5.735 -51.320 ± 5.072 Ankle Y 0.320 ±1.606 -2.790 ±7.245 -0.995 ±0.571 -1.853 ±2.0493 -0.400 ± 1.210 -2.280 ± 5.111 Z 1.360 ± 2.575 10.710 ± 6.653 8.751 ± 9.631 16.647 ± 20.459 5.390 ± 7.293 13.950 ± 15.810 X 2.420 ±2.615 6.090 ± 2.854 9.276 ±2.658 4.543 ±1.806 6.160 ± 2.689 5.250 ± 2.343 Knee Y 0.520 ± 2.008 -0.770 ±0.561 -2.069 ± 8.278 0.822 ±1.806 -0.890 ± 6.309 0.100 ± 0.535 Z 6.890 ±1.262 3.280 ± 6.957 13.957 ±4.875 1.686 ± 16.203 10.740 ± 3.627 2.410 ± 12.617 X 23.880 ±4.229 -3.130 ±5.010 30.176 ±13.597 -0.253 ±2.436 27.310 ± 10.337 -1.560 ± 3.785 Y 0.230 ± 0.482 -1.610 ± 1.646 1.326 ± 10.300 -3.445 ± 3.065 0.830 ± 7.480 -2.610 ± 2.529 Hip Z -11.690 ± 7.276 0.970 ± 2.598 -22.223 ± 4.928 -0.163 ± 1.572 -17.430 ± 5.958 0.350 ± 2.049 Left limb X 23.030 ±7.604 -57.470 ±2.888 21.989 ±6.782 -42.586 ±2.652 22.460 ± 7.025 -49.350 ± 2.699 Ankle Y 1.400 ±6.511 -1.680 ±0.356 -0.346 ±0.332 0.317 ±0.406 0.450 ± 4.409 -0.590 ± 0.382 Z -1.030 ± 3.423 33.120 ± 4.511 8.763 ± 41.224 8.739 ± 11.123 4.310 ± 30.497 19.820 ± 73.176 X 1.200 ±2.408 4.940 ± 1.759 2.958 ±3.111 4.839 ± 4.223 2.160 ± 2.796 4.880 ± 3.323 Knee Y -0.090 ± 1.098 -0.770 ±1.6304 -0.038 ± 0.887 0.696 ±1.645 -0.060 ± 0.967 0.030 ± 1.617 Z 3.810 ±3.016 -6.310 ± 26.992 4.378 ±14.776 2.361 ± 8.818 4.120 ± 11.232 -1.580 ± 19.329 X 22.850 ±4.558 -3.200 ±1.541 26.775 ±7.242 -0.356 ±7.242 24.990 ± 6.099 -1.650 ± 3.562 Y -0.280 ± 4.798 -2.980 ± 2.486 -1.571 ± 2.102 -3.706 ± 1.230 -0.980 ± 3.702 -3.380 ± 1.876 Hip Z -5.370 ± 1.165 -2.310 ± 1.120 -6.937 ± 3.490 -1.571 ± 7.817 -6.230 ± 2.638 -1.910 ± 5.799 Right limb DF – Dorsiflexion; PF – Plantarflexion; Negative outputs (-) suggest the reloading phase ROM is larger than the loading phase ROM; Positive outputs (+) suggest that the loading phase ROM is larger than the reloading phase ROM. Applied Bionics and Biomechanics 7 Table 2: X, Y and Z joint range of force output at the ankle, hip and knee joints for both left and right limbs during the dynamic phases of the trial (N). Female DF Female PF Male DF Male PF All participants DF All participants PF Limb sidedness Joints Joint co-ordinates (mean ± SD) (N) (mean ± SD) (N) (mean ± SD) (N) (mean ± SD) (N) (mean ± SD) (N) (mean ± SD) (N) X -0.032 ± 0.291 -0.469 ± 0.210 0.270 ± 1.126 -0.591 ± 0.130 0.133 ± 0.859 -0.535 ± 0.172 Ankle Y 0.106 ± 0.154 -0.407 ± 0.086 0.444 ± 0.125 -1.049 ± 0.397 0.290 ± 0.136 -0.758 ± 0.297 Z -0.924 ± 0.516 1.653 ± 0.116 -1.017 ± 0.238 1.697 ± 0.236 -0.974 ± 0.393 1.677 ± 0.190 X -0.094 ± 0.298 0.048 ± 0.078 -0.353 ± 0.158 -0.010 ± 0.306 -0.235 ± 0.227 0.016 ± 0.235 Hip Y -0.074 ± 0.155 0.058 ± 0.053 0.041 ± 0.088 -0.089 ± 0.124 -0.011 ± 0.120 -0.023 ± 0.100 Z -0.040 ± 0.187 -0.286 ± 1.268 -0.657 ± 1.889 -0.071 ± 0.204 -0.377 ± 1.374 -0.169 ± 0.874 X -0.290 ± 0.251 0.214 ± 0.499 -0.265 ± 0.128 0.238 ± 0.483 -0.276 ± 0.191 0.227 ± 0.481 Y -0.014 ± 0.259 0.078 ± 0.058 -0.148 ± 0.156 -0.002 ± 0.064 -0.087 ± 0.205 0.034 ± 0.060 Knee Z -0.240 ± 0.186 -0.009 ± 0.186 -0.487 ± 1.615 -0.017 ± 0.232 -0.375 ± 1.476 -0.014 ± 0.208 Left limb X -0.111 ± 0.280 -0.792 ± 0.144 -0.407 ± 1.461 -0.935 ± 0.274 -0.273 ± 1.103 -0.870 ± 0.226 Ankle Y -0.224 ± 0.369 0.529 ± 0.128 -0.476 ± 0.508 1.500 ± 3.174 -0.361 ± 0.441 1.058 ± 2.358 Z -1.028 ± 0.753 1.526 ± 0.173 -1.223 ± 0.162 1.638 ± 0.202 -1.135 ± 0.534 1.587 ± 0.189 X -0.153 ± 0.321 0.038 ± 0.080 -0.388 ± 0.289 -0.103 ± 0.407 -0.281 ± 0.300 -0.039 ± 0.301 Hip Y 0.076 ± 0.090 0.011 ± 0.142 0.683 ± 2.803 0.165 ± 0.151 0.407 ± 2.076 0.095 ± 0.147 Z 0.367 ± 1.855 0.062 ± 0.220 0.328 ± 1.215 -1.705 ± 10.494 0.346 ± 1.506 -0.902 ± 7.719 X -0.295 ± 0.271 0.277 ± 0.199 -0.398 ± 0.076 0.269 ± 0.118 -0.351 ± 0.191 0.273 ± 0.156 Y 0.164 ± 0.296 -0.098 ± 0.085 0.326 ± 0.130 0.059 ± 0.049 0.252 ± 0.216 -0.013 ± 0.67 Knee Z 0.536 ± 2.096 0.143 ± 0.247 0.351 ± 1.493 0.272 ± 0.227 0.435 ± 1.789 0.213 ± 0.233 Right limb DF – Dorsiflexion; PF – Plantarflexion; Negative outputs (-) suggest the reloading phase ROM is larger than the loading phase ROM; Positive outputs (+) suggest that the loading phase ROM is larger than the reloading phase ROM. 8 Applied Bionics and Biomechanics Table 3: Range of Motion (Joint Angle), Range of Forces and Moments Output – Resultant measurements at the ankle, hip and knee joints for both left and right limbs during the dynamic phases of the trial ( ). Limb Resultant Female DF (mean Female PF (mean Male DF (mean Male PF (mean Joints sidedness measurement ± SD) ± SD) ± SD) ± SD) Joint angle ( ) 20.657 ± 6.202 58.477 ± 10.442 21.915 ± 11.470 49.178 ± 21.400 Joint force (N) 0.931 ± 0.612 1.766 ± 0.255 1.142 ± 1.158 2.081 ± 0.480 Ankle Joint moment 320.248 ± 158.134 203.37 ± 127.766 485.938 ± 881.768 302.093 ± 108.393 (Nmm) Joint angle ( ) 7.321 ± 3.530 6.960 ± 7.541 16.886 ± 9.968 4.915 ± 16.403 Joint force (N) 0.126 ± 0.384 0.296 ± 1.272 0.747 ± 1.898 0.114 ± 0.388 Knee Joint moment 142.932 ± 70.291 57.415 ± 88.639 188.285 ± 127.090 105.423 ± 83.966 (Nmm) Joint angle ( ) 24.031 ± 8.430 3.871 ± 5.879 37.499 ± 17.755 3.458 ± 3.919 Joint force (N) 0.290 ±0.406 0.228 ± 0.536 0.574 ± 1.628 0.239 ± 0.540 Hip Joint moment 45.143 ± 149.963 25.122 ± 53.475 130.911 ± 86.212 138.982 ± 69.468 (Nmm) Left limb Joint angle ( ) 23.095 ± 10.580 66.352 ± 5.368 23.676 ± 41.779 43.475 ± 11.442 Joint force (N) 0.336 ± 0.884 1.799 ± 0.259 1.374 ± 1.555 2.410 ± 3.192 Ankle Joint moment 291.668 ± 136.709 184.173 ± 169.349 424.310 ± 158.204 274.117 ± 59.366 (Nmm) Joint angle ( ) 3.996 ± 4.013 8.051 ± 27.098 5.284 ± 15.126 5.429 ± 9.914 Joint force (N) 0.405 ± 1.885 0.074 ± 0.274 0.851 ± 3.069 1.716 ± 10.503 Knee Joint moment 106.293 ± 113.329 54.974 ± 52.011 136.236 ± 144.455 99.029 ± 282.296 (Nmm) Joint angle ( ) 23.474 ± 6.720 4.945 ± 3.132 27.704 ± 8.309 4.041 ± 10.727 Joint force (N) 0.633 ± 2.134 0.327 ± 0.328 0.656 ± 1.501 0.387 ± 0.260 Hip Joint moment 159.135 ± 1076.132 46.801 ± 24.778 107.119 ± 114.153 162.610 ± 113.992 (Nmm) Right limb DF – Dorsiflexion; PF – Plantarflexion. The multivariate analysis for the ROM results only pro- between-subject effects with respect to ROM produced signif- duced a significant effect for foot position (F =82:448, p < icant effects, namely: sidedness at the knee in the Z direction 2 2 0:001, η =0:912, large). All other main effects and interac- (F =6:981, p =0:010, η =0:080, medium) and at the hip in p p 2 2 tions were not significant, i.e., sex (F =0:788, p =0:628, η the Y direction (F =5:801, p =0:018, η =0:068,medium); p p sidedness and foot position at the hip in the Z direction =0:090, medium); sidedness (F =1:793, p =0:084, η = (F =5:880, p =0:018, η =0:068, medium); and gender, sid- 0:183, large); gender and sidedness interaction (F =0:178, p =0:996, η =0:022, small); sex and foot position interac- edness and foot position at the knee in the Z direction (F =4:545, p =0:036, η =0:054, small). With the exception tion (F =1:772, p =0:089, η =0:181, large); sidedness and of knee ROM in the X direction (F =0:902, p =0:345, η = foot position (F =1:168, p =0:328, η =0:127, medium); p 0:011, small) and knee ROM in the Y direction (F =0:188, p and gender, sidedness, and foot position (F =1:030, p = =0:666, η =0:002, small), all other dependent variables 0:425, η =0:114, medium). showed significant between-subject effects. No significant between-subject effects were observed for The multivariate analysis for the joint force results only gender; gender and sidedness interaction; and gender and foot produced a significant effect for sidedness (F =9:944, p < position interaction, with respect to the dependent variables 2 2 0:001, η =0:278, large); phases (F =1:751, p =0:029, η (F <2:013, p >0:05, η =0:054, small). The following p p p Applied Bionics and Biomechanics 9 Male DF ankle Male PF ankle 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 –10 –10 –20 –20 –30 –30 –40 –40 –50 –50 –60 –60 ⁎ –70 –70 XY Z XY Z Ankle joint axes Ankle joint axes Male DF Knee Male PF knee 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 –10 –10 –20 –20 –30 –30 –40 –40 –50 –50 –60 –60 –70 –70 XY Z XY Z Knee joint axes Knee joint axes Male DF hip Male PF hip 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 –10 –10 –20 –20 –30 –30 –40 –40 –50 –50 –60 –60 –70 –70 X Y Z X Y Z Hip joint axes Hip-joint axes M (DF)-LL M (PF)-LL M (DF)-RL M (PF)-RL Figure 4: Grouped bar chart representation showing dorsiflexion (DF) and plantarflexion (PF) position comparisons between the left limb (LL) and right limb (LL) in male (M) participants at the anterior/posterior (X), medial/lateral (Y), and vertical (Z) directions at the ankle, knee, and hip joints. Error bars included ±standard deviation whilst ∗ indicates statistical significance (p <0:05)(n =12). small). The following between-subject effects with respect =0:063, medium); foot position (F =5:334, p <0:001, η to joint force produced significant effects, namely: sidedness =0:171, large); and phases and foot position interaction at the knee in the Y direction (F =70:281, p <0:001, η (F =5:097, p <0:001, η =0:164, large). All other main p =0:227, large) and at the hip in the Y direction effects and interactions were not significant. (F =23:066, p <0:001, η =0:088, medium); foot position No significant differences between-subject effects were p observed for gender; phases; gender and sidedness interac- at ankle in the Z direction (F =34:919, p <0:001, η = tion; gender and phase interaction; gender and foot position 0:127, medium) and at the knee in the X direction interaction; sidedness and phase interaction; gender, sided- (F =6:810, p =0:010, η =0:028, small); sidedness and foot ness, and phase interaction; gender, sidedness, and foot position at the ankle in the Y direction (F =13:820, p < position interaction; gender, phase, and foot position inter- 0:001, η =0:054, small); and phase and foot position action; sidedness, phase, and foot position interaction; and p gender, sidedness, phase, and foot position; with respect to interaction at the ankle in the Z direction (F =38:501, p < 2 2 the dependent variables (F <3:486, p >0:05, η <0:014, 0:001, η =0:243, small). p p Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) 10 Applied Bionics and Biomechanics Female PF ankle Female DF ankle 70 70 60 60 50 50 40 40 30 30 20 20 –10 –10 –20 –20 –30 –30 –40 –40 –50 –60 –60 –50 –70 –70 XY Z XY Z Ankle joint axes Ankle joint axes Female DF knee Female PF knee 70 70 60 60 –10 –10 –20 –20 –30 –30 –40 ⁎ –40 –50 –50 –60 –60 –70 –70 X Y Z X Y Z Knee joint axes Knee joint axes Female DF hip Female PF hip –10 –10 –20 –20 –30 –30 –40 –40 –50 –50 –60 –60 –70 –70 XY Z XY Z Hip joint axes Hip joint axes F (DF) - LL F (PF) - LL F (DF) - RL F (PF) - RL Figure 5: Grouped bar chart representation showing dorsiflexion (DF) and plantarflexion (PF) position comparisons between the left limb (LL) and right limb (LL) in female (F) participants at the anterior/posterior (X), medial/lateral (Y), and vertical (Z) directions at the ankle, knee and hip joints. Error bars included ±standard deviation whilst ∗ indicates statistical significance (p <0:05)(n =10). The multivariate analysis for the joint moment results only the knee and hip resultant force and moment range mea- produced a significant effect for gender (F =3:313, p =0:001, surements with respect to gender. The joint angles, forces, 2 2 and moments produced a similar trend in the Pearson corre- η =0:114, medium); sidedness (F =6:237, p <0:001, η = p p 2 lation measurements. The correlation between the foot posi- 0:195, large); phases (F =3:708, p <0:001, η =0:125, tion and the joint angle, joint force, and joint moment- medium); foot position (F =2:395, p =0:013, η =0:085, dependent variables ranged from r = −0:411 (fair) to r = medium); gender and sidedness interaction (F =4:189, p < 0:315 (fair). Similarly, the foot position and the ROM depen- 0:001, η =0:140, large); and phase and foot position interac- p dent variables ranged from r = −0:887 (very strong) to r = tion (F =2:482, p =0:001, η =0:087, medium). All other 0:065 (poor). main effects and interactions were not significant. Only the ankle resultant ROM and force range during PF 4. Discussion produced greater ROM and force range in comparison to DF. A converse trend was observed for the ankle moment This study investigated the joint angle, joint force, joint range datasets (see Table 3). All other resultant joint angle moment, and ROM responses of the left and right ankle, ROM outputs at the knee and hip produced greater DF knee, and hip lower limb joints between genders whilst per- ROM in comparison to PF. Presented in Table 3 are also forming dynamic DF and PF movements. Specifically, only Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Applied Bionics and Biomechanics 11 Females exhibited higher DF than PF measurements for the ankle joint during the DF and PF movement produced a significantly (p <0:001) higher PF ROM in comparison to the left limb knee joint moments, left limb hip joint forces, the DF movement. The knee and hip joints showed inconsis- and left limb hip joint moments. A similar trend was tencies in their ROM patterns with respect to sidedness and observed for the right limb knee and hip joint forces and foot position. No observed significant (p >0:05) main effects joint moments. The males exhibited similar trends; however, and interactions for ROM were observed for gender, sided- differences were observed in the knee joint forces and in the ness, and their combined interactions with foot position. left and right limb joint moments which produced lower DF Significant main effects for both joint forces and joint outputs in comparison to the PF measurements. There are moments were observed for sidedness, phases, foot position, multiple possibilities as to why lower limb DF and PF and phases and foot position interaction. ROM, forces, and moments may be decreased. These The results suggest that there are no clear definitive dis- include, but are not limited to, age, gender, prior injury, tinctions in the ROM coordinate output measures. Our degenerative diseases, and immobilisation. For example, a results showed that female participants presented with traumatic brain injury and fractures are both, in addition greater DF and PF ROM when compared to males. This to others, known to decrease the compliance of the calf mus- agrees with our first hypothesis. All participants showed dif- cles and therefore inhibit full flexibility [24]. Geographic and ferent joint angles and ROM output measurements between cultural living conditions are also determinants which can limbs. This finding may be aligned with joint flexibility since affect ROM [21]. both males and females exhibited variable joint angles and Mechanical stress exerted on the body and the physio- ROM output measurements. Both genders showed a similar logical adaptations of tissue over time must also be consid- trend in the resultant ankle joint ROM during DF and PF for ered prior to analysing results as this can be apparent with both the left and right limbs. The left and right hip joints increasing age [10]. Although age was not a focus of this also produced similar resultant ROM trends. Although the study, it has been suggested to be a confounding factor in knee and hip joints produced similar resultant ROM trends the ROM of an individual and a potential reason for primary for the left limb, the left and right knee produced dissimilar differences [25]. Wojcik et al. confirm the ideology that trends. On average, the correlations between the foot posi- younger individuals have a substantially larger ROM com- tion (DF and PF) and the lower limb joint angle and ROM pared to older adults as they are more able to utilise the outputs were weak, i.e., poor to fair. available flexibility [26]. It is also thought that post 50 years Our joint motion and ROM analysis revealed findings, of age, muscle strength begins to deteriorate which can prog- ress into reduced motor control at 60+ years with reaction which differed to expected results. As shown in Tables 1–3, there are no clear distinctions that show that the average speeds and movements also deteriorating [27]. Individuals, ROM was greater in females compared to males; therefore, especially the elderly, may also consider strengthening dorsi- our results are not in complete agreement with the limited flexors and plantarflexors to maintain stability, power, and literature available [19, 20]. This could be due to the move- strength necessary for physical function which decreases lin- ment strategies exhibited by participants, which