Independently ambulatory children with spina bifida experience near-typical knee and ankle joint moments and forces during walking.
Marissa R Lee, Jennifer L Hicks, Tishya A L Wren and 1 others
PMID 36283301WHAT IT FOUND
Most independently walking children with spina bifida generate near-typical knee and ankle forces during gait.
However, those with the weakest plantar flexors experienced higher compressive knee and shear ankle forces, suggesting a specific subgroup at risk for altered loading despite high function.
Key findings
01Children with spina bifida walked slower than controls but exhibited near-typical joint moments and tibial forces on average.
02Weaker plantar flexor muscle strength was correlated with greater peak compressive knee forces and shear ankle forces.
03Participants with the lowest plantar flexor strength had joint forces exceeding those of typical development, likely associated with crouch gait patterns.
STILL TO COME
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What it does not show
Small sample size (16 per group) limits the generalizability of findings. Only highly functional, independently ambulatory children were included, so results do not apply to those with lower function or reliance on assistive devices. Musculoskeletal simulations relied on scaled generic models rather than personalized anatomy, which may affect force estimation accuracy. The correlation between plantar flexor strength and joint forces was driven largely by three participants with the weakest muscles; excluding them removed the significance.
Declared interests
None declared in the provided text, though the study was supported by non-U.S. government and NIH extramural grants.
The easy way to misread this
Do not assume that all independently ambulatory children with spina bifida have typical joint loading. The average near-typical forces mask a subgroup with weak plantar flexors who experience higher-than-normal knee and ankle forces, likely due to crouch gait.