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Action of the Subtalar and Ankle-Joint Complex During the Stance Phase of Walking
D. G. WRIGHT, S. M. DESAI and W. H. HENDERSON J Bone Joint Surg Am. 1964;46:361-464.

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Action

of the

Subtalar

and

Ankle-Joint

Complex

During
BY D. G.

the
HENI)ERSON, Laboratory,

Stance
M.D.f,

Phase
s.
SAN i.

of Walking
DESAI, M.E4, AND CALIFORNIA San Francisco and Berkeley

WRIGHT,

W. H.
From tile Biomechanics

B.54, University

FRANCISCO, of California,

Tim this the nmotioim

of

study, between
rotation

a continuation
shoe
about

of previous
leg during the

work
staimce

on
phase

human
of

and

walking

locomotion was

2,3,4,5,9

analyzed

jIm terimms

the

axes

of the

subtalar of Axes of the that axes located

and

ankle

joints.

Location
It
is generally

believed

that

motion

subtalar

and

ankle should many The

joints

closely

appioximates simple axes In geimeral,

that of a simple hinge and of motion. The location of these it may be said that the axes are

the joints has occupied as follows:

therefore have investigators. axis passes

ankle

traimsversely through the body to time talus and runs obliquely Hicks did a comprehensive of ankle to
distal
posterioi

of the talus ; and the downward, outward, study of this subject and axis. one in plantar also
the oblique

subtalar axis is located distal and backward. (Fig. 1). He found two axes flexion. found
mid-tarsal,

nmotion, as a single
to time talus:

one

in dorsiflexion axis, the ankle

They three axes

will

be referred immediately

here

Hicks

time talocalcaneonavicular,

aimd time antero-

nmid-tarsal (Fig. 1). The first two have imearly ideimtical actions. Hicks referred to timem together as time oblique hinge ; they will be referred to imere as time subtalar axis. The other axes described by Hicks, includiimg the aimtei-oposterior mid-tai-sal, ai-e comcerned only with motion of the fore part on the hind part of the
foot

mmd will not woiii

axes

be discussed subject Other

is important

here. and rotation investigators

In all the about are

studies timese in

to be described other axes with was

here, Hicks

a firm locatirnm

shoe to be of

was
t.imese

by the
absent.
1.8

considered

pi-actically

agreement

plamme aimd is externally

of time foot. witim rfhe time

rotated
plaime

to note (Fig. 1) that the ankle axis lies in a Imorizontal in this plane so that it is oblique to the frontal plane
subt.alar axis usually forms aim angle of 10 to IS
8#{149}

obliquely
sagittal

located

degrees

and

45 degrees
Terminology

witim the

horizoimtal

plane

of the

foot

Coimsiderable
of

confusioim

exists

in the

terminology

used

to describe

IflovelflentS betweeim the foot moveflexioii, movemeimts inof

the

two.

and its joints. Often there is inadequate distinction nmade In this paper, we slmall use two different sets of terms to distinguish
foot

nmeimts from
version-eversion,

joint

movenmemits. and terms in anatonmical abduction-adductioim, writing, are do-siflexion-plaiitaiused to describe planes. transversely axis

Time traditional

time foot relative to time sagittal, frontal, Immalmner, immovement about a hypothetical would
*

and transverse axis passing about

by Veteraims Alaska. of California

Stated in a different through the foot would

Contract

be
TEiiis
Faster

doi-siflexion-plantar
inVestigation Seal I)uIl(1ation
Marston

flexion,
supported (1r:ttit
1.)rive,

a vertical
Administration

be

abductionVIOO5M-2075

was

lI1(l

VJ-29.
Anchorage,

t 2313 \\(5t :1:Biome(-hanics

fornia
VOL.

LaI.)orat.ory,

University

\Iedical

Center,

8:111

}rancisco,

Cali-

94122.
46-A, NO. 2. MARCH 1964

361

362

D.

G.

WRIGHT,

S.

M.

DESAI,

AND

W.

H.

HENDERSON

adduction, and in the previous coincide

dorsiflexion-plantar

about a longitudinal section, however, the hypothetical

flexion

axis would the observed ones ; movement

be inversion-eversion. axes of motion about the

in the ankle

As mentioned foot do not combines subtalar plantar called or the and and

with combines

axis

motion

with a slight degree dorsiflexion-abduction-eversion in the other. respectively, to speak Negative recorded
flexion-adduction

of abduction-adduction, in one direction have as either

flexion-adduction-inversion pronation and supination, We positive patterns

represents

These subtalar motions in traditional terms. about appears the as a joint axes downward

been negative

have rotation.

chosen

of motion rotation in this study and

deflection

on

of rotation
plantar

; at the ankle at the subtalar

joint this negative joint it represents

rotation dorsi-

fiexion-abduction-eversion. that has occurred about done in terms of angular cussed later.

When an axis rotation

it is necessary to describe the amount of rotation at a given instant in the walking cycle, it will be relative to a neutral position which will be dis-

Orientation

Scale
10cm.

T.

,d.a.

Fm.

1 joints (except those of the middle three rays)

Location

of joint

axes.

The

axes

of all the

foot

adapted
standing,

from

roentgenograms

of the

experimental
of moderate the first ray

foot.

Foot

in basic

position

of relaxed

flat

extension, the talocalcaneonavicular and midtarsal at full extension-supination, and the fifth ray near to full flexion-supination. d.a., dorsiflexion ankle axis; p.a., plantar flexion ankle axis; ten., talocalcaneonavicular axis; o.m.t., oblique mid-tarsal axis; a.p.m.t., anteroposterior mid-tarsal axis; lr., first ray axis; 5r., fifth ray axis. (Reprinted from The Mechanics of the Foot: I. The Joints by J. H. Hicks. J. Anat., 87 : 350, 1953.)
THE JOURNAL OF BONE AND JOINT SURGERY

the ankle being in a position joints at or near full pronation,

ACTION

OF

THE

SUBTALAII

AND

ANKLE-JOINT

COMPLEX

31;::;

PLANE

OF MOTION

PLANE
PERPENDIGULR

OF MOTION
TO X-AXIS

PERPENDICULAR

TO NEITHER

AXIS

TOP

VIEW

SI DE

VIEW

(a)
FIG.

(b)
2 joint. l)iagranm of uniersal

VOL.

46-A,

NO.

2, MARCh

1964

364

D.

G.

WRIGHT,

S.

M.

DESAI,

AND

W.

H.

