The three-dimensional kinematics and flexibility characteristics of the human ankle and subtalar joints--Part I: Kinematics

The in-vitro, three dimensional kinematic characteristics of the human ankle and subtalar joint were investigated in this study. The main goals of this investigation were: 1) To determine the range of motion of the foot-shank complex and the associated range of motion of the ankle and subtalar joints; 2) To determine the kinematic coupling characteristics of the foot-shank complex, and 3) To identify the relationship between movements at the ankle and subtalar joints and the resulting motion produced between the foot and the shank. The tests were conducted on fifteen fresh amputated lower limbs and consisted of incrementally displacing the foot with respect to the shank while the motion of the articulating bones was measured through a three dimensional position data acquisition system. The kinematic analysis was based on the helical axis parameters describing the incremental displacements between any two of the three articulating bones and on a joint coordinate system used to describe the relative position between the bones. From the results of this investigation it was concluded that: 1) The range of motion of the foot-shank complex in any direction (dorsiflexion/plantarflexion, inversion/eversion and internal rotation/external rotation) is larger than that of either the ankle joint or the subtalar joint.; 2) Large kinematic coupling values are present at the foot-shank complex in inversion/eversion and in internal rotation/external rotation. However, only a slight amount of coupling was observed to occur in dorsiflexion/plantarflexion.; 3) Neither the ankle joint nor the subtalar joint are acting as ideal hinge joints with a fixed axis of rotation.; 4) Motion of the foot-shank complex in any direction is the result of rotations at both the ankle and the subtalar joints. However, the contribution of the ankle joint to dorsiflexion/plantarflexion of the foot-shank complex is larger than that of the subtalar joint and the contribution of the subtalar joint to inversion/eversion is larger than that of the ankle joint.; 5) The ankle and the subtalar joints have an approximately equal contribution to internal rotation/external rotation movements of the foot-shank complex.     

In-vivo range of motion of the subtalar joint using computed tomography

Understanding in vivo subtalar joint kinematics is important for evaluation of subtalar joint instability, the design of a subtalar prosthesis and for analysing surgical procedures of the ankle and hindfoot. No accurate data are available on the normal range of subtalar joint motion. The purpose of this study was to introduce a method that enables the quantification of the extremes of the range of motion of the subtalar joint in a loaded state using multidetector computed tomography (CT) imaging. In 20 subjects, an external load was applied to a footplate and forced the otherwise unconstrained foot in eight extreme positions. These extreme positions were foot dorsiflexion, plantarflexion, eversion, inversion and four extreme positions in between the before mentioned positions. CT images were acquired in a neutral foot position and each extreme position separately. After bone segmentation and contour matching of the CT data sets, the helical axes were determined for the motion of the calcaneus relative to the talus between four pairs of opposite extreme foot positions. The helical axis was represented in a coordinate system based on the geometric principal axes of the subjects’ talus. The greatest relative motion between the calcaneus and the talus was calculated for foot motion from extreme eversion to extreme inversion (mean rotation about the helical axis of 37.3±5.9°, mean translation of 2.3±1.1 mm). A consistent pattern of range of subtalar joint motion was found for motion of the foot with a considerable eversion and inversion component.     

Mobility of the subtalar joint in the intact ankle complex

A previous study by these authors showed that the calcaneus follows a unique path of unresisted coupled motion relative to the tibia during passive flexion and that most of this motion occurred at the ankle level. Subtalar motion in the intact ankle complex was observed only when perturbations from this path were induced by the application of force to the calcaneus. Relative motion of the bones of the ankle complex was tracked by stereophotogrammetry in seven specimens. Anatomical landmarks, reference frames and joint angles were defined by standard techniques. Sequential moments were applied to the calcaneus about the long axis of the tibia. Measured movements at subtalar level demonstrated plantarflexion coupled to supination and internal rotation (inversion) and dorsiflexion coupled to pronation and external rotation (eversion). These movements were resisted and were fully recovered when the external load was removed. Subtalar motion diminished as the ankle approached maximal dorsi- and plantarflexion. Two clearly distinguished mean axes of rotation were observed for inversion and eversion runs. The axes of inversion and eversion of the subtalar complex changed orientation along a preferred and repeatable path. The subtalar joint complex occupied only a single stable position in the unloaded state and with no range of unresisted motion. It is inferred that mobility was possible only by the stretching and lengthening of the ligaments and the indentation of the articular surfaces, requiring the application of loads. The subtalar joint complex behaves like a flexible structure.     