may have early with age [10, 28]. Similarly, children 5 years and below subconsciously been influenced by their peculiarities in responded with a decreased hip and knee movement com- motion and/or vocational tasks differing in certain ways. pared to middle aged individuals due to the inability to com- ROM required on a daily basis at the ankle joint is reduced plete full extension [25]. This is comparable to the decrease below potential; walking requires 30 , and climbing stairs in mobility and flexibility in older adults. ° ° Gender-related disparity can arise due to muscle recruit- 37 is for ascent and 56 for descent [21]. Similar to Roaas and Andersson, ROM at the X-axis of the ankle for both ment that is used repeatedly; for example, during a fall, a the left and right limb in males and females are higher in female is thought to be able to stabilise/recover quicker using PF than in DF; however, they do not significantly differ from ROM and flexibility than males [26]. There are a few limita- each other statistically [22]. The average ROM for all partic- tions in this study that need consideration. Firstly, the par- ticipants recruited were aged between 19 and 30, which ipants in the current study falls within the ROM grouping outlined by the previous study (DF between 5 and 40 ;PF mean the results are not representative of the entire popula- tion. Secondly, due to the limited research in this field, com- between 10 and 55 ), suggesting that between the ages 19 and 40 years the plantarflexors and dorsiflexors remain in parisons of results at the ankle, knee, and hip joints were similar functionality. However, it must also be noted that unable to be confirmed or discussed in detail. Therefore, in future studies, a larger sample size needs to be recruited. the toe flexor strength within the foot plays a key role in standing and walking and therefore are independent con- Earlier studies by Ugbolue et al. have designed, devel- tributors to future incidence of falls. Performance in a PF oped, and validated a new methodological approach to eval- trial may be affected by a decrement in toe flexor strength uate heel pad stiffness and soft tissue deformation in both which continues to decline over time [23]. The left and right limbs between males and females during ankle dynamic unloading and loading activity [29]. To complement Ugbo- limb knee joint moment and hip joint forces and moments produced similar trends. In terms of gender, the kinetic out- lue et al.’s works [29–32], this study provides a useful biome- puts from the female participants were not in agreement chanical database from which potential modelling with our second hypothesis; however, there was a partial information could be obtained. This will aid in computer agreement in the knee joint forces and moments with simulation designed to provide further understanding and insights into the sensitivity of treatment planning, prediction respect to the male participants. 12 Applied Bionics and Biomechanics of treatment outcome, and other healthcare-related opportu- [4] A. Leardini, J. J. O'Connor, F. Catani, and S. Giannini, “The role of the passive structures in the mobility and stability of nities worthy of attention. 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Joint Angle, Range of Motion, Force, and Moment Assessment: Responses of the Lower Limb to Ankle Plantarflexion and Dorsiflexion

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Copyright © 2021 Ukadike Chris Ugbolue et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Applied Bionics and Biomechanics Volume 2021, Article ID 1232468, 13 pages https://doi.org/10.1155/2021/1232468 Research Article Joint Angle, Range of Motion, Force, and Moment Assessment: Responses of the Lower Limb to Ankle Plantarflexion and Dorsiflexion 1,2 2 2 2 Ukadike Chris Ugbolue , Chloe Robson, Emma Donald, Kerry L. Speirs, 3 1,4 5 1 Frédéric Dutheil , Julien S. Baker , Tilak Dias , and Yaodong Gu Faculty of Sports Science, Ningbo University, China School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire G72 0LH, UK CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, 63000 Clermont-Ferrand, France Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong Advanced Textiles Research Group, School of Art and Design, Bonington Building, Nottingham Trent University, UK Correspondence should be addressed to Ukadike Chris Ugbolue; u.ugbolue@uws.ac.uk Received 8 April 2021; Revised 23 July 2021; Accepted 25 August 2021; Published 20 September 2021 Academic Editor: Weijie Fu Copyright © 2021 Ukadike Chris Ugbolue et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There is limited research on the biomechanical assessment of the lower limb joints in relation to dynamic movements that occur at the hip, knee, and ankle joints when performing dorsiflexion (DF) and plantarflexion (PF) among males and females. This study investigated the differences in joint angles (including range of motion (ROM)) and forces (including moments) between the left and right limbs at the ankle, knee, and hip joints during dynamic DF and PF movements in both males and females. Using a general linear model employing multivariate analysis in relation to the joint angle, ROM, force, and moment datasets, the results revealed significant main effects for gender, sidedness, phases, and foot position with respect to joint angles. Weak correlations were observed between measured biomechanical variables. These results provide insightful information for clinicians and biomechanists that relate to lower limb exercise interventions and modelling efficacy standpoints. 1. Introduction roles in human stability and locomotion [2–4]. There is a definitive need in previous and present research for reliable The Augmented Video-based Portable System and the gold studies focusing upon the differences in ankle, knee, and standard 3D Vicon Motion Analysis System (Vicon-UK, hip kinematics and kinetics with direct association to dorsi- flexion (DF) and plantarflexion (PF). Minns Business Park, West Way, Oxford, UK) are validated motion analyses systems that are useful for evaluating the The ankle and the lower limb joints assist with the trans- motion characteristics of the lower limbs [1]. These systems mission of forces and loads between the leg and foot during can work simultaneously and may be integrated with force weight-bearing activities resulting in effective mobility and plates and electromyographic systems. From an anatomical flexibility [5]. The ankle functionally acts as a talocrural joint with movement controlled by two joints, namely, the distal perspective and in line with the Vicon® Plug-In-Gait model (which is predominantly used to biomechanically evaluate end of the tibia and fibula of the lower leg and proximal joint movement), the lower extremity consists of the foot, end of the talus of the foot. DF and PF are movements ankle, knee, and hip joints. These joints all play important exhibited by the ankle. The subtalar joint along with 2 Applied Bionics and Biomechanics ° ° articulation of the other talar bones facilitates inversion and (40-70 of flexion needed) and sit to stand (104 of flexion eversion motions. From a functionality perspective, the dor- needed) [14]. Arnold et al. suggest that the hip flexors do siflexor muscles aid the body in clearing the foot during the not necessarily directly affect the passive movement of the swing phase as well as controlling plantarflexion of the foot ankle; however, it does facilitate the knee to complete its during a heel strike. Plantarflexor muscles are imperative movement, which can influence the flexibility of the to performance during an abundance of daily tasks, from ankle [15]. stair climbing and walking to rising from a chair [6]. During To date, no research has effectively measured the kine- gait motion, the foot must adapt to uneven surfaces and matics and kinetics of the lower limbs during ankle DF absorb shocks before biomechanically changing to exert and ankle PF in a standing position. Nor has a longitudinal force in the later stages when acting as a lever [7]. This fur- study been completed to incorporate changes over time ther permits the muscles and ligaments to contribute to under DF and PF