HENDERSON

Action
The The manner
of a universal

of Axes
permits can
a joint, with

subtalar
joint.

and

ankle-joint this
2 shows

complex
such

flexion
its two

of the through
axes,

foot
x and

on the

the

leg.

in which

is accomplished about that occurs

the plane

be visualized flexion plane. one of one axis

analogy joint on

Figure

y. Through

various amounts the other may

It can

of rotation be accomplished (Fig. rotation

lies within

these axes, in any vertical rotation about if the (x) ; or,

of

member

of the exclusion

be seen can be which

2,a)

(x) to the

of the to the about

on

other axis
axis

(y) about
(y)

accomplished

only

plane stated

of motion differently,
When

is perpendicular no rotation
is imposed

the
the

which

motion.

a rotation

system in a plane that is perpendicular part about each axis (Fig. 2,b) The
.

to amount

neither axis, of rotation

rotation occurring

will take place iim about eaclm axis is to the plane of but illus-

a function
motion.

of how closely that axis approximates This analogy to the ankle-subtalar joint mechanical principles involved.

the perpendicular is an oversimplification

trates

the

When the analogy becomes one member

joint system, the

is applied to the shoe and leg relationships, the shoe, or foot, of the joint; the leg, the other; and the subtalar and ankleinterposed axes. In flexion of the leg on the shoe, the plane of the how much of the motion occurs In ordinary walking, the ankle
of the motion.

motion much
to for the

will determine as ankle rotation.

plane of flexion walking of the

as subtalar rotation and how axis lies nearly perpendicular

however,

leg on the
It was

shoe,
shown

and

rotation
1.7,8

most

not

perfectly

perpendicular a portion of the further examples

to the motion of the

long

axis

of the

foot

around timis axis accounts that the ankle axis is or to the plane of motion; subtalar actioim axis. of the

therefore, Two

must occur application should but the

as rotation around the of this principle to the

subtalar and tibia rotates

ankle-joint complex about its long axis,

be noted. foot is not

First, during stance permitted to adduct

phase the or abduct

because it is fixed to the floor by body weight. Therefore, this tibial rotation must be resolved at the subtalar or ankle axis. The ankle axis lies within the Imorizontal plane of this motion. Thus, this motion of the tibia cannot be resolved about the ankle axis and interimal rotation which the takes place wholly of the tibia acts about through plantar the axis of the subtalar joiimt ; therefore, the subtalar axis to produce pronation of the flexion. foot The relative triceps to the leg. surae, in plantar flexing

is dorsiflexion-abduction-eversion The other example is active foot, rotates

the foot in a plane rotation may be entirely accomplished foot as a lever is preserved by other subtalar joint.

perpendicular at the ankle factors which

to the ankle-joint axis. This joint, and the integrity of the provide immobilization of the

Forces
Figure
function

and forces

Displacements and joints displacements during walking. that are This associated information of California cycle. During
2,9

3 shows of the

some

of the and

with is

subtalar

ankle

derived Some

from previous locomotion studies done at the University of these findings may be summarized briefly here: Stance phase occupies the first 60 per cent of the walking

timis

phase the tibia, as it moves forward over the foot, remains in a parasagittal plane, not deviating medially or laterally (Fig. 3,B and C). From 0 to 15 per cent of the cycle, the foot plantar flexes on the leg and is placed flat on the ground (Fig. 3,C); the anterior internally
this period

tibial muscles (Fig. 3,A) ; and

the foot

act to decelerate weight is gradually

the entire

this motion (Fig. 3,F) ; the tibia rotates applied to the foot until by the end of
body
THE

is supporting

weight
JOURNAL

(Fig.
OF

3,
BONE

D).
AND

At

15 per

cent

JOINT

SURGERY

ACTION

OF

TILE

SUBTALAIt

ANI)

ANKLE-JOINT

COMPLEX

365

of the
exterimally

cycle

timere and

is a chaimge cycle is developed

in direction dorsiflexes i)etween

in most time foot

gait

patterns, 3,C)

and ; the (Fig.

between tibia 3,E). i-otates

15 The

amI(l 50 pei- cent

of the toi-que

time foot

on time leg (Fig.

amid time floor

postei-ior nmuscles of time leg simow progressively latter half of timis pei-iod, umitil nmaxilmmiiimi activity
cycle
(Fig. 3,G).

greatei activity throughout the is i-cached at 45 per cemmt of the replaced by plantar D). 1)uring the end
vei-tical force

Dorsiflexiomi

of

time

foot

ott

the

immaxiimmunm vertical
phase,

force
foot

is developed
flexing

leg (lig.
sharply,

is then 3,C and

time

flexion and of the stance

wheit

time

is plantar

and

immuscie activity

fall oil

mmmaikedly (Iig. 3,C,

I), Ii, aII(I

G).

:cc.
PER

#{149}EL
CENT OF WALKING CYCLE

#{174}

20

40

60

80

00

TIBIALROTATION-TOPVIEW

XI-

c.0 40 60

PER FIG.

CENT

OF WALKING

CYCLE

3 during walking.

Forces
VOl.. 46-A, NO. 2, MARCh

aiid

displacenmetmts

1964

366

D.

G.

WRIGHT,

S.

M.

DESAI,

AND

W.

H.

HENDERSON

Methods
Testing The joint
report

Equipment testing unit used was the mechanical research externally analog of the subtalar and aimkle-

complex developed by the orthotics 6 Briefly, timis device duplicates joiimts. joints 1or this to the simoe When time unit are coiimcident, study, with the unit a stirrup.

group and described time internal-joint

imma previous system of time

ankle and subtalar cal and anatomical normal motions. 4) and

is adjusted so timat the axes of time nmechaimithe wearer feels no interferelmce with Imis was attached to the leg witlm a plaster cast in the Potentionmeters ms-ei-e incorporated

( Fig.

FIG.

4 and ankle-joint system.

Mechanical

analog

of

subtalar

mechanical and worn carried

axes

so that The

rotations testing

about unit

both

axes

could

be recorded in Figure

individually 5. toe of time shoe coimtacts were

circuits for the

simultaneously. Contacts made by time subject. by aim overhead

Walkways were

is shown

on a subject

of conductive Wires from track

covered with

rubber were placed the potentiometers recording

copper sheeting to

at the heel and aimd fronm the

complete time

to the

equipnment.

heel amid toe contacts and For uphill, downhill, and constructed wimicim allowed

were long enough to permit six or seven consecutive steps. sidehill walking, an adjustable copper-covered ramp was for three consecutive steps.
THE JOURNAL OF BONE ANI) JOINT SURGERY

ACTION

OF

THE

SUBTALAR

AN1)

ANKLE-JOINT

COMPLEX

367

Recording The
almd
traciimgs axis.

of lValking electronic
joints
are simowim

Patterns systeni
K

continuously
walking cycle

recoided
in line the form simows top

the
of

position
three rotation

of
tracings. about

time subtalar
Typical time ankle

ankle

during

the

in

Iiigure

6.

