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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (2): 279-285. doi: 10.19723/j.issn.1671-167X.2021.02.008

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Characteristics and related factors of plantar pressure in the chronic ankle instability individuals

HOU Zong-chen1,AO Ying-fang1,HU Yue-lin1,JIAO Chen1,GUO Qin-wei1,HUANG Hong-shi1,REN Shuang1,ZHANG Si1,XIE Xing1,CHEN Lin-xin1,ZHAO Feng1,PI Yan-bin1,LI Nan2,JIANG Dong1,Δ()   

  1. 1. Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
    2. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-02-13 Online:2021-04-18 Published:2021-04-21
  • Contact: Dong JIANG E-mail:bysyjiangdong@126.com
  • Supported by:
    National Key Research and Development Program of China(2018YFF0301100);National Natural Science Foundation of China(31670982);Peking University Clinical Medicine Plus X-Young Scholars Project(PKU2018LCXQ009)

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Abstract:

Objective: To analyze characteristics and related factors of the plantar pressure during the level walking and single leg standing in the chronic ankle instability (CAI) individuals. Methods: From April 2019, 75 CAI individuals and 40 healthy individuals were enrolled in this study. Both of the static and dynamic plantar pressure were measured during six times level walking and three times single leg standing testing. The data including peak force, time to peak force in various foot contact areas and the time to boundary (TTB) and velocity of center of pressure (COP) were measured and compared between the affected side and the unaffected side and between the CAI cases and the healthy individuals. The correlations between the plantar pressure and the gender, Beighton score, affected side and body mass index (BMI) were analyzed. Results: The characteristics of plantar pressure distribution in the CAI individuals included: (1) During the level walking, the affected side showed the similar pressure contribution as the unaffected side (P>0.05). While compared with healthy individuals, there was a significantly higher peak force in the 5th metatarsal area (t=-3.86, P=0.03) of the affected side, lower peak force in the 1st (t=2.99, P=0.02), 2nd metatarsal head areas (t=2.09, P=0.01) of the affected side, medial hindfoot areas of both sides (affected, t=2.33, P=0.01; unaffected, t=3.74, P=0.02) and toes areass of both sides (affected, t=2.23, P=0.01; unaffected, t=3.28, P=0.02) and a delay to peak force in the 4th metatarsal head area (t=3.33, P=0.01) of the affected side. (2) During the single leg standing, the CAI individuals showed significantly worse balance control in the anterior/posterior direction (P<0.05) and lateral/medial direction (P<0.05) compared with the healthy controls, and the affected side had more severe balance control deficit in the lateral/medial direction (P<0.05). (3) The women (P<0.05) and the individuals with higher Beighton scores (P<0.05) showed worse balance control deficit in the lateral/medial direction. Conclusion: CAI individuals showed significantly a more lateral shifted plantar distribution during the level walking compared with the healthy individuals and the tendency was worse on the affected sides, and showed worse balance control in the anterior/posterior direction and lateral/medial direction during the single leg standing. The women and those with generalized ligament laxity showed significantly worse balance control.

Key words: Ankle joint, Ligament injury, Joint instability, Foot pressure

CLC Number: 

  • R648

Table 1

Baseline information"

Items CAI group (n=75) Normal group (n=40) t/χ2 P
Age/years 27.2±6.5 26.2±6.2 0.40 0.69
Gender (male/female) 38/37 19/21 0.80 0.66
Height/cm 169.7±7.7 170.5±6.4 -0.42 0.66
Weight/kg 68.8±6.3 66.7±7.7 0.58 0.57
FAAM ADL 67.6±5.3 98.6±5.6 -4.51 0.02
FAAM sports 55.9±5.4 94.4±4.4 -6.65 0.03
IdFAI 14.3±2.4 2.2±0.6 5.59 0.01
CAIT 14.6±3.4 28.8±3.3 5.52 0.04

Figure 1

Comparison of peak force/weight (PF/W) and time to peak force (TPF) of the affected and the unaffected side PF/W, peak force/weight; TPF, time to peak force; M1-M5, 1st to 5th metatarsal heads; HL, lateral hindfoot; HM, medial hindfoot; T1, toes. *P<0.05."

