Lisfranc injuries affect at least 1 out of every 55,000 people each year. Although they are rare foot injuries, their effects can be devastating. 20-40% of Lisfranc injuries are missed upon first presentation. This increases the number of poor outcomes, resulting in a disproportionate number of malpractice lawsuits and compensation claims. The Kingston Brace was designed to support an injured foot during a CT scan with the goal of providing the diagnosing physician with the best diagnostic information possible. A prototype was designed and built to support a variety of foot orientations in order to determine which orientation is optimal for Lisfranc joint CT scanning. Three fresh frozen cadaver feet were put through several experiments with the Brace. The 2D diagnostic quality of CT scans taken using the Kingston Brace was compared against that of CT scans using the existing protocol. The Kingston Brace allows for a greater visualization of the injured Lisfranc joint than the existing CT protocol. Lisfranc joint spreading was used as a measure of potential pain in injured patients. The joint spreading was minimal, suggesting that injured patients would not feel as much additional pain during imaging. Also, the adoption of the Kingston Brace resulted in no change in the morphological parameters resulting from more advanced 3D analysis. The experimentally determined optimal Kingston Brace orientation was found to be 9◦ of plantarflexion and 13◦ of eversion. These orientations can be incorporated into the next generation of Kingston Brace design. / Thesis (Master, Mechanical and Materials Engineering) -- Queen's University, 2009-07-06 15:01:57.866

The extent to which sensory impairments in the foot, ankle and lower limb persist into the chronic phase of stroke is unclear. Furthermore, the extent to which these impairments influence walking, balance and falls is not well understood. This thesis investigated the prevalence, functional importance and measurement of lower limb somatosensory impairments in ambulatory people with chronic stroke. Methods This thesis comprised three studies: the first, a qualitative investigation, explored the views and experiences of people with chronic stroke (n=13). This led to the second study: a cross sectional observational study in which the prevalence, distribution and functional relevance of lower limb sensory impairments were investigated in chronic stroke participants (n=180) and healthy controls (n=46). The final study, informed by the findings from the first two studies, a “synthesis” review of current sensory measures and patient and carer involvement, developed and evaluated three novel, functionally oriented measures of lower limb somatosensory discrimination in chronic stroke (n=32) and healthy controls (n=32). Results People with stroke felt problems with foot, ankle and lower limb sensation affected their walking, balance and contributed to falls. Furthermore, sensory impairments in the lower limb are prevalent with up to 59% of chronic stroke survivors having a deficit of one or more somatosensory modality. Despite this, weak associations between traditional measures of tactile and proprioceptive sensation and walking, balance and falls were demonstrated. Novel, functionally oriented measures of tactile and proprioceptive discrimination were developed and evaluated. These measures were reliable and valid, showing greater sensitivity to predicting the presence of sensory impairments and had stronger associations with functional measures than traditional sensory tests. Conclusions This thesis has provided a comprehensive picture of lower limb somatosensory dysfunction in chronic stroke survivors. Sensory impairments persist into the chronic phase of stroke in the majority of stroke survivors. The extent to which such impairments influence functional ability warrants further investigation. The use of functionally oriented measures that assess higher-level somatosensation is encouraged.

Thesis (Ph.D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept. of Biomedical Engineering. Title from title-page of electronic thesis. Bibliography: leaves 149-157.

