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Foot and Ankle Biomechanics

1st Edition - December 5, 2022

Editors: William Ledoux, Scott Telfer

Paperback ISBN:

9 7 8 - 0 - 1 2 - 8 1 5 4 4 9 - 6

eBook ISBN:

9 7 8 - 0 - 1 2 - 8 1 5 4 3 7 - 3

Foot and Ankle Biomechanics is a one source, comprehensive and modern reference regarding foot and ankle biomechanics. This text serves as both a master reference for foot… Read more

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Foot and Ankle Biomechanics is a one source, comprehensive and modern reference regarding foot and ankle biomechanics. This text serves as both a master reference for foot biomechanics, presenting a clear state of the research and capabilities in the field. The customers for this book will be those looking for information on foot and ankle biomechanics for a range of applications; for example, designers of orthotics.

Cover image
Title page
Table of Contents
Copyright
Dedication
List of contributors
Preface
Anatomical Terms Used in Foot and Ankle Biomechanics
Part 1: Introduction
Chapter 1. Anatomy of the Foot
Abstract
1.1 Skeletal structures
1.2 Joints
1.3 Muscles and fascial specializations
1.4 Nerves
1.5 Blood supply
Further reading
Chapter 2. Basic Biomechanics
Abstract
2.1 Introduction
2.2 Terminology
2.3 Statics
2.4 Dynamics
2.5 Strength of materials and deformation
2.6 Viscoelasticity
2.7 Summary
References
Chapter 3. Anatomical Nomenclature: Conundrums of Nonstandardized Foot and Ankle Terminology
Abstract
3.1 Introduction
3.2 Anatomical descriptions
3.3 Foot motions
3.4 Terminological implications of mathematical choices
3.5 Conclusion: standardizing foot and ankle terminology
References
Part 2: Function
Chapter 4. Kinematics and Kinetics of the Foot and Ankle during Gait
Abstract
4.1 Introduction
4.2 Overview of relevant anatomy
4.3 Overview of kinematic and kinetic modeling
4.4 Healthy and impaired feet
4.5 Multisegment foot models
4.6 Future areas of research
4.7 Conclusion
References
Chapter 5. Bone, Cartilage, and Joint Function
Abstract
5.1 Bone components and structure
5.2 Cartilage
5.3 Joint functions
5.4 Areas of future research
References
Chapter 6. Muscles and Tendons
Abstract
6.1 Introduction
6.2 Biomechanical function
6.3 Areas of future biomechanical research
References
Chapter 7. Ligaments
Abstract
7.1 Introduction
7.2 Ligament anatomy
7.3 Mechanical properties
7.4 Ligament sprains
7.5 Overcoming limitations
7.6 Future areas of research
References
Chapter 8. Plantar Soft Tissue
Abstract
8.1 Introduction
8.2 Anatomy
8.3 Biomechanical function
8.4 Mechanical properties
8.5 Effect of aging
8.6 Diabetic plantar soft tissue
8.7 Areas of future biomechanical research
References
Part 3: Measurement and Analysis Techniques: Kinematics and Kinetics
Chapter 9. Multisegment Foot Models
Abstract
9.1 Basic principles of multisegment foot models
9.2 Selecting an appropriate multisegment foot model
9.3 Review of current multisegment foot models
9.4 Applications, considerations, and limitations
9.5 Areas of future biomechanical research
References
Chapter 10. Invasive Techniques for Studying Foot and Ankle Kinematics
Abstract
10.1 Introduction
10.2 Early invasive studies of foot and ankle biomechanics
10.3 Radiostereometric analysis
10.4 Applications and significance of studies using intracortical pins for foot and ankle kinematics
10.5 Limitations and future directions
Appendix: Insertion of markers in bones of the foot and ankle
References
Chapter 11. Biplane Fluoroscopy
Abstract
11.1 Introduction
11.2 Background and history of biplane fluoroscopy
11.3 Other techniques for tracking foot bone kinematics
11.4 Challenges specific to foot and ankle tracking with biplane fluoroscopy
11.5 Overview of biplane hardware
11.6 Overview of biplane software
11.7 Clinical biplane foot and ankle studies
11.8 Future applications and directions
References
Chapter 12. Plantar Pressure and Ground Reaction Forces
Abstract
12.1 Introduction: clinical relevance of force and pressure measurements in foot and ankle biomechanics
12.2 Background: force versus pressure
12.3 Research applications and selected clinical examples
12.4 Areas of future research
References
Chapter 13. Electromyography and Dynamometry for Investigating the Neuromuscular Control of the Foot and Ankle
Abstract
13.1 Introduction
13.2 Electromyography
13.3 Dynamometry
13.4 Ankle and foot related considerations and insights
13.5 Future research
References
Chapter 14. From Impossible to Unnoticed: Wearable Technologies and The Miniaturization of Grand Science
Abstract
14.1 Introduction
14.2 The past
14.3 The present
14.4 The future
References
Part 4: Measurement and Analysis Techniques: Imaging
Chapter 15. Integrated Laboratories for Pursuing Pedal Pathologies
Abstract
15.1 Introduction
15.2 Our method of approach
15.3 Integrated laboratories
15.4 Case study of the integrated laboratories concept to the study of hallux rigidus
15.5 Future biomechanical research
References
Chapter 16. Radiographs
Abstract
16.1 Introduction
16.2 Radiographic technology
16.3 Standard radiographic views of the foot and ankle
16.4 Definitions of X-ray measurements of foot shape
