Background

Mobility aids are commonly prescribed to offload an injured lower extremity. Device selection may impact stance foot loading patterns and foot health in clinical populations at risk of foot ulceration.

Research questions

Two questions motivated this study: How does device selection influence peak plantar and regional (rearfoot, mid foot and forefoot) foot forces on the stance foot? Does device selection influence peak, cumulative, and regional plantar forces within a 200 m walking trial?

Methods

Twenty-one older adults walked 200 m at self-selected pace in four randomized conditions for this prospective crossover study. Participants used a walker, crutches, wheeled knee walker (WKW), and no assistive device (control condition). Plantar forces were measured using a wireless in-shoe system (Loadsol, Novel Inc., St. Paul, MN). Repeated measures analyses of variance were used to determine differences in peak and cumulative total and regional forces among walking conditions. Paired sample t-tests compared forces during first and last 30 s epochs of each condition to determine device influence over time.

Results

The WKW reduced peak net forces by 0.29 and 0.35 bodyweight (BW) when compared to the walker or control condition with similar trends in all foot regions. Crutch use had similar peak forces as control. There were no differences in the number of steps taken within devices comparing first and last epochs. Crutches had a 0.04 and 0.07 BW increase in peak net and forefoot forces during the last epoch. Walker use had 66.44 BW lower cumulative forefoot forces in the last epoch.

Significance

Crutches had similar stance foot loading as normal walking while a walker lowered forefoot forces at the expense of increased steps. A WKW may be the best choice to ‘protect’ tissues in the stance foot from exposure to peak and cumulative forces in the forefoot region.

中文翻译：

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在健康的老年人中，正常行走和三种活动辅助装置之间的站立肢体峰值，累积和局部足底足力量的变化。

背景

通常规定使用助行器来减轻受伤的下肢。设备的选择可能会影响有脚溃疡风险的临床人群的脚部脚姿和脚部健康状况。

研究问题

有两个问题推动了这项研究：器械的选择如何影响站立脚上的足底和区域（后脚，中脚和前脚）的峰值脚力？器械的选择是否会影响200 m步行试验中的峰值，累积和局部足底力量？

方法

在这项前瞻性交叉研究中，有21位老年人在四种随机条件下以自行选择的速度行走200 m。参与者使用助行器，拐杖，轮式膝盖助行器（WKW），并且没有辅助装置（控制状态）。使用无线鞋内系统（明尼苏达州圣保罗的Novell Inc.，Loadsol）测量足底力。重复测量方差分析可确定步行条件下峰值力和累积总力以及区域力的差异。配对样本t检验比较了每种情况的前30秒和后30秒内的作用力，以确定随时间变化的设备影响。

结果

与步行者或控制者的状况相比，在所有脚部区域中，WWW都将峰值净力降低了0.29和0.35体重（BW）。拐杖的使用峰值力与控制力相似。比较首个和最后一个时期，设备内采取的步骤数量没有差异。在最后一个时期，拐杖的净峰值和前足力增加了0.04和0.07 BW。步行者的使用在最后一个时期降低了66.44 BW的累积前足力。

意义

拐杖的脚负重与正常行走相似，而步行者以增加步数为代价降低前足力。WKW可能是“保护”站立脚组织免于暴露于前脚区域的峰值和累积力的最佳选择。