Measurements of joint kinematics are essential to understand the pathomechanics of ankle disease and the effects of treatment. Traditional motion capture techniques do not provide measurements of independent tibiotalar and subtalar joint motion. In this study, high-speed dual fluoroscopy images of ten asymptomatic adults were acquired during treadmill walking at 0.5 m/s and 1.0 m/s and a single-leg, balanced heel-rise. Three-dimensional (3D) CT models of each bone and dual fluoroscopy images were used to quantify in vivo kinematics for the tibiotalar and subtalar joints. Dynamic tibiotalar and subtalar mean joint angles often exhibited opposing trends during captured stance. During both speeds of walking, the tibiotalar joint had significantly greater dorsi/plantarflexion (D/P) angular ROM than the subtalar joint while the subtalar joint demonstrated greater inversion/eversion (In/Ev) and internal/external rotation (IR/ER) than the tibiotalar joint. During balanced heel-rise, only D/P and In/Ev were significantly different between the tibiotalar and subtalar joints. Translational ROM in the anterior/posterior (AP) direction was significantly greater in the subtalar than the tibiotalar joint during walking at 0.5 m/s. Overall, our results support the long-held belief that the tibiotalar joint is primarily responsible for D/P, while the subtalar joint facilitates In/Ev and IR/ER. However, the subtalar joint provided considerable D/P rotation, and the tibiotalar joint rotated about all three axes, which, along with translational motion, suggests that each joint undergoes complex, 3D motion.

References

References
1.
Kuettner
,
K. E.
, and
Cole
,
A. A.
,
2005
, “
Cartilage Degeneration in Different Human Joints
,”
Osteoarthritis Cartilage
,
13
(
2
), pp.
93
103
.
2.
Lapidus
,
P. W.
,
1963
, “
Kinesiology and Mechanical Anatomy of the Tarsal Joints
,”
Clin. Orthop. Relat. Res.
,
30
(1), pp.
20
36
.
3.
Morris
,
J. M.
,
1977
, “
Biomechanics of the Foot and Ankle
,”
Clin. Orthop. Relat. Res.
,
122
, pp.
10
17
.
4.
Oatis
,
C. A.
,
1988
, “
Biomechanics of the Foot and Ankle Under Static Conditions
,”
Phys. Therapy
,
68
(
12
), pp.
1815
1821
.
5.
Levangie
,
P. K.
, and
Norkin
,
C. C.
,
2011
,
Joint Structure and Function: A Comprehensive Analysis
,
FA Davis
,
Philadelphia, PA
.
6.
Goto
,
A.
,
Moritomo
,
H.
,
Itohara
,
T.
,
Watanabe
,
T.
, and
Sugamoto
,
K.
,
2009
, “
Three-Dimensional in vivo Kinematics of the Subtalar Joint During Dorsi-Plantarflexion and Inversion-Eversion
,”
Foot Ankle Int.
,
30
(
5
), pp.
432
438
.
7.
Wright
,
D. G.
,
Desai
,
S. M.
, and
Henderson
,
W. H.
,
1964
, “
Action of the Subtalar and Ankle-Joint Complex During the Stance Phase of Walking
,”
J. Bone Joint Surg. Am.
,
46
, pp.
361
382
.
8.
Close
,
J. R.
,
Inman
,
V. T.
,
Poor
,
P. M.
, and
Todd
,
F. N.
,
1967
, “
The Function of the Subtalar Joint
,”
Clin. Orthop. Relat. Res.
,
50
(1), pp.
159
179
.
9.
Ting
,
A. J.
,
Tarr
,
R. R.
,
Sarmiento
,
A.
,
Wagner
,
K.
, and
Resnick
,
C.
,
1987
, “
The Role of Subtalar Motion and Ankle Contact Pressure Changes From Angular Deformities of the Tibia
,”
Foot Ankle
,
7
(
5
), pp.
290
299
.
10.
Hicks
,
J. H.
,
1953
, “
The Mechanics of the Foot. I. The Joints
,”
J. Anat.
,
87
(
4
), pp.
345
357
.
11.
Lundberg
,
A.
,
Svensson
,
O. K.
,
Nemeth
,
G.
, and
Selvik
,
G.
,
1989
, “
The Axis of Rotation of the Ankle Joint
,”
J. Bone Joint Surg. Br.
,
71
(
1
), pp.
94
99
.
12.
Leardini
,
A.
,
Stagni
,
R.
, and
O'Connor
,
J. J.
,
2001
, “
Mobility of the Subtalar Joint in the Intact Ankle Complex
,”
J. Biomech.
,
34
(
6
), pp.
805
809
.
13.
Kirby
,
K. A.
,
2001
, “
Subtalar Joint Axis Location and Rotational Equilibrium Theory of Foot Function
,”
J. Am. Podiatr. Med. Assoc.
,
91
(
9
), pp.