16.5 Foot-specific applications and considerations
16.6 Clinical X-ray measures of foot shape
16.7 Issues with X-ray measures of foot shape
16.8 Areas of future biomechanical research
References
Chapter 17. Computed Tomography of the Foot and Ankle
Abstract
17.1 Introduction
17.2 Foot-specific applications and considerations
17.3 Areas of future biomechanical research
References
Chapter 18. Weight-bearing Computed Tomography of the Foot and Ankle
Abstract
18.1 Introduction
18.2 Biases of conventional radiography
18.3 Technical aspects
18.4 Indications
18.5 3D biometrics
18.6 Advantages and limitations of weight-bearing computed tomography
18.7 Future areas of research
18.8 Conclusion
Acknowledgments
Conflict of interest statement
References
Further reading
Chapter 19. Magnetic Resonance Imaging of the Foot and Ankle
Abstract
19.1 Introduction
19.2 Magnetic resonance imaging sequences
19.3 Magnetic resonance imaging versus computed tomography
19.4 Magnetic resonance imaging appearance of musculoskeletal tissue—normal and pathology
19.5 Tailored magnetic resonance imaging protocol for the foot and ankle—indication driven
19.6 Magnetic resonance imaging anatomy of the foot and ankle
19.7 Areas of future research
References
Chapter 20. Biomechanical Assessment of Soft Tissues in the Foot and Ankle Using Ultrasound
Abstract
20.1 Introduction
20.2 Ultrasound assessment of structural changes: the effect of weightbearing activities
20.3 Ultrasound assessment combined with measurement of load
20.4 Ultrasound elastography (sonoelastography)
20.5 Conclusion and future areas of research
References
Chapter 21. 3D Surface Scanning of the Foot and Ankle
Abstract
21.1 Introduction
21.2 Foot-specific applications and considerations
21.3 Areas of future biomechanical research
References
Part 5: Measurement and Analysis Techniques: Simulation and Modeling
Chapter 22. Cadaveric Gait Simulation
Abstract
22.1 Introduction
22.2 Techniques for dynamic gait simulation
22.3 Limitations of dynamic gait simulation
22.4 Clinical applications of dynamic gait simulation
22.5 Areas of future biomechanical research
22.6 Conclusion
References
Chapter 23. Finite Element Modeling
Abstract
23.1 Introduction
23.2 Basic concepts of finite element modeling
23.3 Applications of finite element analysis in foot biomechanics
23.4 Modeling strategies
23.5 Limitations and future research toward clinically applicable finite element modeling
23.6 Summary
References
Chapter 24. Musculoskeletal Modeling of the Foot and Ankle
Abstract
24.1 Introduction
24.2 Foot specific models and applications
24.3 Areas of future biomechanical research
References
Chapter 25. Predicting and Preventing Posttraumatic Osteoarthritis of the Ankle
Abstract
25.1 Introduction: pathomechanical origins of posttraumatic osteoarthritis
25.2 Pathomechanics I: acute joint injury severity
25.3 Pathomechanics II: chronic stress aberration
25.4 Pathomechanics III: altered kinematics
25.5 Areas of future biomechanical research
25.6 Summary/conclusion
References
Chapter 26. Mechanics of Biological Tissues
Abstract
26.1 Introduction
26.2 Materials and methods
26.3 Conclusion
References
Part 6: Clinical Biomechanics of the Foot and Ankle
Chapter 27. Clinical Examination of the Foot and Ankle
Abstract
27.1 Introduction
27.2 Demographics
27.3 Vital signs
27.4 Patient history
27.5 Assessment of pain
27.6 Visual observation/inspection
27.7 Lower extremity alignment
27.8 Foot posture or foot shape
27.9 Limb length
27.10 Radiographic examination
27.11 Range of motion/flexibility/joint mobility
27.12 Joint mobility
27.13 Ligamentous/stability testing
27.14 Tendon
27.15 Muscle strength
27.16 Sensory testing
27.17 Circulation
27.18 Foot and ankle specific testing
27.19 Footwear examination
27.20 Functional assessment
27.21 Outcomes assessment
27.22 Areas of future biomechanical research
References
Chapter 28. Foot Type Biomechanics
Abstract
28.1 Introduction
28.2 Structural foot type
28.3 Functional foot type
28.4 Foot type biomechanics
28.5 Association with pain and injury
28.6 Treatments
28.7 Areas of future biomechanical research
References
Chapter 29. Traumatic Foot and Ankle Injuries
Abstract
29.1 Introduction
29.2 Pilon fractures
29.3 Calcaneal fractures
29.4 Talus fractures
29.5 Tarsometatarsal (Lisfranc) injuries
29.6 Metatarsal fractures
29.7 Midfoot crush injuries
29.8 Acute ankle sprains
29.9 Syndesmosis tears
29.10 Achilles tendon rupture
29.11 Areas of future research
References
Chapter 30. The Pediatric Foot
Abstract
30.1 Introduction
30.2 Common pathologies affecting pediatric feet
30.3 Functional assessment of the pediatric foot
30.4 Areas for future research
References
Chapter 31. Neurological Foot Pathology
Abstract
31.1 Introduction
31.2 Stroke
31.3 Cerebral palsy
31.4 Toe walking
31.5 Peripheral neuropathy
31.6 Foot drop
31.7 Tarsal tunnel syndrome
31.8 Morton’s neuroma
31.9 Charcot foot
31.10 Charcot-Marie-Tooth disease
31.11 Friedreich’s ataxia
31.12 Poliomyelitis
31.13 Areas of Future Research
References
Chapter 32. Chronic Foot and Ankle Injuries
Abstract
32.1 Introduction
32.2 Chronic ankle instability
32.3 Plantar fasciitis
