Joint torques and powers are reduced during ambulation for both limbs in patients with unilateral claudication Panagiotis Koutakis, MS, Iraklis I. Pipinos,

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Joint torques and powers are reduced during ambulation for both limbs in patients with unilateral claudication Panagiotis Koutakis, MS, Iraklis I. Pipinos, MD, Sara A. Myers, MS, Nicholas Stergiou, PhD, Thomas G. Lynch, MD, Jason M. Johanning, MD Journal of Vascular Surgery Volume 51, Issue 1, Pages 80-88 (January 2010) DOI: 10.1016/j.jvs.2009.07.117 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 An illustration of the stance phase of walking with the dominant flexor and extensor muscle groups that are involved in the three phases is produced. The dominant muscle groups are identified in red if they contract concentrically and in purple if they contract eccentrically. a, Early stance phase lasts from ipsilateral heel strike to contralateral toe off thus covering the first double support phase (initial 20% of stance). The right leg is accepting the majority of body weight as it descends from previously being in single support on the left leg. In this phase, the right hip extensors concentrically contract to extend the hip, the knee extensors eccentrically contract to allow the knee to bend, and the ankle dorsiflexors eccentrically contract to maintain ankle dorsiflexion. b, Mid stance phase lasts from contralateral (here left) toe off until contralateral heel strike. During single support, the body is at its highest point over the extended ipsilateral leg. The body has maximum potential energy preparing to fall forward for the next double support. Limited muscular contractions are needed during this phase except when the knee extensors contract concentrically to extend the knee and straighten the leg. c, Late stance lasts from contralateral heel strike to ipsilateral toe off. It is the final 20% of stance and is the second double support phase. In this phase, the body is propelled forward onto the extended left leg mainly by the action of the ankle plantar flexors. Functionally, these muscles contract concentrically and accelerate the leg and the trunk forward and upward over the left leg thus providing forward progression and weight support. Journal of Vascular Surgery 2010 51, 80-88DOI: (10.1016/j.jvs.2009.07.117) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 The ensemble-average joint torque curves of the affected limb for the patients with peripheral arterial disease-pain free (PAD-PF) and peripheral arterial disease-with pain (PAD-P; n = 24 limbs) and the healthy controls (control, n = 20 limbs) during the stance phase for the (a) ankle and (b) knee joints. Torques are normalized to body mass in kg. Error bars represent the standard deviation of the mean values. ADT, Ankle dorsiflexion torque; APT, ankle plantar flexion torque; KET, extensor torque; KFT, flexor torque. bP <.05, Significant differences between groups (PAD-PF affected limb vs control). dP <.05, Significant differences between groups (PAD-P affected limb vs control). eP <.05, Significant differences between testing conditions (PAD-PF vs PAD-P). Journal of Vascular Surgery 2010 51, 80-88DOI: (10.1016/j.jvs.2009.07.117) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 The ensemble-average joint power curves of the affected limb for the patients with peripheral arterial disease-pain free (PAD-PF) and peripheral arterial disease-with pain (PAD-P; n = 24 limbs) and the healthy controls (control, n = 20 limbs) during the stance phase for the (a) ankle and (b) knee joints. Note: A1 ankle power absorption in late mid stance, A2 ankle power generation in late stance, K1 knee power absorption in early stance, K2 knee power generation in early stance, K3 knee power absorption in late stance. Error bars represent the standard deviation of the mean values. bP <.05, Significant differences between groups (PAD-PF affected limb vs control). dP <.05, Significant differences between groups (PAD-P affected limb vs control). eP <.05, Significant differences between testing conditions (PAD-PF vs PAD-P). Journal of Vascular Surgery 2010 51, 80-88DOI: (10.1016/j.jvs.2009.07.117) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 The ensemble-average joint power curves of the non-affected limb for the patients with peripheral arterial disease-pain free (PAD-PF) and peripheral arterial disease-with pain (PAD-P; n = 24 limbs) and the healthy controls (control, n = 20 limbs) during the stance phase for the (a) ankle and (b) knee, joints. A1, Ankle power absorption in late mid stance; A2, ankle power generation in late stance; K1, knee power absorption in early stance; K2, knee power generation in early mid stance; K3, knee power absorption in late stance. Error bars represent the standard deviation of the mean values. aP <.05, Significant differences between groups (PAD-PF, nonaffected limb vs control). cP <.05, Significant differences between groups (PAD-P, nonaffected limb vs control). eP <.05, Significant differences between testing conditions (PAD-PF vs PAD-P). Journal of Vascular Surgery 2010 51, 80-88DOI: (10.1016/j.jvs.2009.07.117) Copyright © 2010 Society for Vascular Surgery Terms and Conditions