465
487
.
14.
Valderrabano
,
V.
,
Nigg
,
B. M.
,
von Tscharner
,
V.
,
Stefanyshyn
,
D. J.
,
Goepfert
,
B.
, and
Hintermann
,
B.
,
2007
, “
Gait Analysis in Ankle Osteoarthritis and Total Ankle Replacement
,”
Clin. Biomech. (Bristol, Avon)
,
22
(
8
), pp.
894
904
.
15.
Gorton
,
G. E.
, III
,
Hebert
,
D. A.
, and
Gannotti
,
M. E.
,
2009
, “
Assessment of the Kinematic Variability Among 12 Motion Analysis Laboratories
,”
Gait Posture
,
29
(
3
), pp.
398
402
.
16.
Bauman
,
J. M.
, and
Chang
,
Y. H.
,
2010
, “
High-Speed X-Ray Video Demonstrates Significant Skin Movement Errors With Standard Optical Kinematics During Rat Locomotion
,”
J. Neurosci. Methods
,
186
(
1
), pp.
18
24
.
17.
Bonnechere
,
B.
,
Sholukha
,
V.
,
Salvia
,
P.
,
Rooze
,
M.
, and
Van Sint Jan
,
S.
,
2015
, “
Physiologically Corrected Coupled Motion During Gait Analysis Using a Model-Based Approach
,”
Gait Posture
,
41
(
1
), pp.
319
322
.
18.
de Asla
,
R. J.
,
Kozánek
,
M.
,
Wan
,
L.
,
Rubash
,
H. E.
, and
Li
,
G.
,
2009
, “
Function of Anterior Talofibular and Calcaneofibular Ligaments During In-Vivo Motion of the Ankle Joint Complex
,”
J. Orthop. Surg. Res.
,
4
(
1
), pp.
4
7
.
19.
de Asla
,
R. J.
,
Wan
,
L.
,
Rubash
,
H. E.
, and
Li
,
G.
,
2006
, “
Six DOF in vivo Kinematics of the Ankle Joint Complex: Application of a Combined Dual-Orthogonal Fluoroscopic and Magnetic Resonance Imaging Technique
,”
J. Orthop. Res.
,
24
(
5
), pp.
1019
1027
.
20.
Caputo
,
A. M.
,
Lee
,
J. Y.
,
Spritzer
,
C. E.
,
Easley
,
M. E.
,
DeOrio
,
J. K.
,
Nunley
,
J. A.
, and
DeFrate
,
L. E.
,
2009
, “
in vivo Kinematics of the Tibiotalar Joint After Lateral Ankle Instability
,”
Am. J. Sports Med.
,
37
(
11
), pp.
2241
2248
.
21.
Campbell
,
K. J.
,
Wilson
,
K. J.
,
LaPrade
,
R. F.
, and
Clanton
,
T. O.
,
2014
, “
Normative Rearfoot Motion During Barefoot and Shod Walking Using Biplane Fluoroscopy
,”
Knee Surg. Sports Traumatol. Arthrosc.
,
24
(
4
), pp.
1402
1408
.
22.
Koo
,
S.
,
Lee
,
K. M.
, and
Cha
,
Y. J.
,
2015
, “
Plantar-Flexion of the Ankle Joint Complex in Terminal Stance is Initiated by Subtalar Plantar-Flexion: A Bi-Planar Fluoroscopy Study
,”
Gait Posture
,
42
(
4
), pp.
424
429
.
23.
Peltz
,
C. D.
,
Haladik
,
J. A.
,
Hoffman
,
S. E.
,
McDonald
,
M.
,
Ramo
,
N. L.
,
Divine
,
G.
,
Nurse
,
M.
, and
Bey
,
M. J.
,
2014
, “
Effects of Footwear on Three-Dimensional Tibiotalar and Subtalar Joint Motion During Running
,”
J. Biomech.
,
47
(
11
), pp.
2647
2653
.
24.
Wang
,
B.
,
Roach
,
K. E.
,
Kapron
,
A. L.
,
Fiorentino
,
N. M.
,
Saltzman
,
C. L.
,
Singer
,
M.
, and
Anderson
,
A. E.
,
2015
, “
Accuracy and Feasibility of High-Speed Dual Fluoroscopy and Model-Based Tracking to Measure in vivo Ankle Arthrokinematics
,”
Gait Posture
,
41
(
4
), pp.
888
893
.
25.
Fiorentino
,
N. M.
,
Kutschke
,
M. J.
,
Atkins
,
P. R.
,
Foreman
,
K. B.
,
Kapron
,
A. L.
, and
Anderson
,
A. E.
,
2015
, “
Accuracy of Functional and Predictive Methods to Calculate the Hip Joint Center in Young Non-Pathologic Asymptomatic Adults With Dual Fluoroscopy as a Reference Standard
,”
Ann. Biomed. Eng.
