Northwestern University Feinberg School of Medicine

Northwestern University Prosthetics-Orthotics Center

Mediolateral Foot Placement and Related Biomechanical Impairments in Post-Stroke Individuals

Co-Principal Investigators: Steven A. Gard, PhD, and Stefania Fatone, PhD, BPO(Hons)

Student Investigator: Angelika N. Zissimopoulos, MS

Funded by: Orthotic and Prosthetic Education and Research Foundation (RFA OPERF-2010-FA-1; 2010 Recipient Angelika Zissimopoulos)Dr. John N. Nicholson Fellowship (2007-2012 Recipient Angelika Zissimopoulos)National Institute on Disability and Rehabilitation Research (grant H133E090009, 2008-2013)

Status: Completed


Tapelines to measure mediolateral foot placement.During locomotion, accurate mediolateral (ML) foot placement is important because it is closely related to movement of the body center of mass and is an effective mechanism for maintaining dynamic balance (i.e., forward progression without a fall) . The lower limb is aligned for each foot placement during the preceding swing phase of gait. Stroke is the leading cause of long term disability; and after a stroke, the swing phase is often characterized by drop foot and associated compensations to create toe clearance. Therefore, the phase of gait important for lower limb alignment and ML foot placement is characterized by abnormal positioning and movement.

Neither ML foot placement accuracy nor correlations between abnormal swing phase biomechanics and ML foot placement accuracy have been investigated in the post-stroke population. The first two aims of this study will address these gaps in current knowledge regarding post-stroke locomotion. Furthermore, the equinovarus position of the foot (and therefore the associated swing phase compensations) can be clinically addressed by prescribing an ankle-foot orthosis (AFO). It is currently unknown whether AFO related improvements in swing phase ankle and foot alignment have a positive effect on ML placement. This question is addressed by the last aim of this study. By investigating ML foot placement, a mechanism important for balance during locomotion, we will contribute new knowledge to the body of literature related to balance capabilities in post-stroke individuals.

Related Publications

Zissimopoulos A, Gard S, Stine R, Fatone S. Effects of an Ankle-Foot Orthosis on Foot Placement Post-Stroke: Balance Implications. Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists (AAOP), March 21-24, Atlanta, GA, USA, 2012 (Podium Presentation).

Zissimopoulos A, Gard S, Stine R, Fatone S. Mediolateral Foot Placement during Post-Stroke Ambulation with and without an Ankle-Foot Orthosis. World Congress of the International Society for Prosthetics and Orthotics, February 4-7, Hyderabad, India, 2013 (Podium Presentation).

Zissimopoulos A, Fatone S, Stine R, Gard S. (2013) Effects of a Non-Rigid AFO on ML Foot Placement during Post-Stroke Locomotion, Gait and Clinical Movement Analysis Society, May 14-17, Cincinnati, OH, USA (Poster Presentation).

Zissimopoulos, Angelika (2013) An Investigation of Mediolateral Foot Placement during Post-Stroke Gait," PhD Dissertation, Biomedical Engineering, Northwestern University.

Zissimopoulos A, Fatone S and Gard S. (2014) The Effect of Ankle-Foot Orthoses on Self-reported Balance Confidence in Persons with Chronic Post-Stroke Hemiplegia. Prosthetics Orthotics International. 38(2)148-154. [Abstract]

Zissimopoulos A, Stine R, Fatone S, and Gard S. (2014) “Mediolateral foot placement ability during ambulation in individuals with chronic post-stroke hemiplegia.” Gait and Posture. DOI: 10.1016/j.gaitpost.2014.01.015. [Abstract]

Zissimopoulos A, Fatone S, Gard SA (2014) Effects of an Ankle-Foot Orthosis on Mediolateral Foot Placement Ability during Post-Stroke Gait. Prosthetics Orthotics International, May 30. pii: 0309364614534294. [Epub ahead of print].