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The effect of rotational stiffness on ankle tibiocalcaneal motion and ligament strain during external rotation

The rotational stiffness of footwear has been previously shown to have an effect on ankle kinematics and injury risk, but this relationship has not yet been modeled. The aim of this study was to derive equations from experimental data that were able to predict ankle kinematics under various torsional stiffness constraints and use these equations to estimate ligament strains. Three athletic tapes were tested for their ability to constrain the ankle during external rotation. Six subjects then performed a voluntary external foot rotation using the selected tape designs to constrain the ankle, as well as with no constraints. The motion of the calcaneus with respect to the tibia (tibiocalcaneal motion) from 0° to 15° of tibia rotation and predictive equations were determined to establish tibiocalcaneal rotation, eversion, and flexion as a function of gross tibia motion and tape stiffness. These predictive equations were then used to drive a computational model in which ankle ligament strains were determined at 15° of tibia rotation and for ankle constraint stiffness ranging from 0 to 30 N m/deg. The three tapes provided significantly different constraint stiffnesses during external foot rotation. There was no statistical effect of ankle constraint on the dorsiflexion response of the ankle (p = 0.461). In contrast, there was an effect of constraint stiffness on tibiocalcaneal external rotation (p < 0.001) and tibiocalcaneal eversion (p < 0.001). Results of the model simulation revealed the highest ligament strains in the anterior tibiotalar ligament and anterior tibiofibular ligament. Anterior tibiotalar ligament strain increased with increasing constraint stiffness, while there was little effect of constraint stiffness on anterior tibiofibular ligament strain. Results from this study could aid in the design of footwear, as well as the analysis of clinical injuries.