Computational joint models provide insight into the biomechanical function of human joints. Through both deformable and rigid body modeling, the structure-function relationship governing joint behavior is better understood, and subsequently, knowledge regarding normal, diseased, and/or injured function is garnered. Given the utility of these computational models, it is imperative to supply them with appropriate inputs such that model function is representative of true joint function. In these models, Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) scans and literature inform the bony anatomy and mechanical properties of muscle and ligamentous tissues, respectively. In the case of the latter, literature reports a wide range of values or average values with large standard deviations due to the inability to measure the mechanical properties of soft tissues in vivo. This makes it difficult to determine which values within the published literature to assign to computational models, especially patient-specific models. Therefore, while the use of published literature serves as a reasonable first approach to set up a computational model, a means of improving the supplied input data was sought. This work details the application of artificial neural networks (ANNs), specifically feedforward and radial basis function networks, to the optimization of ligament stiffnesses for the improved performance of pre- and post-operative, patient-specific foot/ankle computational models. ANNs are mathematical models that utilize learning rules to determine relationships between known sets of inputs and outputs. Using knowledge gained from these training data, the ANN may then predict outputs for similar, never‑before-seen inputs. Here, an optimal network of each ANN type was found, per mean square error and correlation data, and then both networks were used to predict optimal ligament stiffnesses corresponding to a single patient’s radiographic measurements. Both sets of predictions were ultimately supplied to the patient-specific computational models, and the resulting kinematics illustrated an improvement over the existing models that utilized literature-assigned stiffnesses. This research demonstrated that neural networks are a viable means to hone in on ligament stiffnesses for the overall objective of improving the predictive ability of a patient-specific computational model.

Injuries to the lower extremity are frequent and severe in frontal automotive collisions, often leading to pain and long-term impairment. Most injury criteria developed for the lower extremity are conducted with the foot and ankle in a neutral posture, do not take into account footwear, and assess injury risk to the entire lower extremity at the tibia. An instrumented boot, designed to address some of these challenges, was calibrated over a range of impact energies expected in frontal automotive collisions. A dynamic calibration method was developed to convert changes in voltage across a piezoresistive polymer to the applied axial force. The instrumented boot was then used to examine the axial impact response of two commonly used Anthropomorphic Test Device (ATD) lower legs, under altered ankle postures. Both posture and ATD model were found to affect the load distribution on the foot, highlighting the need to establish injury limits for non-neutral postures as well as selecting the appropriate ATD model. The instrumented boot provided regional loading information that was not reflected in standard industry metrics, emphasizing the importance of increased instrumentation in this area. A technique was developed for mounting cadaveric feet to ATD tibia shafts, in order to gather industry-relevant load data while examining the impact characteristics of the foot. Load data were collected at the plantar surface of the foot using the instrumented boot, as well as the tibia load cells in the ATD shaft, that highlighted differences in load transmission through cadaveric and ATD feet. Understanding the impact characteristics of ATDs under non-standard ankle postures as well as examining the load transmission through cadaveric feet highlighted some shortcomings with current injury assessment techniques. The results of this work can be used to improve future collision testing practices, in order to reduce the incidence of lower extremity injuries. / Thesis / Master of Applied Science (MASc) / Foot and ankle injuries are common in automotive collisions and often lead to pain and long-term impairment. Experimental work on these types of injuries is traditionally conducted with the foot and ankle positioned in a neutral ankle posture, which does not reflect the range of ankle postures individuals may assume in a car crash. The purpose of this work was to use biomechanical tools to assess foot/ankle injury risk. Impact testing was performed on two commonly used crash test dummy lower legs in conditions relevant to those experienced in car crashes. A technique was developed to mount cadaveric feet to crash test dummy tibias to gather injury information of the foot, while also collecting load data in the tibia shaft – relevant metrics for industry crash testing. The results of this work outline the shortcomings of traditional injury assessment methods and may be used to improve future practices.

Title Atypical Pronation of the Sub-Talar Joint: Its Implications on the Lower Limb Background Atypical pronation of the sub-talar joint, or overpronation of the foot, as it is more commonly known, is a current subtopic in foot and lower limb-related biomechanical issues. Typical pronation is a tri-planar movement that involves eversion of the hindfoot, combined with abduction and dorsiflexion of the forefoot. Atypical pronation is recognized when this motion is excessive, and may be determined by the extent and duration to which this occurs according to the rhythmic timing during the gait pattern. It is a mechanical problem of the foot that primarily results from a subluxation or shift of the sub-talar joint and bones of the mid- and hind-foot. As a common finding in the general population, especially in those with flexible flat feet, atypical pronation may result chronically in a displacement of the bones and joints of the lower limb. Research has stated that excessive pronation of the ankle-foot complex may cause change in position of certain bones in the lower limb. This is believed to occur through an interaction between foot and pelvis through a kinetic chain mechanism. Furthermore, it has been stated that atypical pronation may affect weight transfer of the lower limb during gait that may...