The

tion) The
flection negative time

Aim upward deflectioim occurs ; a dowimward deflection, with nmiddle line represents rotation
occurs rotation toe contact

with negative about

positive rotation rotation (plaimtar time subtalar axis.

(dorsiflexion-abducflexion-adductioim). Here am upward

de-

with
broken

positive
at the makes

(pronation).

rotation (supination) , a downward deflection with The bottom liime shows time imeel contact nmade and
beginning it possible ammd cud, to orieimt respectively, time iotatioimal
iii

of the

stance patterns figure.

plmase. in

This

imeel-aimd-toe

record

relation

to time walkiimg

cycle.

Two

complete

cycles

are

simowim

Im(;. 5 lestitig
uiiit imi

1)1(e

oIl

SUII)j((t.

All

ti-aeings

progress

fi-oimm

left
deflection

to

right. so time. that

standard

calil)I-atiomi

was

used

so

timat

omme ceimtimeter

of constalmt one

vertical imm all

represemmt.s

8 degrees
in every

of rotation.
along case are

Time paper
time imorizoimtal of time left

speed
scale foot

was

kept

ti-acings elapsed

temi centimeters Tracings

repieseimts

second

of

and leg. Wimen time tracings

were

obtained they generally

from

each

trip

along

the

walkway

(five

consecutive
Results

steps)

from
yet

the
been

superimposed, first step were

attained

showed a imigh degree discarded since the of time first step as presented here of the superimposed
bridge. flie

of similarity (Fig. 7). normal walkilmg speed along time imorizoimtal are
or in time

imad not varied average

tm-acings. fornmed the

and

time traciimgs

axis

fm-oimm time others. The tracings curves drawn from the means
*

illustrations recordimmgs
l)otemltionm(!ter

either
typical unit

The

sensing

device

was

a \Viieatstone

elenmemit. iim the bridge circuit. Initial 1)alance (zero output) could 1)05iti11 of the suhtalar or ankle joint. To acimieve balance, a I)oterltionmeter with the transducer. Calibration was effected by selecting tue appropriate series with the op)osing leg. The voltage changes in the circuit were recorded graph, MO(l(l 504 it.
\.OL,. 46-A. NO. 2.
MARC!!

varial)le

be estal)lished at any was adjusted iii series resistance inserted in by an Olimier 1)vno-

1964

368

D.

G.

WRIGHT,

S.

M.

DESAI,

AND

W.

H.

HENDERSON

A typical
series of these

section
tracings

of the

records

obtained The

is shown graphic of the

in Figure or best and

6 ; Figure line

simows lines

a in the

superimposed.

average ankle

of the joint

Figure The subject

7 is represented in Figure 8. neutral position was the position was standing relaxed with the knees

subtalar the arms

wimen

fully

extended,

at the

sides,

feet six inches taken as zero for balancing shown by the

apart, and a comfortable amount of toeing-out. This position was degree of rotation for both joints and was also the position cimosen the electronic recording equipment at zero. This neuti-al position is horizontal straight line passing through all tracings.

FIG. Typical record of

6 and subtalar rotations.

ankle

t
positive ANKLE ROTAT ION
negative

t positive
Su BTALAR

STANCE

PHASE

ROTATION
negative

I
FIG.

7
rotations (five consecutive steps).

Superinmposed

records

of ankle

and

subtalar

The was rotation rotation, Measurement

positive from the for was

rotation its second

that onset time over (at the

occurred to the heel same time

at the rise). period. The

subtalar the ankle-joint

joint ankle

during joint motion,

staimce began also

phase positive

measured

at which

imegative

measured of Toeing-out
of

1\Ieasurement

the

amount

of toeing-out
THE

(abduction)
JOURNAL OF

during
BONE AND

walking
JOINT

was
SURGERY

ACTION

OF

THE

SUBTALAR

ANI)

ANKLE-JOINT

COMPLEX

369 shoe (Fig. 5). these

made The two

poiimts

possible aimgie points on

by ink-marking formed on the

devices walkway by

fixed the of the to the

to the

heel

and

toe

of the

intersection walkway long axis true to

of a line was measured, of the foot

connecting by

with a line along the center the shoe were then related

and the two means of a was calcufrom the ink calcanei and

roentgeimogram made through the lat.ed by applying the appropriate marks.

pass between

shoe. The correction

amount the angle

of toeing-out measured the

8#{149}

Time long the

axis of the foot was considered heads of the first and second
TABLE
FACTORS AFFECTING AMOUNT

to bisect metatarsals
I

tuber

OF

SUBTALAR

ROTATION

1)egrees Run (ormdit First

run Second run normal

(Average #1 ( Degrees)

Measurements

of Rotation of 20 to 30 Consecutive

Steps)

Run
4/12/60

#2 ( Degrees)
(Millimeters)

Run
4/15/60

#3 ( Degrees)

4/8/60

ions nornmal

(Millimeters)

(Millimeters)

8.3 8.2 7.8 9.4 11.8 3.1 Not done Not done

6.6 6.6 6.2 7.5 9.5 2.5

7.8 7.4 7.9 9.0 13.3 4.4 8.6 7.4

6.2 5.9 6.3 7.0 10,6 3.5 6.9 5.9

8.6 7.4 7.6 7.8 done done 8.5 7.7

6.9 5.9 6.1 6.2

No

arnm
arnm

swing
swirmg

Exaggerated
Toeing-out Toeing-in
Long stride

Not Not

Short

stride

6.9 6.2

TABLE
EFFECT OF CADENCE ON

II
1)EGREES OF ROTATION

(Subject Subtalar (Degrees of Rotation) Nornmal average

seventeemi

1)GW) Ankle Axis ( Degrees of Rotation) Stance Phase (Duration in Seconds) Cadence (Cycles per Minute)

Axis

gait: values steps

for 6 (5.7) 17 (16.8) .80 48

Ra1)id
average

gait:
values

for 6 (6.4) 17 (16.8) .67 56

eleven Slow gait:

steps

average
twelvesteps

values

for
6(6.1) 18(18.4) .96 41

Measurement Time axes

of Axes

on Testing

Unit and others were ankle were assumed to be correct and the had the lay

as described

by Hicks

unit was so adjusted. freedom of motion fiimal locatioim

aloimg each axis

Further adjustments about time subtalar and by

could

then made ummtil time subject axes. In order to determine were chosen
was on

assumed
and

the
be

axes,
measured

two

points
wimile

on time unit
the subject.

which
I\Ieasure-

time unit

ments
paper, Time

ere
poimmts

made
so located

in three was
on the

dimensions. dropped
paper

While to
established

the paper
two

subject from
dimensions.

stood each

on a piece point
The third

of ruled the unit.

dimension

a perpendicular obtaiimed by measuring

the

on

was gauge.
VOL.

the points

length (and

of each the

perpendicular axes which they

by means defined)

of a surface were plotted

Projections
4k-A, NO. 2. MARCH

of these
1964

370 in two axes plaimes, relative

D.