conditions. Therefore, further in-depth overall stability, and therefore, a biomechanical evaluation investigation is required. There has been a definitive need, of this function can aid in treatment from injury and notifi- previously and presently for reliable research studies to focus cation of any dysfunctions [5, 8]. on the differences in ankle, knee, and hip kinematics and The normal range of motion (ROM) of the ankle during kinetics with direct association to PF and DF. There are ° ° DF is 10-20 degrees ( research topics on DF and PF during landing and other ) and 25-30 during PF, contributing to inversion and eversion [9]. Among healthy and physically movements; however, there is little information regarding active individuals, greater passive DF ROM is seen to the dynamic movements of the ankle whilst standing in rela- increase the risk of knee displacement and these biomechan- tion to the biomechanical correlates of movement at the ical factors can be associated with further injuries such as knee and hip joints. anterior cruciate ligament injury during landing [10]. Simi- The purpose of this study was to investigate any differ- larly, Flanagan et al. suggest the capabilities of the ankle in ences in joint angles, range of motion (ROM), forces, and relation to the plantarflexors can change as much as 25% moments between the left and right limbs at the ankle, knee, depending on age and gender with respect to torque and and hip joints during dynamic DF and PF movements in ROM. Ankle injuries are the most common injury when par- both male and female subjects. It is hypothesized that (a) ticipating in exercise and sport [4] with the plantarflexors females will have a greater ROM in both DF and PF in com- and dorsiflexors potentially playing a role in reducing the parison to males and (b) the heel raise task will produce likelihood of injury. The ankle plantarflexors can substan- higher ground reaction forces, higher forces at the lower tially change the risk of an anterior cruciate ligament and limb joints, and larger moments at the lower limb joints in knee displacement injury [10]. Conversely, dorsiflexors can- comparison to the fore-foot raise task. not withstand the same volume of shock as their counter- parts. As the ground reaction force applied to the joint increases, the hip, knee, and ankle acquire further strain, 2. Method which would occur during landing from height or pivotal situations. 2.1. Participants. Twenty-two healthy individuals, twelve The knee is able to passively affect the DF and PF angles males and ten females, with a mean ± SD age, height, and at the ankle through the Achilles tendons becoming con- body mass of 23:04 ± 2:8 years, 169:82 ± 5:88 cm, and tracted or relaxed on potentially compromising surfaces 69:83 ± 15:03 kg (males: 23:64 ± 3:26 years, 171:77 ± 8:72 [11]. In doing so, the femoral condyles within the knee are cm, and 72:24 ± 16:89 kg; females: 22:18 ± 2:64 years, appropriately loaded with forces prior to transfer onto the 163:45 ± 5:19 cm, and 62:75 ± 15:14 kg), respectively, volun- tibial plateau. The loads placed upon the medial and lateral teered to participate in the study. All participants were phys- compartments of the tibial plateau are dependent on the ically active and able-bodied whilst being free from any structure of the knee and whether varus and valgus deformi- lower limb injuries at the time of testing. Additional infor- ties are present [9]. If an infirmity becomes apparent such as mation from the participants regarding activity levels and osteoarthritis, this particular link of the process can be com- time of activities before embarking on the experimental pro- promised changing the overall mechanical structure of the tocol was controlled prior to data collection. All participants ankle-subtaler joint complex [12]. The knee also further were required not to have engaged in any physical activity assists in proprioception through complex neuromuscular for 48 hours before commencement of the experiment. All structures allowing stability and motion of the lower limbs. participants were right leg dominant. This was confirmed The hip works as a ball and socket joint with motion by identifying what leg the subjects preferred to kick a foot- occurring in three dimensions. The hip joint has two liga- ball with. All subjects were tested at the same relative time ments which anteriorly stabilise the hip (iliofemoral and (morning testing) to minimize data contamination from pubofemoral) and one ligament which is used for posterior diurnal variation effects. stability (ischiofemoral). This allows the femur to flex Ethical approval was obtained from the University of the ° ° between 120 and 135 (90 when fully extended) and extend West of Scotland (Ethical Approval Number 2017-0967- between 10 and 30 [13]. Females generally have a greater 844). Each participant reviewed the information sheet, com- ROM and flexibility compared to men due to bone structure pleted a medical health questionnaire, and provided written differences, related to childbearing. The hip is able to cope informed consent. There was no obligation from the individ- with day to day physical activities such as ascending stairs uals to complete the study, and participants were given Applied Bionics and Biomechanics 3 freedom to withdraw at any time. A risk assessment was also Prior to commencement of the dynamic trials, a famil- completed prior to experimental testing. iarisation period of ten minutes was permitted to ensure par- ticipants were able to complete the movements at a 2.2. Instrumentation and Laboratory Configuration. Eight controlled speed. They were only allowed five repetitions Vicon Bonita Motion Analysis cameras (Oxford Metrics for each movement to reduce the potential impact and learn- Ltd, Oxford, UK) mounted on scaffolding provided a field ing effects of the protocol as outlined by behavioural learn- of view that allowed the lower limb movements to be cap- ing theory. Although the order of the tasks was tured for analysis. The Vicon Bonita Motion Analysis Sys- randomised, to standardize the test protocol, the number tem was linked to an ultra giganet box which collected the of trials, experimenter, and stance were kept consistent lower limb kinematic data at a rate of 250 Hz. The two throughout each session. Following this, each participant AMTI force plates (1.2 m) (AMTI, Watertown, MA, USA) stood on the AMTI force plates, ensuring that the feet were were connected to the Vicon Bonita Motion System and a shoulder width apart and that the hands were placed on interfaced via the ultra giganet box. Kinetic data were col- the hips. The left and right feet were positioned on two inde- lected at a sampling rate of 1000 Hz. Prior to data capture, pendent force plates. Both feet were placed at the centre and the reset button was activated as data were collected from fully within the boundaries of each force plate. Two static both systems integrated through the Vicon Nexus software. trials were taken in this position whilst the participant stood still, followed by two sets of three dynamic trials—DF and 2.3. Experimental Design. The experimental protocol for this PF (Figure 2). The first dynamic trial involved the comple- pilot study required one visit per participant to the Biome- tion of the DF movement phase. This consisted of three con- chanics Laboratory at the University of the West of Scotland. tinuous phases being held for two seconds each: foot flat, Prior to testing, reflective objects in the laboratory were fore-foot raise, and foot flat. The trial ended after a two- removed or concealed to prevent interference during the second time limit once the second foot flat phase elapsed. data capture session. Cameras positioned within the field On completion, a further two trials of data were collected. of view of the participants were inspected, and any reflec- The second set of dynamic trials followed a similar pattern tions identified were masked using the Vicon Nexus Mask but in a PF movement phase. This consisted of three contin- Cameras software function. The Vicon Bonita Motion Anal- uous phases being held for two seconds each: foot flat, heel ysis system was both statically and dynamically calibrated raise, and foot