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Rigby E1, Ferreira K2, Katuli S2, Pierce C2
1Singapore Institute of Technology, Health and Sciences Cluster, Singapore, Singapore, 2Andrews University, Physical Therapy Department, Berrien Springs, United States
Background: Walker boots are beneficial in allowing functional treatment of acute and chronic conditions that require immobilisation of the foot and ankle. Ambulating in a walker boot, however, introduces an artificial leg length discrepancy. Leg length discrepancies have been associated with various musculoskeletal conditions and functional compromise. Levelling devices such as an EvenupTM device have been investigated for kinetic and kinematic measures while this study aims to look at temporospatial measures. Further understanding of temporospatial measures of gait when ambulating in a walker boot would be helpful for design modification.
Purpose: The purpose of this study is to assess the effect an EvenupTM on the artificial leg length discrepancy introduced by a walker boot with a sample size (N=87) and a wide range of temporospatial parameters. We hypothesised wearing an EvenupTM device on the contralateral foot to a walker boot would mitigate the effects of the artificial leg length discrepancy when ambulating in a walker boot.
Methods: The study is a retrospective analysis of combined data from two studies including healthy subjects (N=87, male = 45, female = 42, age 18-60 years). The analysis included one repeated independent variable (boot condition) with three levels (shoes only, boot only, boot + EvenupTM). Temporospatial parameters were measured in a random order over four walking trials for each condition. A GAITrite® system measured velocity, cadence, stride length, step length, step time, stance time, swing time, swing percentage of the gait cycle, and toe-in/toe-out.
Results: A one-way repeated ANOVA was conducted. Velocity, cadence and stride length decreased in a walker boot, but showed no significant improvement with the addition of the EvenupTM device. Measures of left step length, left step time, and left swing time all significantly improved towards the control condition showing a mitigation of effect of the leg length discrepancy while measures of right step time, left stance time, right swing time and swing time as a percentage of the gait cycle significantly increased away from the control condition unexpectedly exhibiting the opposite result.
Conclusion(s): The study findings showed the addition of an EvenupTM device does not consistently mitigate the effect of the leg length discrepancy introduced when ambulating in a walker boot. Certain temporospatial measures were found to not significantly change, some were mitigated while others significantly increased with the addition of the EvenupTM device.
Implications: Levelling devices reportedly improve pain and function when ambulating in a walker boot. Our study showed the mitigating effect on leg length discrepancy by an EvenupTM device resulted in only some of the temporospatial measures being mitigated while increased others. The study highlights the impact of a levelling device when ambulating in a walker boot. This impact should be taken into account when designing modifications to walker boots to help mitigate gait disturbances related to ankle immobilization.
Keywords: Short-leg walker boot, leg length discrepancy, temporospatial gait parameters
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Purpose: The purpose of this study is to assess the effect an EvenupTM on the artificial leg length discrepancy introduced by a walker boot with a sample size (N=87) and a wide range of temporospatial parameters. We hypothesised wearing an EvenupTM device on the contralateral foot to a walker boot would mitigate the effects of the artificial leg length discrepancy when ambulating in a walker boot.
Methods: The study is a retrospective analysis of combined data from two studies including healthy subjects (N=87, male = 45, female = 42, age 18-60 years). The analysis included one repeated independent variable (boot condition) with three levels (shoes only, boot only, boot + EvenupTM). Temporospatial parameters were measured in a random order over four walking trials for each condition. A GAITrite® system measured velocity, cadence, stride length, step length, step time, stance time, swing time, swing percentage of the gait cycle, and toe-in/toe-out.
Results: A one-way repeated ANOVA was conducted. Velocity, cadence and stride length decreased in a walker boot, but showed no significant improvement with the addition of the EvenupTM device. Measures of left step length, left step time, and left swing time all significantly improved towards the control condition showing a mitigation of effect of the leg length discrepancy while measures of right step time, left stance time, right swing time and swing time as a percentage of the gait cycle significantly increased away from the control condition unexpectedly exhibiting the opposite result.
Conclusion(s): The study findings showed the addition of an EvenupTM device does not consistently mitigate the effect of the leg length discrepancy introduced when ambulating in a walker boot. Certain temporospatial measures were found to not significantly change, some were mitigated while others significantly increased with the addition of the EvenupTM device.
Implications: Levelling devices reportedly improve pain and function when ambulating in a walker boot. Our study showed the mitigating effect on leg length discrepancy by an EvenupTM device resulted in only some of the temporospatial measures being mitigated while increased others. The study highlights the impact of a levelling device when ambulating in a walker boot. This impact should be taken into account when designing modifications to walker boots to help mitigate gait disturbances related to ankle immobilization.
Keywords: Short-leg walker boot, leg length discrepancy, temporospatial gait parameters
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Topic: Musculoskeletal: lower limb; Human movement analysis; Orthopaedics
Ethics approval required: No
Institution: Andrews University
Ethics committee: Andrews University IRB 17 October 17, 2017
Reason not required: IRB protocol #17-156 determined Exempt from IRB review under regulation 46.10(b) as retrospective study with previous approval
All authors, affiliations and abstracts have been published as submitted.