G. WRIGHT,

S.

M.

DESAI,

AND

W.

H.

HENDERSON

time horizontal to the floor and

and

the

vertical. long axis

In this of the Studies

way, foot

the could

inclination be determined.

of timese

to the

Experimental Effect of Various Factors of the normal testing

HEEL

on Subtalar

Rotation how much in walking

only subtalar

The objective takes place during investigation, the

first study was to determine walking and what variables unit was adjusted to record

subtalar rotation affect it. For this

rotatioim.

CONTACT

TOE OFF

HEEL

CONTACT

ANKLE ROTATiON

STANCE T
.

PHASE

FOOT

IMMOBILE+

SUBTALAR ROTATION

20

40

60

80

100

PER GENT OF WALKING

FIG.

CYCLE
(subject DGW),

8
normal walking

Aimkle

mmd subtalar

rotations

during

HEEL

ANKLE
ROTATION

FOOT

IMMOBILE

SUBTALAR ROTATION

FIG.

9 with
THE

Ankle

and

subtalar

rotations

during

walking

toeing-out
JOURNAL OF

(subject
BONE AND

DGW).
JOINT SURGERY

.iCTION

OF

THE

SUBTALAII

ANI)

ANKLE-JOINT

COMPLEX

371

HEELCONTAT

TOEOFF

ROATgN

+FOOT

IMMOBILE

SUBTALAR

______

FIG. Aiikle
1.11(1 sul)talar rotations

10 walking with toeing-in (subject 1)(\V).

(luring

It
axis

was

anticipated

that

increasiimg

the

rotation

of

time

tibia

about

its

loimg

would

immcrease

time amoummt

of subtalar

rotatioim

through

the

mechanism

de-

sclibe(l previously. To test swing and with leimgtimened

of time

this concept, stride. Both

during

walking of these

was studied witim increased arm variables should increase rotation

stride should also produce

tibia

about

its loimg axis

walkiimg.

Lengtlmeimed

greater

ankle motiomm. Toenmg-imm and tceimmg-out

iii

were

also

studied

in order

to

observe

the walking
was

effect

of were

cimamiges

Tai)le obtained
all
ItIflS.

placement I gives
data

of time foot relative time results of timis

and cud

to time plaime study. Readings

run and the

of progressiomm. for normal

same subject

at the Time steps

i)eginnilmg

of each

used

for

commsecutive nmeasui-emmments
staimce iiote phase were

in Table I are averages ummder that particular nmade from

of time

of measurements condition on that component amount and

The through

of twenty particular of stance rotation

to thirty day. All phase. during of of on

to the

weie
was

during Table
order toeing-in of

the I timat

positive-rotation time normal

It cami be seen pi-oduced

motation

of positive

by
of the

5.9 to 6.9 degrees aimd toeiimg-out. lies

transmitted

timat time only deviations explanation for the lack timat their
time

effect
the
foot,

of time other
axial

variables
tibia

probably
being

in time fact

effect
subtalar

depends
axis

as discusse(1 previously. However, during niost of stance dut-itig w-hich the rotations were measured-time shoe with its was fixed to time floor by body weight and very little inotioim was time shoe

phase-time relatively permitted

phase flat sole between not to of the three

axis

cause
foot,

and time floor. The effect nmotion of time shoe relative and imence of the joint axes, If w-e return to the analogy
are imecessary for this

of toeing-in and toeing-out, however, was to the floor i)ut ratimer to alter the position relative to the plane of progiession. of the universal joint (Fig. 2), we see that
principle to apply to the ankle and subtalar

conditions
systeni:

1. One timat portion 2. We

46-A, NO.

menmber of stance
must know

of the phase
the
1964

system

must

be immobile, the
the

aimd so we must is flat

member

consider
and

only
so must

during which plane in which

foot
otlmer

on the

ground;

is moving

vor..

2, MARCH

372

D.

G.

WRIGHT,

S.

M.

DESAI,

AND

W.

H.

HENDERSON

accept plane
3.

the evidence of progression We must on the of Various

If the

from Figure of the body assume that, is that

3,B that
as a whole; the

the time by the

tibia under

moves

in a plane the member

parallel only on the

to the rotation other.

during imposed

consideration, of one

imposed Effect

system Positions

flexing

of the Axis of the preceding

System section are correct, time axis system should

conclusions

behave nearly

in a predictable time ankle axis

manner when placed in various positions. is perpendicular to the plane of progression,

TOEOFF

Thus, the more the greater should

HEELCONTACT

HEELCONTACT

,
ANKLE ROTATION
_

,::::::::::::::b_
I

STANCE

PHASE

-40H
+FOOT IMMOBILEU#{216}

PER
Ankle
and

CENT
FIG. 11

OF

WALKING
walking

CYCLE
(subject JM).

subtalar

rotations

during

normal

be its role about

is firm

in the axis

rotation

which

is imposed

by

flexion

of time tibia.

Similarly,

immotion

the
these

positioned

of time subtalar farther from the

by

joint should perpendicular.

patterns

increase as the axis The second study

of subtalar and

of the aimkle joint attempted to conankle-joint rotation

assumptions

obtaining

for

various 1
.

positions Toeing-in and

of their Toeing-out 10 show steps from the

axes

relative

to the

plane

of progression.

Figures patteins
patterns

8, 9, and of
were

the in same

mean normal, subject

or best

curves same

plotted and day.

from toeing-in It was

superimposed walkiimg. assumed

All

consecutive taken

toeing-out, on the

timat

the
ili a

foot

( broken
ankle with

was lines
iii

flat mm the ground during on the tracings) and that, manner

nornial

the time between the vei-tical duriimg this time, the axis system

markings beimaved

predictable joiimt respect

as indicated previously. We have walking lies in time horizoimtal plane plane of the foot.
One

seen that the axis of time amid is externally rotated expect that, as time time ankle axis to the plane of pi-ogressively, while

to the

frontal

would,

therefore, to toeing-out, pei-peimdicular

foot position was would be positioned

shifted from progressively about axis

toeing-in farther

to normal from the

progression, amid rotation rotation about the subtalar

the ankle axis would increase

THE

would decrease progressively.

