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1.
The aim of this study was to use a two-axis ankle joint model and an optimisation process (van den Bogert et al., 1994) to calculate and compare the talocrural and subtalar hinge axes for non-weight-bearing ankle motion, weight-bearing ankle motion, and walking in normal, healthy adult subjects and to see which of the first two sets of axes better fit the walking data. Motion data for the foot and shank were collected on eight subjects whilst they performed the activities mentioned. After choosing the best marker sets for motion tracking, a two-hinge ankle joint model was fit to the motion data. Ankle joint ranges of motion were also calculated. It was found that the model fit the experimental data well, with non-weight-bearing motion achieving the best fit. Despite this, the calculated axis orientations were highly variable both between motion types and between subjects. No significant difference between the fit of the non-weight-bearing and weight-bearing models to the walking data was found, which implies that either set of functional axes is adequate for modeling walking; however, the subtalar deviation angle was significantly closer for the weight-bearing activity and walking than for the non-weight-bearing activity and walking, which suggests that it is marginally better to use the weight-bearing functional motions. The results lead to questions about the appropriateness of the two-hinge ankle model for use in applications in which the behaviour of the individual joints of the ankle complex, rather than simply the relative motion of the leg and foot, is important.  相似文献   

2.
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.  相似文献   

3.
Two-dimensional methods have been applied to determine the Achilles tendon moment arm in previous studies, although the talocrural joint rotates in three-dimension. The purpose of this study was to develop a method for determining the Achilles tendon moment arm in three-dimensions (3DMA). A series of sagittal ankle images were obtained at ankle positions of -20°, -10° (dorsiflexed position), 0° (neutral position), +10°, +20°, and +30° (plantarflexed position). The talocrural joint axis was determined as the finite helical axis of the ankle joint over 20° of displacement, and the 3DMA was determined as the shortest distance from the talocrural joint axis to the line of action of the Achilles tendon force. The corresponding 2DMA was determined with the center of rotation method using the images captured on the sagittal plane passing through the mid-point of the medio-lateral width of the tibia. The 3DMA ranged from 35 to 41 mm across various ankle positions and was, on average, 11 mm smaller than 2DMA. The difference between the two measures was attributable primarily to the deviations of the talocrural joint axis from the anatomical medio-lateral direction. The deviations on the coronal plane (21.4±20.7°) and on the transverse planes (14.8±22.6°) accounted for the errors of 1.3 mm and 3.0 mm, respectively. In addition, selecting either a medially or laterally misaligned sagittal-plane image for determining the 2DMA gave rise to error by 3.5 mm. The remaining difference was accounted for by the random measurement error.  相似文献   

4.
The subtalar joint is important in frontal plane movement and posture of the hindfoot. Abnormal subtalar joint moments caused by muscle forces and the ground reaction force acting on the foot are thought to play a role in various foot deformities. Calculating joint moments typically requires knowledge of the location of the joint axis; however, location of the subtalar axis from measured movement is difficult because the talus cannot be tracked using skin-mounted markers. The accuracy of a novel technique for locating the subtalar axis was assessed in vivo using magnetic resonance imaging. The method was also tested with skin-mounted markers and video motion analysis. The technique involves applying forces to the foot that cause pure subtalar joint motion (with negligible talocrural joint motion), and then using helical axis decomposition of the resulting tibiocalcaneal motion. The resulting subtalar axis estimates differed by 6° on average from the true best-fit subtalar axes in the MRI tests. Motion was found to have been applied primarily about the subtalar joint with an average of only 3° of talocrural joint motion. The proposed method provides a potential means for obtaining subject-specific subtalar axis estimates which can then be used in inverse dynamic analyses and subject-specific musculoskeletal models.  相似文献   

5.
The objective of the present study was to investigate the in-vitro, coupled, three-dimensional load-displacement and flexibility characteristics of the human ankle joint complex consisting of the talocrural and the talocalcaneal joints and to determine the effects that sectioning of the anterior talofibular ligament has on these characteristics. Similar to other anatomical joints such as the knee and the intervertebral joint, the ankle joint complex was found to exhibit highly nonlinear load-displacement characteristics with the angular displacement approaching asymptotic values as the external load was increased. Therefore, a procedure of incremental linearization was used to derive the flexibility characteristics of this structure. According to this procedure, external loads were applied to the calcaneus in small increments and its resulting three dimensional displacements were recorded. The incremental flexibility coefficients were then derived by assuming linear load-displacement relationship for each increment. From the results obtained from fifteen human ankle specimens, it was evident that the ankle joint complex exhibit highly coupled flexibility and load-displacement characteristics. It was further concluded that the ankle joint complex is the most flexible in the neighborhood of the unloaded, neutral position and that all the flexibility coefficients of the structure decrease rapidly toward the extremes of the range of motion. Rupture of the anterior talofibular ligament was found to have a significant effect on the load-displacement and flexibility characteristics of the ankle joint complex. This effect was manifested as a change in the load-displacement characteristics and a large increase in the flexibility coefficients primarily in those corresponding to rotations in the transverse and the coronal plane. The results of the present study can provide the necessary data base for the development of quantitative diagnostic technique for identifying the site and the extent of injury to the collateral ligaments of the ankle.  相似文献   

