Leg, Foot, and Ankle Injury Biomechanics

Though rarely life-threatening by themselves, lower extremity injuries are often a debilitating and costly injury affecting the broad populace, and can occur as result of a variety of different injury mechanisms. This chapter details basic lower extremity anthropometry, and reviews the currently available studies and injury criteria available for automotive, sports, and military related injury mechanisms. Detailed analysis and critique of published injury studies are presented.

[1]  Claude Tarriere,et al.  Quasistatic characterization of the human foot-ankle joints in a simulated tensed state and updated accidentological data , 1997 .

[2]  D. Prieskorn,et al.  Integrity of the First Metatarsophalangeal Joint: A Biomechanical Analysis , 1995, Foot & ankle international.

[3]  John A. Ward,et al.  Anatomy of the lisfranc ligament. , 2008 .

[4]  H. Teufelsbauer,et al.  Effect of body armor on simulated landmine blasts to cadaveric legs. , 2005, The Journal of trauma.

[5]  Claude Tarriere,et al.  Dynamic Biomechanical Dorsiflexion Responses and Tolerances of the Ankle Joint Complex , 1997 .

[6]  Y. Uchio,et al.  Isolated plantar dislocation of the intermediate cuneiform bone. A case report. , 2004, The Journal of bone and joint surgery. American volume.

[7]  James T. Patrie,et al.  Tolerance of the human leg and thigh in dynamic latero-medial bending , 2004 .

[8]  Marianne Wilhelm,et al.  Validation of lower limb surrogates as injury assessment tools in floor impacts due to anti-vehicular land mines. , 2008, Military medicine.

[9]  Rolf H Eppinger,et al.  The effects of axial preload and dorsiflexion on the tolerance of the ankle/subtalar joint to dynamic inversion and eversion. , 2002, Stapp car crash journal.

[10]  Richard W. Kent,et al.  Data Censoring and Parametric Distribution Assignment in the Development of Injury Risk Functions from Biochemical Data , 2004 .

[11]  C. Bir,et al.  Lower extremity injury criteria for evaluating military vehicle occupant injury in underbelly blast events. , 2009, Stapp car crash journal.

[12]  B D Beynnon,et al.  Calibration and application of an intra-articular force transducer for the measurement of patellar tendon graft forces: an in situ evaluation. , 1999, Journal of biomechanical engineering.

[13]  Jeffrey Richard Crandall,et al.  The Tibia Index: A Step in the Right Direction , 2000 .

[14]  Rolf H. Eppinger,et al.  DYNAMIC AXIAL TOLERANCE OF THE HUMAN FOOT-ANKLE COMPLEX , 1996 .

[15]  S. Kaar,et al.  Lisfranc joint displacement following sequential ligament sectioning. , 2007, The Journal of bone and joint surgery. American volume.

[16]  L. Kaplan,et al.  Incidence and variance of foot and ankle injuries in elite college football players. , 2011, American journal of orthopedics.

[17]  A I King,et al.  A Mechanism of Injury to the Forefoot in Car Crashes , 2005, Traffic injury prevention.

[18]  K. Søballe,et al.  The stabilizing effect of the ligamentous structures in the sinus and canalis tarsi on movements in the hindfoot , 1988, The American journal of sports medicine.

[19]  J. Crandall,et al.  Evaluation of lower limb injury mitigation from inflatable carpet in sled tests with intrusion using the Thor Lx , 2001 .

[20]  M. Krismer,et al.  Biomechanical properties of the human tibia: fracture behavior and morphology. , 1996, Forensic science international.

[21]  J. Wiley The mechanism of tarso-metatarsal joint injuries. , 1971, The Journal of bone and joint surgery. British volume.

[22]  Dipan Bose,et al.  The tolerance of the femoral shaft in combined axial compression and bending loading. , 2009, Stapp car crash journal.

