Research on Motion of the Foot and Ankle
Remarkable Research on Motion of Major Joints of Foot and Ankle
Gait Posture. 2008 Jul;28(1):93-100. Epub 2007 Dec 21.
Invasive in vivo measurement of rear-, mid- and forefoot motion during walking. Lundgren P, Nester C, Liu A, Arndt A, Jones R, Stacoff A, Wolf P, Lundberg A. Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
The aim of this work was to use bone anchored external markers to describe the kinematics of the tibia, fibula, talus, calcaneus, navicular, cuboid, medial cuneiform, first and fifth metatarsals during gait. Data were collected from six subjects. There was motion at all the joints studied. Movement between the talus and the tibia showed the expected predominance of sagittal plane motion, but the talocalcaneal joint displayed greater variability than expected in its motion. Movement at the talonavicular joint was greater than at the talocalcaneal joint and motion between the medial cuneiform and navicular was far greater than expected. Motion between the first metatarsal and the medial cuneiform was less than motion between the fifth metatarsal and cuboid. Overall the data demonstrated the complexity of the foot and the importance of the joints distal to the rearfoot in its overall dynamic function.
Gait Posture. 2008 Jul;28(1):93-100. Epub 2007 Dec 21.
Invasive in vivo measurement of rear-, mid- and forefoot motion during walking. Lundgren P, Nester C, Liu A, Arndt A, Jones R, Stacoff A, Wolf P, Lundberg A. Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
The aim of this work was to use bone anchored external markers to describe the kinematics of the tibia, fibula, talus, calcaneus, navicular, cuboid, medial cuneiform, first and fifth metatarsals during gait. Data were collected from six subjects. There was motion at all the joints studied. Movement between the talus and the tibia showed the expected predominance of sagittal plane motion, but the talocalcaneal joint displayed greater variability than expected in its motion. Movement at the talonavicular joint was greater than at the talocalcaneal joint and motion between the medial cuneiform and navicular was far greater than expected. Motion between the first metatarsal and the medial cuneiform was less than motion between the fifth metatarsal and cuboid. Overall the data demonstrated the complexity of the foot and the importance of the joints distal to the rearfoot in its overall dynamic function.
Emails I sent to Professor Nester
From: jerry hesch, mhs To: Christopher Nester Sent: Tuesday, April 07, 2009 8:59 PM Subject: Re: Lundgren et al Dear Professor Nester, Thank you for a copy of the brilliant paper. I think it is perhaps the best basic science foot and ankle paper of the decade! I have taken the liberty to share it with a few, trust that is OK? I do have several comments and questions which I will post shortly. I apologize for the delay, but will get to it very soon. Best Regards, Jerry Hesch, MHS, PT From: jerry hesch, mhs To: Christopher Nester Sent: Wednesday, April 08, 2009 3:19 PM Subject: Re: Lundgren et al Dear Professor Nester,
Thank you again for sharing your research paper with me. I have read it a few times and have a few comments and questions. I would be very grateful for our shared insight in the issues raised below. Please respond to questions and comments.
1. I look forward to creating a table of the average motions so it will be easy to use and commit these to memory. This being for individual joints and for several joints that make up a particular region.
2. If I understand correctly when motion is describes as for example between the cuboid and 5th metatarsal, it describes motion of BOTH, as opposed to one being fixed?
3. The use of 3 markers per pin is simple - yet brilliant! I can see the advantage over use of just one marker, which I would probably have done without further thought.
4. The motion described is rotation as it is measured in degrees. Is there any way to discern glide/slide in mm?
5. The above question is very relevant as a lot of clinicians describe a posterior glide mobilization to the talus, yet I can't help but wonder about the concept. I believe that glide is actually slight at the tibio-talar joint, but rotation in the sagittal plane is much greater. therefore I mobilize the talus with a posterior glide FORCE with heel of hand on the very small portion of talus that is accessible anteriorly. To that I add an anterior drawer/scoop of the calcaneus which I believe engages the talus and induces the primary motion of rotation of talus on tibia.
6. Any thoughts on the reason for some of the low CMC's?
7. I am very interested in learning about the average amount of motions such as superior and inferior glide of the fibula, distraction/compression of the talus on tibia and calcaneus, etc.
8. I am intrigued that the talonavicular motion exceeded the transverse plane motion at the talo-calcaneal. especially intriguing also was the fact that sagittal plane motion of the medial arch exceeded that of the tibio-talar joint in 5/6.
9. Very intriguing that only 1/3 had calcaneal eversion occurring right at or right after heel strike.
10. I am passionate about joint mobilization of the foot and ankle, and I utilize a series at the major joints. I am intrigued that direct attempts to restore calcaneal valgus/eversion fail, but after performing prepatory mobilization at all other major articulations, valgus/eversion is readily increased by inferior distraction of the calcaneus and then aBducting the calcaneus with moderate force 30 reps. Of course this works with average clients who have lost that motion, but not in those who have developmental lack of valgus/eversion or a traumatic bleed into the joint with dense scar tissue.
11. do you intend to do any clinical research, such as pre and post joint mobilization?