6.
The present study aimed to re-examine the influence of the isometric plantarflexors contraction on the Achilles tendon moment arm (ATMA) and the factors influencing the ATMA in three-dimensions. A series of coronal magnetic resonance images of the right ankle were recorded at foot positions of 10° of dorsiflexion, neutral position, and 10° of plantarflexion for the rest condition and the plantarflexors contraction condition at 30% maximal voluntary effort. The shortest distance between the talocrural joint axis and the line of action of the Achilles tendon force projected to the orthogonal plane of the talocrural joint axis was determined as the ATMA. The ATMA determined in the contraction condition was significantly greater by 8 mm than that determined in the rest condition. The talocrural joint axis was displaced anteriorly by 3 mm and distally by 2 mm due to the muscle contraction. As the same time, the line of action of the Achilles tendon force was displaced posteriorly by 5 mm and medially by 2 mm. These linear displacements of the talocrural joint axis and the line of action of the Achilles tendon force accounted for the difference in the ATMAs between the two conditions by 35.9 and 62.4%, respectively. These angular displacements accounted for the total of 0.4% increase in the ATMA. These results confirm the previous findings reported in two-dimensional studies and found that the linear displacement of the line of action of the Achilles tendon force is the primary source of the contraction-induced increase in the ATMA.  相似文献   

7.
8.
Objective: To explore the accurate in vivo kinematic changes in the ankle complex when wearing low- and high-heel shoes (LHS and HHS, respectively). Materials and methods: Twelve young women were tested unilaterally. Three-dimensional models of the tibia, talus, and calcaneus were first created based on CT scan results. The subjects walked at a self-controlled speed in barefoot, LHS (4 cm), and HHS (10 cm) conditions. A fluoroscopy system captured the lateral fluoroscopic images of the ankle complex. The images of seven key positions in the stance phase were selected, and 3D to 2D bone model registrations were performed to determine the joint positions. The mean of 6 degree of freedom (DOF) range of motions (ROM), joint positions, and angular displacements of the ankle complex during the gait were then obtained. Results: For the talocrural joint, the rotational ROMs of the subjects either in LHS or HHS condition displayed no significant difference from those in barefoot condition. For the subtalar joint, all the rotational ROMs in the HHS condition and the internal/external rotations in the LHS condition significantly decreased compared with those in the barefoot condition. The talocrural joint was positioned significantly more plantarflexed, inverted, internally rotated, and posteriorly seated in all seven poses in HHS condition, compared with those in barefoot condition. Conclusion: HHS mainly affected the rotational motion of the ankle complex during walking. The talocrural joint position was abnormal, and the subtalar joint ROM decreased during the gait in HHS condition. Only a few kinematic changes occurred in LHS condition relative to the barefoot condition.  相似文献   

9.
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.  相似文献   


10.
For measuring the in-vivo range of motion of the hindfoot, a CT-based bone contour registration method (CT-BCM) was developed to determine the three-dimensional position and orientation of bones. To validate this technique, we hypothesized that the range of motion in the hindfoot is equally, accurately measured by roentgen stereophotogrammetric analysis (RSA) as by the CT-BCM technique.Tantalum bone markers were placed in the distal tibia, talus and calcaneus of one cadaver specimen. With a fixed lower leg, the cadaveric foot was held in neutral and subsequently loaded in eight extreme positions. Immediately after acquiring a CT-scan with the foot in a position, RSA radiographs were made. Bone contour registration and RSA was performed. Helical axis parameters were calculated for talocrural and subtalar joint motion from neutral to extreme positions and between opposite extreme positions. Differences between CT-BCM and RSA were calculated.Compared with RSA, the CT-BCM data registered an overall root mean square difference (RMSd) of 0.21° for rotation about the helical axis, and 0.20 mm translation along the helical axis for the talocrural and subtalar joint and for all motions combined. The RMSd of the position and direction of the helical axes was 3.3 mm and 2.4°, respectively. The latter errors were larger with smaller helical rotations.The differences are similar to those reported for validated RSA and thus are not clinically relevant. Concluding, CT-BCM is an accurate and accessible alternative for studying joint motion, as it does not have the risk of infection and overlapping bone markers.  相似文献   

11.