flat. The trial ended after two seconds of before each session of testing. Prior to testing using the the second foot flat phase. This was repeated twice to Vicon Nexus software, individual participant details, i.e., ensure that three sets of data were collected. Once tasks age (years), and anthropometric measurements, i.e., height were completed, the participant then stepped off the force (cm) and body mass (kg) alongside right and left leg length plates and removed the retroreflective markers and their (mm), right and left knee width (mm), and right and left involvement was complete. ankle width (mm), were obtained. Body mass and height 2.4. Statistical Analysis. Statistical analysis software Jamovi were measured using a calibrated scale (Seca 803, England) (Version 0.9.5.12) was used to determine descriptive and and stadiometer (Seca 213, England). All other measure- inferential statistics. Kinematic (joint angle and ROM) data ments were obtained using a small anthropometer measure- were manually transferred from the Vicon Nexus 2.8.1 into ment instrument-Lafayette (http://ProHealthcareProducts Microsoft Excel 2019 version 16.23 (Microsoft Corporation, .com, Lehi, UT, USA) and clinical measuring tape. All Redmond, Washington, USA). The normality of distribution acquired measurements were imputed into the Vicon Nexus was determined using the Shapiro-Wilk test. Anthropomet- software to define each participant before running the Lower ric statistical differences between gender and sidedness were Limb static and dynamic Plug-In-Gait models. The Plug-In- examined. Both PF ROM and DF ROM were calculated as Gait model is the Vicon Nexus’ implementation of the con- follows: ventional gait model. Using a direct (nonoptimal) pose esti- mation, the Plug-In-Gait computes and defines the position ROM = unloaded phase – loaded phase and orientation of each segment based on a set of three ðÞ ðÞ ankle,knee,hip tracking markers. + unloaded phase – reloaded phase : ðÞ Individuals were required to wear dark, figure-fitting ð1Þ clothing and remove shoes during the session. A technical assistant with experience using the Plug-In-Gait marker instrumentation then placed sixteen (14 mm) retroreflective The ROM represented the lower limb range of motion markers accurately on each individuals’ lower limbs accord- (range of forces and moments was also calculated similarly). ing to the Plug-In-Gait marker placement guide. A double- The loaded phase represented the joint angle/force/moment sided tape was used to ensure adherence of retroreflective at the initial foot flat position, unloaded phase represented markers to the skin and fitted clothing of the limb joints the joint angle/force/moment at the fore-foot raise (or heel and segments. The placements on both the left and right raise) position, and reloaded phase represented the joint limbs were as follows: anterior superior iliac spine (ASIS), angle/force/moment at the final foot flat position. posterior superior iliac spine (PSIS), lateral midthigh, lateral General linear model multivariate analyses were applied knee, lateral midtibia, lateral malleolus, and calcaneus and to the joint angle, joint force, joint moment, and ROM data- nd metatarsal head. See Figure 1 for visual representation. sets using IBM SPSS Statistics for Windows, Version 25.0. 4 Applied Bionics and Biomechanics Figure 1: Visual representation of marker placement—positioning of sixteen retroreflective markers on the lower limbs of a participant. tistic (η ) in relation to multivariate analyses was calculated. The values of 0.0099, 0.0588, and 0.1379 were considered small, medium, and large effect sizes, respectively [18]. A Bonferroni post hoc test was applied to test for multiple comparisons in the dependent variables for observed means with respect to gender, sidedness, phases, and foot position. p <0:05 was considered significant. 3. Results The leg length (mm), anterior superior iliac spine trochanter distance (mm), knee width (mm), and ankle width (mm) anthropometric measurements showed no statistical differ- A BC D F ences between the left and right limbs (p >0:05) or between genders (p >0:05). The anthropometric measurements in Dorsiflexion task Plantarflexion task terms of gender and sidedness are displayed in (Figure 3). The ROM at the ankle, knee, and hip joints (Table 1) Figure 2: Pictorial description of the plantarflexion (PF) and together with the range of forces (Table 2) over the antero- dorsiflexion (DF) tasks showing (a) loaded phase (foot flat), (b) posterior (X), mediolateral (Y), and longitudinal (Z) axes unloaded phase (during PF), (c) reloading of the heel (foot flat), and resultant datasets are displayed in (Table 3). (d) loaded phase (foot flat), (e) unloaded phase (during DF), and In terms of DF movement, the female ankle ROM on the (f) reloaded phase (foot flat). Note both tasks were performed as X-and Y-axes for both limbs were higher in comparison to two independent sessions and were randomised. ° ° the males (left female: X =20:610 ±5:409, Y =0:320 ± ° ° 1:606; left male: X =20:067 ±6:204, Y = –0:995 ±0:571; ° ° right female: X =23:030 ±7:604, Y =1:400 ±6:511;right ° ° (IBM Corp., Armonk, New York). The within subject vari- male: X =21:989 ±6:782, Y = –0:346 ±0:332). Females dis- ables (dependent variables) were joint angle position, joint played a decreased ROM compared to males in the X-and Z force position, joint moment position, and joint angle -axes of the knee joints (left female: X =2:420 ±2:615, Z = ° ° ° ROM in the anterior/posterior (X), medial/lateral (Y), and 6:890 ±1:262; left male: X =9:276 ±2:658, Z =13:957 ± ° ° vertical (Z) directions at the ankle, knee, and hip joints. 4:875; right female: X =1:200 ±2:408, Z =3:810 ±3:016; ° ° External moments were reported and together with the force right male: X =2:958 ±3:111, Z =4:378 ±14:776)and on outputs were extracted from the Plug-in-Gait model. The the X-axis of the hip joint for both limbs (left female: X = ° ° between subject factors (independent variable) included gen- 23:880 ±4:229;leftmale: X =30:176 ±13:597; right female: ° ° der, sidedness, phases, and foot position. The Pearson corre- X =22:850 ±4:558; right male: X =26:775 ±7:242). lation (r) was performed to establish the level of interaction Similar to the DF trials, females produced a higher ROM between the foot position independent variable and the joint at the ankle over the X and Y components for both the left angle position, joint force position, joint moment position, and right limbs during PF (left female: X = –57:42 ±3:505, ° ° and joint angle ROM-dependent variables. When imple- Y = –2:79 ±7:245; left male: X = –46:238 ±5:932, Y = – ° ° menting the Pearson correlation, the r values obtained var- 1:853 ±2:0493; right female: X = –57:47 ±2:888, Y = – ° ° ° ied between −1 and +1 where 1 is a perfect correlation and 1:68 ±0:356; right male: X = –42:586 ±2:652, Y =0:317 0 represents no correlation. Further interpretations of r ±0:406). Females displayed an increased ROM compared include the following: 1> r ≥ 0:8 (very strong), 0:8> r ≥ 0:6 to males at the Y-axis for knee joints (left female: X = – ° ° (moderate), 0:6> r ≥ 0:3 (fair), and 0:3> r ≥ 0:1 (poor) [16, 0:77 ±0:561; left male: X =0:822 ±1:806; right female: X ° ° 17]. To determine the effect size, the partial eta squared sta- =0:77 ±1:6304; right male: X =0:696 ±1:645) and at the Applied Bionics and Biomechanics 5 Leg length Knee width 1500 150 1000 100 Le limb Right limb Le limb Right limb ASIS trochanter dista Ankle width 100 100 60 60 40 40 Le limb Right limb Le limb Right limb Male Female Figure 3: Grouped bar chart representation of the anthropometric datasets with respect to sidedness and gender. X-axis of the hip joint for both limbs (left female: X = – The between-subjects effect yielded a significant effect ° ° 3:13 ±5:01; left male: X = –0:253 ±2:436; right female: X for gender with respect to the ankle joint angle in the Y ° 2 = –3:2 ±1:541; right male: X = –0:356 ±7:242). Bar chart direction (F =12:522, p <0:001, η =0:050, small); hip displays for males and females in terms of differences in sid- joint angle in the Y direction (F =17:339, p <0:001, η = edness with respect to DF and PF are shown in Figures 4 and 