A spatio-temporal and kinematic description of self-selected walking in adults with Achondroplasia
Introduction
Achondroplasia is the most prevalent type of skeletal dysplasia and is defined by shorter stature due to disproportionately smaller limb to torso length, compared to age matched able-bodied individuals, hereafter referred to as ‘controls’ [[1], [2], [3]]. Despite these well documented differences, few investigations have commented on how the shorter lower limb lengths of individuals with Achondroplasia may alter their functional tasks, such as walking. It has recently been shown that the Gait Profile Score (GPS) of adults with Achondroplasia is higher than controls [4]. However, while GPS is useful in describing a global difference in gait between populations, it does not pertain to mechanisms that describe the overall difference in gait. While individuals with Achondroplasia appear to be unaffected by gait limiting pathologies, such as those that are explained by neurological impairment, muscle weakness, amputation or skeletal deformity [[5], [6], [7], [8], [9], [10]], their shorter legs and relatively longer foot (foot-to-leg length ratio) appear to lead to greater knee flexion and ankle dorsiflexion angles during the entire stride compared to controls [4,11]. To date there appear to be four data sets that describe gait and lower limb joint kinematics during self-selected walking (SSW) in groups with Achondroplasia, all of which show subtle differences in kinematic patterns compared to controls [4,[11], [12], [13]], with some suggesting these differences are required to avoid toe contact with the floor during swing [4,11]. None of these studies however, provide a full spatio-temporal or kinematic analysis of gait in any population with Achondroplasia, who have not undergone leg lengthening surgery, to help further explain the differences in kinematics compared to controls. The aim of this study was to therefore describe time normalised kinematic gait patterns of SSW in adults with Achondroplasia who had not undergone leg lengthening surgery and compare these measures to controls. It was hypothesised that there would be kinematic differences between groups for all lower limb joints, but due to the lack of data describing Achondroplasic gait, these hypotheses are two-tailed.
Section snippets
Participants
After written consent, 10 males with Achondroplasia (Achondroplasic group) and 17 able-bodied males (controls) volunteered to participate in the study (Table 1). All participants reported they were free from lower limb injury and the Achondroplasia group have not undergone leg lengthening surgery. Ethical approval was obtained from the local committee and each participant attended one testing session at a gait laboratory where anthropometric and kinematic assessments at SSW were conducted.
Kinematic measures
Anthropometric measures
There was no difference in age between groups (P = 0.487), but the Achondroplasic group were 23 % shorter in stature (P < 0.001), were 19 % lighter (P < 0.001) and had a 41 % shorter leg than controls (P < 0.001, Table 1).
Spatio-Temporal
The Achondroplasic group were 23 % slower (P < 0.001), had a 29 % shorter stride length (P < 0.001) and a 13 % higher stride frequency than controls (P < 0.001, Table 2). When presented as dimensionless values, the group with Achondroplasia had a longer stride than controls
Discussion
This study aimed to describe spatio-temporal and kinematic parameters of the lower limbs during SSW gait in a group of adults with Achondroplasia who had not undergone limb lengthening surgery. The main findings were that adults with Achondroplasia walk slower and have a greater stride frequency than controls and the same group are more ‘flexed’ at the pelvis, hip, knee and ankle throughout the stride cycle than controls.
The slower SSW of the Achondroplasic group compared to controls was
Conclusion
The current study aimed to present a comprehensive analysis of time normalised lower limb gait kinematics in a homogenous adult population with Achondroplasia who had not undergone limb lengthening surgery. We have demonstrated that this group walk slower and have a higher stride frequency and shorter stride length than controls. Numerous differences in discrete kinematics of the lower limbs exist between the groups, which combine to present a more flexed gait in the Achondroplasic group. The
Declaration of Competing Interest
The authors have no conflict of interest.
Acknowledgements
The authors would like to thank the Dwarf Sports Association (Dronfield, UK. Registered Charity number: 1041961) for their assistance in recruitment and Dream it Believe it Achieve it (Northwich, UK. Registered Charity Number: 1153116) for which D. Sims received initial postgraduate funding.
References (26)
- et al.
Standard growth curves for achondroplasia
J. Pediatr.
(1978) - et al.
A quantitative description of self-selected walking in adults with Achondroplasia using the gait profile score
Gait Posture
(2019) - et al.
The gait profile score and movement analysis profile
Gait Posture
(2009) - et al.
Correlations of the gait profile score and the movement analysis profile relative to clinical judgments
Gait Posture
(2010) - et al.
The minimal clinically important difference for the Gait Profile Score
Gait Posture
(2012) - et al.
Medial-lateral centre of mass displacement and base of support are equally good predictors of metabolic cost in amputee walking
Gait Posture
(2017) - et al.
Kinematic characteristics of achondroplasia
Gait Posture
(2006) - et al.
O052 Gait characteristics of achondroplasia following lower limb-lengthening
Gait Posture
(2008) - et al.
A gait analysis data collection and reduction technique
Hum. Mov. Sci.
(1991) Scaling gait data to body size
Gait Posture
(1996)
Data management in gait analysis for clinical applications
Clin. Biomech.
The energetics of human walking: is Froude number (Fr) useful for metabolic comparisons?
Gait Posture
Mechanical properties of the patellar tendon in adults and children
J. Biomech.
Cited by (3)
Lower limb biomechanics during gait in children with Achondroplasia
2021, Journal of BiomechanicsCitation Excerpt :In two recent studies on physically active and otherwise healthy adult male subjects with Achondroplasia, subjects were reported to have greater overall global involvement compared to controls and a more flexed position throughout gait for the lower limbs (Sims et al., 2019, Sims et al., 2020). Shorter legs and a longer relative foot length (foot-to-leg length ratio) were suggested as possible contributors to this flexed position (Sims et al., 2020). Based on the current literature it is difficult to understand fully how gait in children with Achondroplasia is altered compared to their typically developed (TD) peers.
Gait in children with achondroplasia – a cross-sectional study on joint kinematics and kinetics
2022, BMC Musculoskeletal DisordersThe talar morphology of a hypochondroplasic dwarf: A case study from the Italian Late Antique period
2022, International Journal of Osteoarchaeology