ReviewMulti-segment foot models and their use in clinical populations
Introduction
In standard clinical gait analysis, three-dimensional (3D) motion of large body segments, such as the thorax, pelvis, thighs, and shanks, is analysed under the rigid-body assumption thus kinematics can be estimated from the trajectories of three non-aligned skin markers attached to palpable bony landmarks. The foot, however, is made up of 26 small bones and presents few accessible landmarks therefore markers attachment to bony landmarks can be challenging. Over the last three decades several methods have been proposed to improve the kinematic analysis of foot segments. These have recently been termed multi-segment foot models (MFMs). There remains considerable debate over how best to group foot bones into segments, particularly in specific, clinical contexts.
The value of multi-segment, rather than single-segment motion tracking has been demonstrated by observing kinematic alterations at foot joints other than the ankle, in both typically developing and clinical populations [1,2]. Significant differences have also been reported [3] when the multi-segment Oxford Foot Model (OFM, see Table 1) and the Plug-in-Gait (single-segment foot) model were used to characterize normal-arched and flat feet. The additional value of multi-segment foot analysis has also been demonstrated with respect to traditional identification of anatomical deformities in static conditions [4]. Measurements are affected by the complexity of multi-segment foot modeling and intrinsic errors from motion of the skin markers with respect to the underlying bone, the so-called soft tissue artifacts. However, the alternative techniques used in routine clinical analysis have significant limitations. Video fluoroscopy and bone pins provide more accurate measures of foot joint motion but are also invasive. Inertial sensors [[5], [6], [7]] and marker-less dynamic 3D scanning [8] are less invasive, but anatomical accuracy is compromised.
A number of review papers on multi-segment foot models (MFM) have been published. Rankine et al. [9] reported a systematic analysis of twenty-five papers, where models were classified in terms of number of bony segments and types of joint rotations. Deschamps et al. [10] showed that some foot joint rotation measures are still unreliable and observed that MFMs have yet to be used to address clinical problems. According to Bishop et al. [11] this is the consequence of poorly described or flawed methodologies, preventing readers from replicating the analysis in real clinical settings. To overcome these limitations and to provide common platforms for sharing and comparing foot kinematic data, they proposed a number of standards for reporting MFMs. The association between foot posture and lower limb kinematics has been addressed in a review by Bult et al. [12]. Novak et al. [13] highlighted the strengths and weaknesses of the most widely used MFMs. A thorough recent survey of the MFMs can be found also in Leardini et al. [14].
The last few decades have seen the emergence of many different MFMs, but little has yet been done to determine their clinical relevance in terms of treatment planning and quantification of outcomes. The present paper aims at reviewing available MFMs, discussing major methodological and technical issues, with a special focus on clinical applications. This knowledge should provide the basis for the selection of the most appropriate model from the currently available techniques, according to the specific population and study hypotheses, and highlight which clinical questions have directly benefitted from utilization of these MFMs.
Section snippets
Material and methods
From January to September 2018 PubMed and Google Scholar were searched for papers on kinematics of human foot segments in-vivo, i.e. any model that included more than one segment. The search included the key words “gait”, “foot”, “kinematics” and “segment” or “model” and involved all relevant previous review papers. The search was extended to all those papers cited in this initial series. All papers were analyzed and categorized into primarily methodological ones or clinical applications of a
Results and discussion
39 papers presenting an original MFM and 65 clinical papers met the inclusion criteria; these are discussed respectively in Parts I and II.
Concluding remarks
A large variety of MFMs based on different marker sets is currently available in the literature (Table 1). Some of these are available to users via simple-to-use software programs, which save time and resources in writing ad-hoc programs. Also according to a recent review [11], the most widely used MFMs are those supported by papers providing exhaustive instructions on marker positioning, data smoothing, definition of the anatomical frames, and joint conventions. This has also enhanced
Conflict of interest
No conflict of interest has to be reported by the authors.
Funding
The Italian Ministry of Health funds for current research and the 5x1000 funds for health research (2018).
References (149)
- et al.
A new protocol for 3D assessment of foot during gait: application on patients with equinovarus foot
Clin. Biomech.
(2011) - et al.
Multi-segment foot landing kinematics in subjects with chronic ankle instability
Clin. Biomech.
(2015) - et al.
One- and multi-segment foot models lead to opposite results on ankle joint kinematics during gait: Implications for clinical assessment
Clin. Biomech.
(2015) - et al.
Multi-segment foot kinematics after total ankle replacement and ankle arthrodesis during relatively long-distance gait
Gait Posture
(2012) - et al.