[23]  T. Jeffreys LISFRANC'S FRACTURE-DISLOCATION: A CLINICAL AND EXPERIMENTAL STUDY OF TARSO-METATARSAL DISLOCATIONS AND FRACTURE-DISLOCATIONS. , 1963, The Journal of bone and joint surgery. British volume.

[24]  B. Fleming,et al.  Factors influencing the output of an implantable force transducer. , 2000, Journal of biomechanics.

[25]  A M Hill,et al.  Blast Mines: Physics, Injury Mechanisms And Vehicle Protection , 2009, Journal of the Royal Army Medical Corps.

[26]  T. Hosea,et al.  Prospective Evaluation of Syndesmotic Ankle Sprains without Diastasis * , 2001, The American journal of sports medicine.

[27]  Gerald W. Nyquist,et al.  Injury Tolerance Characteristics of the Adult Human Lower Extremities Under Static and Dynamic Loading , 1986 .

[28]  D. Viano,et al.  Biomechanical properties of human cadaveric ankle-subtalar joints in quasi-static loading. , 1998, Journal of biomechanical engineering.

[29]  B S Mather,et al.  Correlations between strength and other properties of long bones. , 1967, The Journal of trauma.

[30]  Jeffrey Richard Crandall,et al.  The Influence of Padding and Shoes on the Dynamic Response of Dummy Lower Extremities , 1996 .

[31]  Patricia C. Dischinger,et al.  THE INFLUENCE OF FOOTWELL INTRUSION ON LOWER EXTREMITY RESPONSE AND INJURY IN FRONTAL CRASHES , 1995 .

[32]  R. Haut,et al.  Eversion during external rotation of the human cadaver foot produces high ankle sprains , 2012, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[33]  Bowers Kd,et al.  Turf-toe: a shoe-surface related football injury. , 1976 .

[34]  Paul C. Begeman,et al.  Human ankle impact response in dorsiflexion , 1990 .

[35]  J. J. Boyle,et al.  Strain measurement in lateral ankle ligaments , 1990, The American journal of sports medicine.

[36]  T. Jeffreys LISFRANC'S FRACTURE-DISLOCATION , 1963 .

[37]  Roger C. Haut,et al.  Development and Validation of a Computational Model to Study the Effect of Foot Constraint on Ankle Injury due to External Rotation , 2011, Annals of Biomedical Engineering.

[38]  Steven Millington,et al.  Injury tolerance and response of the ankle joint in dynamic dorsiflexion. , 2004, Stapp car crash journal.

[39]  Janusz Kajzer,et al.  Response of the knee joint in lateral impact: effect of bending moment , 1993 .

[40]  T. Wickiewicz,et al.  Turf-toe: An analysis of metatarsophalangeal joint sprains in professional football players , 1990, The American journal of sports medicine.

[41]  Gerald W. Nyquist,et al.  Tibia bending: strength and response , 1985 .

[42]  Guy S. Nusholtz,et al.  Static and dynamic bending strength of the leg , 1997 .

[43]  Robert S. Salzar,et al.  Development of a Test Methodology to Evaluate Mine Protective Footwear , 2004 .

[44]  J. Mcelhaney,et al.  Dynamic response of bone and muscle tissue. , 1966, Journal of applied physiology.

[45]  N. LAUGE-HANSEN,et al.  Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. , 1950, Archives of surgery.

[46]  M J Boytim,et al.  Syndesmotic ankle sprains , 1991, The American journal of sports medicine.

[47]  J. Crandall,et al.  INJURY MECHANISMS AND CRITERIA FOR THE HUMAN FOOT AND ANKLE UNDER AXIAL IMPACTS TO THE FOOT , 1998 .

[48]  Shashi Kuppa,et al.  An overview of knee-thigh-hip injuries in frontal crashes in the United States , 2003 .

[49]  J. R. Close,et al.  Some applications of the functional anatomy of the ankle joint. , 1956, The Journal of bone and joint surgery. American volume.

