Development, Validation, and Application of Dynamic Imaging to Quantify in Vivo Kinematics of the Foot and Ankle

Quantification of joint angles and translations (i.e., kinematics) is essential to understand how injury and trauma affect joint mechanics. Despite the large number of injuries, there is limited research regarding the mechanics of the joints in the foot or ankle. To address this dearth of knowledge, the overarching goal of this dissertation was to develop, validate, and apply dynamic imaging to quantify in vivo kinematics of the foot and ankle.

The first theme of this dissertation detailed the development and validation of dual fluoroscopy (DF) and model-based tracking to quantify three dimensional (3D) kinematics of the ankle. A cadaver study was performed to evaluate the accuracy of the DF system against the reference standard, dynamic radiostereometric analysis. The mean angular and translational biases of the DF system did not exceed 1.7° and 0.5 mm, respectively.

The validated DF system was used in the second theme of this dissertation to assess and compare tibiotalar and subtalar kinematics in control subjects and patients with chronic ankle instability (CAI). In controls, the tibiotalar joint was found to provide significantly more dorsi/plantarflexion range of motion (ROM) than the subtalar joint. Conversely, the subtalar joint provided significantly more inversion/eversion ROM than the tibiotalar joint. During heelrise, controls exhibited increased tibiotalar and subtalar internal rotation and subtalar inversion going into plantarflexion, while CAI patients exhibited increased tibiotalar and subtalar external rotation and subtalar eversion. These altered mechanics may indicate potential characteristics of CAI.

Due to several limitations, DF is impractical for many clinical and research applications. As such, the third theme of this dissertation evaluated the accuracy of the modified Shriners Hospitals for Children Greenville skin marker model, using DF as the reference standard. Significant differences between skin markers and DF were often seen in ankle and midfoot angles during large ROM and the loading and unloading portions of stance, indicating that skin marker models may be less accurate during highly dynamic activities. These data will be used to improve model accuracy and provide improved tools for clinical and research applications.