JOURNAL 01 BONE

AND

JOINT

SURGERY

ACTION

OF

THE

SUBTALAII

AN!)

ANKLE-JOINT

COMPLEX

373

HEEL

CONTACT r I

TOE OFF

ANKLE ROTAT ION

if

100

+FOOT

IMMOBILE

Su BTA LAR ROTATION

FIG.

12 walking with toeing-out (subject

Ankle

and

suhtaiar

rotations

(luring

J\I).

ANKLE ROTATION

IFOOT

IMMOBILE+!

ROTATION

FIG. Armkle 911(1 slli)taltlr rotations during

13
walking with toeing-in (subject

J \I).

Jim Figumes
axis of

8 timrougim
joint

10 it can did

be seen

for subject
the amount

DGW

that

rotation of rotation
about

about
this

time about
axis

the

subtalai

increase

as expected.

Time pattern
of rotation

time axis of time aimkle jonmt also changed, but during stance phase was essentially unchanged.
VOL. 46-A, NO. 2, MARCh 1964

374
This study

D.

G. WRIGHT,

5.

M.

DESAI,

AND

W.

H.

HENDERSON

was

repeated

with

second

subject

(JM)

who

imad

an

habitual

toeing-out through toeing-out

rotation.

gait. 13. Again,

His

patterns the subtalar

for

these motion

three

conditions

are increased

shown from

in Figures toeing-iim

11 to

progressively

and the ankle In an attempt

patterns showed a change to quantitate this increase

in form but not in degree of in subtalar rotation, a study

20
(1)

w
w a:

Lii I6 2
0 I2-

S 5 5

I0
a:
8S .5 S .. .5

_J < Icx
C)

0
0

1__I

8 TOE-OUT

12

I6

20 DEGREES
toeing-out

24

28

DURING
FIG.

WALKING,
14 increased with

Effect

on

subtalar

rotation

of walking

(subject

DGW).

20 U)

5 .5

Lii
c
I2-.. II-

5 5

#{149}
S S
-

S S S 555

a:I6-

S S

0 a: w
-I

8-

z
44

0 0

I 4

12

16

20

24

28

TOE-OUT
Effect on ankle rotation

DURING
FIG.

WALKING,
15
increased
THE

DEGREES
toeing-out
JOURNAL OF

of walking

with

(subject
BONE AND

DUW). JOINT SURGERY

ACTION

OF

THE

SUBTALAR

AND

ANKLE-JOINT

COMPLEX

375 steps,
was

was

made

irm which
subtalar and

time degree
ankle

of toeing-out,
During

measured
this study,

for many
toeing-out

was but

plotted ankle

agaiimst

rotation.

progressively

iimcreased rotations

by conscious remained

effort. essentially

Subtalar unchanged

rotations (Figs.

increased 14 and 15).

as anticipated

HEEL

CONTACT

TOE OFF

HEEL

CONTACT

TOE OFF

RN

IO#{149}

.FOOT

IMMOBLE-4

(a)

INVERTED

ILOWER)

FOOT

Ib)

EVERTED

(HIGHER)

FOOT

Fm. Ankle 911(1 subtalar rotations during

1#{128}) sidehull walking (subject l)G\V).

I/\

_-----1
.

I
TOE OFF PIEELCOP4TACT

HEEL

CONTACT

TOEOFF

RAN

4FOOT

IMMO8ILE-.#{216}

.+ IO#{149}
.FOOT IMMOBILE

-0.

JL
SUBLAR

a)
Ankle

ASCENT

OF SLOPE

b)

DESCENT

OF

SLOPE

FIG.

17 slope walking (subject DGIV).

amid sul)talar

rotations

(Itiring

2. This

Sidehill

Walking
requires that time uphill
iii

coimditiomm

foot

be placed pimase.

in an attitude
of the

of eversion
foot, acting

and

the

downimill

foot

in inversion

stance

Eversion

tlmrough time subtalar joint, stilts in external rotation.

results in internal rotatioim of the tibia amid inversion We would, them-efore, expect that, during walking

rewith

time foot everted, time amikle axis would be rotated into a position more nearly perpemidicular to time plane of progm-essiomi and that the opposite would occur with the foot in inversiomi. The rotation about time ankle axis should 1)e greatest in eversion
vol..
46-A, NO. 2, MARCH 1964

376

D.

G. WRIGHT,

S.

M.

DESAI,

AND

W.

H.

HENDERSON

and
inversion

least

in inversion, whereas and least in eversion.

motion (The

at the assumption

subtalar joint should is made hem-c that

be greatest the degree Altimougim

in of this of

toeing-in and of toeing-out factor was not measured, Figure a 9.5-degree

whereas

was consistent duriimg both situations. no subjective difference was noted.) recorded of the slightly during horizontal motion walking was eversion was only
TOEOFF

16 shows

patterns

aloimg greatly

time side increased,

slope. With subtalar motion

foot, ankle altered.

HEELCONTACT

HEELCONTACT

TOEOFF

ANKLE ROTATION

_4. 10
SUBTALAR ROTATION

4FOOT

IMMOBILE+

O_

.4-FOOT

IMMOBILE

-+

(CI

ASCENT

OF SLOPE FIG.

Ib)

DESCENT

OF

SLOPE

18 slope walking
TOECONTACT

Ankle
TOECONTACT

and
,

subtalar

rotations
IIEELOFF

during

(subject

DGW).
IIEELOFF

RN

IO#{149}

4FOOT

IMMOBILE

=I

-__.__.________j__t..

(0)

SUBJECT

DGW FIG.

Ib) 19

SUBJECT

JM

Ankle

and

subtalar

rotations

during

backward

walking.

3.

Uphill

and

Downhill
were during the studied stance slope.

