Journal of Medical Engineering & Technology, Volume 12, Number 1 (January/February 19881, pages 15-19

Vector (butterfly) diagrams for 0 steoarthritic gait: a preliminary report

Soussan Khodadadeh
Orthotic Research C5 Locomotor Assessment Unit, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswcshy, Shropshire SYlO 7AG, OK

This paper describes brieJy a simple three-dimensional vector diagram display combining all the force components o gait in one f diagram. The locus o f the centre ofpressure o f thefeet on theground is J;lb illustrated. This provides a useful reference for the consideration ofthe position ofthe centre of body mass over onefoot or the other. In the case o f some pathological gaits, the lateral displacement can be substantial. The traditional two-dimensional diagram fails to show some ofthese effects.

o.6

Left

1.2 m

Introduction
The traditional form of displaying gait measurements includes the plotting, on a time basis, of the vertical, horizontal and lateral components of the force between the feet and the ground. An alternative form of visual display of force plate readings is the well-known display due to Pedotti [ l ] in which the vertical (2) and horizontal (Y) force components are combined into a resultant polar vector ( R )at an angle (0) to the vertical acting at the centre ofthrust on the foot. As the locus of the centre ofpressure moves along the ground so radial vectors emanate, producing the characteristic fan-shaped diagrams shown in figure 1. In some cases the vertical-horizontal vector combination alone fully indicates the condition of the pathological gait, so these diagrams are adequate. However, Khodadadeh [2] has shown that in many instances ofosteoarthritic gait the lateral ( X ) component of the gait force is most significant, and in a few cases all three components are significant. It is therefore essential at least in an initial investigation of pathological gait that all relevant force components are measured and displayed. This will be provided by a three-dimensional display. We believe a more comprehensive assessment can be obtained with a three dimensional representation of the data. This is a brief preliminary report on a relatively simple method of displaying all three force components, and on its value.

Post-op. results
Patient no.

B 2

0. 0
Right

0. 6 m

Figure I . Vector (butterJy) diagrams ,fir osteoarthritic gait.

the plate(s) are calculated from the forces and moments 4. by the method described by Khodadadeh [ ] In the case of single (one leg) support, if the co-ordinates of the centre of pressure are (Xo, Yo, 0) and the total force is ( X I ,Y1,ZI) kN(figure 2 [ a ] ) ,the resultant force vectoris represented in the butterfly diagram by a straight-line joining points (Xo, Yo, 0) and (X, XI,Yo YI, 2,).

In the double support case there are force vectors from both feet, F R [= (XR, YR, ZR)]from the right leg and Fl, [= (XL, Y,-, Z L ) ] from the left leg. The resultant force vector I = ( X R XL, YR YL, ZR Z,) acts at an angle defined by the appropriate direction cosines (figure 2[b]). Hence to plot the resultant vector all that is needed is the point of application, at plate level, of the resultant. The resultant vector will pass through the point of intersection of the forces FR and FL. The resultant centre of pressure for the double support case is determined by projecting the force I through this common point to the intersection with the horizontal plane at plate level.

Three-dimensionaldiagrams
Isometric drawings (Abbott [3]) are used to display the three-dimensional data so that measurements or estimations of the length of the resultant force vector may be made. The force components arc measured by means of Kistler force plates; the co-ordinates of the centre of pressure in

Patients studied
The technique has been used to assess 42 patients, with an average age of 65 years ( 2 7 female and 15 male) before and approximately six months after a Charnley total hip replacement operation. When the patient was walking without hesitation the Kistler plate recording was started. Three specimen walks were recorded. All patients could walk independently without walking aids.

S. Khodadadeh Vrctor (huttrrfl!) diagrams for osteoarthritic gait

F o r c e vector
P r o j e c t i o n of f o r c e onto (X,Y, 2) coordinates

\
\

Resul t a n t
Force

\ \\<
\\

I n t e r s e c t i o n of s i n g l e forces

Resultant of P
(6)

Eigure 2. Components and line o f Application o f resultant force. ( A ) Single support; (6) double support; C of P = centre of pressure; FR = ,/Drce sector ?fright leg; FI- =force vector o f left leg. Where f u l l lines = single support; dotted lines = double support.

S . Khodadadeh \cctor (butterfly) diaqrams fix- ostcoarthritic gait

I
kN

lil

1 4 -

1 2 1 0 -

0.8 -

0 60 L-

- 7 0 2 -

Figure 3. Three-dimensional vector (butlerjy) diagramsfor osteoarthritic gail (wilh unilaleral hip disease). Direction oJwalking right to lefi. Full lines = single support; dotled lines = double support.

kN

1.4
1.2

kN

1.L
1.2
1.0

0.80.6-

0 4 0.2

.r k

7
I I

Patient no. A 2 Pre-op walk 2

-.-J

Figure 4. Three-dimensional cector (butterJy) diagramsfor osteoarthritic gait (x)ith unilateral hip disease). Direction ofirtalking ri<qlitto lefi. Full lines = single support; dolled lines = double support.