Background

Open total extrusion of the talus without concomitant fracture is an extremely rare injury. We present 6-year follow-up data of a patient treated using a temporary spanning external fixator and less invasive single K-wire fixation.

Case presentation

A 55-year-old Asian man who had a totally extruded talus without fracture underwent immediate reimplantation surgery. A spanning external fixator with single antegrade K-wire fixation was applied to maintain the reimplanted talus. During 6 years of follow-up, he could walk without aids and could squat, corresponding to an American Orthopaedic Foot and Ankle Society score of 85. We found that the suspect lesion that was evident at 6 months after surgery had disappeared at 12 months postoperatively on the basis of sequential follow-up magnetic resonance imaging. There was no evidence of osteonecrosis of the dislocated talus at the final follow-up.

Conclusions

In patients with a totally extruded talus, a surgical strategy including immediate reimplantation of the talus and a temporary spanning fixator with single K-wire fixation might be useful to allow early mobilization around the ankle joint and to prevent additional damage of the foot without significant complications.
  相似文献   

12.
The locations of the joint axes of the ankle complex vary considerably between subjects, yet no noninvasive method with demonstrated accuracy exists for locating these axes. The moments of muscle and ground reaction forces about the joint axes are dependent on axis locations, making knowledge of these locations critical to accurate musculoskeletal modeling of the foot and ankle. The accuracy of a computational optimization method that fits a two-revolute model to measured motion was assessed using computer-generated data, a two-revolute mechanical linkage, and three lower-leg cadaver specimens. Motions were applied to cadaver specimens under axial load while bone-mounted markers attached to the tibia, talus, and calcaneus were tracked using a video-based motion analysis system. Estimates of the talocrural and subtalar axis locations were computed from motions of the calcaneus relative to the tibia using the optimization method. These axes were compared to mean helical axes computed directly from tibia, talus, and calcaneus motions. The optimization method performed well when the motions were computer-generated or measured in the mechanical linkage, with angular differences between optimization and mean helical axes ranging from 1 deg to 5 deg. In the cadaver specimens, however, these differences exceeded 20 deg. Optimization methods that locate the anatomical joint axes of the ankle complex by fitting two revolute joints to measured tibia-calcaneus motions may be limited because of problems arising from non-revolute behavior.  相似文献   

13.
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.  相似文献   

14.
Bone fracture reduction and bone axial dynamization are important operations which effectiveness can be further enhanced by the use of a unilateral external fixator. By design, axial dynamization can be performed through reciprocating one of its translational joints. However, non-axial dynamization may occur after correcting residual fracture deformity. To explore and to maximize its full potential, the joint adjustment constraint equations for fracture reduction and alignment of axial dynamization under unilateral external fixation are derived. Their physical implications and criteria on the kinematic structure of a fixator are then established. In order to correctly make the alignment of axial dynamization with the proper fracture reduction, this study shows that the linkage of a bone–fixator system should have a minimum of eight degrees-of-freedom (DOFs) with at least two nonparallel rotational DOFs adjacent to both ends of the designated single translational DOF for axial dynamization. Thus, the adjustment of the connection between bone pin/pin clamp of Othofix® fixator is required, while the alignment of one of the translational joints of Dynafix® fixator with its bone segment axis during fracture stabilization procedure is a crucial step. A conceptual fixator that requires neither an adjustment of the pin/pin clamp connection nor special pre-alignment is demonstrated. Based on the constraint equations and criteria developed throughout this study, the creation of an effective frame design of external fixation device becomes feasible.  相似文献   

15.
Talocrural joints of the African apes, modern humans, and A.L.288-1 are compared in order to investigate ankle function in the Hadar hominids. Comparisons between the hominids and African pongids clearly illustrate the anatomical and mechanical changes that occurred in this joint as a consequence of the evolutionary transition to habitual bipedality. Features which are considered include the obliquity of the distal tibial articular surface, the shape of the talar trochlea, and the location and functional implications of the talocrural axis. In every functionally significant feature examined the A.L.288-1 talocrural joint is fully bipedal. Moreover, the Hadar ankle complex also shows the functional constraints which are necessarily imposed by the adaptation to habitual bipedalism.  相似文献   

16.
Mobility of the subtalar joint in the intact ankle complex   总被引:8,自引:0,他引:8  
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.  相似文献   