32.4 Tendinopathy (Achilles, peroneal, and posterior tibialis)
32.5 Stress fractures (navicular, metatarsals)
32.6 Sesamoiditis
32.7 Retrocalcaneal bursitis
32.8 Areas of future research for chronic foot and ankle injuries
References
Chapter 33. Hallux Valgus
Abstract
33.1 Introduction
33.2 Prevalence
33.3 Etiology
33.4 Diagnosis and imaging
33.5 Clinical presentation
33.6 Functional outcomes
33.7 Treatment pathways
33.8 Future directions for research
33.9 Summary
References
Chapter 34. Osteoarthritis of the Foot and Ankle
Abstract
34.1 Introduction
34.2 First metatarsophalangeal joint osteoarthritis
34.3 Midfoot osteoarthritis
34.4 Ankle osteoarthritis
34.5 Areas of future biomechanical research
34.6 Summary
References
Chapter 35. Diabetic Foot Disease
Abstract
35.1 Background on diabetes
35.2 Overview of key negative outcomes of diabetic foot disease
35.3 Risk factors for the development and progression of diabetic foot disease
35.4 Changes in kinematics and kinetics in diabetic foot disease
35.5 Changes in tissue characteristics
35.6 The relationship between foot deformities and plantar ulceration
35.7 The relationship between lower extremity fractures and Charcot neuropathic osteoarthropathy
35.8 Areas of future biomechanical research
References
Chapter 36. Rheumatic Foot Disease
Abstract
36.1 Introduction
36.2 Rheumatoid arthritis
36.3 Spondlyarthropathies
36.4 Juvenile idiopathic arthritis
36.5 Connective tissue disorders
36.6 Gout
36.7 Future research
References
Chapter 37. The Aging Foot
Abstract
37.1 Changing properties and functions of foot tissues
37.2 Foot posture and morphology
37.3 Foot function (kinematics/kinetics/plantar pressures)
37.4 Foot posture, foot disorders, and mobility limitations
37.5 Areas for future research
References
Chapter 38. Biomechanics of Athletic Footwear
Abstract
38.1 Introduction
38.2 Anatomy of a running shoe
38.3 Biomechanics of athletic footwear design
38.4 Types of shoes and their features
38.5 Shod versus barefoot
38.6 Footwear related injuries
38.7 Future footwear research
References
Chapter 39. Minimal Shoes: Restoring Natural Running Mechanics
Abstract
39.1 Introduction
39.2 Brief history of running footwear
39.3 Biomechanics of barefoot and conventional shod running
39.4 Minimal footwear running
39.5 Effect of minimal shoes on the foot musculoskeletal system
39.6 Summary
39.7 Future research
References
Part 7: Clincial Interventions
Chapter 40. Foot Orthoses
Abstract
40.1 Introduction
40.2 Biomechanical effects of foot orthoses
40.3 Effects of foot orthosis on clinical conditions
40.4 Areas of future research
References
Chapter 41. Ankle-Foot Orthoses and Rocker Bottom Shoes
Abstract
41.1 Introduction
41.2 Ankle-foot orthoses
41.3 Rocker bottom shoes
41.4 Roll-over shape
41.5 Patient populations
41.6 Design and prescription of ankle-foot orthosis
41.7 Design and prescription of rocker bottom shoes
41.8 Variations on materials
41.9 New designs
41.10 Sport applications
41.11 Areas of future research
References
Chapter 42. Diabetic Footwear
Abstract
42.1 Introduction
42.2 Foot biomechanics and offloading
42.3 The biomechanical effect of diabetic footwear and offloading devices
42.4 Footwear and offloading for ulcer healing
42.5 Diabetic footwear for ulcer prevention
42.6 Footwear and offloading adherence
42.7 Other considerations
42.8 Future research
42.9 Conclusions
References
Chapter 43. Reconstructions for Adult-acquired Flatfoot Deformity
Abstract
43.1 Introduction
43.2 Hindfoot valgus
43.3 Forefoot external rotation
43.4 Sag at the talonavicular joint
43.5 Failure of the posterior tibial tendon
43.6 Gastrocnemius and Achilles tightness
43.7 Medial arch eversion
43.8 Special considerations
43.9 Future biomechanical studies and conclusion
References
Chapter 44. Cavus Foot Reconstructions
Abstract
44.1 Introduction
44.2 Etiology
44.3 Clinical presentation and associated pathology
44.4 Physical exam
44.5 Imaging
44.6 Biomechanical changes of pes cavus
44.7 Conservative management
44.8 Surgical management
44.9 Areas of future research
References
Chapter 45. Biomechanics of Hindfoot Fusions
Abstract
45.1 Introduction
45.2 Complex hindfoot biomechanics
45.3 Conditions that may require hindfoot fusion
45.4 Presurgical assessment
45.5 Imaging
45.6 Goals in treatment
45.7 Corrective options
45.8 Areas of future interest
References
Chapter 46. Biomechanics of Foot and Ankle Fixation
Abstract
46.1 Introduction
46.2 Screws
46.3 Plates
46.4 Post and screw constructs
46.5 Nails
46.6 Beams
46.7 Areas of future research
References
Chapter 47. Ankle Arthroplasty and Ankle Arthrodesis
Abstract
47.1 Introduction
47.2 Brief description and history of surgical techniques
47.3 Biomechanical factors in presurgical assessment and consideration of arthroplasty or arthrodesis
47.4 Biomechanical considerations/complications of arthroplasty or arthrodesis
47.5 Biomechanical outcomes
47.6 Clinical outcomes
47.7 Areas of future biomechanical research
References
Chapter 48. Prosthetic Feet
Abstract
48.1 Introduction
48.2 Prescription and expected use of prosthetic feet
48.3 Form of prosthetic feet
48.4 Function of prosthetic feet
48.5 Future prosthetic foot research
References
Index

