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Title: Extrinsic foot muscle forces and joint contact forces in flexible flatfoot adult with foot orthosis : a parametric study of tibialis posterior muscle weakness
Authors: Peng, Y 
Wang, Y 
Wong, DWC 
Chen, TLW 
Zhang, G 
Tan, Q 
Zhang, M 
Issue Date: Jul-2021
Source: Gait and posture, July 2021, v. 88, p. 54-59
Abstract: Background: The posterior tibialis tendon dysfunction (PTTD) is typically associated with progressive flatfoot deformity, which could be alleviated with foot orthosis. However, the evaluation of tibialis posterior (TP) weakness on lower limb mechanics of flatfoot adults with foot orthoses is scarce and requires further investigation.
Research question: This study aimed to examine the effects of TP weakness on lower limb mechanics in flatfoot adults with foot orthosis through gait analysis and musculoskeletal modelling.
Methods: Fifteen young adults with flatfoot were recruited from University to perform a gait experiment with and without foot orthoses. Data collected from the motion capture system were used to drive the musculoskeletal modelling for the estimation of the joint force and extrinsic muscle forces of the lower limb. A parametric analysis was conducted by adjusting the TP muscle strength from 40 % to 100 %. Two-way repeated measures ANOVA was used to compare the peak extrinsic foot muscle forces and joint forces among different levels of TP weakness and insole conditions.
Results: TP weakness significantly increased ankle joint force superoinferiorly (F = 125.9, p < 0.001) and decreased anteroposteriorly (F = 125.9, p < 0.001), in addition to a significant increase in the muscle forces of flexor hallucis longus (p < 0.001) and flexor digitorum longus (p < 0.001). Besides, the foot orthosis significantly reduced most peak muscle forces whilst significantly reduced the second peak knee force and peak ankle force compared to the control condition (F = 8.79–30.9, p < 0.05).
Significance: The increased extrinsic foot muscle forces (flexor hallucis longus and flexor digitorum longus) and ankle joint forces in the TP weakness condition indicated that TP weakness may induce compensatory muscle activation and attenuated joint load. The abnormal muscle and joint mechanics in flatfoot adults with TP weakness might be restored by the orthosis.
Keywords: Foot orthoses
Gait analysis
Joint contact force
Musculoskeletal dynamics simulation
Tibialis posterior muscle
Publisher: Elsevier
Journal: Gait and posture 
ISSN: 0966-6362
EISSN: 1879-2219
DOI: 10.1016/j.gaitpost.2021.05.009
Rights: © 2021 Elsevier B.V. All rights reserved.
© 2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
The following publication Peng, Y., Wang, Y., Wong, D. W. C., Chen, T. L. W., Zhang, G., Tan, Q., & Zhang, M. (2021). Extrinsic foot muscle forces and joint contact forces in flexible flatfoot adult with foot orthosis: A parametric study of tibialis posterior muscle weakness. Gait & Posture, 88, 54-59 is available at
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