Foot and Ankle Injuries in Variable Energy Impacts

A total of 60 pendulum impacts to the plantar surface of 15 lower limb PMHS were conducted. Impact conditions were chosen to obtain data from high velocity tests without injury to model an under-vehicle landmine blast. For 19 impacts the specimen was initially positioned in 20-deg of dorsiflexion. The remaining impacts used neutral positioning.

The foot and ankle response was investigated based on impact energy and velocity. Response was characterized by heel pad and ankle joint stiffness. For neutral tests, axial force vs. compression corridors were developed for 2-3 m/s, 4-6 m/s, and 7-63 J impacts. For dorsiflexion tests corridors of 1-3 m/s, 6-8 m/s, 7-20 J, and 80-100 J were developed. These results indicate foot and ankle response is not more sensitive to impact energy than velocity. Lower limb manikins should be sensitive to both heel pad and ankle joint stiffness.

Fourteen calcaneus fractures and two tibia fractures were observed. Injury risk curves were developed for both neutral and dorsiflexion positioning using logistic regression. Strain gage data were used to obtain uncensored force values. In neutral, 50% probability of injury occurred at tibia axial force of 6800 N. In dorsiflexion, 50% probability occurred at 7900 N, but the regression was not statistically significant. These preliminary results indicate dorsiflexed specimens fracture at a higher force than neutral specimens.