[50]  Jason R. Kerrigan,et al.  Experiments for establishing pedestrian-impact lower limb injury criteria , 2003 .

[51]  Janusz Kajzer,et al.  Response of the knee joint in lateral impact: effect of shearing loads , 1990 .

[52]  Dipan Bose,et al.  Response of the knee joint to the pedestrian impact loading environment , 2004 .

[53]  François Bermond,et al.  SHEARING AND BENDING HUMAN KNEE JOINT TESTS IN QUASI-STATIC LATERAL LOAD , 1995 .

[54]  Robert B. Anderson,et al.  Turf Toe Injuries of the Hallux Metatarsophalangeal Joint , 2002 .

[55]  W. Hayes,et al.  The compressive behavior of bone as a two-phase porous structure. , 1977, The Journal of bone and joint surgery. American volume.

[56]  Patrick St. Pierre,et al.  Syndesmosis Sprains of the Ankle , 1990, Foot & ankle.

[57]  Roger C. Haut,et al.  Determination of ligament strain during high ankle sprains due to excessive external foot rotation in sports , 2012 .

[58]  O. Rasmussen,et al.  Distal tibiofibular ligaments. Analysis of function. , 1982, Acta orthopaedica Scandinavica.

[59]  F. G. Evans,et al.  Strength of biological materials , 1970 .

[60]  J. Crandall,et al.  Age, sex, causal and injury patterns in tarsometatarsal dislocations: a literature review of over 2000 cases. , 2012, Foot.

[61]  D. Otte,et al.  Biomechanics of injuries to the foot and ankle joint of car drivers and improvements for an optimal car floor development , 1992 .

[62]  Calculation of long bone loading using strain gauges , 2004 .

[63]  E. Trepman,et al.  Stability of Lisfranc Joints in Ballet Pointe Position , 2005, Foot & ankle international.

[64]  W P Smutz,et al.  Mechanical Behavior of the Lisfranc and Dorsal Cuneometatarsal Ligaments: In Vitro Biomechanical Study , 2001, Journal of orthopaedic trauma.

[65]  S. Robin,et al.  CADAVER LOWER LIMB DYNAMIC RESPONSE IN INVERSION-EVERSION , 2000 .

[66]  Yasuhiro Matsui,et al.  Shearing and bending effects at the knee joint at high speed lateral loading , 1997 .

[67]  Jason R. Kerrigan,et al.  Rate-sensitive constitutive and failure properties of human collateral knee ligaments , 2003 .

[68]  J R Crandall,et al.  Rate-independent characteristics of an arthroscopically implantable force probe in the human achilles tendon. , 1999, Journal of biomechanics.

[69]  E R Guise,et al.  Rotational ligamentous injuries to the ankle in football , 1976, The American journal of sports medicine.

[70]  Cynthia E Dunning,et al.  Evaluation of the Biofidelity of the HIII and MIL-Lx Lower Leg Surrogates Under Axial Impact Loading , 2012, Traffic injury prevention.

[71]  T Pandelani,et al.  The practical evaluation of the Mil-Lx lower leg when subjected to simulated vehicle under belly blast load conditions , 2010 .

[72]  A. Burstein,et al.  The elastic and ultimate properties of compact bone tissue. , 1975, Journal of biomechanics.

[73]  Claude Tarriere,et al.  BIOMECHANICAL RESPONSE AND PHYSICAL PROPERTIES OF THE LEG, FOOT, AND ANKLE , 1996 .

[74]  Matthew P Reed,et al.  The tolerance of the human hip to dynamic knee loading. , 2002, Stapp car crash journal.

[75]  L. Dias The lateral ankle sprain: an experimental study. , 1979, The Journal of trauma.

[76]  Rolf H. Eppinger,et al.  Ankle joint injury mechanism for adults in frontal automotive impact , 1991 .

[77]  Michael S Orendurff,et al.  Regional Foot Pressure during Running, Cutting, Jumping, and Landing , 2008, The American journal of sports medicine.