0:067, medium); knee joint angle in the X direction 5, respectively. (F =17:025, p <0:001, η =0:066, medium); and knee joint The multivariate analysis for the joint angle results angle in the Y direction (F =16:250, p <0:001, η =0:063, showed that there was a significant main effect for gender p medium). Sidedness also yielded a significant effect for the (F =18:273, p <0:001, η =0:415, large), sidedness ankle joint angle in the Y direction (F =5:542, p =0:019, (F =2:681, p =0:006, η =0:094, medium), phases p 2 η = 0.023, small) and hip joint angle in the Z direction (F =5:031, p <0:001, η =0:163, large), and foot position (F =6:884, p =0:009, η =0:028, small). Significant effects (F =22:112, p <0:001, η =0:462, large). There were also were observed for phases regarding the ankle joint angle significant main effects for gender and sidedness interactions in the X direction (F =17:785, p <0:001, η =0:129, (F =3:931, p <0:001, η =0:132, medium), as well as medium) and hip joint angle in the X direction phases and foot position interactions (F =11:787, p <0:001 2 (F =10:190, p <0:001, η =0:078, medium). The foot , η =0:313, large). No significant differences were observed position also produced significant effects with respect to for interaction effects between gender and phases (F =0:298, the ankle joint angle in the X direction (F = 103:015, p < p =0:998, η =0:011, medium); gender and foot position 0:001, η =0:300, large); and hip joint angle in the X (F =1:025, p =0:421, η =0:038, small); sidedness and direction (F =23:412, p <0:001, η =0:089, medium). phases (F =1:000, p =1:000, η =0:007, small); sidedness Apart from the gender and sidedness interaction (for the and foot position (F =0:197, p =0:994, η =0:008, small); p knee in the X direction (F =10:482, p =0:001, η = gender, sidedness, and phases (F =0:029, p =1:000, η = p 0:042, small) and hip joint angle in the Y direction 0:001, small); gender, sidedness, and foot position (F =6:649, p =0:011, η =0:027, small)); and phases and (F =0:085, p =1:000, η =0:003, small); gender, phases, foot position interaction (for the ankle joint angle in the 2 2 and foot position (F =0:243, p =1:000, η =0:009, small); X direction (F = 105:157, p <0:001, η =0:467, large) p p sidedness, phases, and foot position (F =0:151, p =1:000, and hip joint angle in the X direction (F =13:271, p > 2 2 η =0:006, small); and gender, sidedness, phases, and foot 0:001, η =0:100, medium)); no significant effects were p p observed for all other interactions. position (F =0:047, p =1:000, η =0:002, small). Leg length (mm) ASIS tronchanter distance (mm) Ankle width (mm) Knee width (mm) 6 Applied Bionics and Biomechanics Table 1: X, Y and Z ROM joint angle output at the ankle, knee and hip joints for both left and right limbs during the dynamic phases of the trial ( ). Female DF Female PF Male DF Male PF All participants DF All participants PF Limb sidedness Joints Joint co-ordinates ° ° ° ° ° ° (mean ± SD) ( ) (mean ± SD) ( ) (mean ± SD) ( ) (mean ± SD) ( ) (mean ± SD) ( ) (mean ± SD) ( ) X 20.610 ±5.409 -57.420 ±3.505 20.067 ±6.204 -46.238 ±5.932 20.310 ± 5.735 -51.320 ± 5.072 Ankle Y 0.320 ±1.606 -2.790 ±7.245 -0.995 ±0.571 -1.853 ±2.0493 -0.400 ± 1.210 -2.280 ± 5.111 Z 1.360 ± 2.575 10.710 ± 6.653 8.751 ± 9.631 16.647 ± 20.459 5.390 ± 7.293 13.950 ± 15.810 X 2.420 ±2.615 6.090 ± 2.854 9.276 ±2.658 4.543 ±1.806 6.160 ± 2.689 5.250 ± 2.343 Knee Y 0.520 ± 2.008 -0.770 ±0.561 -2.069 ± 8.278 0.822 ±1.806 -0.890 ± 6.309 0.100 ± 0.535 Z 6.890 ±1.262 3.280 ± 6.957 13.957 ±4.875 1.686 ± 16.203 10.740 ± 3.627 2.410 ± 12.617 X 23.880 ±4.229 -3.130 ±5.010 30.176 ±13.597 -0.253 ±2.436 27.310 ± 10.337 -1.560 ± 3.785 Y 0.230 ± 0.482 -1.610 ± 1.646 1.326 ± 10.300 -3.445 ± 3.065 0.830 ± 7.480 -2.610 ± 2.529 Hip Z -11.690 ± 7.276 0.970 ± 2.598 -22.223 ± 4.928 -0.163 ± 1.572 -17.430 ± 5.958 0.350 ± 2.049 Left limb X 23.030 ±7.604 -57.470 ±2.888 21.989 ±6.782 -42.586 ±2.652 22.460 ± 7.025 -49.350 ± 2.699 Ankle Y 1.400 ±6.511 -1.680 ±0.356 -0.346 ±0.332 0.317 ±0.406 0.450 ± 4.409 -0.590 ± 0.382 Z -1.030 ± 3.423 33.120 ± 4.511 8.763 ± 41.224 8.739 ± 11.123 4.310 ± 30.497 19.820 ± 73.176 X 1.200 ±2.408 4.940 ± 1.759 2.958 ±3.111 4.839 ± 4.223 2.160 ± 2.796 4.880 ± 3.323 Knee Y -0.090 ± 1.098 -0.770 ±1.6304 -0.038 ± 0.887 0.696 ±1.645 -0.060 ± 0.967 0.030 ± 1.617 Z 3.810 ±3.016 -6.310 ± 26.992 4.378 ±14.776 2.361 ± 8.818 4.120 ± 11.232 -1.580 ± 19.329 X 22.850 ±4.558 -3.200 ±1.541 26.775 ±7.242 -0.356 ±7.242 24.990 ± 6.099 -1.650 ± 3.562 Y -0.280 ± 4.798 -2.980 ± 2.486 -1.571 ± 2.102 -3.706 ± 1.230 -0.980 ± 3.702 -3.380 ± 1.876 Hip Z -5.370 ± 1.165 -2.310 ± 1.120 -6.937 ± 3.490 -1.571 ± 7.817 -6.230 ± 2.638 -1.910 ± 5.799 Right limb DF – Dorsiflexion; PF – Plantarflexion; Negative outputs (-) suggest the reloading phase ROM is larger than the loading phase ROM; Positive outputs (+) suggest that the loading phase ROM is larger than the reloading phase ROM. Applied Bionics and Biomechanics 7 Table 2: X, Y and Z joint range of force output at the ankle, hip and knee joints for both left and right limbs during the dynamic phases of the trial (N). Female DF Female PF Male DF Male PF All participants DF All participants PF Limb sidedness Joints Joint co-ordinates (mean ± SD) (N) (mean ± SD) (N) (mean ± SD) (N) (mean ± SD) (N) (mean ± SD) (N) (mean ± SD) (N) X -0.032 ± 0.291 -0.469 ± 0.210 0.270 ± 1.126 -0.591 ± 0.130 0.133 ± 0.859 -0.535 ± 0.172 Ankle Y 0.106 ± 0.154 -0.407 ± 0.086 0.444 ± 0.125 -1.049 ± 0.397 0.290 ± 0.136 -0.758 ± 0.297 Z -0.924 ± 0.516 1.653 ± 0.116 -1.017 ± 0.238 1.697 ± 0.236 -0.974 ± 0.393 1.677 ± 0.190 X -0.094 ± 0.298 0.048 ± 0.078 -0.353 ± 0.158 -0.010 ± 0.306 -0.235 ± 0.227 0.016 ± 0.235 Hip Y -0.074 ± 0.155 0.058 ± 0.053 0.041 ± 0.088 -0.089 ± 0.124 -0.011 ± 0.120 -0.023 ± 0.100 Z -0.040 ± 0.187 -0.286 ± 1.268 -0.657 ± 1.889 -0.071 ± 0.204 -0.377 ± 1.374 -0.169 ± 0.874 X -0.290 ± 0.251 0.214 ± 0.499 -0.265 ± 0.128 0.238 ± 0.483 -0.276 ± 0.191 0.227 ± 0.481 Y -0.014 ± 0.259 0.078 ± 0.058 -0.148 ± 0.156 -0.002 ± 0.064 -0.087 ± 0.205 0.034 ± 0.060 Knee Z -0.240 ± 0.186 -0.009 ± 0.186 -0.487 ± 1.615 -0.017 ± 0.232 -0.375 ± 1.476 -0.014 ± 0.208 Left limb X -0.111 ± 0.280 -0.792 ± 0.144 -0.407 ± 1.461 -0.935 ± 0.274 -0.273 ± 1.103 -0.870 ± 0.226 Ankle Y -0.224 ± 0.369 0.529 ± 0.128 -0.476 ± 0.508 1.500 ± 3.174 -0.361 ± 0.441 1.058 ± 2.358 Z -1.028 ± 0.753 1.526 ± 0.173 -1.223 ± 0.162 1.638 ± 0.202 -1.135 ± 0.534 1.587 ± 0.189 X -0.153 ± 0.321 0.038 ± 0.080 -0.388 ± 0.289 -0.103 ± 0.407 -0.281 ± 0.300 -0.039 ± 0.301 Hip Y 0.076 ± 0.090 0.011 ± 0.142 0.683 ± 2.803 0.165 ± 0.151 0.407 ± 2.076 0.095 ± 0.147 Z 0.367 ± 1.855 0.062 ± 0.220 0.328 ± 1.215 -1.705 ± 10.494 0.346 ± 1.506 -0.902 ± 7.719 X -0.295 ± 0.271 0.277 ± 0.199 -0.398 ± 0.076 0.269 ± 0.118 -0.351 ± 0.191 0.273 ± 0.156 Y 0.164 ± 0.296 -0.098 ± 0.085 0.326 ± 0.130 0.059 ± 0.049 0.252 ± 0.216 -0.013 ± 0.67 Knee Z 0.536 ± 2.096 0.143 ± 0.247 0.351 ± 1.493 0.272 ± 0.227 0.435 ± 1.789 0.213 ± 0.233 Right limb DF – Dorsiflexion; PF – Plantarflexion; Negative outputs (-) suggest the reloading phase ROM is larger than the loading phase ROM; Positive outputs (+) suggest that the loading phase ROM is larger than the reloading phase ROM. 8 Applied Bionics and Biomechanics Table 3: Range of Motion (Joint Angle), Range of Forces and Moments Output – Resultant measurements at the ankle, hip and knee joints for both left and right limbs during the dynamic phases of the trial ( ). Limb Resultant Female DF (mean Female PF (mean Male DF (mean Male PF (mean Joints sidedness measurement ± SD) ± SD) ± SD) ± SD) Joint angle ( ) 20.657 ± 6.202 58.477 ± 10.442 21.915 ± 11.470 49.178 ± 21.400 Joint force (N) 0.931 ± 0.612 1.766 ± 0.255 1.142 ± 1.158 2.081 ± 0.480 Ankle Joint moment 320.248 ± 158.134 203.37 ± 127.766 485.938 ± 881.768 302.093 ± 108.393 (Nmm) Joint angle ( ) 7.321 ± 3.530 6.960 ± 7.541 16.886 ± 9.968 4.915 ± 16.403 Joint force (N) 0.126 ± 0.384 0.296 ± 1.272 0.747 ± 1.898 0.114 ± 0.388 Knee Joint moment 142.932 ± 70.291 57.415 ± 88.639 188.285 ± 127.090 105.423 ± 83.966 (Nmm) Joint angle ( ) 24.031 ± 8.430 3.871 ± 5.879 37.499 ± 17.755 3.458 ± 3.919 Joint force (N) 0.290 ±0.406 0.228 ± 0.536 0.574 ± 1.628 0.239 ± 0.540 Hip Joint moment 45.143 ± 149.963 25.122 ± 53.475 130.911 ± 86.212 