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Photo of Dr. Hillstrom

Howard J. Hillstrom, PhD


Photo of Dr. Hillstrom

Howard J. Hillstrom, PhD


Back in the Game Patient Stories

Research Description

As a biomedical engineer with 26 years of experience in directing motion analysis laboratories, Dr. Hillstrom has a strong background in the biomechanics of human movement with special attention to the lower extremity and related pathologies. His philosophy for research in the neuromusculoskeletal system is that structure and function are intimately related on multiple scales from the cellular level to the whole body. Abnormal (malaligned) structures are associated with aberrant function (gait), so when structures (alignment) are improved through conservative (orthoses) or surgical care, improved function generally results.

Dr. Hillstrom began with a hypothesis that foot structure and function was related and that foot type was associated with certain pedal pathologies. In his first publication on this subject he served as the advisor to his doctoral student Jinsup Song, DPM, PhD. In his first NIH grant (1R03HD053135-01) he was able to extend this work and distinguish low, normal, and high arched asymptomatic feet from both structural and functional perspectives. These publications and several others document the methods, reliability of measurements, and the application to investigate foot and lower limb pathologies. This previous work has established the foundation to examine the prevalence of foot structure, function, and flexibility in other cohorts as well as the incidence of lower limb musculoskeletal injuries and pathologies in this context.

Dr. Hillstrom has served as a co-investigator on the Framingham Foot Study (Marian T Hannan, DSc, MPH, principal investigator), which utilized some of the previously developed measures of foot structure and function to examine a cohort of older adults. In this study over 3000 subjects were evaluated for their association between measures of foot structure and function with pain, foot, and lower limb disorders. Biomechanical variables and epidemiological methods were combined in a highly productive way which resulted in over two-dozen publications from the Framingham Foot Study.

One of the most disabling and increasingly prevalent pathologies in the US is osteoarthritis (OA). Dr. Hillstrom has studied knee OA patients with a bow-legged posture (genu-varum) and evaluated how foot and ankle alignment interacts with knee malalignment. He assesses patients to determine how the structural (joint space narrowing) and functional (peak knee adduction angle) aspects correlate to pain in this population.

Dr. Hillstrom, in conjunction with a computational modeler Rajshree Mootanah, PhD, MBA, developed a subject-specific finite element model of the knee and validated that model by comparing predicted joint stress to experimentally measured joint contact pressure in the same cadaveric specimen from which the model was built. In addition, the model has been used to examine the role of surgical realignment (high tibial osteotomy), as well as partial meniscectomy and the impact these procedures have upon joint stress. The importance of this work is that joint stress, whether from increased BMI, soft tissue injury, or malalignment, is considered a strong candidate factor for damaging the joint with OA.

Finally, in a collaboration with Daryl D'Lima, MD, PhD and BJ Fregley, PhD, he recently studied a patient with an electronic total knee replacement (e-tibia) that transmits the joint contact forces which were received and analyzed in conjunction with other kinematic and kinetic variables in the HSS motion analysis laboratory. Each of six different knee braces were able to reduce joint contact forces to varying levels (manuscript in preparation). Dr. Hillstrom served as the primary investigator or co-investigator in all of these studies.

Dr. Hillstrom served as a principal investigator, co-investigator, or consultant on six NIH and NSF research grants and has conducted over 80 funded investigations in human movement with patient self-assessed outcomes in individuals with neuromusculoskeletal pathologies. He has also published over 90 peer reviewed manuscripts and 10 book chapters addressing concerns in healthy and pathologic human movement.

Selected Publications

Roberts D, Hillstrom H, Kim JH. Instantaneous Metabolic Cost of Walking: Joint-Space Dynamic Model with Subject-Specific Heat Rate. PLoS One. 2016 Dec 28;11(12):e0168070. doi: 10.1371/journal.pone.0168070. PubMed PMID: 28030598.

Mootanah R, Imhauser CW, Reisse F, Carpanen D, Walker RW, Koff MF, Lenhoff MW, Rozbruch SR, Fragomen AT, Dewan Z, Kirane YM, Cheah K, Dowell JK, Hillstrom HJ. Development and validation of a computational model of the knee joint for the evaluation of surgical treatments for osteoarthritis. Comput Methods Biomech Biomed Engin. 2014;17(13):1502-17. doi: 10.1080/10255842.2014.899588. Epub 2014 May 1. PMID: 24786914

Zifchock RA, Kirane Y, Hillstrom H; Hospital for Special Surgery Lower Extremity Realignment Research Group. Are joint structure and function related to medial knee OA pain? A pilot study. Clin Orthop Relat Res. 2011 Oct;469(10):2866-73. doi: 10.1007/s11999-011-1969-9. Epub 2011 Jul 19. PMID: 21769678

Shultz SP, Sitler MR, Tierney RT, Hillstrom HJ, Song J. Effects of pediatric obesity on joint kinematics and kinetics during 2 walking cadences. Arch Phys Med Rehabil. 2009 Dec;90(12):2146-54. doi: 10.1016/j.apmr.2009.07.024.PMID: 19969183

Golightly YM, Hannan MT, Dufour AB, Hillstrom HJ, Jordan JM. Foot disorders associated with overpronated and oversupinated foot function: the Johnston County osteoarthritis project. Foot Ankle Int. 2014 Nov;35(11):1159-65. doi: 10.1177/1071100714543907. Epub 2014 Jul 18. PMID: 25037712.