Year	Entry
1993	Begeman P, Balakrishnan P, Levine R, King A. Dynamic human ankle response to inversion and eversion. In: Proceedings of the 37th Stapp Car Crash Conference. November 7-8, 1993; San Antonio, TX. Warrendale, PA: Society of Automotive Engineers:83-93. SAE 933115.
1990	Begeman PC, Prasad P. Human ankle impact response in dorsiflexion. In: Proceedings of the 34th Stapp Car Crash Conference. November 4-7, 1990; Orlando, FL. Warrendale, PA: Society of Automotive Engineers:39-53. SAE 902308.
1995	Schueler F, Mattern R, Zeidler F, Scheunert D. Injuries of the lower legs - foot, ankle joint, tibia; mechanisms, tolerance limits, injury-criteria evaluation of a recent biomechanic experiment-series (impact-tests with a pneumatic-biomechanic-impactor). In: Proceedings of the 1995 International IRCOBI Conference on the Biomechanics of Impact. September 13-15, 1995; Brunnen, Switzerland.33-45.
1996	Crandall JR, Portier L, Petit P, Hall GW, Bass CR, Klopp GS, Hurwitz S, Pilkey WD, Trosseille X, Tarrière C, Lassau J-P. Biomechanical response and physical properties of the leg, foot, and ankle. In: Proceedings of the 40th Stapp Car Crash Conference. November 4-6, 1996; Albuquerque, NM. Warrendale, PA: Society of Automotive Engineers:173-192. SAE 962424.
2002	Funk JR, Crandall JR, Tourret LJ, MacMahon CB, Bass CR, Patrie JT, Khaewpong N, Eppinger RH. The axial injury tolerance of the human foot/ankle complex and the effect of Achilles tension. J Biomech Eng. 2002;124(6):750-757.
2001	Kuppa S, Wang J, Haffner M, Eppinger R. Lower extremity injuries and associated injury criteria. In: Proceedings of the 17th International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 4-7, 2001; Amsterdam, The Netherlands.
2001	Wang J, Bird R, Swinton B, Krstic A. Protection of lower limbs against floor impact in army vehicles experiencing landmine explosion. J Battlefield Technol. 2001;4(3):8-12.
2006	Geurts J, van der Horst M, Leerdam P-J, Bir C, van Dommelen H, Wismans J. Occupant safety: mine detonation under vehicles a numerical lower leg injury assessment. In: Proceedings of the 2006 International IRCOBI Conference on the Biomechanics of Impact. September 20-22, 2006; Madrid, Spain.373-376.
2008	Bir C, Barbir A, Dosquet F, Wilhelm M, van der Horst M, Wolfe G. Validation of lower limb surrogates as injury assessment tools in floor impacts due to anti-vehicular land mines. Mil Med. December 2008;173(12):1180-1184.
2005	Wolff KS, Prusa AM, Wibmer A, Rankl P, Firbas W, Teufelsbauer H. Effect of body armor on simulated landmine blasts to cadaveric legs. J Trauma. July 2005;59(1):202-208.
2005	Manseau J, Keown M. Development of an assessment methodology for lower leg injuries resulting from anti-vehicular blast landmines. In: Gilchrist MD, ed. IUTAM Symposium on Impact Biomechanics: From Fundamental Insights to Applications. Dordrecht, The Netherlands: Springer; 2005:33-40. Solid Mechanics and Its Applications; vol 124.
1965	Hirsch C, Lewis J. Experimental ankle-joint fractures. Acta Orthop Scand. 1965;36(4):408-417.
2010	McKay BJ. Development of Lower Extremity Injury Criteria and Biomechanical Surrogate to Evaluate Military Vehicle Occupant Injury During an Explosive Blast Event [PhD thesis]. Detroit, MI: Wayne State University; 2010.
1998	Kitagawa Y, Ichikawa H, King AI, Levine RS. A severe ankle and foot injury in frontal crashes and its mechanism. In: Proceedings of the 42nd Stapp Car Crash Conference. November 2-4, 1998; Tempa, AZ. Warrendale, PA: Society of Automotive Engineers:1-12. SAE 983145.
1996	Petit P, Portier L, Foret-Bruno J-Y, Trosseille X, Parenteau C, Coltat J-C, Tarriere C, Lassau J-P. Quasistatic characterization of the human foot-ankle joints in a simulated tensed state and updated accidentological data. In: Proceedings of the 1996 International IRCOBI Conference on the Biomechanics of Impact. September 11-13, 1996; Dublin, Ireland.363-376.
1998	Crandall JR, Kuppa SM, Klopp GS, Hall GW, Pilkey WD, Hurwitz SR. Injury mechanisms and criteria for the human foot and ankle under axial impacts to the foot. Int J Crashworthiness. 1998;3(2):147-162.
2000	Funk JR. The Effect of Active Muscle Tension on the Axial Impact Tolerance of the Human Foot/ankle Complex [PhD thesis]. Charlottesville, VA: University of Virginia; August 2000.
