Genu valgum (GV) is a common lower limb deformity that may increase the risk of anterior cruciate ligament (ACL) injury. This study used OpenSim musculoskeletal modeling and kinematic analysis to investigate the mechanical responses of the ACL under fatigue in females with GV. Eight females with GV and eight healthy controls completed a running-induced fatigue protocol. Lower limb kinematic and kinetic data were collected and used to simulate stress and strain in the anteromedial ACL (A–ACL) and posterolateral ACL (P–ACL) bundles, as well as peak joint angles and knee joint stiffness. The results showed a significant interaction effect between group and fatigue condition on A–ACL stress. In the GV group, A–ACL stress was significantly higher than in the healthy group both before and after fatigue (p < 0.001) and further increased following fatigue (p < 0.001). In the pre-fatigued state, A–ACL strain was significantly higher during the late stance phase in the GV group (p = 0.036), while P–ACL strain significantly decreased post-fatigue (p = 0.005). Additionally, post-fatigue peak hip extension and knee flexion angles, as well as pre-fatigue knee abduction angles, showed significant differences between groups. Fatigue also led to substantial changes in knee flexion, adduction, abduction, and hip/knee external rotation angles within the GV group. Notably, knee joint stiffness in this group was significantly lower than in controls and decreased further post-fatigue. These findings suggest that the structural characteristics of GV, combined with exercise-induced fatigue, exacerbate A–ACL loading and compromise knee joint stability, indicating a higher risk of ACL injury in fatigued females with GV.

Different shapes of carbon-fiber plates (CFPs) are likely to affect lower limb biomechanics, particularly under conditions of running-induced fatigue, and potentially impact runners’ performance and risk of injury. However, no studies have yet elucidated the precise effects of CFP shapes on the lower limb biomechanical characteristics subsequent to running-induced fatigue. The purpose of this study was to investigate the effects of different CFP shapes in running shoes on the lower limb biomechanics of runners following running-induced fatigue. 12 male runners (aged 21.8 ± 1.3 years, mass 59.1 ± 4.1 kg, height 168.9 ± 2.2 cm, weekly running distance 68.8 ± 5.5 km/week) were recruited for this study. Two-way repeated measures ANOVA was used to compare kinematic and kinetic data, while SPM (Statistical Parametric Mapping) was used to assess the activation levels of lower limb muscles. Compared to wearing flat CFP shoes (“Flat”), wearing curved CFP shoes (“Curve”) resulted in a significant reduction in the hip (p = 0.034) and knee contact angle (p < 0.000), as well as a significant decrease in the hip flexion moment (p = 0.008). The activation level of the tibialis anterior (TA) was significantly higher when wearing “Curve” in pre-fatigue compared to “Flat”, whereas the opposite was observed post-fatigue. The curved CFP altered the bending angle of the forefoot, thereby significantly reducing the joint angles and joint moments of the hip and knee.

Footwear design, especially the curvature of carbon plates, may influence fatigue perception, but few studies have integrated footwear features into fatigue prediction models. This study aimed to develop a hybrid CNN-LSTM model to predict runners’ fatigue states and evaluate the impact of footwear characteristics on fatigue perception. Twelve male marathon runners (age = 21.8 ± 1.3 years; body mass = 59.1 ± 4.1 kg; height = 168.9 ± 2.2 cm; and weekly mileage = 68.8 ± 5.5 km) participated. They wore two types of carbon-plated shoes (flat plate, FP, and curved plate (CP)) and ran at a steady pace (Borg score 13) until a Borg score of 16 or 85% of maximum heart rate was reached for 2 min. EMG signals and physiological data were collected during treadmill running. A hybrid CNN-LSTM model was trained with and without footwear features to predict fatigue states. The model with footwear features achieved 85% accuracy, compared to 69% without. Curved carbon plate (CP) shoes delayed semi-fatigue onset, indicating better initial support, but the time to full fatigue was similar for both shoe types. The CNN-LSTM model effectively predicted fatigue states, with significant improvement when footwear features were included. Footwear design, particularly carbon plate curvature, influenced fatigue perception.

Introduction: Foot progression angle affects gait and lowerlimb alignment. Altered angles may increase knee and ankle loading and produce tissue loading patterns previously linked to musculoskeletal injury. This study investigates how different foot progression angles modify knee and ankle biomechanics in young adults with flexible flatfoot. Methods: 28 participants (aged 18–35 years) with flexible flatfoot completed gait trials under three foot progression angle conditions. Kinematic and kinetic variables were analyzed using one-dimensional statistical parametric mapping. A 1D convolutional neural network was applied to classify progression angle patterns based on flexible flatfoot severity and gait biomechanics. Results: Decreasing foot progression angle reduced the ankle eversion/inversion range and knee abduction and external rotation (p < 0.05). Increasing foot progression angle lowered early stance ankle plantarflexion and increased knee abduction/external rotation (p < 0.05). Kinetically, a smaller foot progression angle reduced peak ankle plantarflexion moment and knee extension moment but increased the first peak of the knee adduction moment and rotational moment fluctuations (p < 0.05). A larger foot progression angle reduced rotational fluctuations and terminal stance knee extension moment (p < 0.05). The convolutional neural network model was most accurate for moderate flexible flatfoot cases, and ankle coronal and knee transverse biomechanics showed the strongest discriminative power. Conclusion: Modifying the foot progression angle can meaningfully alter knee and ankle loading in young adults with flexible flatfoot. Neutral or mild toe-in angles may help mitigate excessive eversion and rotational stress, suggesting a simple noninvasive adjustment that clinicians can incorporate during gait retraining or orthotic prescription. Because biomechanical responses vary across individuals, FPA modification may be the most effective when tailored to patient-specific gait characteristics. In addition, deep-learning-based gait classification shows promise for supporting personalized monitoring and guiding clinical decision-making during rehabilitation.

Purpose: This study evaluated tibiofemoral loading and medial meniscal stress distribution in individuals with flexible flatfoot (FFF) during walking under different foot progression angle (FPA) conditions. Methods: This study analyzed the gait of 28 FFF patients (16 males, 12 females) under three FPA conditions (neutral, toe-in, toe-out). Kinematic (Vicon) and kinetic (Kistler) data were used to estimate tibiofemoral forces in OpenSim. Subsequently, joint angles and muscle forces at peak tibiofemoral forces were used to drive a finite element (FE) model of the knee, enabling the comparison of meniscal von Mises stress, maximum shear stress, and contact pressure across FPA conditions. Results: Tibiofemoral force increased during early stance (9–11%) in the toe-in condition with this increase reaching statistical significance in males (p = 0.008, mean partial η2=0.70 within the SPM-identified cluster). FE analysis showed that peak stresses and contact pressure were primarily localized in the anterior region of the medial meniscus. A consistent directional response to FPA was observed with the lowest peak values occurring in the toe-in condition and the highest values in the toe-out condition. Conclusion: Adjusting FPA modulates intra-articular knee loading via the kinetic chain. For FFF patients, neutral FPA provides stable loading. The toe-in condition presents a complex mechanism: despite increasing tibiofemoral force (notably in males), it reduces peak stress by altering contact mechanics and stress distribution. Therefore, FFF gait interventions must be individualized based on factors like foot morphology, sex, and functional goals.