A mechanical supination sprain simulator for studying ankle supination sprain kinematics

This study presents a free-fall mechanical supination sprain simulator for evaluating the ankle joint kinematics during a simulated ankle supination sprain injury. The device allows the foot to be in an anatomical position before the sudden motion, and also allows different degrees of supination, or a combination of inversion and plantarflexion. Five subjects performed simulated supination sprain trials in five different supination angles. Ankle motion was captured by a motion analysis system, and the ankle kinematics were reported in plantarflexion/dorsiflexion, inversion/eversion and internal/external rotation planes. Results showed that all sprain motions were not pure single-plane motions but were accompanied by motion in other two planes, therefore, different degrees of supination were achieved. The presented sprain simulator allows a more comprehensive study of the kinematics of ankle sprain when compared with some previous laboratory research designs.     

Brief communication: Cineradiographic analysis of the chimpanzee (Pan troglodytes) talonavicular and calcaneocuboid joints

During terrestrial locomotion, chimpanzees exhibit dorsiflexion of the midfoot between midstance and toe‐off of stance phase, a phenomenon that has been called the “midtarsal break.” This motion is generally absent during human bipedalism, and in chimpanzees is associated with more mobile foot joints than in humans. However, the contribution of individual foot joints to overall foot mobility in chimpanzees is poorly understood, particularly on the medial side of the foot. The talonavicular (TN) and calcaneocuboid (CC) joints have both been suggested to contribute significantly to midfoot mobility and to the midtarsal break in chimpanzees. To evaluate the relative magnitude of motion that can occur at these joints, we tracked skeletal motion of the hindfoot and midfoot during passive plantarflexion and dorsiflexion manipulations using cineradiography. The sagittal plane range of motion was 38 ± 10° at the TN joint and 14 ± 8° at the CC joint. This finding indicates that the TN joint is more mobile than the CC joint during ankle plantarflexion–dorsiflexion. We suggest that the larger range of motion at the TN joint during dorsiflexion is associated with a rotation (inversion–eversion) across the transverse tarsal joint, which may occur in addition to sagittal plane motion. Am J Phys Anthropol 154:604–608, 2014. © 2014 Wiley Periodicals, Inc.     

Comparison of in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and matched asymptomatic control subjects

The purpose of this study was to compare in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and asymptomatic control subjects. Segmental foot motion during walking and step descent was assessed using a multi-segment foot model in 30 patients with midfoot arthritis and 20 age, gender and BMI matched controls. Peak and total range of motion (ROM), referenced to subtalar neutral, were examined for each of the following dependent variables: 1st metatarso-phalangeal (MTP1) dorsiflexion, 1st metatarsal (MT1) plantarflexion, ankle dorsiflexion, calcaneal eversion and forefoot abduction. The results showed that, compared to level walking, step descent required greater MTP1 dorsiflexion (p<0.01), MPT1 plantarflexion (p<0.01), ankle dorsiflexion (p<0.01), calcaneus eversion (p=0.03) and forefoot abduction (p=0.01), in all subjects. In addition, step descent also necessitated greater MTP1 dorsiflexion (p<0.01), ankle dorsiflexion (p<0.01) and forefoot abduction (p=0.02) excursion compared to walking. Patients with midfoot arthritis responded differently to the step task compared to control subjects in terms of MT1 and calcaneus eversion excursion. During walking, patients with midfoot arthritis showed significantly less MT1 plantarflexion excursion compared to control subjects (p=0.03). However, during step descent, both groups showed similar MT1 plantarflexion excursion. During walking, patients with midfoot arthritis showed similar calcaneus eversion excursion compared to control subjects. However, during step descent, patients with midfoot arthritis showed significantly greater calcaneus eversion excursion compared to control subjects (p=0.03). Independently or in combination, these motions may contribute to articular stress and consequently to symptoms in patients with midfoot arthritis.     