[78]  Nicolas Newell,et al.  In-vehicle extremity injuries from improvised explosive devices: current and future foci , 2011, Philosophical Transactions of the Royal Society B: Biological Sciences.

[79]  Attilio Santucci,et al.  Anatomy of the Lisfranc Joint Complex , 1997, Foot & ankle international.

[80]  Jason R. Kerrigan,et al.  Dynamic Response Corridors of the Human Thigh and Leg in Non-Midpoint Three-Point Bending , 2005 .

[81]  Richard W Kent,et al.  Etiology and biomechanics of first metatarsophalangeal joint sprains (turf toe) in athletes. , 2012, Critical reviews in biomedical engineering.

[82]  Y Ichikawa Kitagawa,et al.  LOWER LEG INJURIES CAUSED BY DYNAMIC AXIAL LOADING AND MUSCLE TESTING , 1998 .

[83]  D. W. Wilson Injuries of the tarso-metatarsal joints. Etiology, classification and results of treatment. , 1972, The Journal of bone and joint surgery. British volume.

[84]  Albert I. King,et al.  Dynamic human ankle response to inversion and eversion , 1993 .

[85]  C. Dunning,et al.  Development of an apparatus to produce fractures from short-duration high-impulse loading with an application in the lower leg. , 2010, Journal of biomechanical engineering.

[86]  Rainer Mattern,et al.  Injuries of the lower legs - foot, ankle joint, tibia; mechanisms, tolerance limits, injury - criteria evaluation of a recent biomechanic experiment series (impact tests with a pneumatic-biomechanic impactor) , 1995 .

[87]  P. Riley,et al.  Development of an injury risk function for first metatarsophalangeal joint sprains. , 2013, Medicine and science in sports and exercise.

[88]  E. Olson,et al.  The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. , 1995, The Journal of bone and joint surgery. American volume.

[89]  J McMaster,et al.  Principles And Problems Underlying Testing The Effectiveness Of Blast Protective Footwear , 2002, Journal of the Royal Army Medical Corps.

[90]  Dipan Bose,et al.  Injury tolerance and moment response of the knee joint to combined valgus bending and shear loading. , 2008, Journal of biomechanical engineering.

[91]  M Martens,et al.  The mechanical characteristics of the long bones of the lower extremity in torsional loading. , 1980, Journal of biomechanics.

[92]  Jason R. Kerrigan,et al.  Dynamic Response Corridors and Injury Thresholds of the Pedestrian Lower Extremities , 2004 .

[93]  S. Belkoff,et al.  Ligamentous Restraints of the Second Tarsometatarsal Joint: A Biomechanical Evaluation , 2001, Foot & ankle international.

[94]  Rolf H Eppinger,et al.  The axial injury tolerance of the human foot/ankle complex and the effect of Achilles tension. , 2002, Journal of biomechanical engineering.

[95]  Masaaki Tanahashi,et al.  Development of a Biofidelic Flexible Pedestrian Leg-form Impactor (Flex-PLI 2004) and Evaluation of its Biofidelity at the Component Level and at the Assembly Level , 2005 .

[96]  J. Melvin,et al.  Accidental Injury: Biomechanics and Prevention , 1993 .

[97]  O. Rasmussen,et al.  Experimental ankle injuries. Analysis of the traumatology of the ankle ligaments. , 1983, Acta orthopaedica Scandinavica.

[98]  John W Powell,et al.  A biomechanical investigation of ankle injury under excessive external foot rotation in the human cadaver. , 2010, Journal of biomechanical engineering.

[99]  A Method to Induce Navicular-Cuneiform/Cuneiform-First Metatarsal Sprain in Athletes , 2012 .

[100]  M J Shereff,et al.  In Vitro Determination of Midfoot Motion , 1989, Foot & ankle.

[101]  C. Frey,et al.  Plantarflexion Injury to the Metatarsophalangeal Joint (“Sand Toe”) , 1996, Foot & ankle international.