Associations Between Limited Dorsiflexion Under Load and Compensatory Hip/Pelvic Gait Patterns in Healthy Adults

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

Regarding the manuscript entitled ”Compensatory gait patterns at the hip and pelvis are associated with 2 limited weightbearing dorsiflexion capacity in healthy adults”, the authors have examined how limited weightbearing ankle dorsiflexion influences lower-limb movement patterns and plantar pressure distribution during walking. In 27 healthy adults, smaller dorsiflexion values measured with the weightbearing lunge test were linked to notable compensations throughout the lower-extremity kinematic chain. Individuals with reduced dorsiflexion showed less ankle dorsiflexion and knee flexion during late stance, along with greater hip abduction and increased contralateral pelvic drop during early and mid-stance. At the foot, these individuals also displayed reduced heel loading and an earlier shift of force toward the midfoot. Overall, the findings indicate that ankle mobility restrictions lead to compensations reaching as far proximally as the pelvis, highlighting the importance of assessing weightbearing ankle dorsiflexion when evaluating lower-extremity movement dysfunction.

By considerring the mentioned manuscript the following remarks are made:

1. The introduction section is well described by having in sight the current state-of –the art as long as the research objectives were identified.

 

2. Regarding the materials and methods – section 2:

- There is a list of healthy participants, my question is why you don’t evaluate the ones with problems?

- On the procedures perhaps is better to provide some technical data about the instruments that you used, and a research workflow which is better to understand for the readers.

 - Figure 1 provides only images and no values at all the diagrams which is better to have as percent.

Also is better to have snapshots during a complete evaluation of a human subject which is will be better to understand the position of the human from Figure 1.

I don’t know if the term ”flexed” for the lower limb motion if it is proper one.

 

3. Results section:

- Figure 2 please add measuring units especially on the vertical axis. The size of the diagrams could be enlarged for a better view. Please explain in diagrams there is a grey zone….what is the meaning of this?

- Figure 3 is better to have 100% of a complete gait phase on the horizontal axis I guess.

- The acquired values mentioned in table 1 there were experimentally obtained? …if not please provide a calculus algorithm that lead to the obtained values.

- In Table 1 for the ”r” parameter there is negative results. Why are negatives instead of positive ones?

 

4. Discussions section:

In this section probably there is a reason for the negative results.

Could you please expand more the impact of the obtained results of the research?

 

5. Conclusion section:

Here there are general ones. Perhaps you can balance with the ones from discussion section.

Please specify if some objective remains unsolved or all the objectives proposed through this research there were accomplished.

It is better to present future works which involves the presented results from the manuscript and perhaps their utility for other researchers or researches.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this manuscript. The study addresses a clinically relevant question: the relationship between weightbearing dorsiflexion (WBLT) and kinematic and pedobarographic gait patterns, using IMUs and a pressure walkway. The methodological approach is novel, and the use of SPM adds value to the time-series analysis. The manuscript has potential, but it requires substantial revisions before it can be considered for publication.

Major Comments

1.- The study includes 27 participants, which is limited for multiple correlations. A power analysis or a clear justification of the sample size is required, along with confidence intervals for all reported correlations.

2.- The manuscript does not adequately detail the analytical procedure: control of multiple comparisons, cluster size criteria, critical statistics, number of permutations (if applicable), and the specific regression model used. These elements must be explicitly reported to ensure transparency and reproducibility.

3.- Analyzing only the left leg can introduce bias and waste information. A bilateral analysis or a mixed model that considers both limbs within the subject is recommended, or failing that, justification and demonstration that the results are equivalent in both legs.

4.- Gait speed directly affects kinematic and plantar pressure results. Average gait speed and variability. A reanalysis adjusting gait speed for sex and height/body mass would be advisable.

5.- The authors describe how the heel lift moment was identified through visualization of the walkway and that “peak WBDF” was measured, but crucial details are missing: How was the angle calculated? Were IMUs used to derive the ankle-to-knee angle during the lunge, or was a virtual inclinometer used? What are the units (°) and reference system? The exact formula/methodology (vectors/axis systems), calculation accuracy/resolution, and examples of typical values ​​must be included. This is essential for reproducibility. The methods section should include specific information on the reported validity of the ankle/pelvis IMU system and the calibration and filtering procedures that reduce systematic errors.

6.- We recommend including confidence intervals for the correlation coefficients as well as exact time intervals of significance in SPM, maximum r values ​​and associated statistics. We recommend including confidence intervals for correlation coefficients as well as exact time intervals of significance in the SPM regression analyses, maximum r values ​​and associated statistics.

Minor Comments

1,- Review typographical and grammatical errors (e.g., duplicate words, punctuation). Review phrases such as “Normal walking gait may require only 10-15º” (requires duplication). There are several long sentences with awkward punctuation; I suggest reviewing the scientific English by a native reviewer or professional service. Standardize terminology: the correct form is Statistical Parametric Mapping.

2.- Tables and figures: In Table 1: include confidence intervals for means and for r; specify units in the heading (e.g., N/kg). In Figures 2 and 3, include in the legends the maximum r values ​​and the exact time intervals where SPM was significant. Add a 95% confidence interval for the time series of means.

3.-Some references are incomplete (e.g., reference 14 lacks bibliographic information). Fix missing references and standardize the format. Complete the missing references and ensure consistency between citations.

4.- Clarify units and definitions of angular measurements when comparing with previous studies. When "40º" is mentioned as a cutoff in previous studies, clarify whether it refers to absolute degrees of the ankle, the tibial angle relative to the vertical, or something else. Ensure consistency in the geometric reference across studies for comparison.

Comments on the writing

Abstract: Change “The findings of the present study demonstrate that limitations in dorsiflexion create compensatory movement patterns…” → “The findings indicate that limited dorsiflexion under load is associated with compensatory movement patterns…”

We recommend changing the title to “Associations between limited dorsiflexion under load and compensatory hip/pelvic gait patterns in healthy adults” to emphasize the correlation.

Author Response

Please see the attachment. 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for permitting me to review this manuscript 

The authors 
 examined the relationships of maximum weightbearing dorsiflexion 
and spatial measures  phase of walking gait. in 27 patients  They concluded that limited weightbearing dorsiflexion capacity was associated with compensatory lower extremity kinematics and plantar pressure distribution throughout the stance phase of gait In addition , patients less dorsiflexion capacity had decreased heel impulses and earlier timesto peak force at the midfoot and suggest the need to evaluate distal mobility as part of proximal 
joint dysfunction

Here are my suggestions 

A brief  summary description of the gait would help the non expert readers 

Please explain the convinience for sample size selection 

Please define cut foo values for foot  dorsiflexion  restriction 

Please report at least one possible  practical conclusion except evaluation 

 

Author Response

Please see the attachment. 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

I thank the authors for their responses. All questions have been clarified, and we believe the manuscript has been substantially improved. We recommend its publication in present form.

Comments on the Quality of English Language

The English is fine and does not require any improvement.