Mootanah R, Song J, Lenhoff MW, Hafer JF, Backus SI, Gagnon D, Deland JT 3rd, Hillstrom HJ. Foot Type Biomechanics Part 2: are structure and anthropometrics related to function? Gait Posture. 2013 Mar;37(3):452-6. doi: 10.1016/j.gaitpost.2012.09.008. Epub 2012 Oct 26. PMID: 23107624.

Hillstrom HJ, Song J, Kraszewski AP, Hafer JF, Mootanah R, Dufour AB, Chow BS, Deland JT 3rd. Foot type biomechanics part 1: Structure and function of the asymptomatic foot., Gait Posture. 2013 Mar;37(3):445-51. doi: 10.1016/j.gaitpost.2012.09.007. PMID: 231076255.

Rao S, Song J, Kraszewski A, Backus S, Ellis SJ, Deland JT, Hillstrom HJ. The effect of foot structure on 1st metatarsophalangeal joint flexibility and hallucal loading. Gait Posture. 2011 May; 34(1):131-7. Epub 2011 May 1. PMID: 21536440.

Ledoux WR, Meaney DF, Hillstrom HJ.A quasi-linear, viscoelastic, structural model of the plantar soft tissue with frequency-sensitive damping properties, J Biomech Eng. 2004 Dec;126(6):831-7.

Song J, Hillstrom HJ, Secord D, Levitt J. Foot type biomechanics. comparison of planus and rectus foot types. J Am Podiatr Med Assoc. 1996 Jan;86(1):16-23.PMID: 8808320.

For more publications, please see the PubMed listing.

Selected Presentations

Knee Osteoarthritis: Experimental and Computational Approaches towards Understanding Pathomechanics, Hillstrom, HJ, Invited Lecture at the Bio-Robotics and Biomechanics Laboratory, Techion, Haifa, Israel, February 22, 2017.

Hillstrom, HJ, Foot type biomechanics: A matter of structure, function and flexibility, Computer Methods in Biomechanics and Biomedical Engineering (CMBBE), Tel Aviv, Israel, September 20-22, 2016.

Mootanah R., Carpanen D., Reisse F., Rozbruch S.R., HIllstrom H.J. Application of a Validated Computational Knee Model to Predict Improved Joint Reconstruction, Computer Methods in Biomechanics and Biomedical Engineering (CMBBE), Tel Aviv, Israel, September 20-22, 2016.

Hillstrom, HJ, Tse, J, D'Lima, DD, Garrison, G, Fregly, BJ. The effect of non-surgical realignment therapies upon knee contact mechanics;Computer Methods in Biomechanics and Biomedical Engineering (CMBBE), Tel Aviv, Israel, September 20-22, 2016.

Invited Presentations from Mootanah, R, Schwachmeyer, V, Bruggemann, G-P, Hillstrom, HJ, Rosenbaum, D. Special Session Intra-articular Load and Contact Stress. Expert Scientific Meeting (ESM) on Load Distribution Measurement, Lisbon, Portugal, July 27-30, 2016.

Boyd, JL, Morgan, OJ, Koff, M, Ellis, SJ, Deland, JT, Hillstrom, HJ, Mootanah, R, The Effect of Cheilectomy and Moberg Osteotomy on First Metatarsophalangeal Joint Contact Mechanics. Expert Scientific Meeting (ESM) on Load Distribution Measurement, Lisbon, Portugal, July 27-30, 2016

Shultz, SP, Song, J, Kraszewski, A, Hafer, J, Rao, S, Backus, SI, Mootanah, R, Hillstrom, HJ, Hillstrom, HJ, Determinants of Foot Type, ORS: Orlando, March 18 – 21, 2016, (Poster).

Hillstrom, HJ, Joshi, R, Miranda, M, Backus, SI, Hafer, J, Gibbons, M, Thaqi, I, Lenhoff, M, Hannan, M, Endo, Y, Sculco, T, Lane, J., Effect of Increased Serum Vitamin D on Structure and Function of Post-Menapausal Women: A Pilot Study, ORS: Orlando, March 18 – 21, 2016 (Poster).

Song, J, Neary, M, Zifchock, RA, Cameron, K, Trepal, M, Hillstrom, HJ, Differences in Foot Structure, Flexibility, and Function Across Race and Gender, ORS: Orlando, March 18 – 21, 2016 (Poster).

The Role of the foot and Ankle in Lower Extremity Osteoarthritis: Lessons from Experimental and Computational Biomechanics, Hillstrom, HJ, at NY16, the New York Podiatric Clinical Conference, January 24, 2016.

Appointments

Director, Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery
Adjunct Associate Professor, Temple University
Thesis Examiner, Graduate School, Temple University
Visiting Assistant Research Professor, Drexel University