1Valking
walking phase, Since the up and down a ramp with was in dorsiflexion ascending orientation of both joint axes in this situation, be the same going rotations about presumably because in the iiext section. subject DGW did a 15-degree iiiand in plantar with respect to the net rotaup and going the aimkle axis of inactivity Subject J\i not.

dine.
flexion

The subjects Each foot, descending plane

changes

the
tional

of progression
about

was essentially unchanged the axes were expected to in Figures 17 arid descent on the ramp, factor will be considered and ankle motion, while

down.
were

However,

as shown during ; this subtalar Walking that

18, the

of the showed

much greater triceps surae increased

4. Backward
It

was

anticipated

backward

walking
THE

would
JOURNAL

produce
OF BONE

a revem-sal
AND JOINT

of the
SURGERY

ACTION

OF

THE

SUBTALAR

AND

ANKLE-JOINT

COMPLEX

377

imormal
subjects

displacements. walking

In Figure backward with lines. reversed

19, displacement their normal

patterns patterns

are presented obtained on the

for the same

two day

shown reversed in broken were very similar to the of ankle motion. time action of the Effect of Action
i\Iaxinmunm

It can be seen that the backward-walking normal patterns except for a much was presumably associated with

greater

patterns range of

This effect, again, triceps surae. of the Triceps

ankle motion

elimination

Surac was produced by backward walking, downhmill walking,

amid also by triceps surae during In inactivity

eversion while was decreased is not clear.

walking. In or eliminated,

each of timese commditions, although the mechanism this pattern was heel rise, a subject
OFF

the action of the of this decrease associated with with paralysis

eversioim

order to confirm the idea that of time triceps surae in producing

HEEL

indeed (WHH)

ANKLE

ROTATION

--.H
IO#{149}

+L
SUBTALAR

14

FOOT

IMMOBILE

ROTATION

N-.

_________ ]-

--------r-20 gait

__________________________
-

Fm;.

Ankle

9.11(1 subtalar

rotations

iim I)aralytic

(subject

\VHH).

of

time

leg

was

studied.

Time

only

functional

muscle 20) of

in the time same

excursion

leg

was

a weak
were seen

tibialis excursion
in the

anterior.
and time

The
same

ankle
nearly

pattern
linear

here

(Fig.

showed
that

maximum
thmat

development

pattermms

just

mentioimed. be realized that time pattern of knee motion (and therefore and of ankle motion) was altered in this subject and may in backward walking, ramp walking, and sidehill walking. of tibia! also have The most surae also may

It must displacemeimt been altered

important
jim producing

associated
heel rise,

finding
but

imere was
altered

the

effect

of inactivity
of the

of the
other

triceps

rotational

patterns

joints

have Effect

aim important of Tarious Time anmoumit

effect Cadences of rotation were Rotation

on time amount

of ankle-joint

rotation.

was found During

compared (Table Normal II).

for

rapid,

nornial,

and

slow

gait.

No

siglmificalmt S4thlalar

differences and
.1 nkle

Level

Walking ankle joints was nmeasured studies was used to deterTime degree of toeing-out on time unit was of time axes

duiiimg mine
assunmed

Fimially, level wimich with

after
NO.

the raimge of motion in time subtalar and walking. The informatiomm gained iim previous factors
eaclm
2. MARCH

should was
ruim.
1964

affect

these and

measurements. time location

eacim step

nmeasured

recorded
VOL.
46-A,

378 Values example, for

D.

G.

WRIGHT,

5.

M.

DESA!,

AND

W.

H.

HENDERSON

For

certain steps were discarded when the subject lost balance,

as not there

being was

those of normal a sharp deflection

walking. in the

subtalar pattern. Also not considered were steps in which there was premature heel rise as indicated by a negative deflection in the ankle patterns during time latter half of stance phase. Such steps were not taken into account because they produced a reduction steps with
In

in the premature III, ankle and

amount heel axes that

of subtalar rise taking are occurred

rotation. Figure place in the first. listed in stance of the phase amount

21 shows of

two rotation

consecutive about level walking. the

Table

measurements

subtalar

during

normal

FIG.

21 heel rise (subject

Recordings The amount 6 degrees toeing-out foot. The

showing

early

DGW). been established as between second day of this study, his axis two

5 and average of the

of toeing-out for on several previous axis was, after location

subject DGW had occasions. On the

correction, assumed

5.5 degrees to the true longitudinal in adjusting the unit was similar on the was
6 degrees

days. The average subtalar rotation was 14 degrees on both days.

and

the

average

ankle

rotation

Discussion Location
The system,

of Axes
testing fixed to unit the used foot and in these leg and studies adjusted can to best be described rotation as around a detector certain record

axes. The unit was first adjusted described in previous anatomical ences, further adjustments were The that objection the unit may rather be made than that the foot

to the positions of the ankle and subtalar axes studies 1,7,8#{149} Then, to allow for individual differmade until the subject had freedom of motion. the unit dictates is less the adaptable motions could of the than occurring the foot during and hence walking

and that lack of feeling of restriction by the wearer of the adaptability of the foot. However, in view to which made to the original allow freedom

be simply a manifestation careful anatomical studies adjustment and ankle that would

adjustment conformed and the final individual of movement, it is believed that the subtalar not significantly state. to Other positive
THE

motions allowed by the unit were have occurred in the unencumbered

different

from

those

Ankle

and

Subtalar foot

Rotations approaches

in heel

Relation strike,

Events rotation
JOURNAL

of the Walking takes

OF BONE

Cycle (Figs.
JOINT

As the

place
AND

8 and
SURGERY

ACTION

OF

THE

SUBTALAII

AND

ANKLE-JOINT

COMPLEX

379

TABLE
TAILE 3
-

III
MID AIIKI.E AXES

MEASUREMENTS

OP

ROTATIW4

ABOUT
of

SUBTALkR

DURING

NORMAL LEVEL

WALKING

Subject Millimeters TIRSTD).T

v,rtical

11GW
deflection; 1 a. SECOND 0.8#{176} DAY

AX IS LOCATION
Ankle: horizontal,
0

AX IS LOCATION
102#{176}with
0

long with

&xi. long

Ankle:

horizontal,
0

990

wttm 12

long

axis long axis

Subtalar:

48

with

floor;

12

axis

Subtalar:

38

with

floor;

with

ANKLE

RIYEATION

SUBTALAR

ROTATION S 4
4 6 6

ANKLE ROTATION 14 11
13 18 19

SIIBTALAR 5 8
11 7 10

ROTATION

21 19
19 17 18

15
15 14 18 19

7
8 5 S 7

17
21 15 19 21

3
9 7
9

7 ANKLE ROTATION 14 15 13 SIBTALAR 10 9 7 ROTATION

TOE
13 11 14

OUT

17

6 9 6 7 11 6 8 9 8 6 4 9 5 7 7 7

17 20 20 14 18 1 16 18 17 16 19 19 20 18 17 17

7 9 7
N

20
21 17 18 18 18 16 17 19 17 15 18 17 15 17

15
15 20 16 20 11, 18 18 12 14 14 18 15

10
5 8 8 5

12
10 12 13 10 10 13 13 7 10 9 Il 15 (5.8#{176}) 11.5#{176}

10 9 7 5 9 10 7 10 10 10 6 5

4
T 7 5 11 4 7 9 (12.6#{176})

Average
18 18 7 8 15 17 8 8

15.8

: 3

19
18 16 17 Is 20 18
A

6
8 9 10

13
14 16 19

8
8 7 6

6
13 8 1 (14.4#{176})
7

20
16 [6 1 (5 7#{176}) Average 21 17.2 (13.8#{176})

8
5

vera,c

18

7 7 5 (6.0

AIICLE

ROTATION:

14#{176}

AWLE

ROTATION:

14
SUBTALAR

ROTATION:
(corrected):

6 5.5

SUBTALAR

ROTATION:

6
TOE OUT

11). (1ig.