12. Is there any way that I might be able to participate in clinical research?
13. Your comment early in the paper contrasting other approaches of measurement causes me to wonder if the use of stereophotogrammetry of the sacroiliac joint has any limitations? would your approach applied to the sacroiliac have distinct advantages? If so, any chance of pursuing it?
Please see:
Sturesson B, Uden A, Vleeming A. A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine. 2000;25:364–368.
Sturesson B, Selvik G, Uden A. Movements of the sacroiliac joints: a roentgen stereophotogrammetric analysis. Spine. 1989;14:162–165.
Tullberg T, Blomberg S, Branth B, Johnsson R. Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine. 1998;23:1124–1128; discussion 1129.
14. What are your plans for future studies? Any plan to study motion at the superior tibio-fibular joint?
15. On page 99 2nd column first sentence: "A further comparison of walking with bone pins and walking with markers attached to the skin has recently been reported." A little more elaboration would be welcomed. May I please request a copy of this paper #20, and any others that you deem relevant?
16. I often encounter what I believe to be bizarre statements that require elaboration such as that found at several sources, including orthopedic surgery web sites "as the foot/calcareous dorsiflexed the talus plantarflexes"??????? If they mean that it is "relative and early in the motion before the calcaneus engages the talus...OK!
Thank you very much for your kindness in taking the time to address my comments and questions.
Best Regards,
Jerry Hesch, MHS, PT
25837 E Maple Pl
Aurora, Colorado 80018
303-366-9445 MST
Thank you again for sharing your research paper with me. I have read it a few times and have a few comments and questions. I would be very grateful for our shared insight in the issues raised below. Please respond to questions and comments.
1. I look forward to creating a table of the average motions so it will be easy to use and commit these to memory. This being for individual joints and for several joints that make up a particular region.
2. If I understand correctly when motion is describes as for example between the cuboid and 5th metatarsal, it describes motion of BOTH, as opposed to one being fixed?
3. The use of 3 markers per pin is simple - yet brilliant! I can see the advantage over use of just one marker, which I would probably have done without further thought.
4. The motion described is rotation as it is measured in degrees. Is there any way to discern glide/slide in mm?
5. The above question is very relevant as a lot of clinicians describe a posterior glide mobilization to the talus, yet I can't help but wonder about the concept. I believe that glide is actually slight at the tibio-talar joint, but rotation in the sagittal plane is much greater. therefore I mobilize the talus with a posterior glide FORCE with heel of hand on the very small portion of talus that is accessible anteriorly. To that I add an anterior drawer/scoop of the calcaneus which I believe engages the talus and induces the primary motion of rotation of talus on tibia.
6. Any thoughts on the reason for some of the low CMC's?
7. I am very interested in learning about the average amount of motions such as superior and inferior glide of the fibula, distraction/compression of the talus on tibia and calcaneus, etc.
8. I am intrigued that the talonavicular motion exceeded the transverse plane motion at the talo-calcaneal. especially intriguing also was the fact that sagittal plane motion of the medial arch exceeded that of the tibio-talar joint in 5/6.
9. Very intriguing that only 1/3 had calcaneal eversion occurring right at or right after heel strike.
10. I am passionate about joint mobilization of the foot and ankle, and I utilize a series at the major joints. I am intrigued that direct attempts to restore calcaneal valgus/eversion fail, but after performing prepatory mobilization at all other major articulations, valgus/eversion is readily increased by inferior distraction of the calcaneus and then aBducting the calcaneus with moderate force 30 reps. Of course this works with average clients who have lost that motion, but not in those who have developmental lack of valgus/eversion or a traumatic bleed into the joint with dense scar tissue.
11. do you intend to do any clinical research, such as pre and post joint mobilization?
12. Is there any way that I might be able to participate in clinical research?
13. Your comment early in the paper contrasting other approaches of measurement causes me to wonder if the use of stereophotogrammetry of the sacroiliac joint has any limitations? would your approach applied to the sacroiliac have distinct advantages? If so, any chance of pursuing it?
Please see:
Sturesson B, Uden A, Vleeming A. A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine. 2000;25:364–368.
Sturesson B, Selvik G, Uden A. Movements of the sacroiliac joints: a roentgen stereophotogrammetric analysis. Spine. 1989;14:162–165.
Tullberg T, Blomberg S, Branth B, Johnsson R. Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine. 1998;23:1124–1128; discussion 1129.
14. What are your plans for future studies? Any plan to study motion at the superior tibio-fibular joint?
15. On page 99 2nd column first sentence: "A further comparison of walking with bone pins and walking with markers attached to the skin has recently been reported." A little more elaboration would be welcomed. May I please request a copy of this paper #20, and any others that you deem relevant?
16. I often encounter what I believe to be bizarre statements that require elaboration such as that found at several sources, including orthopedic surgery web sites "as the foot/calcareous dorsiflexed the talus plantarflexes"??????? If they mean that it is "relative and early in the motion before the calcaneus engages the talus...OK!
Thank you very much for your kindness in taking the time to address my comments and questions.
Best Regards,
Jerry Hesch, MHS, PT
25837 E Maple Pl
Aurora, Colorado 80018
303-366-9445 MST