Hindfoot kinematics and kinetics - A combined in vivo and in silico analysis approach

• Published in: Gait & posture 2024-07, Vol.112, p.8-15
• Main Authors: Postolka, Barbara, Killen, Bryce A., Boey, Hannelore, Malaquias, Tiago M., Natsakis, Tassos, Clockaerts, Stefan, Misselyn, Dominique, Coudyzer, Walter, Vander Sloten, Jos, Jonkers, Ilse
• Format: Article
• Language: English
• Subjects: 4D CT; Adult; Ankle Joint - diagnostic imaging; Ankle Joint - physiology; Articular joint mechanics; Biomechanical Phenomena; Computer Simulation; Female; Foot - diagnostic imaging; Foot - physiology; Foot-ankle complex; Four-Dimensional Computed Tomography; Gait - physiology; Hindfoot; Humans; Kinetics; Male; Range of Motion, Articular - physiology; Subtalar joint; Subtalar Joint - diagnostic imaging; Subtalar Joint - physiology; Talocrural joint; Young Adult
• ISSN: 0966-6362; 1879-2219; 1879-2219
• DOI: 10.1016/j.gaitpost.2024.04.023

The complex anatomical structure of the foot-ankle imposes challenges to accurately quantify detailed hindfoot kinematics and estimate musculoskeletal loading parameters. Most systems used to capture or estimate dynamic joint function oversimplify the anatomical structure by reducing its complexity. Can four dimensional computed tomography (4D CT) imaging in combination with an innovative foot manipulator capture in vivo hindfoot kinematics during a simulated stance phase of walking and can talocrural and subtalar articular joint mechanics be estimated based on a detailed in silico musculoskeletal foot-ankle model. A foot manipulator imposed plantar/dorsiflexion and inversion/eversion representing a healthy stance phase of gait in 12 healthy participants while simultaneously acquiring 4D CT images. Participant-specific 3D hindfoot rotations and translations were calculated based on bone-specific anatomical coordinate systems. Articular cartilage contact area and contact pressure of the talocrural and subtalar joints were estimated using an extended foot-ankle model updated with an elastic foundation contact model upon prescribing the participant-specific rotations measured in the 4D CT measurement. Plantar/dorsiflexion predominantly occurred at the talocrural joint (RoM 15.9±3.9°), while inversion/eversion (RoM 5.9±3.9°) occurred mostly at the subtalar joint, with the contact area being larger at the subtalar than at the talocrural joint. Contact pressure was evenly distributed between the talocrural and subtalar joint at the beginning of the simulated stance phase but was then redistributed from the talocrural to the subtalar joint with increasing dorsiflexion. In a clinical case study, the healthy participants were compared with four patients after surgically treaded intra-articular calcaneal fracture. The proposed workflow was able to detect small but meaningful differences in hindfoot kinematics and kinetics, indicative of remaining hindfoot pathomechanics that may influence the onset and progression of degenerative joint diseases. •4D CT enables in vivo quantification of dynamic gait-like motion of the hindfoot.•Talocrural joint allows plantar/dorsiflexion; subtalar enables inversion/eversion.•Musculoskeletal modelling allows quantification of dynamic hindfoot loading.•Talocrural contact pressure is negatively correlated with talocrural dorsiflexion.•Detection of meaningful differences between healthy and pathological subjects.