[he 3,F)

pretibial
are no

nmuscles doubt negative aimkle

past

wimicim show responsible rotatioim for about

increasiimg

electrical

activity
first

during

timis

time

there cycle the

joimmt
VOL.

is a sharp (Fig. position

4 degiees
46-A, NO.

this motiolm. Immediately both axes during time in the past

timis

after
5
pei

heel
cent

strike,
of time

8). This of the

movement
imeutial.
1964

results
During

foot neutral
5 per

beiimg
cent

placed
of time

flat position

on time floor
time

with

8 to 10 degrees

aimd the

of time subtalar
pretibial

cycle,

2, MARCH

380

D.

G.

WRIGHT,

S.

M.

DESAI,

AND

\V.

H.

HENDERSON

muscles

show

their

peak

activity,

their

function

being

to

decelerate

this

motion

and thus prevent a slap of the foot on the floor. The small occurs in both patterns is possibly a rebound effect produced the shoe. At about 10 per cent of the cycle, positive rotation joint. graphic Our data methods are
(Fig.

deflection which next by the elasticity of begins at the ankle

in accord with 3,C). By the

the curve of ankle motion obtained by phototime 20 per cent of the cycle has been reached, full body extremity is moving weight is now beitmg is in swing pimase. forward over the

the ankle has rotated a few degrees past neutral. The carried by the extremity (Fig. 3,D) and the opposite
From 20 per cent

to 50 per

cent on the

of the ground
rotation

cycle,

the

body

foot,
time,

which
there

is immobilized
is progressive

positive

until at rotation
muscles

50 per at the

cent both patterns ankle joint, and

change rotation joint flexion the falls period

by body weight (Fig. 3,D). During this at both the ankle and the subtalar joint, direction. There is then sudden negative ceases at the subtalar joint. The posterior in a way analogous of the foot early rotation occurs this at the period of immobilization during the stance at the ankle During to that in stance ankle of the (Fig. phase. joint phase, joint foot.
3,D).

anterior
50 to
is

halt rotation muscles halt 65 per from cent the the of the ground, vertical

at the ankle the plantar cycle, ending force

imi wimichm the phase. From as the

At 65

negative

heel per

lifted

As would

be expected,

to zero

cent of the cycle, the toe leaves the ground, ending the foot is in 6 to 8 degrees of negative rotation degrees returned tibia
from

At timis poimmt, and jim 4 to 6 the foot is

of negative to neutral

rotation position.

at

the

subtalar

joint.

swing

One factor which has not yet been taken into account about its long axis. Figure 3,A is a curve representing highly variable data 2,9#{149} In general, it may be said that the tibia externally.

is the this during

rotatiomi rotation the first

of time drawn 15 per

cent of the cycle phase it rotates

rotation

rotates internally, and during the remainder While the tibia rotates internally, there the subtalar rotation. joint ; and while the tibia This action will be discussed

of time stance is negative rotates again exterlater.

naliy,
Analogy

at both both joints

the ankle and show positive

of Universal
As previously

Joint
stated the ankle and subtalar joints act together to foot provide a between the so in a plane foot and the leg. As the that is not perpendicular dorsiflexes to the aimkle

universal-joint on the leg axis, system

(Fig.

type of linkage in walking, it does rotation there is not

so that However, which

is necessary about the subtalar as well as the ankle axis. is one feature of the action of the ankle and subtalar-joint made apparent by the simplified analogy of the universal joint to the axes of the universal joint, the ankle axis and the subtalar and are not mutually perpendicular. If a model of the system seen that flexion of the leg with respect to the shoe not oimly both axes but also requires tibia! rotation has been joint was used rotation of the experimentally to predict the action tibia about its observed (Fig. of the joint is

axis
is

2). In contrast do not intersect made, it can be

requires rotation long axis. This 3,A). The analogy system motion flat ing, plane
It

about theoretical of the

universal

in each situation studied. is predictable during the

Figures segment

8 through of the stance toeing-in closer studies is oblique to the

THE

13 show that the subtalar phase in which the foot to toeing-out perpendicular rotation. ankle axis is exterimally

on the ground. the subtalar of motion has been

Thus, progressing from axis becomes progressively and noted as predicted from the shows anatomical

to normal to being greater that the to the plane

walkto the

progressively

rotated in the horizontal As a result, this axis

plane and hence is not perpendicular

frontal plane of the foot. of motion eveim with no

OF BONE AND JOINT

JOURNAL

SURGERY

ACTION

OF

THE

SUI3TALAR

ANI)

ANKLE-JOINT

COMPLEX

381 as the
amount

toeimig-out.
position
rotatiomi,

It would
changed

be progressively
from toeing-ui to be seen

farther
normal

from
to

that
toeing-out.

perpendicular
The

walking
of ankle

then,

would

be expected that
were

to become the

progressively

less

duriimg

this

sequence.

In 1igures 14 degrees
subtalar

8 through 13, it can in all tracings, but

and ankle rotations

that the pattern

amount of ankle of ankle rotation

the degree

rotation was 12 to changed. When

of toeing-out, the

plotted
.

against

filmdimmgs were the same (Figs. ilmcreaSed in an approximately

rfhmree suggested. explanations First, for

14 and 15) Subtalar rotation linear manner, whereas ankle

this lack of effect on the

increased rotation may

as toeing-out was unaffected.

rotations can be

ankle-joint

the our

effect

of toeing-out

on the

ankle

joint

be too

small

to be

detected
positiomms

by
of

toeimg-out

oim ankle
of time

motion

metimods. Second, aimd toeing-in through the triceps deviated from of our analogy. that the pattern pattern walked

the muscle effort required may have exerted a selective surae. Third, with toeing-out, the parasagittal of ankle rotation plane for walked with and DGW

to maintain the suppressive effect the movement imot conformed was

tibia may to time limitations

have

hence

It is interestiimg sinmilar to the normal When the subjects

of time

in toeing-out

for JM, who habitually along aim inclined surface

toeing-out. 9.5 degrees

of eversion it was cause

which

uphill foot and 9.5 expected that the resultant

loimgitudiimal rotation of

degrees of inversion altered staimce-phase

the tibia through the

of the downhill foot (Fig. 16), position of each foot would

action of the subtalar joint,

would in turn change progression. Eversion ankle should

greater

the orientation of the foot perpendicular In theory,

of the ankle should rotate to therefore, the the

joint with respect the tibia internally plane of progression ankle-joint

to the plane of bringing the and immversion should was twice be as

axis do

more the

nearly opposite.