,
44
(
7
), pp.
2168
2180
.
26.
Kadaba
,
M. P.
,
Ramakrishnan
,
H. K.
, and
Wootten
,
M. E.
,
1990
, “
Measurement of Lower Extremity Kinematics During Level Walking
,”
J. Orthop. Res.
,
8
(
3
), pp.
383
392
.
27.
Bey
,
M. J.
,
Zauel
,
R.
,
Brock
,
S. K.
, and
Tashman
,
S.
,
2006
, “
Validation of a New Model-Based Tracking Technique for Measuring Three-Dimensional, in vivo Glenohumeral Joint Kinematics
,”
ASME J. Biomech. Eng.
,
128
(
4
), pp.
604
609
.
28.
Winter
,
D. A.
,
2005
,
Biomechanics and Motor Control of Human Movement
,
Wiley
,
Hoboken, NJ
.
29.
Siegler
,
S.
,
Chen
,
J.
, and
Schneck
,
C. D.
,
1988
, “
The Three-Dimensional Kinematics and Flexibility Characteristics of the Human Ankle and Subtalar Joints—Part I: Kinematics
,”
ASME J. Biomech. Eng.
,
110
(
4
), pp.
364
373
.
30.
Engsberg
,
J. R.
,
1987
, “
A Biomechanical Analysis of the Talocalcaneal Joint—In Vitro
,”
J. Biomech.
,
20
(
4
), pp.
429
442
.
31.
McMaster
,
M.
,
1976
, “
Disability of the Hindfoot After Fracture of the Tibial Shaft
,”
J. Bone Joint Surg. Br.
,
58
(
1
), pp.
90
93
.
32.
Stormont
,
D. M.
,
Morrey
,
B. F.
,
An
,
K. N.
, and
Cass
,
J. R.
,
1985
, “
Stability of the Loaded Ankle. Relation Between Articular Restraint and Primary and Secondary Static Restraints
,”
Am. J. Sports Med.
,
13
(
5
), pp.
295
300
.
33.
Yamaguchi
,
S.
,
Sasho
,
T.
,
Kato
,
H.
,
Kuroyanagi
,
Y.
, and
Banks
,
S. A.
,
2009
, “
Ankle and Subtalar Kinematics During Dorsiflexion-Plantarflexion Activities
,”
Foot Ankle Int.
,
30
(
04
), pp.
361
366
.
34.
Moro-oka
,
T. A.
,
Hamai
,
S.
,
Miura
,
H.
,
Shimoto
,
T.
,
Higaki
,
H.
,
Fregly
,
B. J.
,
Iwamoto
,
Y.
, and
Banks
,
S. A.
,
2007
, “
Can Magnetic Resonance Imaging-Derived Bone Models be Used for Accurate Motion Measurement With Single-Plane Three-Dimensional Shape Registration?
,”
J. Orthop. Res.
,
25
(
7
), pp.
867
872
.
35.
Schache
,
A. G.
,
Blanch
,
P. D.
,
Rath
,
D. A.
,
Wrigley
,
T. V.
,
Starr
,
R.
, and
Bennell
,
K. L.
,
2001
, “
A Comparison of Overground and Treadmill Running for Measuring the Three-Dimensional Kinematics of the Lumbo-Pelvic-Hip Complex
,”
Clin. Biomech. (Bristol, Avon)
,
16
(
8
), pp.
667
680
.
36.
Riley
,
P. O.
,
Paolini
,
G.
,
Della Croce
,
U.
,
Paylo
,
K. W.
, and
Kerrigan
,
D. C.
,
2007
, “
A Kinematic and Kinetic Comparison of Overground and Treadmill Walking in Healthy Subjects
,”
Gait Posture
,
26
(
1
), pp.
17
24
.
37.
Donatelli
,
R.
,
1995
,
The Biomechanics of the Foot and Ankle
,
FA Davis
,
Philadelphia
.
38.
Isman
,
R. E.
, and
Inman
,
V. T.
,
1968
, “
Anthropometric Studies of the Human Foot and Ankle
,” Biomechanics Laboratory, University of California, Oakland, CA.
39.
Stagni
,
R.
,
Leardini
,
A.
,
O'Connor
,
J. J.
, and
Giannini
,
S.
,
2003
, “
Role of Passive Structures in the Mobility and Stability of the Human Subtalar Joint: A Literature Review
,”
Foot Ankle Int.
,
24
(
5
), pp.
402
409
.
40.
Leardini
,
A.
,
O'Connor
,
J. J.
,
Catani
,
F.
, and
Giannini
,
S.
,
1999
, “
Kinematics of the Human Ankle Complex in Passive Flexion; A Single Degree of Freedom System
,”
J. Biomech.
,
32
(
2
), pp.
111
118
.
You do not currently have access to this content.