138.982 ± 69.468 (Nmm) Left limb Joint angle ( ) 23.095 ± 10.580 66.352 ± 5.368 23.676 ± 41.779 43.475 ± 11.442 Joint force (N) 0.336 ± 0.884 1.799 ± 0.259 1.374 ± 1.555 2.410 ± 3.192 Ankle Joint moment 291.668 ± 136.709 184.173 ± 169.349 424.310 ± 158.204 274.117 ± 59.366 (Nmm) Joint angle ( ) 3.996 ± 4.013 8.051 ± 27.098 5.284 ± 15.126 5.429 ± 9.914 Joint force (N) 0.405 ± 1.885 0.074 ± 0.274 0.851 ± 3.069 1.716 ± 10.503 Knee Joint moment 106.293 ± 113.329 54.974 ± 52.011 136.236 ± 144.455 99.029 ± 282.296 (Nmm) Joint angle ( ) 23.474 ± 6.720 4.945 ± 3.132 27.704 ± 8.309 4.041 ± 10.727 Joint force (N) 0.633 ± 2.134 0.327 ± 0.328 0.656 ± 1.501 0.387 ± 0.260 Hip Joint moment 159.135 ± 1076.132 46.801 ± 24.778 107.119 ± 114.153 162.610 ± 113.992 (Nmm) Right limb DF – Dorsiflexion; PF – Plantarflexion. The multivariate analysis for the ROM results only pro- between-subject effects with respect to ROM produced signif- duced a significant effect for foot position (F =82:448, p < icant effects, namely: sidedness at the knee in the Z direction 2 2 0:001, η =0:912, large). All other main effects and interac- (F =6:981, p =0:010, η =0:080, medium) and at the hip in p p 2 2 tions were not significant, i.e., sex (F =0:788, p =0:628, η the Y direction (F =5:801, p =0:018, η =0:068,medium); p p sidedness and foot position at the hip in the Z direction =0:090, medium); sidedness (F =1:793, p =0:084, η = (F =5:880, p =0:018, η =0:068, medium); and gender, sid- 0:183, large); gender and sidedness interaction (F =0:178, p =0:996, η =0:022, small); sex and foot position interac- edness and foot position at the knee in the Z direction (F =4:545, p =0:036, η =0:054, small). With the exception tion (F =1:772, p =0:089, η =0:181, large); sidedness and of knee ROM in the X direction (F =0:902, p =0:345, η = foot position (F =1:168, p =0:328, η =0:127, medium); p 0:011, small) and knee ROM in the Y direction (F =0:188, p and gender, sidedness, and foot position (F =1:030, p = =0:666, η =0:002, small), all other dependent variables 0:425, η =0:114, medium). showed significant between-subject effects. No significant between-subject effects were observed for The multivariate analysis for the joint force results only gender; gender and sidedness interaction; and gender and foot produced a significant effect for sidedness (F =9:944, p < position interaction, with respect to the dependent variables 2 2 0:001, η =0:278, large); phases (F =1:751, p =0:029, η (F <2:013, p >0:05, η =0:054, small). The following p p p Applied Bionics and Biomechanics 9 Male DF ankle Male PF ankle 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 –10 –10 –20 –20 –30 –30 –40 –40 –50 –50 –60 –60 ⁎ –70 –70 XY Z XY Z Ankle joint axes Ankle joint axes Male DF Knee Male PF knee 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 –10 –10 –20 –20 –30 –30 –40 –40 –50 –50 –60 –60 –70 –70 XY Z XY Z Knee joint axes Knee joint axes Male DF hip Male PF hip 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 –10 –10 –20 –20 –30 –30 –40 –40 –50 –50 –60 –60 –70 –70 X Y Z X Y Z Hip joint axes Hip-joint axes M (DF)-LL M (PF)-LL M (DF)-RL M (PF)-RL Figure 4: Grouped bar chart representation showing dorsiflexion (DF) and plantarflexion (PF) position comparisons between the left limb (LL) and right limb (LL) in male (M) participants at the anterior/posterior (X), medial/lateral (Y), and vertical (Z) directions at the ankle, knee, and hip joints. Error bars included ±standard deviation whilst ∗ indicates statistical significance (p <0:05)(n =12). small). The following between-subject effects with respect =0:063, medium); foot position (F =5:334, p <0:001, η to joint force produced significant effects, namely: sidedness =0:171, large); and phases and foot position interaction at the knee in the Y direction (F =70:281, p <0:001, η (F =5:097, p <0:001, η =0:164, large). All other main p =0:227, large) and at the hip in the Y direction effects and interactions were not significant. (F =23:066, p <0:001, η =0:088, medium); foot position No significant differences between-subject effects were p observed for gender; phases; gender and sidedness interac- at ankle in the Z direction (F =34:919, p <0:001, η = tion; gender and phase interaction; gender and foot position 0:127, medium) and at the knee in the X direction interaction; sidedness and phase interaction; gender, sided- (F =6:810, p =0:010, η =0:028, small); sidedness and foot ness, and phase interaction; gender, sidedness, and foot position at the ankle in the Y direction (F =13:820, p < position interaction; gender, phase, and foot position inter- 0:001, η =0:054, small); and phase and foot position action; sidedness, phase, and foot position interaction; and p gender, sidedness, phase, and foot position; with respect to interaction at the ankle in the Z direction (F =38:501, p < 2 2 the dependent variables (F <3:486, p >0:05, η <0:014, 0:001, η =0:243, small). p p Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) 10 Applied Bionics and Biomechanics Female PF ankle Female DF ankle 70 70 60 60 50 50 40 40 30 30 20 20 –10 –10 –20 –20 –30 –30 –40 –40 –50 –60 –60 –50 –70 –70 XY Z XY Z Ankle joint axes Ankle joint axes Female DF knee Female PF knee 70 70 60 60 –10 –10 –20 –20 –30 –30 –40 ⁎ –40 –50 –50 –60 –60 –70 –70 X Y Z X Y Z Knee joint axes Knee joint axes Female DF hip Female PF hip –10 –10 –20 –20 –30 –30 –40 –40 –50 –50 –60 –60 –70 –70 XY Z XY Z Hip joint axes Hip joint axes F (DF) - LL F (PF) - LL F (DF) - RL F (PF) - RL Figure 5: Grouped bar chart representation showing dorsiflexion (DF) and plantarflexion (PF) position comparisons between the left limb (LL) and right limb (LL) in female (F) participants at the anterior/posterior (X), medial/lateral (Y), and vertical (Z) directions at the ankle, knee and hip joints. Error bars included ±standard deviation whilst ∗ indicates statistical significance (p <0:05)(n =10). The multivariate analysis for the joint moment results only the knee and hip resultant force and moment range mea- produced a significant effect for gender (F =3:313, p =0:001, surements with respect to gender. The joint angles, forces, 2 2 and moments produced a similar trend in the Pearson corre- η =0:114, medium); sidedness (F =6:237, p <0:001, η = p p 2 lation measurements. The correlation between the foot posi- 0:195, large); phases (F =3:708, p <0:001, η =0:125, tion and the joint angle, joint force, and joint moment- medium); foot position (F =2:395, p =0:013, η =0:085, dependent variables ranged from r = −0:411 (fair) to r = medium); gender and sidedness interaction (F =4:189, p < 0:315 (fair). Similarly, the foot position and the ROM depen- 0:001, η =0:140, large); and phase and foot position interac- p dent variables ranged from r = −0:887 (very strong) to r = tion (F =2:482, p =0:001, η =0:087, medium). All other 0:065 (poor). main effects and interactions were not significant. Only the ankle resultant ROM and force range during PF 4. Discussion produced greater ROM and force range in comparison to DF. A converse trend was observed for the ankle moment This study investigated the joint angle, joint force, joint range datasets (see Table 3). All other resultant joint angle moment, and ROM responses of the left and right ankle, ROM outputs at the knee and hip produced greater DF knee, and hip lower limb joints between genders whilst per- ROM in comparison to PF. Presented in Table 3 are also forming dynamic DF and PF movements. Specifically, only Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Range of motion (°) Applied Bionics and Biomechanics 11 Females exhibited higher DF than PF measurements for the ankle joint during the DF and PF movement produced a significantly (p <0:001) higher PF ROM in comparison to the left limb knee joint moments, left limb hip joint forces, the DF movement. The knee and hip joints showed inconsis- and left limb hip joint moments. A similar trend was tencies in their ROM patterns with respect to sidedness and observed for the right limb knee and hip joint forces and foot position. No observed significant (p >0:05) main effects joint moments. The males exhibited similar trends; however, and interactions for ROM were observed for gender, sided- differences were observed in the knee joint forces and