1997	Portier L, Petit P, Dômont A, Trosseille X, Le Coz J-Y, Tarrière C, Lassau J-P. Dynamic biomechanical dorsiflexion responses and tolerances of the ankle joint complex. In: Proceedings of the 41st Stapp Car Crash Conference. November 13-14, 1997; Lake Buena Vista, FL. Warrendale, PA: Society of Automotive Engineers:207-224. SAE 973330.
1999	Yoganandan N, Pintar FA, Gennarelli TA, Seipel R, Marks R. Biomechanical tolerance of calcaneal fractures. In: 43rd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 20-21, 1999; Barcelon, Spain.345-356.
2011	Funk JR. Ankle injury mechanisms: lessons learned from cadaveric studies. Clin Anat. April 2011;24(3):350-361.
1998	Kuppa SM, Klopp GS, Crandall JR, Hall G, Yoganandan N, Pintar FA, Eppinger RH, Sun E, Khaewpong N, Kleinberger M. Axial impact characteristics of dummy and cadaver lower limbs. In: Proceedings of the 16th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 31–June 4, 1998; Windsor, Ontario, Canada.1608-1617.
2005	van der Horst MJ, Simms CK, van Maasdam R, Leerdam PJC. Occupant lower leg injury assessment in landmine detonations under a vehicle. In: Gilchrist MD, ed. IUTAM Symposium on Impact Biomechanics: From Fundamental Insights to Applications. Dordrecht, The Netherlands: Springer; 2005:41-49. Solid Mechanics and Its Applications; vol 124.
2000	Funk JR, Tourret LJ, George SE, Crandall JR. The role of axial loading in malleolar fractures. In: Proceedings of the SAE World Congress. March 6-9, 2000; Detroit, MI. Warrendale, PA: Society of Automotive Engineers. SAE 2000-01-0155.
2004	Lessley D, Crandall J, Shaw G, Kent R, Funk J. A normalization technique for developing corridors from individual subject responses. In: Proceedings of the SAE World Congress & Exhibition. March 8-11, 2004; Detroit, MI. Warrendale, PA: Society of Automotive Engineers. SAE 2004-01-0288.
1997	Klopp GS, Crandall JR, Hall GW, Pilkey WD, Hurwitz SR, Kuppa SM. Mechanisms of injury and injury criteria for the human foot and ankle in dynamic axial impacts to the foot. In: Proceedings of the 1997 International IRCOBI Conference on the Biomechanics of Impact. September 24-26, 1997; Hannover, Germany.73-86.
2000	McMaster J, Parry M, Wallace WA, Wheeler L, Owen C, Lowne R, Oakley C, Roberts AK. Biomechanics of ankle and hindfoot injuries in dynamic axial loading. Stapp Car Crash J. 2000;44:357-377. SAE 2000-01-SC23.
2004	Rudd R, Crandall J, Millington S, Hurwitz S, Höglund N. Injury tolerance and response of the ankle joint in dynamic dorsiflexion. Stapp Car Crash J. 2004;48:1-26. SAE 2004-22-0001.
1996	Yoganandan N, Pintar FA, Boynton M, Begeman P, Prasad P, Kuppa SM, Morgan RM, Eppinger RH. Dynamic axial tolerance of the human foot-ankle complex. In: Proceedings of the 40th Stapp Car Crash Conference. November 4-6, 1996; Albuquerque, NM. Warrendale, PA: Society of Automotive Engineers:207-218. SAE 962426.
1950	Lauge-Hansen N. Fractures of the ankle, II: combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60(5):957-985.
2000	Sokol Jaffredo A, Potier P, Robin S, Le Coz J-Y, Lassau J-P. Cadaver lower limb dynamic response in inversion-eversion. In: Proceedings of the 2000 International IRCOBI Conference on the Biomechanics of Impact. September 20-22, 2000; Montpellier, France.183-194.
1997	Manning P, Wallace WA, Roberts AK, Owen CJ, Lowne RW. The position and movement of the foot in emergency manoeuvres and the influence of tension in the Achilles tendon. In: Proceedings of the 41st Stapp Car Crash Conference. November 13-14, 1997; Lake Buena Vista, FL. Warrendale, PA: Society of Automotive Engineers:195-206. SAE 973329.
1998	Manning P, Wallace A, Owen C, Roberts A, Oakley C, Lowne R. Dynamic response and injury mechanism in the human foot and ankle and an analysis of dummy biofidelity. In: Proceedings of the 16th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 31–June 4, 1998; Windsor, Ontario, Canada.1960-1998.
2002	Funk JR, Srinivasan SCM, Crandall JR, Khaewpong N, Eppinger RH, Jaffredo AS, Potier P, Petit PY. The effects of axial preload and dorsiflexion on the tolerance of the ankle/subtalar joint to dynamic inversion and eversion. Stapp Car Crash J. 2002;46:245-265. SAE 2002-22-0013.
2009	McKay BJ, Bir CA. Lower extremity injury criteria for evaluating military vehicle occupant injury in underbelly blast events. Stapp Car Crash J. 2009;53:229-249. SAE 2009-22-0009.