Estimates of Achilles tendon moment arm differ when axis of ankle rotation is derived from ankle motion

The plantarflexor moment arm of the Achilles tendon determines the mechanical advantage of the triceps surae and also indirectly affects muscle force generation by setting the amount of muscle-tendon shortening per unit of ankle joint rotation. The Achilles tendon moment arm may be determined geometrically from an axis (or center) of joint rotation and the line of action of the tendon force, but such moment arms may be sensitive to the location of the joint axis. Using motion analysis to track an ultrasound probe overlying the Achilles tendon along with markers on the shank and foot, we measured Achilles tendon moment arm during loaded and unloaded dynamic plantarflexion motions in 15 healthy subjects. Three representations of the axis or center of rotation of the ankle were considered: (1) a functional axis, defined by motions of the foot and shank; (2) a transmalleolar axis; and (3) a transmalleolar midpoint. Moment arms about the functional axis were larger than those found using the transmalleolar axis and transmalleolar midpoint (all p < 0.001). Moment arms computed with the functional axis increased with plantarflexion angle (all p < 0.001), and increased with loading in the most plantarflexed position (p < 0.001) but these patterns were not observed when either using a transmalleolar axis or transmalleolar midpoint. Functional axis moment arms were similar to those estimated previously using magnetic resonance imaging, suggesting that using a functional axis for ultrasound-based geometric estimates of Achilles tendon moment arm is an improvement over landmark-based methods.     

Evaluating foot kinematics using magnetic resonance imaging: from maximum plantar flexion, inversion, and internal rotation to maximum dorsiflexion, eversion, and external rotation

The foot consists of many small bones with complicated joints that guide and limit motion. A variety of invasive and noninvasive means [mechanical, X-ray stereophotogrammetry, electromagnetic sensors, retro-reflective motion analysis, computer tomography (CT), and magnetic resonance imaging (MRI)] have been used to quantify foot bone motion. In the current study we used a foot plate with an electromagnetic sensor to determine an individual subject's foot end range of motion (ROM) from maximum plantar flexion, internal rotation, and inversion to maximum plantar flexion, inversion, and internal rotation to maximum dorsiflexion, eversion, and external rotation. We then used a custom built MRI-compatible device to hold each subject's foot during scanning in eight unique positions determined from the end ROM data. The scan data were processed using software that allowed the bones to be segmented with the foot in the neutral position and the bones in the other seven positions to be registered to their base positions with minimal user intervention. Bone to bone motion was quantified using finite helical axes (FHA). FHA for the talocrural, talocalcaneal, and talonavicular joints compared well to published studies, which used a variety of technologies and input motions. This study describes a method for quantifying foot bone motion from maximum plantar flexion, inversion, and internal rotation to maximum dorsiflexion, eversion, and external rotation with relatively little user processing time.     

Searching for the “sweet spot”: the foot rotation and parallel engagement of ankle ligaments in maximizing injury tolerance

Ligament sprains, defined as tearing of bands of fibrous tissues within ligaments, account for a majority of injuries to the foot and ankle complex in field-based sports. External rotation of the foot is considered the primary injury mechanism of syndesmotic ankle sprains with concomitant flexion and inversion/eversion associated with particular patterns of ligament trauma. However, the influence of the magnitude and direction of loading vectors to the ankle on the in situ stress state of the ligaments has not been quantified in the literature. The objective of the present study was to search for the maximum injury tolerance of a human foot with an acceptable subfailure distribution of individual ligaments. We used a previously developed and comprehensively validated foot and ankle model to reproduce a range of combined foot rotation experienced during high-risk sports activities. Biomechanical computational investigation was performed on initial foot rotation from \(20{^{\circ }}\) of plantar flexion to \(15{^{\circ }}\) of dorsiflexion, and from \(15{^{\circ }}\) of inversion to \(15{^{\circ }}\) of eversion prior to external rotation. Change in initial foot rotation shifted injury initiation among different ligaments and resulted in a wide range of injury tolerances at the structural level (e.g., 36–125 Nm of rotational moment). The observed trend was in agreement with a parallel experimental study that initial plantar flexion decreased the incidence of syndesmotic injury compared to a neutral foot. A mechanism of distributing even loads across ligaments subjected to combined foot rotations was identified. This mechanism is potential to obtain the maximum load-bearing capability of a foot and ankle while minimizing the injury severity of ligaments. Such improved understanding of ligament injuries in athletes is necessary to facilitate injury management by clinicians and countermeasure development by biomechanists.     