A wearable system for multi-segment foot kinetics measurement
J. Biomech.
(2014) - et al.
Dynamic 3D scanning as a markerless method to calculate multi-segment foot kinematics during stance phase: methodology and first application
J. Biomech.
(2014) - et al.
Body of evidence supporting the clinical use of 3D multisegment foot models: a systematic review
Gait Posture
(2011) - et al.
Recommendations for the reporting of foot and ankle models
J. Biomech.
(2012) - et al.
The relationship between foot posture and lower limb kinematics during walking: a systematic review
Gait Posture
(2013) - et al.
Foot kinematics and kinetics during adolescent gait
Gait Posture
(2003)
Rear-foot, mid-foot and fore-foot motion during the stance phase of gait
Gait Posture
Impact of mediolateral segmentation on a multi-segment foot model
Gait Posture
The effect of low-mobile foot posture on multi-segment medial foot model gait kinematics
Gait Posture
A multi-segment foot model based on anatomically registered technical coordinate systems: method repeatability and sensitivity in pediatric planovalgus feet
Gait Posture
A kinematic description of dynamic midfoot break in children using a multi-segment foot model
Gait Posture
Concurrent repeatability and reproducibility analyses of four marker placement protocols for the foot-ankle complex
J. Biomech.
Comparison of three-dimensional multi-segmental foot models used in clinical gait laboratories
Gait Posture
Human movement analysis using stereophotogrammetry Part 3. Soft tissue artifact assessment and compensation
Gait Posture
An investigation into the deformable characteristics of the human foot using fluoroscopic imaging
Clin. Biomech.
Quantifying skin motion artifact error of the hindfoot and forefoot marker clusters with the optical tracking of a multi-segment foot model using single-plane fluoroscopy
Gait Posture
Foot bone kinematics as measured in a cadaveric robotic gait simulator
Gait Posture
Foot kinematics during walking measured using bone and surface mounted markers
J. Biomech.
In vitro study of foot kinematics using a dynamic walking cadaver model
J. Biomech.
Intrinsic foot kinematics measured in vivo during the stance phase of slow running
J. Biomech.
Invasive in vivo measurement of rear-, mid- and forefoot motion during walking
Gait Posture
Functional units of the human foot
Gait Posture
An objective evaluation of a segmented foot model
Gait Posture
Error in the description of foot kinematics due to violation of rigid body assumptions
J. Biomech.
Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy
Gait Posture
Functional evaluation of bilateral subtalar arthroereisis for the correction of flexible flatfoot in children: 1-year follow-up
Gait Posture
Are flexible flat feet associated with proximal joint problems in children?
Gait Posture
Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the Oxford Foot Model
Gait Posture
Comparison of foot segmental mobility and coupling during gait between patients with diabetes mellitus with and without neuropathy and adults without diabetes
Clin. Biomech.
The relationship between quality of life and foot function in children with flexible flatfeet
Gait Posture
Relationships between segmental foot mobility and plantar loading in individuals with and without diabetes and neuropathy
Gait Posture
Kinematic foot types in youth with equinovarus secondary to hemiplegia
Gait Posture
Classification of midfoot break using multi-segment foot kinematics and pedobarography
Gait Posture
Characterising the clinical and biomechanical features of severely deformed feet in rheumatoid arthritis
Gait Posture
Repeatability of a 3D multi-segment foot model protocol in presence of foot deformities
Gait Posture
Repeatability of the Oxford Foot Model in children with foot deformity
Gait Posture
Repeatability of a multi-segment foot protocol in adult subjects
Gait Posture
Effect of taping on multi-segmental foot kinematic patterns during walking in persons with chronic ankle instability
J. Sci. Med. Sport
Correlates between kinematics and baropodometric measurements for an integrated in-vivo assessment of the segmental foot function in gait
J. Biomech.
Anatomical masking of pressure footprints based on the Oxford Foot Model: validation and clinical relevance
Gait Posture
A video-based technique for measuring ankle-subtalar motion during stance
J. Biomed. Eng.
Talocrural and talocalcaneal joint kinematics and kinetics during the stance phase of walking
J. Biomech.
Three-dimensional kinematics of the rearfoot during the stance phase of walking in normal young adult males
Clin. Biomech.
Repeatability and sources of variability in multi-center assessment of segmental foot kinematics in normal adults
Gait Posture
A model for the evaluation of lower extremity kinematics with integrated multisegmental foot motion
J. Exp. Clin. Med.
Three-dimensional kinematics of the forefoot, rearfoot, and leg without the function of tibialis posterior in comparison with normals during stance phase of walking
Clin. Biomech.
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- 1
Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
- 2
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.