Ground reaction forces and muscle activity while walking on sand versus stable ground in individuals with pronated feet compared with healthy controls

Background Sand is an easy-to-access, cost-free resource that can be used to treat pronated feet (PF). Therefore, the aims of this study were to contrast the effects of walking on stable ground versus walking on sand on ground reaction forces (GRFs) and electromyographic (EMG) activity of selected lower limb muscles in PF individuals compared with healthy controls. Methods Twenty-nine controls aged 22.2 +/- 2.5 years and 30 PF individuals aged 22.2 +/- 1.9 years were enrolled in this study. Participants walked at preferred speed and in randomized order over level ground and sand. A force plate was included in the walkway to collect GRFs. Muscle activities were recorded using EMG system. Results No statistically significant between-group differences were found in preferred walking speed when walking on stable ground (PF: 1.33 +/- 0.12 m/s; controls: 1.35 +/- 0.14 m/s; p = 0.575; d = 0.15) and sand (PF: 1.19 +/- 0.11 m/s; controls: 1.23 +/- 0.18 m/s; p = 0.416; d = 0.27). Irrespective of the group, walking on sand (1.21 +/- 0.15 m/s) resulted in significantly lower gait speed compared with stable ground walking (1.34 +/- 0.13 m/s) (p<0.001; d = 0.93). Significant main effects of "surface" were found for peak posterior GRFs at heel contact, time to peak for peak lateral GRFs at heel contact, and peak anterior GRFs during push-off (p<0.044; d = 0.27-0.94). Pair-wise comparisons revealed significantly smaller peak posterior GRFs at heel contact (p = 0.005; d = 1.17), smaller peak anterior GRFs during push-off (p = 0.001; d = 1.14), and time to peak for peak lateral GRFs (p = 0.044; d = 0.28) when walking on sand. No significant main effects of "group" were observed for peak GRFs and their time to peak (p>0.05; d = 0.06-1.60). We could not find any significant group by surface interactions for peak GRFs and their time to peak. Significant main effects of "surface" were detected for anterior-posterior impulse and peak positive free moment amplitude (p<0.048; d = 0.54-0.71). Pair-wise comparisons revealed a significantly larger peak positive free moment amplitude (p = 0.010; d = 0.71) and a lower anterior-posterior impulse (p = 0.048; d = 0.38) when walking on sand. We observed significant main effects of "group" for the variable loading rate (p<0.030; d = 0.59). Pair-wise comparisons revealed significantly lower loading rates in PF compared with controls (p = 0.030; d = 0.61). Significant group by surface interactions were observed for the parameter peak positive free moment amplitude (p<0.030; d = 0.59). PF individuals exhibited a significantly lower peak positive free moment amplitude (p = 0.030, d = 0.41) when walking on sand. With regards to EMG, no significant main effects of "surface", main effects of "group", and group by surface interactions were observed for the recorded muscles during the loading and push-off phases (p>0.05; d = 0.00-0.53). Conclusions The observed lower velocities during walking on sand compared with stable ground were accompanied by lower peak positive free moments during the push-off phase and loading rates during the loading phase. Our findings of similar lower limb muscle activities during walking on sand compared with stable ground in PF together with lower free moment amplitudes, vertical loading rates, and lower walking velocities on sand may indicate more relative muscle activity on sand compared with stable ground. This needs to be verified in future studies.