In vivo determination of the anatomical axes of the ankle joint complex: An optimization approach

This study investigates the feasibility of a subject-specific three-dimensional model of the ankle joint complex for kinematic and dynamic analysis of movement. The ankle joint complex was modelled as a three-segment system, connected by two ideal highe joints: the talocrural and the subtalar joint. A mathematical formulation was developed to express the three-dimensional translation and rotation between the foot and shank segments as a function of the two joint angles, and 12 model parameters describing the locations of the joint axes. An optimization method was used to fit the model parameters to three-dimensional kinematic data of foot and shank markers, obtained during test movements throughout the entire physiological range of motion of the ankle joint. The movement of the talus segment, which cannot be measured non-invasively, is not necessary for the analysis.

This optimization method was used to determine the position and orientation of the joint axes in 14 normal subjects. After optimization, the discrepancy between the best fitting model and actual marker kinematics was between 1 and 3 mm for all subjects. The predicted inclination of the subtalar joint axis from the horizontal plane was 37.4±2.7°, and the medial deviation was 18.0±16.2°. The lateral side of the talucrural axis was directed slightly posteriorly (6.8±8.1°), and inclined downward by 7.0±5.4°. These results are similar to previously reported typical results from anatomical, in vitro, studies. Reproducibility was evaluated by repeated testing of one subject, which resulted in variations of about one-fifth of the standard deviation within the group, the inclination of the subtalar joint axis was significantly correlated to the arch height and a radiographic ‘tarsal index’. It is concluded that this optimization method provides the opportunity to incorporate inter-individual anatomical differences into kinematic and dynamic analysis of the ankle joint complex. This allows a more functional interpretation of kinematic data, and more realistic estimates of internal forces.     

Kinematics of the ankle joint complex in snowboarding

Because snowboarders are known to injure their ankles more often than Alpine skiers, it has been postulated that stiffer snowboard boots would provide better protection to the ankle than current soft boots do. Snowboarders are also known to injure their front ankle more often than their back ankle, presumably because of the asymmetrical rotations of the ankles due to asymmetrical binding adjustement. To test these hypotheses, we measured the kinematics of the feet and legs of 5 snowboarders wearing soft boots and stiffer step-in boots during snowboarding maneuvers using an electromagnetic motion tracking system. The results were expressed in anatomically relevant rotations of the ankle joint complex, namely dorsi-/plantar flexion, eversion/inversion, and internal/external rotation. The measured ankle rotations show differences in the movement patterns of the front and back legs. Step-in boots were shown to allow less dorsiflexion, eversion, and external rotation than softer boots, possibly explaining why they are associated with a lower rate of fractures of the talus than soft boots.     

Calculating the axes of rotation for the subtalar and talocrural joints using 3D bone reconstructions

Orientation of the subtalar joint axis dictates inversion and eversion movements of the foot and has been the focus of evolutionary and clinical studies for a number of years. Previous studies have measured the subtalar joint axis against the axis of the whole foot, the talocrural joint axis and, recently, the principal axes of the talus. The present study introduces a new method for estimating average joint axes from 3D reconstructions of bones and applies the method to the talus to calculate the subtalar and talocrural joint axes. The study also assesses the validity of the principal axes as a reference coordinate system against which to measure the subtalar joint axis. In order to define the angle of the subtalar joint axis relative to that of another axis in the talus, we suggest measuring the subtalar joint axis against the talocrural joint axis. We present corresponding 3D vector angles calculated from a modern human skeletal sample. This method is applicable to virtual 3D models acquired through surface-scanning of disarticulated 'dry' osteological samples, as well as to 3D models created from CT or MRI scans.     

Influence of kinematic analysis methods on detecting ankle and subtalar joint instability

Patients with subtalar joint instability may be misdiagnosed with ankle instability, which may lead to chronic instability at the subtalar joint. Therefore, it is important to understand the difference in kinematics after ligament sectioning and differentiate the changes in kinematics between ankle and subtalar instability. Three methods may be used to determine the joint kinematics; the Euler angles, the Joint Coordinate System (JCS) and the helical axis (HA). The purpose of this study was to investigate the influence of using either method to detect subtalar and ankle joints instability. 3D kinematics at the ankle and subtalar joint were analyzed on 8 cadaveric specimens while the foot was intact and after sequentially sectioning the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), the cervical ligament and the interosseous talocalcaneal ligament (ITCL). Comparison in kinematics calculated from sensor and anatomical landmarks was conducted as well as the influence of Euler angles and JCS rotation sequence (between ISB recommendation and previous research) on the subtalar joint. All data showed a significant increase in inversion when the ITCL was sectioned. There were differences in the data calculated using sensors coordinate systems vs. anatomic coordinate systems. Anatomic coordinate systems were recommended for these calculations. The Euler angle and JCS gave similar results. Differences in Euler angles and JCS sequence lead to the same conclusion in detecting instability at the ankle and subtalar joint. As expected, the HA detected instability in plantarflexion at the ankle joint and in inversion at the subtalar joint.     