William Ledoux

Associate Professor at Center for Limb Loss and Mobility (CLIMB) at the University of Washington Dr. Ledoux's research has been devoted to preventing limb loss, either functionally or anatomically. He has 18 years professional experience in this research field. He has used CT, MRI, motion analysis, and more recently, a custom developed biplane fluoroscope, to quantify reduced lower limb function (i.e., functional limb loss) in different foot types (flat feet and high arched) compared to neutrally aligned feet. He has studied the functional aspects of various orthopedic foot maladies using the custom developed Robotic Gait Simulator. Additionally, he has explored functional differences between ankle fusion and ankle joint replacement for end-stage ankle arthritis. Anatomical limb loss prevention has involved quantifying the mechanical, histological and biochemical differences between normal and diabetic plantar soft tissue and foot ligaments. Dr. Ledoux has also developed a patient-specific finite element foot model, including customized anatomy and tissue properties, for the purpose of quantifying the effects of increased tissue stiffness and foot deformity on internal tissue stresses.

Affiliations and expertise

Associate Professor, Center for Limb Loss and Mobility (CLIMB), University of Washington, USA

Scott Telfer

Scott Telfer is a Research Assistant Professor in the Department of Orthopaedics & Sports Medicine at the University of Washington, Seattle with affiliate positions at the Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, and the Department of Mechanical Engineering, University of Washington, Seattle. He has spent the last 10 years studying the biomechanics of the foot and ankle with a focus on orthotic interventions, computational simulation, and measurement technologies.

Affiliations and expertise

Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, United States; Department of Mechanical Engineering, University of Washington, Seattle, WA, United States; RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, United States