in the ness, and their combined interactions with foot position. left and right limb joint moments which produced lower DF Significant main effects for both joint forces and joint outputs in comparison to the PF measurements. There are moments were observed for sidedness, phases, foot position, multiple possibilities as to why lower limb DF and PF and phases and foot position interaction. ROM, forces, and moments may be decreased. These The results suggest that there are no clear definitive dis- include, but are not limited to, age, gender, prior injury, tinctions in the ROM coordinate output measures. Our degenerative diseases, and immobilisation. For example, a results showed that female participants presented with traumatic brain injury and fractures are both, in addition greater DF and PF ROM when compared to males. This to others, known to decrease the compliance of the calf mus- agrees with our first hypothesis. All participants showed dif- cles and therefore inhibit full flexibility [24]. Geographic and ferent joint angles and ROM output measurements between cultural living conditions are also determinants which can limbs. This finding may be aligned with joint flexibility since affect ROM [21]. both males and females exhibited variable joint angles and Mechanical stress exerted on the body and the physio- ROM output measurements. Both genders showed a similar logical adaptations of tissue over time must also be consid- trend in the resultant ankle joint ROM during DF and PF for ered prior to analysing results as this can be apparent with both the left and right limbs. The left and right hip joints increasing age [10]. Although age was not a focus of this also produced similar resultant ROM trends. Although the study, it has been suggested to be a confounding factor in knee and hip joints produced similar resultant ROM trends the ROM of an individual and a potential reason for primary for the left limb, the left and right knee produced dissimilar differences [25]. Wojcik et al. confirm the ideology that trends. On average, the correlations between the foot posi- younger individuals have a substantially larger ROM com- tion (DF and PF) and the lower limb joint angle and ROM pared to older adults as they are more able to utilise the outputs were weak, i.e., poor to fair. available flexibility [26]. It is also thought that post 50 years Our joint motion and ROM analysis revealed findings, of age, muscle strength begins to deteriorate which can prog- ress into reduced motor control at 60+ years with reaction which differed to expected results. As shown in Tables 1–3, there are no clear distinctions that show that the average speeds and movements also deteriorating [27]. Individuals, ROM was greater in females compared to males; therefore, especially the elderly, may also consider strengthening dorsi- our results are not in complete agreement with the limited flexors and plantarflexors to maintain stability, power, and literature available [19, 20]. This could be due to the move- strength necessary for physical function which decreases lin- ment strategies exhibited by participants, which may have early with age [10, 28]. Similarly, children 5 years and below subconsciously been influenced by their peculiarities in responded with a decreased hip and knee movement com- motion and/or vocational tasks differing in certain ways. pared to middle aged individuals due to the inability to com- ROM required on a daily basis at the ankle joint is reduced plete full extension [25]. This is comparable to the decrease below potential; walking requires 30 , and climbing stairs in mobility and flexibility in older adults. ° ° Gender-related disparity can arise due to muscle recruit- 37 is for ascent and 56 for descent [21]. Similar to Roaas and Andersson, ROM at the X-axis of the ankle for both ment that is used repeatedly; for example, during a fall, a the left and right limb in males and females are higher in female is thought to be able to stabilise/recover quicker using PF than in DF; however, they do not significantly differ from ROM and flexibility than males [26]. There are a few limita- each other statistically [22]. The average ROM for all partic- tions in this study that need consideration. Firstly, the par- ticipants recruited were aged between 19 and 30, which ipants in the current study falls within the ROM grouping outlined by the previous study (DF between 5 and 40 ;PF mean the results are not representative of the entire popula- tion. Secondly, due to the limited research in this field, com- between 10 and 55 ), suggesting that between the ages 19 and 40 years the plantarflexors and dorsiflexors remain in parisons of results at the ankle, knee, and hip joints were similar functionality. However, it must also be noted that unable to be confirmed or discussed in detail. Therefore, in future studies, a larger sample size needs to be recruited. the toe flexor strength within the foot plays a key role in standing and walking and therefore are independent con- Earlier studies by Ugbolue et al. have designed, devel- tributors to future incidence of falls. Performance in a PF oped, and validated a new methodological approach to eval- trial may be affected by a decrement in toe flexor strength uate heel pad stiffness and soft tissue deformation in both which continues to decline over time [23]. The left and right limbs between males and females during ankle dynamic unloading and loading activity [29]. To complement Ugbo- limb knee joint moment and hip joint forces and moments produced similar trends. In terms of gender, the kinetic out- lue et al.’s works [29–32], this study provides a useful biome- puts from the female participants were not in agreement chanical database from which potential modelling with our second hypothesis; however, there was a partial information could be obtained. This will aid in computer agreement in the knee joint forces and moments with simulation designed to provide further understanding and insights into the sensitivity of treatment planning, prediction respect to the male participants. 12 Applied Bionics and Biomechanics of treatment outcome, and other healthcare-related opportu- [4] A. Leardini, J. J. O'Connor, F. Catani, and S. Giannini, “The role of the passive structures in the mobility and stability of nities worthy of attention. In general, the force and moment the human ankle joint: a literature review,” Foot & Ankle Inter- results presented in Table 3 appear small and could suggest national, vol. 21, no. 7, pp. 602–615, 2000. that DF and PF exercises may have low impacts in terms [5] S. Yamaguchi, T. Sasho, H. Kato, Y. Kuroyanagi, and S. A. of forces exerted on the knee and hip joints. In order to pre- Banks, “Ankle and subtalar kinematics during dorsiflexion- dict treatment outcomes, ankle DF and PF may be a useful plantarflexion activities,” Foot & Ankle International, vol. 30, rehabilitation exercise regime that could reduce further risks no. 4, pp. 361–366, 2009. of injuries to the knee and hip among patients recovering [6] S. P. Flanagan, J.-E. Song, M.-Y. Wang, G. A. Greendale, S. P. from injuries in these specific areas. This research project Azen, and G. J. 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Finally, the results from this study provide females,” Baltic Journal of Health and Physical Activity, insightful information for clinicians and biomechanists that vol. 10, no. 3, pp. 48–56, 2018. relate to lower limb exercise interventions and modelling [9] A. Monk, J. Van Oldenrijk, N. D. Riley, R. H. Gill, and efficacy standpoints. D. Murray, “Biomechanics of the lower limb,” Surgery, vol. 34, pp. 427–435, 2016. Data Availability [10] C.-M. Fong, J. T. Blackburn, M. F. Norcross, M. McGrath, and D. A. Padua, “Ankle-dorsiflexion range of motion and landing The biomechanical data used to support the findings of this biomechanics,” Journal of Athletic Training, vol. 46, no. 1, study are available from the corresponding author upon pp. 5–10, 2011. request. [11] K. F. Orishimo, G. Burstein, M. J. 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Journal

Applied Bionics and BiomechanicsHindawi Publishing Corporation

Published: Sep 20, 2021

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