Table 2

Comparison of the parameters of the affected and the unaffected side during the single leg standing"

Parameters Affected side Unaffected side t P
TTB absolute/s
Anterior-posterior 0.62±0.10 0.71±0.12 -0.47 0.99
Medial-lateral 0.06±0.01 0.13±0.02 -2.15 0.03
TTB mean/s
Anterior-posterior 2.92±1.30 3.13±1.44 0.65 0.12
Medial-lateral 1.10±1.21 3.37±1.29 -3.12 0.02
TTB standard deviation/s
Anterior-posterior 2.02±0.35 2.10±0.30 0.88 0.34
Medial-lateral 1.43±0.22 1.62±0.24 2.03 0.04
COP velocity/(cm/s)
Anterior-posterior 9.93±0.32 9.06±0.36 -0.89 0.89
Medial-lateral 8.22±0.42 8.04±0.40 -0.99 0.83

Table 3

Comparison of the parameters of the CAI group and the control group during the single leg standing and walking"

Parameters Control group CAI group
Involved Uninvolved Affected Unaffected
PF/W/(N/kg)
M1 1.47±0.27 1.39±0.22 1.15±0.20* 1.26±0.20
M2 3.61±0.32 3.34±0.33 3.22±0.41* 3.31±0.17
M3 3.05±0.37 3.26±0.38 3.05±0.30 3.01±0.32
M4 1.44±0.36 1.40±0.37 1.45±0.32 1.46±0.21
M5 0.96±0.21 0.97±0.28 1.21±0.21* 1.01±0.21
T1 2.16±0.33 2.04±0.34 1.47±0.38* 1.53±0.36#
HL 4.54±0.42 4.59±0.38 4.55±0.41 4.34±0.55
HM 4.56±0.56 4.30±0.60 3.62±0.55* 3.56±0.62#
TPF/%
M1 70.4±5.7 67.0±7.2 70.5±8.0 66.6±7.3
M2 75.0±4.6 74.1±4.7 74.9±6.7 72.2±5.4
M3 72.8±5.8 73.0±4.4 72.9±6.7 69.6±5.8
M4 61.3±5.3 60.2±5.5 65.7±6.5* 60.9±6.1
M5 52.7±6.2 52.9±6.8 54.4±6.4 46.9±6.7
T1 77.3±6.3 76.3±6.1 77.1±5.1 72.8±3.5
HL 15.5±3.2 16.5±3.2 18.3±2.2 15.5±3.7
HM 16.9±3.0 17.7±3.9 19.4±3.3 17.9±3.9
TTB absolute/s
Anterior-posterior 0.51±0.08 0.52±0.07 0.35±0.07* 0.63±0.06
Medial-lateral 0.10±0.02 0.13±0.03 0.08±0.01* 0.11±0.02
TTB mean/s
Anterior-posterior 2.73±0.32 2.77±0.33 3.87±0.31* 2.95±0.33
Medial-lateral 1.63±0.32 1.53±0.35 1.35±0.26* 1.38±0.29#
TTB standard deviation/s
Anterior-posterior 2.09±0.17 2.09±0.16 2.16±0.12 2.12±0.14
Medial-lateral 1.52±0.28 1.54±0.22 1.57±0.15 1.48±0.20
COP velocity/(cm/s)
Anterior-posterior 4.52±0.23 4.56±0.32 8.93±0.44* 9.07±0.36#
Medial-lateral 5.49±0.49 5.83±0.52 7.68±0.44* 7.98±0.50#

Figure 2

Heat map of foot pressure distribution between normal (left) and CAI patients (right) during walking: The black line represents the vertical direction, and the red line represents the forward direction"

Table 4

Univariate analysis or correlation analysis of the plantar pressure parameters with difference between CAI patients and the normal"

Parameters Gender Beighton score Affected side BMI
t P r P t P r P
TPF
M4 -0.52 0.62 0.18 0.31 0.37 0.35 0.23 0.19
PF/W
M1 -0.38 0.30 -0.16 0.37 0.36 0.38 -0.01 0.93
M2 1.31 0.22 -0.18 0.30 0.54 0.17 -0.24 0.17
M5 0.37 0.79 0.30 0.09 0.45 0.41 0.14 0.44
T1 0.58 0.56 0.31 0.09 0.68 0.52 -0.32 0.35
HM -1.02 0.31 0.32 0.07 0.79 0.52 -0.17 0.06
COP velocity
Anterior-posterior -1.43 0.57 0.06 0.71 0.59 0.60 0.24 0.14
Medial-lateral -2.35 0.01 -0.50 0.01 -0.52 0.15 0.04 0.80
TTB absolute
Anterior-posterior 0.38 0.45 -0.10 0.55 0.62 0.50 0.12 0.49
Medial-lateral -0.86 0.46 0.10 0.56 -0.85 0.35 0.72 0.67
TTB mean
Anterior-posterior -1.44 0.60 -0.10 0.55 -0.49 0.27 -0.24 0.15
Medial-lateral 0.59 0.01 -0.52 0.01 -0.15 0.38 -0.14 0.41
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