Year	Entry
1996	Kidder SM, Abuzzahab FS Jr, Harris GF, Johnson JE. A system for the analysis of foot and ankle kinematics during gait. IEEE Trans Rehabil Eng. March 1996;4(1):25-32.
2007	Fong DT-P, Hong Y, Chan L-K, Yung PS-H, Chan K-M. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94.
2005	Chiari L, Della Croce U, Leardini A, Cappozzo A. Human movement analysis using stereophotogrammetry, II: instrumental errors. Gait Post. February 2005;21(2):197-211.
1965	Freeman MAR. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg. November 1965;47B(4):669-677.
2011	Anderson DD, Chubinskaya S, Guilak F, Martin JA, Oegema TR, Olson SA, Buckwalter JA. Post-traumatic osteoarthritis: improved understanding and opportunities for early intervention. J Orthop Res. June 2011;29(6):802-809.
2006	Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA. Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma. November–December 2006;20(10):739-744.
1991	Davis RB III, Õunpuu S, Tyburski D, Gage JR. A gait analysis data collection and reduction technique. Hum Mov Sci. October 1991;10(5):575-587.
2014	Kapron AL, Aoki SK, Peters CL, Maas SA, Bey MJ, Zauel R, Anderson AE. Accuracy and feasibility of dual fluoroscopy and model-based tracking to quantify in vivo hip kinematics during clinical exams. J Appl Biomech. June 2014;30(3):461-470.
2001	Carson MC, Harrington ME, Thompson N, O’Connor JJ, Theologis TN. Kinematic analysis of a multi-segment foot model for research and clinical applications: a repeatability analysis. J Biomech. October 2001;34(10):1299-1307.
1994	Yeung MS, Chan K-M, So CH, Yuan WY. An epidemiological survey on ankle sprain. Br J Sports Med. June 1994;28(2):112-116.
1991	Scott SH, Winter DA. Talocrural and talocalcaneal joint kinematics and kinetics during the stance phase of walking. J Biomech. 1991;24(8):743-752.
1997	Buckwalter JA, Mankin HJ. Articular cartilage, II: degeneration and osteoarthrosis, repair, regeneration, and transplantation. J Bone Joint Surg. April 1997;79A(4):612-632.
2012	Maas SA, Ellis BJ, Ateshian GA, Weiss JA. FEBio: finite elements for biomechanics. J Biomech Eng. January 2012;134(1):011005.
1957	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. December 1957;16(4):494-502.
2010	Arnold EM, Ward SR, Lieber RL, Delp SL. A model of the lower limb for analysis of human movement. Ann Biomed Eng. February 2010;38(2):269-279.
2008	Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res. March 2008;26(3):332-341.
2005	Leardini A, Chiari L, Della Croce U, Cappozzo A. Human movement analysis using stereophotogrammetry, III: soft tissue artifact assessment and compensation. Gait Post. February 2005;21(2):212-225.
2007	Leardini A, Benedetti MG, Berti L, Bettinelli D, Nativo R, Giannini S. Rear-foot, mid-foot and fore-foot motion during the stance phase of gait. Gait Post. 2007;25(3):453-462.
1999	Leardini A, Benedetti MG, Catani F, Simoncini L, Giannini S. An anatomically based protocol for the description of foot segment kinematics during gait. Clin Biomech (Bristol, Avon). 1999;14(8):528-536.
1990	Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res. May 1990;8(3):383-392.
1992	Lafortune MA, Cavanagh PR, Sommer HJ III, Kalenak A. Three-dimensional kinematics of the human knee during walking. J Biomech. April 1992;25(4):347-357.
2010	Saraswat P, Andersen MS, MacWilliams BA. A musculoskeletal foot model for clinical gait analysis. J Biomech. 2010;43(9):1645-1652.
1995	Cappozzo A, Catani F, Della Croce U, Leardini A. Position and orientation in space of bones during movement: anatomical frame definition and determination. Clin Biomech (Bristol, Avon). June 1995;10(4):171-178.
2006	Bey MJ, Zauel R, Brock SK, Tashman S. Validation of a new model-based tracking technique for measuring three-dimensional, in vivo glenohumeral joint kinematics. J Biomech Eng. August 2006;128(4):604-609.
2007	Jenkyn TR, Nicol AC. A multi-segment kinematic model of the foot with a novel definition of forefoot motion for use in clinical gait analysis during walking. J Biomech. 2007;40(14):3271-3278.
2001	Hunt AE, Smith RM, Torode M, Keenan A-M. Inter-segment foot motion and ground reaction forces over the stance phase of walking. Clin Biomech (Bristol, Avon). August 2001;16(7):592-600.
2003	Beumer A, Valstar ER, Garling EH, van Leeuwen WJ, Sikma W, Niesing R, Ranstam J, Swierstra BA. External rotation stress imaging in syndesmotic injuries of the ankle: comparison of lateral radiography and radiostereometry in a cadaveric model. Acta Orthop Scand. 2003;74(2):201-205.
1989	Lundberg A. Kinematics of the ankle and foot: in vivo roentgen stereophotogrammetry. Acta Orthop Scand. 1989;60(suppl 223):1-26.
2003	MacWilliams BA, Cowley M, Nicholson DE. Foot kinematics and kinetics during adolescent gait. Gait Post. 2003;17(3):214-224.
1984	Winter DA. Kinematic and kinetic patterns in human gait: variability and compensating effects. Hum Mov Sci. March–June 1984;3(1-2):51-76.

Year

Entry

1996

Kidder SM, Abuzzahab FS Jr, Harris GF, Johnson JE. A system for the analysis of foot and ankle kinematics during gait. IEEE Trans Rehabil Eng. March 1996;4(1):25-32.

2007

Fong DT-P, Hong Y, Chan L-K, Yung PS-H, Chan K-M. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94.

2005

Chiari L, Della Croce U, Leardini A, Cappozzo A. Human movement analysis using stereophotogrammetry, II: instrumental errors. Gait Post. February 2005;21(2):197-211.

1965

Freeman MAR. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg. November 1965;47B(4):669-677.

2011

Anderson DD, Chubinskaya S, Guilak F, Martin JA, Oegema TR, Olson SA, Buckwalter JA. Post-traumatic osteoarthritis: improved understanding and opportunities for early intervention. J Orthop Res. June 2011;29(6):802-809.