Ankylosing Spondylitis

Ankylosing Spondylitis is a chronic inflammatory disorder that affects the spine and sacroiliac joints resulting in limitation of spinal mobility, loss of lumbar lordosis, increased dorsal kyphosis, flexion contracture of the hip and consequent flexion of the knee.

Gait alterations in patients with ankylosing spondylitis were investigated in detail by Del Din et al. who measured three-dimensional kinematics and kinetics of trunk, pelvis, hip, knee and ankle in twenty-four subjects, out of which twelve were diagnosed with ankylosing spondylitis.

The authors observed that in order to maintain their balance during gait and cope with a rigid cervical kyphosis, patients tend to adopt a compensatory strategy by pivoting their trunk around the lumbo-sacral hinge to shift their centre of mass backward.

In addition to this, there was a reduction in pelvic oscillation and hip and knee joint extensions during the loading response and in the last two phases of the gait cycle.

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Initial contact entailed a decrease in ankle plantar flexion and a dorsiflexion moment was registered at heel strike, together with an excessive posterior force which lead to lower gait velocity, shorter stride length during gait, as well as lower vertical force during stance.

Plantar pressure measurements of the feet can also provide data about postural control as proved by Aydin et al. in their study on plantar loading disturbances found in patients with ankylosing spondylitis.

By obtaining pedobarographic measurements of thirty-eight patients with the condition, the authors established that dynamic peak plantar pressures in the metatarsal regions and mid-foot were higher among the ankylosing spondylitis patients in comparison to the normal controls.

The authors attributed this increase in plantar pressure to the impaired dynamic posture of the patients; during gait, motion range of the knee and ankle changes continuously which makes compensatory excessive knee flexion and ankle plantar flexion (seen in the stance phase) ineffective in allowing movement of the body’s centre of mass backward to prevent falling forward.

These findings need to be included in the formulation of specific rehabilitation interventions which must be tailored to meet each individual’s requirements according to modifications in gait. 

Strengthening exercises targeted at muscle groups involved in postural alignment such as the back extensors, shoulder retractors and hip extensors are advocated by Kim Nolte of the Health Professionals’ Council of South Africa.

The efficacy of custom made orthotics in the redistribution of plantar pressure makes its inclusion in preventative and treatment strategies important for the long-term management of various foot and postural problems.

MASS4D® bespoke foot orthotics help to support the structure of the foot in its optimally functional position, allowing for increased proprioceptive input and effective lower limb muscle spindle firing.

This contributes to the reduction of stress placed on the entire spine allowing for the optimal functioning of all joints in the foot.

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References:

1. Aydin, E., Turan, Y., Tastaban, E., Omurlu, I. K., Sendur, O. F. (2015) Plantar Pressure Distribution In Patients With Ankylosing Spondylitis. Clinical Biomechanics: February 2015, Vol. 30, No. 3, pp. 238-242. DOI: 10.1016/j.clinbiomech.2015.02.003
2. Del Din, S., Carraro, E., Sawacha, Z., Guiotto, A., Bonaldo, L., Masiero, S., Cobelli, C. (2011) Impaired Gait in Ankylosing Spondylitis. Medical & Biological Engineering: July 2011, Vol. 49, No. 7, pp. 801-809. DOI: 10.1007/s11517-010-0731-x
3. Nolte, K., van Rensburg, C. J. (2001) The Role of Exercise In The Rehabilitation of Ankylosing Spondylitis. International Journal of Sports Medicine: November 2001, Vol. 2, No. 4. 

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