1.24

I / I I

kN

o.81
0.6
I
-.

-.-

.-.>----___ m ->

P a t i e n t no. B 3 Post-op walk 1

J
Figuw 5.7%r-ee-dinirnriorial m l o r (butlerJv) dia\qrcinis f o r osleoarlhrilic gait fu7irh bihteral h i p di.rease). Direction (jzr,alking righl Iefi. Full linrr = tingle support: dotted lines = double .support.
lo

kN

1.2

&
l o

1
Patient no. C 1

0.8
kN

L7

0 6

0.i f

0.2

-.

-.-

S . Khodadadeh \.ci.tor (Ixittcrtly) diagrams for ostcoarthritic gait

The patients were divided into three groups:

Group A

Patients with unilatrral hip disease (23 patients).

Group 3 - Patients with bilatrral hip disease (1 1 patients). Group C- Patients with the first of two total hip replacements (8 patients).

centre of pressure. T h e post-operativc diagram shows a clear improvement, with smooth curves for hoth centres of pressure. Hcre it can be seen also that bunching in the horizontal direction is typically accompanied by some lateral displacement, so that therc is, in fact, continuing motion of the foot, even though inspection of the plot of horizontal against vertical factors would indicate stasis. Figure 6 illustrates an obvious factor, namely a walk with one foot badly splayed out. Again, the horizontal projection would show slower motion than the actual speed at the plate. The right foot, pre-operatively, and the left foot, post-operatively, also show the typical bunching of vectors near a lateral shift in the motion of the centre of pressure.

A selection of these cases have been chosen to illustrate

the value of the techniques.

Results and discussion

Figure 3 shows, for the pre-operative condition of the right foot, motion of the centre of pressure which is so complex that it would be totally obscured in the conventional two-dimensional diagram. The centre advances, retreats in the same line, and finally proceeds in a different path to completion. For the left foot, the progression is smooth, but the shorter vector length and outline indicate the defective leg as clearly as in the simple two-dimensional butterfly diagram. The postoperative results show smoother movement of the centre of pressure, clearly tracing the non-linear motion, together with an adequately-developed butterfly outline. Both diagrams of figure 3 show two common characteristics of the double support vectors. Firstly the smooth transition from the single supports (full line), to double support (dotted lines), despite the known unreliability of the individual vectors near the heel-strike and toe-off. Secondly, the combined centre of pressure always moves steadily across from right leg to left, whereas it might be expected, at least for paticnts with a severe condition, that there would be a sharp sideways movement corresponding to the transfer of weight from one leg to the other. In figure 4, two further points are exhibited. The difference between the left leg and the diseased right leg preoperatively is obvious but it is noticeable that the transient vectors are well separated laterally from the steady-state principal group. This suggests strongly that they arise from calculations based on insufficiently accurate Kistlcr plate output, whereas the two-dimensional representation often shows the transients as being close to heel-strike and toe-off, which would indicate a possible genuine significance. Pre-operatively , the double support vectors are very widely spaced near the right foot toe-off illustrating a lurch towards the healthy leg. The correction of this condition is shown by the much more even spacing post-operatively. Figure 5 shows a very slow walk, with tight bunching of all vectors pre-operatively and an erratic trace for the

Conclusions
Polar vector butterfly diagrams provide a useful visual means of representing gait force data which in conjunction with the temporal plottings of vertical, horizontal and lateral force components enable assessment to be made of the gait of patients before and after hip replacement operations. Although butterfly diagrams in two-dimensional form are well known, we belicve the three-dimensional diagrams presented here are more advantageous in that all force components are rcpresented. In particular, the movement of the centre ofpressure across the plates during double support gives a useful reference for the consideration ofthe position of the centre of mass over one foot or the other. This aspect of gait is not revealed by temporal plottings. However, it is not possible to estimate from some of the resultant vectors the magnitude of the lateral and horizontal force components.

Acknowledgements

I would like to thank M r J. D. Harris, Director of Oxford Orthopaedic Engineering Centre, and Department of Health and Social Security and Oxford University Computing Centre for providing facilities for this study.
References

the the the the

1. PEDOTTI, (1977) Simple equipment used in clinical A. practice for evaluation of locomotion. IEEE Tran.mcfions on Biomedical Engineering, BME-24, 5. 2. KHODADADEH, (1987) Quantitative approach to osteoS. arthritic gait assessment. Engineering in ,bfedzcine, 16, 1. 3. ABBOTT,LV. (1944) Machine Drawing and Design. Part I (Blackie & Sons Ltd, U K ) , pp. 24-48. 4. KHODADADEH, (1981) The use of the force plates in S. the clinical examination of locomotor disabilities (M.Sc. lhesis, University of Oxford).

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