17.
A hinged external fixator is used to allow early knee rehabilitation in case of injury or trauma, as an alternative approach to immobilization. It is mainly adopted for the treatment of dislocations, which involve tearing of the ligaments, and it basically consists of two links connected to each other by a revolute joint. Each link is fixed to the femur and tibia via pin fixation, and the revolute joint is approximately aligned to the knee flexion-extension (FE) axis. The advantage in its implantation is to protect ligament reconstruction, while allowing for an aggressive rehabilitation. Traditional fixators only accommodate the functional flexion movement in a limited range, i.e. where the anatomical movement is closer to a planar circular trajectory. This paper presents the conceptual design and implantation procedure of a double-axis fixator, which accommodates both FE and longitudinal internal-external rotation. The procedure is based on accurate knee kinematics measurements and on computer-aided multibody simulations to assist clinicians in the implantation. An experimental test is presented using an artificial knee, and guidelines are given for in vitro studies. The proposed technique may allow for a better understanding of knee kinematics and have the potential advantage to increase the range of motion in postoperative rehabilitation.  相似文献   

18.
Plots were made of multiunit activity versus ankle joint position for receptors in each of the 12 muscles crossing the cat ankle joint, except peroneus tertius, by recording from populations of afferent fibers in muscle nerves. The discharge was measured 15 or 30 sec after terminating the movements that altered the position of the joint. These recordings were dominated by large-spike activity that would be expected to originate mainly from primary spindle endings. Seven of the 12 muscles also cross other joints. Their responses at a given ankle joint position were so altered by changes in the position of the knee or toe joints that they could not reliably signal the position of the ankle joint. As judged from multiunit recording, receptors in each of the five muscles specific to the ankle joint were influenced by more than one axis of ankle joint displacement.

Single-unit recording from dorsal root filaments was used to determine whether primary or secondary spindle receptors in soleus and tibialis anterior could selectively signal one axis of ankle joint rotation. Individual soleus receptors were tested both on the flexion extension axis and with a combined adduction–eversion movement.

For 38 of the 70 soleus receptors examined (54%), firm adduction–eversion produced a level of activity greater than that caused by 10° of flexion, and for 77% the level of activity was greater than that caused by 5° of flexion. For 168 of the 184 tibialis anterior receptors studied (91%), firm abduction inversion produced a level of activity greater than that caused by 10° of extension. Thus few receptors were found that responded exclusively to one axis of rotation.

One way in which the position of the ankle joint could be specified in the face of multiaxial receptor activity is by examining the receptor discharge from more than one muscle. A suggestion for how the nervous system might do this is given in the discussion.  相似文献   

19.
The purpose of this investigation was to study the kinematics and kinetics of the joints between the leg and calcaneus during the stance phase of walking. The talocrural and talocalcaneal joints were each assumed to act as monocentric single degree of freedom hinge joints. Motion at one joint was defined by the relative rotation of a point on the opposing joint. The results, based upon the gait of three subjects, showed that the hinge joint assumption may be reasonable. A discrepancy in the kinematics was shown between the talocrural joint rotation and its commonly assumed sagittal plane representation, especially during initial flatfoot. This discrepancy is due to the fact that the sagittal plane rotation is created by the combined rotations of the talocrural and talocalcaneal joints. The talocalcaneal joint showed a peak 25-30 Nm supinatory moment at 80% of stance. The talocrural joint moment was qualitatively similar to the commonly measured sagittal plane moment, but the present results show that the sagittal plane moment overpredicted the true moment by 6-22% due to the two-dimensional assumption.  相似文献   

20.

Background

Studies of syndesmosis injuries have concentrated on cadaver models. However, they are unable to obtain exact data regarding the stress and displacement distribution of various tissues, and it is difficult to compare models. We investigated the biomechanical effects of inferior tibiofibular syndesmosis injuries (ITSIs) and screw fixation on the ankle using the finite element (FE) method.

Methodology/Principal Findings

A three-dimensional model of a healthy ankle complex was developed using computed tomography (CT) images. We established models of an ITSI and of screw fixation at the plane 2.5 cm above and parallel to the tibiotalar joint surface of the injured syndesmosis. Simulated loads were applied under three conditions: neutral position with single-foot standing and internal and external rotation of the ankle. ITSI reduced contact forces between the talus and fibula, helped periarticular ankle ligaments withstand more load-resisting movement, and increased the magnitude of displacement at the lower extreme of the tibia and fibula. ITSI fixation with a syndesmotic screw reduced contact forces in all joints, decreased the magnitude of displacement at the lower extreme of the tibia and fibula, and increased crural interosseous membrane stress.

Conclusions/significance

Severe syndesmosis injuries cause stress and displacement distribution of the ankle to change multidirectional ankle instability and should be treated by internal fixation. Though the transverse syndesmotic screw effectively stabilizes syndesmotic diastasis, it also changes stress distribution around the ankle and decreases the joint''s range of motion (ROM). Therefore, fixation should not be performed for a long period of time because it is not physiologically suitable for the ankle joint.  相似文献   

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