The purpose of this study was to quantify the accuracy and precision of a biplane fluoroscopy system for model-based tracking of in vivo hindfoot motion during over-ground gait. Gait was simulated by manually manipulating a cadaver foot specimen through a biplane fluoroscopy system attached to a walkway. Three 1.6-mm diameter steel beads were implanted into the specimen to provide marker-based tracking measurements for comparison to model-based tracking. A CT scan was acquired to define a gold standard of implanted bead positions and to create 3D models for model-based tracking. Static and dynamic trials manipulating the specimen through the capture volume were performed. Marker-based tracking error was calculated relative to the gold standard implanted bead positions. The bias, precision, and root-mean-squared (RMS) error of model-based tracking was calculated relative to the marker-based measurements. The overall RMS error of the model-based tracking method averaged 0.43 ± 0.22 mm and 0.66 ± 0.43° for static and 0.59 ± 0.10 mm and 0.71 ± 0.12° for dynamic trials. The model-based tracking approach represents a non-invasive technique for accurately measuring dynamic hindfoot joint motion during in vivo, weight bearing conditions. The model-based tracking method is recommended for application on the basis of the study results.

Current methods of quantifying foot kinematics during gait typically use markers placed externally on bony anatomic locations. These models are unable to analyze talocrural or subtalar motion because the talus lacks palpable landmarks to place external markers. Alternative methods of measuring these clinically relevant joint motions are invasive and have been limited to research purposes only. This study explores the use of fluoroscopy to noninvasively quantify talocrural and subtalar sagittal plane kinematics. A fluoroscopy system (FS) was designed and built to synchronize with an existing motion analysis system (MAS). Simultaneous fluoroscopic, marker motion, and ground reaction force (GRF) data were collected for five subjects to demonstrate system application. A hindfoot sagittal plane model was developed to evaluate talocrural and subtalar joint motion. Maximum talocrural plantar and dorsiflexion angles averaged among all the subjects occur at 12% and 83% of stance, respectively, with a range of motion of 20.1 deg. Maximum talocrural plantar and dorsiflexion angles averaged among all the subjects occur at toe-off and 67% of stance, respectively, with a range of motion of 8.7 deg. Based on the favorable comparison between the current fluoroscopically measured kinematics and previously reported results from alternative methods, it is concluded that fluoroscopic technology is well suited for measuring the sagittal plane hindfoot motion.

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Background: Identifying talar position during ambulation has proved difficult as the talus lacks palpable landmarks for skin marker placement and more invasive methodologies such as bone pins are not practical for most clinical subjects. A fluoroscopic motion system was used to track the talus and calcaneus, allowing kinematic analysis of the talocrural and subtalar joints. Methods: Thirteen male subjects (mean age 22.9 ± 3.0 yr) previously screened for normal gait were tested. A fluoroscopy unit was used to collect images at 120 fps during stance. Sagittal motion of the talocrural and subtalar joints were analyzed. Results: The inter-subject mean and standard deviation values for all 58 trials of 13 subjects are reported. Maximum talocrural joint plantarflexion of 11.2 degrees (4.3 degrees of standard deviation) occurred at 11% stance and maximum dorsiflexion of -6.9 degrees (5.6 degrees of standard deviation) occurred at 85%. Maximum subtalar joint plantarflexion of 4.8 degrees (1.0 degrees of standard deviation) occurred at 96% stance and maximum dorsiflexion of -3.6 degrees (2.3 degrees of standard deviation) occurred at 30%. Talocrural and subtalar range of motion values during stance were 18.1 and 8.4 degrees respectively. Conclusion: Existing fluoroscopic technology is capable of defining sagittal plane talocrural and subtalar motion during gait. These kinematic results compare favorably with more invasive techniques. This type of assessment could support more routine analysis of in vivo bony motion during gait. Clinical Relevance: Fluoroscopic technology offers improved sagittal plane motion evaluation during weightbearing with potential application in patients with end stage ankle arthritis, postoperative ankle replacements and fusions, and orthotics and braces.

Both short and tall CAM boots reduced talocrural and subtalar motion during gait. The short CAM boot was more convenient to use, whereas the tall CAM boot more effectively reduced motion. In treatments requiring greater immobilization of the talocrural and subtalar joints, the tall CAM boot should be considered.