title: Joint torques and powers are reduced during ambulation for both limbs in patients with unilateral claudication.
abstract: OBJECTIVE
  Symptomatic peripheral arterial disease (PAD) results in significant gait impairment. In an attempt to fully delineate and quantify these gait alterations, we analyzed joint kinematics, torques (rotational forces), and powers (rotational forces times angular velocity) in patients with PAD with unilateral claudication for both the affected and nonaffected legs.
  
  
  METHODS
  Twelve patients with unilateral PAD (age, 61.69 +/- 10.53 years, ankle-brachial index [ABI]: affected limb 0.59 +/- 0.25; nonaffected limb 0.93 +/- 0.12) and 10 healthy controls (age, 67.23 +/- 12.67 years, ABI >1.0 all subjects) walked over a force platform to acquire gait kinetics, while joint kinematics were recorded simultaneously. Data were collected for the affected and nonaffected limbs during pain free (PAD-PF) and pain induced (PAD-P) trials. Kinetics and kinematics were combined to quantify torque and powers during the stance period from the hip, knee, and ankle joints.
  
  
  RESULTS
  The affected limb demonstrated significantly (P <.05) reduced ankle plantar flexion torque compared to controls during late stance in both PAD-PF and PAD-P trials. There were significant reductions in ankle plantar flexion power generation during late stance for both the affected (P <.05) and nonaffected limbs (P <.05) compared to control during PAD-PF and PAD-P trials. No significant differences were noted in torque comparing the nonaffected limbs in PAD-PF and PAD-P conditions to control for knee and hip joints throughout the stance phase. Significant reductions were found in knee power absorption in early stance and knee power generation during mid stance for both limbs of the patients with PAD as compared to control (P <.05).
  
  
  CONCLUSIONS
  Patients with PAD with unilateral claudication demonstrate significant gait impairments in both limbs that are present even before they experience any claudication symptoms. Overall, our data demonstrate significantly reduced ankle plantar flexion torque and power during late stance with reduced knee power during early and mid stance for the affected limb. Further studies are needed to determine if these findings are dependent on the location and the severity of lower extremity ischemia and whether the changes in the nonaffected limb are the result of underlying PAD or compensatory changes from the affected limb dysfunction.
authors.affiliation: Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Neb, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Koutakis
authors.forename: Iraklis I
authors.initials: II
authors.lastname: Pipinos
authors.forename: Sara A
authors.initials: SA
authors.lastname: Myers
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stergiou
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Lynch
authors.forename: Jason M
authors.initials: JM
authors.lastname: Johanning
mesh_terms: D000222:Adaptation, Physiological; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D005080:Exercise Test; D005684:Gait; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000503:physiopathology*; D007596:Joints / Q000503:physiopathology*; D007719:Knee Joint / Q000503:physiopathology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology*; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000503:physiopathology*; D016059:Range of Motion, Articular; D019415:Torque; D016138:Walking