Effects Of Functional Training Of Lower Limbs And FES On Gait And Balance Ability Of Patients With Early PTTD

Objective: to compare the differences of foot morphology,foot and ankle function,walking biomechanical characteristics and dynamic balance ability between early PTTD patients and healthy people,and to explore the intervention effects of lower limb functional training and functional electrical stimulation on early PTTD patients.Methods: 20 early PTTD subjects(PTTD group)and 20 healthy ankle subjects(healthy group)were included.The Arch Height Index,the Navicular Drop Test,FPI-6,AOFAS,The number of single heels raised,pain and YBT were tested and evaluated,and 40 subjects were collected by Vicon 3D motion capture system,Kistler 3D force table and Opto Gait optical gait detection system.The differences between PTTD group and healthy group were compared.20 subjects in PTTD group were randomly divided into functional training group(functional training group)and functional electrical stimulation group(FES group),intervening for 8 weeks,three times a week.In the functional training group,the whole lower limb training was carried out,which included the enhancement of foot and ankle muscles and the activation of muscles around the hip joint.In FES group,abductor muscle and tibialis anterior muscle were stimulated by functional electrical stimulation.After the intervention,all the above parameters of PTTD subjects were collected again,and the effects of functional training and functional electrical stimulation on arch shape,foot posture and function,tibialis posterior muscle function,gait and balance ability of PTTD subjects were compared and analyzed.Results:(1)compared with the healthy group,the arch height index and the NDT in the PTTD group were significantly lower than those in the healthy group(P<0.001),the FPI-6 in the PTTD group were significantly higher than those in the healthy group,and the AOFAS ankle-hindfoot function score was significantly lower than that in the healthy group(P <0.001).The number of single heels raised in the PTTD group was significantly less than that in the healthy group,and the VAS pain score was significantly higher than that in the healthy group(P<0.001).The walking speed and stride length of PTTD group were lower than those of healthy group(P<0.05),and the time of double support phase was significantly longer than that of healthy group(P < 0.001).During the walking support period,the hip flexion-extension angle decreased and hip inversion increased in the PTTD group compared with the healthy group(P<0.05);the knee extension and valgus peak increased(P<0.05);the ankle plantarflexion-dorsal extension angle peak decreased and valgus angle increased(P<0.05);the first peak of V-GRF was smaller in the PTTD group than in the healthy group during the support period(P<0.05),and the second peak of V-GRF was significantly smaller than that of the healthy group,and the displacement range of the COP in the left and right directions was significantly larger than that of the healthy group(P<0.001).The peak hip extension moment in the PTTD group during the support period was smaller than that in the healthy group,the peak internal rotation moment was larger than that in the healthy group(P< 0.05),the peak knee flexion and internal rotation moment was smaller than that in the healthy group,the peak internal rotation moment was larger than that in the healthy group(P< 0.05),the peak ankle plantarflexion moment was significantly smaller than that in the healthy group(P < 0.001),the peak internal rotation moment was smaller than that in the healthy group,and the peak external rotation moment was larger than that in the healthy group(P < 0.05).In YBT test,the indexes of internal side,posterior external side and comprehensive touch distance in PTTD group were significantly lower than those in healthy group(P<0.001).(2)Comparison between functional training group and FES group: after intervention,the arch height index of both groups was higher than that before,and the AHI of functional training group was higher than that of FES group(P < 0.05).The NDT in functional training group after intervention was significantly lower than that in FES group(P< 0.001).The FPI-6 score in the functional training group decreased significantly after intervention(P<0.001),and was lower than that in the FES group(P<0.05).The AOFAS scores of the two groups after intervention were higher than those before intervention(P<0.05),but there was no significant difference between the two groups(P=0.130).After intervention,the number of single heel raised of one foot in functional training group was higher than that in FES group(P<0.05).After intervention,the VAS score in both groups was significantly lower than that before intervention(P<0.001),and the VAS score in the FES group was lower than that in the functional training group(P<0.05).After intervention,the walking space-time parameters such as stride length and walking speed in the functional training group were larger than those before intervention and larger than those in the FES group,and the time of double support phase in the functional training group was shorter than that in the FES group(P <0.05).After the intervention,the hip adduction and ankle valgus angles during walking support decreased in the functional training group and were smaller than those in the FES group(P<0.05);the peak hip extension and abduction angles and peak ankle valgus angles increased and were larger than those in the FES group(P<0.05).The ankle plantarflexion and dorsiflexion angles increased in both groups before and after the intervention,and there was no difference between the groups.The range of motion of the ankle coronal plane increased in the FES group after the intervention and was greater than that in the functional training group(P<0.05).After the intervention,the second peak of V-GRF in the functional training group was greater than that before the intervention and greater than that in the FES group(P<0.05);the displacement of the plantar center of pressure in the left and right directions was smaller than that before the intervention and smaller than that in the FES group(P<0.05).there was no statistical difference between the peak of vertical ground return and the displacement of the plantar center of pressure in the FES group before and after the intervention(P>0.05).After the intervention,the peak hip extension moment during the support period in the functional training group was greater than that before the intervention and greater than that in the FES group(P<0.05);the peak hip abduction moment was greater than that before the intervention and greater than that in the FES group(P<0.05);the peak knee valgus moment was less than that before the intervention and less than that in the FES group(P<0.05);the peak ankle plantarflexion moment and peak ankle inversion moment were greater than that before the intervention and greater than that in the FES group(P<0.05).The peak hip abduction moment during the support period in the FES group after the intervention was smaller than that before the intervention(P<0.05).After the intervention,the YBT test functional training group had greater anterior,posterior-internal,posterior-external and integrated touch distance indices than before the intervention and greater than the FES group(P <0.05).there was no statistical difference in the YBT test results before and after the intervention in the FES group(P>0.05).Conclusions:(1)in the early stage,PTTD showed obvious arch collapse,excessive pronation,low dynamic stability,decreased ankle function,decreased tibialis posterior muscle function,decreased walking efficiency,hip adduction,knee valgus and ankle valgus,and decreased dynamic balance.(2)intervention can improve the abnormal performance of PTTD,relieve pain and improve the function of foot and ankle.Functional training is more beneficial to improve the function of tibialis posterior muscle,strengthen the dynamic stability of foot arch,improve excessive pronation of foot,improve walking efficiency,improve hip adduction and ankle valgus,stabilize posture and improve dynamic balance ability.(3)the effect of functional electrical stimulation on PTTD is limited to the movement of ankle joint in the sagittal plane,which can not stop the development of ankle valgus,but it is more effective in relieving pain.Clinically,the appropriate intervention method can be chosen according to the specific conditions and needs of patients with early PTTD.