PMC6107083_01
Graphs depicting the ankle and knee sagittal plane joint kinematics (left panels) and joint moments (right panels) throughout the gait cycle for TB01 (top) and TB02 (bottom). In each graph, the barefoot condition is shown in red, braced condition in blue, and normative gait data (for comparison) in black. The shaded area around each line represents the SD for the 5 trials used to calculate the mean for the braced and barefoot conditions. The x-axis is normalized to % gait cycle (from initial contact to initial contact). The vertical lines towards the center of the graph depict toe-off, which designates the transition from stance to swing phase of gait, and correspond to each of the three conditions. For ankle and knee angles, positive values indicate dorsiflexion and knee flexion respectively. For ankle and knee moments, positive values indicate plantar-flexor and flexor moments, respectively. These graphs show that in the barefoot condition (red), both participants exhibit features consistent with genu recurvatum gait, i.e., increased ankle plantar flexion at initial contact, increased knee extension in stance, and a large and prolonged internal knee flexor moment in stance when compared to lab-based normative values, (black). For both TB01 and TB02, these variables showed improvements (change toward the normative value) with the addition of the AAFO (blue).
nihms983261f2.jpg
PMC6107083_02_nihms983261f2.jpg
F2
The left knee flexor moment integral in stance was 0.63 Nm.s/Kg (0.10) for the barefoot condition and significantly improved to 0.02 Nm.s/Kg (0.01, p <0.00) with the addition of the AAFO (Figure 2).
Bar plots showing the mean (computed across 5 gait cycles) and 95% confidence interval error bars for three key gait variables measured in our case series: ankle angle at initial contact (A, D), peak knee extension during stance (B, E), and peak knee flexor moment during stance (C, F) for TB01 (left panels A-C) and TB02 (right panels D-F). *Represents significant difference detected using a paired t-test between braced and barefoot conditions (p<.05). Note that the paired t-test for peak knee flexor moment for TB01 was not significant (C), but it met the second criterion for evaluating differences between the two conditions, i.e. the average value for the braced condition exceeded the 95% CI for the barefoot condition.
nihms983261f3.jpg
PMC6107083_02_nihms983261f3.jpg
F3
For the barefoot condition, the left ankle at initial contact was 20  (1.21 ) of plantar flexion, which significantly improved to 7  (1.22 , p<0.01) of dorsiflexion with the application of the AAFO (Figure 3). Left peak knee extension during stance significantly improved from 23  (0.65 ) of extension for the barefoot condition to 11  (1.24 , p<0.01) of extension for the braced condition (Figure 3). The left peak internal knee flexor moment during stance was 0.88 Nm/Kg (0.05) for the barefoot condition and significantly reduced to 0.21Nm/Kg (0.04, p<0.00) for the braced condition (Figure 3).
PMC6107083_02
Graphs depicting the ankle and knee sagittal plane joint kinematics (left panels) and joint moments (right panels) throughout the gait cycle for TB01 (top) and TB02 (bottom). In each graph, the barefoot condition is shown in red, braced condition in blue, and normative gait data (for comparison) in black. The shaded area around each line represents the SD for the 5 trials used to calculate the mean for the braced and barefoot conditions. The x-axis is normalized to % gait cycle (from initial contact to initial contact). The vertical lines towards the center of the graph depict toe-off, which designates the transition from stance to swing phase of gait, and correspond to each of the three conditions. For ankle and knee angles, positive values indicate dorsiflexion and knee flexion respectively. For ankle and knee moments, positive values indicate plantar-flexor and flexor moments, respectively. These graphs show that in the barefoot condition (red), both participants exhibit features consistent with genu recurvatum gait, i.e., increased ankle plantar flexion at initial contact, increased knee extension in stance, and a large and prolonged internal knee flexor moment in stance when compared to lab-based normative values, (black). For both TB01 and TB02, these variables showed improvements (change toward the normative value) with the addition of the AAFO (blue).
nihms983261f2.jpg
PMC6107083_02_nihms983261f2.jpg
F2
The left knee flexor moment integral in stance was 0.63 Nm.s/Kg (0.10) for the barefoot condition and significantly improved to 0.02 Nm.s/Kg (0.01, p <0.00) with the addition of the AAFO (Figure 2).
Bar plots showing the mean (computed across 5 gait cycles) and 95% confidence interval error bars for three key gait variables measured in our case series: ankle angle at initial contact (A, D), peak knee extension during stance (B, E), and peak knee flexor moment during stance (C, F) for TB01 (left panels A-C) and TB02 (right panels D-F). *Represents significant difference detected using a paired t-test between braced and barefoot conditions (p<.05). Note that the paired t-test for peak knee flexor moment for TB01 was not significant (C), but it met the second criterion for evaluating differences between the two conditions, i.e. the average value for the braced condition exceeded the 95% CI for the barefoot condition.
nihms983261f3.jpg
PMC6107083_02_nihms983261f3.jpg
F3
For the barefoot condition, the left ankle at initial contact was 20  (1.21 ) of plantar flexion, which significantly improved to 7  (1.22 , p<0.01) of dorsiflexion with the application of the AAFO (Figure 3). Left peak knee extension during stance significantly improved from 23  (0.65 ) of extension for the barefoot condition to 11  (1.24 , p<0.01) of extension for the braced condition (Figure 3). The left peak internal knee flexor moment during stance was 0.88 Nm/Kg (0.05) for the barefoot condition and significantly reduced to 0.21Nm/Kg (0.04, p<0.00) for the braced condition (Figure 3).