Year

Entry

1993

Begeman P, Balakrishnan P, Levine R, King A. Dynamic human ankle response to inversion and eversion. In: Proceedings of the 37th Stapp Car Crash Conference. November 7-8, 1993; San Antonio, TX. Warrendale, PA: Society of Automotive Engineers:83-93. SAE 933115.

1990

Begeman PC, Prasad P. Human ankle impact response in dorsiflexion. In: Proceedings of the 34th Stapp Car Crash Conference. November 4-7, 1990; Orlando, FL. Warrendale, PA: Society of Automotive Engineers:39-53. SAE 902308.

1995

Schueler F, Mattern R, Zeidler F, Scheunert D. Injuries of the lower legs - foot, ankle joint, tibia; mechanisms, tolerance limits, injury-criteria evaluation of a recent biomechanic experiment-series (impact-tests with a pneumatic-biomechanic-impactor). In: Proceedings of the 1995 International IRCOBI Conference on the Biomechanics of Impact. September 13-15, 1995; Brunnen, Switzerland.33-45.

1996

Crandall JR, Portier L, Petit P, Hall GW, Bass CR, Klopp GS, Hurwitz S, Pilkey WD, Trosseille X, Tarrière C, Lassau J-P. Biomechanical response and physical properties of the leg, foot, and ankle. In: Proceedings of the 40th Stapp Car Crash Conference. November 4-6, 1996; Albuquerque, NM. Warrendale, PA: Society of Automotive Engineers:173-192. SAE 962424.

2002

Funk JR, Crandall JR, Tourret LJ, MacMahon CB, Bass CR, Patrie JT, Khaewpong N, Eppinger RH. The axial injury tolerance of the human foot/ankle complex and the effect of Achilles tension. J Biomech Eng. 2002;124(6):750-757.

2001

Kuppa S, Wang J, Haffner M, Eppinger R. Lower extremity injuries and associated injury criteria. In: Proceedings of the 17th International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 4-7, 2001; Amsterdam, The Netherlands.

2001

Wang J, Bird R, Swinton B, Krstic A. Protection of lower limbs against floor impact in army vehicles experiencing landmine explosion. J Battlefield Technol. 2001;4(3):8-12.

2006

Geurts J, van der Horst M, Leerdam P-J, Bir C, van Dommelen H, Wismans J. Occupant safety: mine detonation under vehicles a numerical lower leg injury assessment. In: Proceedings of the 2006 International IRCOBI Conference on the Biomechanics of Impact. September 20-22, 2006; Madrid, Spain.373-376.

2008

Bir C, Barbir A, Dosquet F, Wilhelm M, van der Horst M, Wolfe G. Validation of lower limb surrogates as injury assessment tools in floor impacts due to anti-vehicular land mines. Mil Med. December 2008;173(12):1180-1184.

2005

Wolff KS, Prusa AM, Wibmer A, Rankl P, Firbas W, Teufelsbauer H. Effect of body armor on simulated landmine blasts to cadaveric legs. J Trauma. July 2005;59(1):202-208.

2005

Manseau J, Keown M. Development of an assessment methodology for lower leg injuries resulting from anti-vehicular blast landmines. In: Gilchrist MD, ed. IUTAM Symposium on Impact Biomechanics: From Fundamental Insights to Applications. Dordrecht, The Netherlands: Springer; 2005:33-40. Solid Mechanics and Its Applications; vol 124.

1965

Hirsch C, Lewis J. Experimental ankle-joint fractures. Acta Orthop Scand. 1965;36(4):408-417.

2010

McKay BJ. Development of Lower Extremity Injury Criteria and Biomechanical Surrogate to Evaluate Military Vehicle Occupant Injury During an Explosive Blast Event [PhD thesis]. Detroit, MI: Wayne State University; 2010.

1998

Kitagawa Y, Ichikawa H, King AI, Levine RS. A severe ankle and foot injury in frontal crashes and its mechanism. In: Proceedings of the 42nd Stapp Car Crash Conference. November 2-4, 1998; Tempa, AZ. Warrendale, PA: Society of Automotive Engineers:1-12. SAE 983145.