A comparison of dorsal and heel plate foot tracking methods on lower extremity dynamics

The primary method to model ankle motion during inverse dynamic calculations of the lower limb is through the use of skin-mounted markers, with the foot modeled as a rigid segment. Motion of the foot is often tracked via the use of a marker cluster triad on either the dorsum, or heel, of the foot/shoe. The purpose of this investigation was to evaluate differences in calculated lower extremity dynamics during the stance phase of gait between these two tracking techniques. In an analysis of 7 subjects, it was found that sagittal ankle angles and sagittal ankle, hip and knee moments were strongly correlated between the two conditions, however, there was a significant difference in peak ankle plantar flexion and dorsiflexion angles. Frontal ankle angles were only moderately correlated and there was a significant difference in peak ankle eversion and inversion, resulting in moderate correlations in frontal plane moments and a significant difference in peak hip adductor moments. We demonstrate that the technique used to track the foot is an important consideration in interpreting lower extremity dynamics for clinical and research purposes.     

In vivo kinematics of two-component total ankle arthroplasty during non-weightbearing and weightbearing dorsiflexion/plantarflexion

Relatively high rates of loosening and implant failure have been reported after total ankle arthroplasty, especially in first and second generation implants. Abnormal kinematics and incongruency of the articular surface may cause increased loads applied to the implant with concomitant polyethylene wear, resulting in loosening and implant failure. The purpose of this study was to measure three-dimensional kinematics of two-component total ankle arthroplasty during non-weightbearing and weightbearing activities, and to investigate incongruency of the articular surfaces during these activities. Forty-seven patients with a mean age of 71 years were enrolled. Radiographs were taken at non-weightbearing maximal dorsiflexion and plantarflexion, and weightbearing maximal dorsiflexion, plantarflexion, and neutral position. 3D-2D model-image registration was performed using the radiographs and the three-dimensional implant models, and three-dimensional joint angles were determined. The implanted ankles showed 18.1±8.6° (mean±standard deviation) of plantarflexion, 0.1±0.7° of inversion, 1.2±2.0° of internal rotation, and 0.8±0.6mm of posterior translation of the talar component in the non-weightbearing activity, and 17.8±7.5° of plantarflexion, 0.4±0.5° of inversion, 1.8±2.0° of internal rotation, and 0.7±0.5mm of posterior translation in the weightbearing activity. There were no significant differences between the non-weightbearing and weightbearing kinematics except for the plantarflexion angle. Incongruency of the articular surface occurred in more than 75% of the ankles. Our observations will provide useful data against which kinematics of other implant designs, such as three-component total ankle arthroplasty, can be compared.     

Analysis of surface-to-surface distance mapping during three-dimensional motion at the ankle and subtalar joints

Joint surface interaction and ligament constraints determine the kinematic characteristics of the ankle and subtalar joints. Joint surface interaction is characterized by joint contact mechanics and by relative joint surface position potentially characterized by distance mapping. While ankle contact mechanics was investigated, limited information is available on joint distance mapping and its changes during motion. The purpose of this study was to use image-based distance mapping to quantify this interaction at the ankle and subtalar joints during tri-planar rotations of the ankle complex. Five cadaveric legs were scanned using Computed Tomography and the images were processed to produce 3D bone models of the tibia, fibula, talus and calcaneus. Each leg was tested on a special linkage through which the ankle complex was loaded in dorsiflexion/plantarflexion, inversion/eversion, and internal/external rotation and the resulting bone movements were recorded. Fiduciary bone markers data and 3D bone models were combined to generate color-coded distance maps for the ankle and subtalar joints. The results were processed focusing on the changes in surface-to-surface distance maps between the extremes of the range of motion and neutral. The results provided detailed insight into the three-dimensional highly coupled nature of these joints showing significant and unique changes in distance mapping from neutral to extremes of the range of motion. The non-invasive nature of the image-based distance mapping technique could result, after proper modifications, in an effective diagnostic and clinical evaluation technique for application such as ligament injuries and quantifying the effect of arthrodesis or total ankle replacement surgery.     

Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis

Background

Clinically, plantar fasciitis (PF) is believed to be a result and/or prolonged by overpronation and excessive loading, but there is little biomechanical data to support this assertion. The purpose of this study was to determine the differences between healthy individuals and those with PF in (1) rearfoot motion, (2) medial forefoot motion, (3) first metatarsal phalangeal joint (FMPJ) motion, and (4) ground reaction forces (GRF).

Methods

We recruited healthy (n=22) and chronic PF individuals (n=22, symptomatic over three months) of similar age, height, weight, and foot shape (p>0.05). Retro-reflective skin markers were fixed according to a multi-segment foot and shank model. Ground reaction forces and three dimensional kinematics of the shank, rearfoot, medial forefoot, and hallux segment were captured as individuals walked at 1.35 ms⁻¹.

Results

Despite similarities in foot anthropometrics, when compared to healthy individuals, individuals with PF exhibited significantly (p<0.05) (1) greater total rearfoot eversion, (2) greater forefoot plantar flexion at initial contact, (3) greater total sagittal plane forefoot motion, (4) greater maximum FMPJ dorsiflexion, and (5) decreased vertical GRF during propulsion.

Conclusion

These data suggest that compared to healthy individuals, individuals with PF exhibit significant differences in foot kinematics and kinetics. Consistent with the theoretical injury mechanisms of PF, we found these individuals to have greater total rearfoot eversion and peak FMPJ dorsiflexion, which may put undue loads on the plantar fascia. Meanwhile, increased medial forefoot plantar flexion at initial contact and decreased propulsive GRF are suggestive of compensatory responses, perhaps to manage pain.     

The jump shot - a biomechanical analysis focused on lateral ankle ligaments

Handball is one of the top four athletic games with highest injury risks. The jump shot is the most accomplished goal shot technique and the lower extremities are mostly injured. As a basis for ankle sprain simulation, the aim of this study was to extend the ankle region of an existing musculoskeletal full-body model through incorporation of three prominent lateral ankle ligaments: ligamentum fibulotalare anterius (LFTA), ligamentum fibulotalare posterius (LFTP), ligamentum fibulocalcaneare (LFC). The specific objective was to calculate and visualise ligament force scenarios during the jumping and landing phases of controlled jump shots. Recorded kinematic data of performed jump shots and the corresponding ground reaction forces were used to perform inverse dynamics. The calculated peak force of the LFTA (107 N) was found at maximum plantarflexion and of the LFTP (150 N) at maximum dorsiflexion. The peak force of the LFC (190 N) was observed at maximum dorsiflexion combined with maximum eversion. Within the performed jump shots, the LFTA showed a peak force (59 N to 69 N) during maximum plantarflexion in the final moment of the lift off. During landing, the force developed by the LFTA reached its peak value (61 N to 70 N) at the first contact with the floor. After that, the LFTP developed a peak force (70 N to 118 N). This model allows the calculation of forces in lateral ankle ligaments. The information obtained in this study can serve as a basis for future research on ankle sprain and ankle sprain simulation.     

Validity and reliability of a new in vivo ankle stiffness measurement device

This investigation was designed to test the validity and reliability of a new measure of inversion/eversion ankle stiffness on a unique medial/lateral swaying cradle device utilizing a test/retest with comparison to a known standard. Ankle stiffness is essential to maintaining joint stability. Most ankle injuries occur via an inversion mechanism. To date, very little information is available regarding stiffness of the evertor muscles in the prevention of excessive inversion joint rotation. Transient oscillation data representing inversion/eversion stiffness was obtained in a bipedal weight-bearing stance with an upright posture. Using commercially available springs with stiffness of 4.80N/cm the measured value recorded by the cradle was 4.87N/cm. Mean active stiffness values of the ankle were 35.70Nm/cm (SD 9.45). The trial-to-trial reliability ICC (2,1) coefficient was 0.96 with an SEM of 2.05Nm/rad, and the day-to-day reliability ICC (2,k) coefficient was 0.93 and an SEM of 3.00Nm/rad. The results demonstrate that inversion/eversion ankle stiffness measures on this device are a valid, repeatable and consistent measure. This is relevant because the ability to accurately quantify inversion/eversion ankle stiffness will improve our understanding of biomechanical stability and factors that influence it. It will also enable identification of ankle injury risk factors that will lead to more efficient rehabilitation programs and injury prevention strategies.