1996

Petit P, Portier L, Foret-Bruno J-Y, Trosseille X, Parenteau C, Coltat J-C, Tarriere C, Lassau J-P. Quasistatic characterization of the human foot-ankle joints in a simulated tensed state and updated accidentological data. In: Proceedings of the 1996 International IRCOBI Conference on the Biomechanics of Impact. September 11-13, 1996; Dublin, Ireland.363-376.

1998

Crandall JR, Kuppa SM, Klopp GS, Hall GW, Pilkey WD, Hurwitz SR. Injury mechanisms and criteria for the human foot and ankle under axial impacts to the foot. Int J Crashworthiness. 1998;3(2):147-162.

2000

Funk JR. The Effect of Active Muscle Tension on the Axial Impact Tolerance of the Human Foot/ankle Complex [PhD thesis]. Charlottesville, VA: University of Virginia; August 2000.

1997

Portier L, Petit P, Dômont A, Trosseille X, Le Coz J-Y, Tarrière C, Lassau J-P. Dynamic biomechanical dorsiflexion responses and tolerances of the ankle joint complex. In: Proceedings of the 41st Stapp Car Crash Conference. November 13-14, 1997; Lake Buena Vista, FL. Warrendale, PA: Society of Automotive Engineers:207-224. SAE 973330.

1999

Yoganandan N, Pintar FA, Gennarelli TA, Seipel R, Marks R. Biomechanical tolerance of calcaneal fractures. In: 43rd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 20-21, 1999; Barcelon, Spain.345-356.

2011

Funk JR. Ankle injury mechanisms: lessons learned from cadaveric studies. Clin Anat. April 2011;24(3):350-361.

1998

Kuppa SM, Klopp GS, Crandall JR, Hall G, Yoganandan N, Pintar FA, Eppinger RH, Sun E, Khaewpong N, Kleinberger M. Axial impact characteristics of dummy and cadaver lower limbs. In: Proceedings of the 16th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 31–June 4, 1998; Windsor, Ontario, Canada.1608-1617.

2005

van der Horst MJ, Simms CK, van Maasdam R, Leerdam PJC. Occupant lower leg injury assessment in landmine detonations under a vehicle. In: Gilchrist MD, ed. IUTAM Symposium on Impact Biomechanics: From Fundamental Insights to Applications. Dordrecht, The Netherlands: Springer; 2005:41-49. Solid Mechanics and Its Applications; vol 124.

2000

Funk JR, Tourret LJ, George SE, Crandall JR. The role of axial loading in malleolar fractures. In: Proceedings of the SAE World Congress. March 6-9, 2000; Detroit, MI. Warrendale, PA: Society of Automotive Engineers. SAE 2000-01-0155.

2004

Lessley D, Crandall J, Shaw G, Kent R, Funk J. A normalization technique for developing corridors from individual subject responses. In: Proceedings of the SAE World Congress & Exhibition. March 8-11, 2004; Detroit, MI. Warrendale, PA: Society of Automotive Engineers. SAE 2004-01-0288.

1997

Klopp GS, Crandall JR, Hall GW, Pilkey WD, Hurwitz SR, Kuppa SM. Mechanisms of injury and injury criteria for the human foot and ankle in dynamic axial impacts to the foot. In: Proceedings of the 1997 International IRCOBI Conference on the Biomechanics of Impact. September 24-26, 1997; Hannover, Germany.73-86.

2000

McMaster J, Parry M, Wallace WA, Wheeler L, Owen C, Lowne R, Oakley C, Roberts AK. Biomechanics of ankle and hindfoot injuries in dynamic axial loading. Stapp Car Crash J. 2000;44:357-377. SAE 2000-01-SC23.

2004

Rudd R, Crandall J, Millington S, Hurwitz S, Höglund N. Injury tolerance and response of the ankle joint in dynamic dorsiflexion. Stapp Car Crash J. 2004;48:1-26. SAE 2004-22-0001.

1996

Yoganandan N, Pintar FA, Boynton M, Begeman P, Prasad P, Kuppa SM, Morgan RM, Eppinger RH. Dynamic axial tolerance of the human foot-ankle complex. In: Proceedings of the 40th Stapp Car Crash Conference. November 4-6, 1996; Albuquerque, NM. Warrendale, PA: Society of Automotive Engineers:207-218. SAE 962426.

1950

Lauge-Hansen N. Fractures of the ankle, II: combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950;60(5):957-985.

2000

Sokol Jaffredo A, Potier P, Robin S, Le Coz J-Y, Lassau J-P. Cadaver lower limb dynamic response in inversion-eversion. In: Proceedings of the 2000 International IRCOBI Conference on the Biomechanics of Impact. September 20-22, 2000; Montpellier, France.183-194.

1997

Manning P, Wallace WA, Roberts AK, Owen CJ, Lowne RW. The position and movement of the foot in emergency manoeuvres and the influence of tension in the Achilles tendon. In: Proceedings of the 41st Stapp Car Crash Conference. November 13-14, 1997; Lake Buena Vista, FL. Warrendale, PA: Society of Automotive Engineers:195-206. SAE 973329.

1998

Manning P, Wallace A, Owen C, Roberts A, Oakley C, Lowne R. Dynamic response and injury mechanism in the human foot and ankle and an analysis of dummy biofidelity. In: Proceedings of the 16th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 31–June 4, 1998; Windsor, Ontario, Canada.1960-1998.

2002

Funk JR, Srinivasan SCM, Crandall JR, Khaewpong N, Eppinger RH, Jaffredo AS, Potier P, Petit PY. The effects of axial preload and dorsiflexion on the tolerance of the ankle/subtalar joint to dynamic inversion and eversion. Stapp Car Crash J. 2002;46:245-265. SAE 2002-22-0013.

2009

McKay BJ, Bir CA. Lower extremity injury criteria for evaluating military vehicle occupant injury in underbelly blast events. Stapp Car Crash J. 2009;53:229-249. SAE 2009-22-0009.

Year	Entry
2021	Hostetler ZS, Aira J, Caffrey J, Gayzik FS. Analyzing the force variation and response of a human body finite element model in the underbody blast environment. In: Proceedings of the 2021 International IRCOBI Conference on the Biomechanics of Injury. September 8-10, 2021; Online.616-625.
2014	Van Tuyl JT. Development of a Force Sensing Insole to Quantify Impact Loading to the Foot in Various Postures [Master's thesis]. Hamilton, ON: McMaster University; 2014.
2016	Bailey AM. Injury Assessment for the Human Leg Exposed to Axial Impact Loading [PhD thesis]. Charlottesville, VA: University of Virginia; September 2016.
2020	Ceritano DW. Sex-Based Differences in Calcaneal Injury Tolerances Under High-Rate Loading [Master's thesis]. Virginia Polytechnic Institute and State University; May 22, 2020.

Year

Entry

2021

Hostetler ZS, Aira J, Caffrey J, Gayzik FS. Analyzing the force variation and response of a human body finite element model in the underbody blast environment. In: Proceedings of the 2021 International IRCOBI Conference on the Biomechanics of Injury. September 8-10, 2021; Online.616-625.

2014

Van Tuyl JT. Development of a Force Sensing Insole to Quantify Impact Loading to the Foot in Various Postures [Master's thesis]. Hamilton, ON: McMaster University; 2014.

2016

Bailey AM. Injury Assessment for the Human Leg Exposed to Axial Impact Loading [PhD thesis]. Charlottesville, VA: University of Virginia; September 2016.

2020

Ceritano DW. Sex-Based Differences in Calcaneal Injury Tolerances Under High-Rate Loading [Master's thesis]. Virginia Polytechnic Institute and State University; May 22, 2020.