rotation

great and tive. foot and

bodys

in eversion in eversion. As imoted

than in inversion. This difference was the ankle obtained is inactive pattern

In our studies, mcre than had in eversion when the triceps in the limb with

ankle rotation been anticipated. was similar surae was the everted known foot

already

in configum-ation to be because macthis

degree to the patterns Possibly, the triceps (Fig. l6,b) was at the kmmee had to go through of the
center been

higher level on the incline and the correspondimmg ankle a greater range of motion on this side to achieve effective and so
be

simortening have
must

extremity
It

prevent
concluded

excessive
that this

vertical
portion

oscillation
of the study

of the
would

of gravity.

must

better rotation affected

done

with

the

feet

at equal

levels. amid everted Alteration knee may foot of the well have positions, rotational affected above and

Time
imave

of the tibia, produced the knee joint as well patterns of the suggested. in Figure produced that slightly the femur,

by inverted as the ankle. tibia, the and

amid displacement ankle below Timese eversioim. nearly

rotation as al ready Time subtalar patterns the neutral position patterns also show This is presumably perpeimdicular Time patterns

16 show

expected

displacenment

by eversion niore rotation effect and

and inversion during occurred in inversion of placing the subtalar incline

walking. than in axis (Figs. more 17

anticipated

to the obtained

plane of moti.n. for walking up

down

a 15-degree

amid 18) simow the effect of time triceps ranmp, time foot was placed in an attitude axis
to

sum-ae on ankle rotation. In walking up the of slight positive rotation about the ankle amid this
Walking

at time onset
10 degrees
of as
of

of the
stance

stance
phase

phase
progressed.

positive
dowim

rotation
the
.JM

immcreased
ranip, when

by
the

only
energy

contl-ibutioim

the
to 30

triceps
degrees.
motion 1964

was
timan

ummecessary,
down

time Since

ankle JM had

i-otation motiomi
VOL. 46-A,

28

Imi walking

time ramp,

simowed a total showed mnore aim hal)itual

positive subtalar

aimd less
NO.

ankle

did

l)GW.

toeimmg-out

2, MARCH

382 walk,
It

D.

G.

WRIGHT,

5.

M.

DE5AI,

AND

W.

H.

HENDERSON

the
is

results
interesting

were

compatible that the as during used an

with subtalar ascent.

the motion

universal-joint shown lever during This immobilization

analogy. by JM active during of the descent subtalar of the joint of the

ramp allows
triceps In

was the
surae.

entirely foot to

absent be

efficient

contraction

an attempt to minimize the effect of muscle action, tracings were made as the subjects walked backward (Fig. 19). These patterns were similar to the reversed normal patterns for the same subjects, except that the ankle patterns showed the increased rotation associated with absence of action of the triceps surae. The pat-

terns the with

for backward ramp. DGW.

These tracings

walking, also show

provide

if reversed, more
one

would and
most

be similar less ankle

to those motion
arguments

for walking for JM

for

down

They

subtalar
of the

as compared
ascribing a

convincing

universal-joint with
rotation. negative

type positive
For every

of action rotation
negative

to the of the
rotation

subtalar ankle

and joint,

ankle-joint the subtalar the are

system. joint

During shows

stance, positive

every

rotation. to
in

If The

the

original rotation conditions

toeing-out, and

of the ankle joint, records are examined, is that in the other. of walking or uphill the joints

subtalar the paired

interdependent,

joint shows events are

rota-

seen
tion joints

coincide. one

implication

necessitating is seen in the other

as in toeing-in,

is required,

The same coordination except when unusual walking.

of the two muscle effort

Normal

Range

of Subtalar

Ankle
for one

Motion
was subject or made to during toeing-out determine level the walking. position normal The of the range preceding foot and whereas to be in the rethat of

In the
subtalar sections
action

final
ankle

study, motion

an that

attempt

and had
of the

established

a toeing-in

triceps surae changes in cadence, stride The location of each

agreement with

significantly altered length, and extent axis was measured the anatomical studies.

subtalar and ankle motion, of arm swing did not. from the unit and was seen the and only laxity subtalar 14 degrees but
14

general

first the that ing.

velop

The average values for motion about subject in stance phase were 6 degrees The value over joint may ankle joint of 6 degrees the same contributes the after appears period was significantly progressive fusion. ankle motion the subtalar This fact
in the

and ankle of positive when

joints for rotation,

spectively.

to be small,

it is realized

degrees to the motion which has

it can be appreciated of normal level walkbeen observed to de-

explain

subtalar

Conclusions
It is concluded

that between

the the

subtalar foot that and the

joint the subtalar

plays leg and

a small during ankle the

but joints

essential phase are

role

iii

the

motion walking. and and

occurring It is further in general act ankle rotations

for

stance

of mmormal

believed

interdependent

as a single mechanism for the stance phase subject.

during were found

walking. The average subtalar to be 6 degrees and 14 degrees,

respectively,

one

References
1.
2.
BARNErF,

C. H.,

and

NAPIER, OF,

J. R.: The Prosthetic Information

Artificial (Continued

fluence
Human
thel
Project,

upon
Advisory
June

the Form
UNIVERSITY

of the Talus
Other
on

and the Mobility

Limbs,

CALIFORNIA,

Locomotion

and

Axis of Rotation of the Ankle Joint in Man. Its Inof the Fibula. J. Anat., 86 : 1-9, 1952. Devices Research Project: Fundamental Studies of Relating to Design of Artificial Limbs. [Report to
National 464)
JOURNAL OF BONE AND JOINT SURGERY

Committee 1947.

Research

Council.

Berkeley,

The

on page
THE

464
patients. cent; decrease der and flexion of arm made Shoulder at flexion

PROCEEDINGS

had
16 per was found

decreased
cent; to and

an average
extension approximately Arm-length

the
in

elbow,

of

of 23 per cent; shoulder the elbow, 14 per cent.

per cent, as compared were most

abduction,

28 per

The normal
with the right
sigimificalmt.

force
shoulRoent-

the left arm

both arm-length
of

be

right-handed

patients.

discrepancies

genograms

The

greatest

arms revealed difference was

an average
2.2 centimeters.

loss of length
The longer

of 1.5 centimeters
after operation, the effect
exercises

of the left arm.

the greater the lateral ad-

arm-length

difference.

The author
thoracotomy on

suggested
the strength

that

additional
of the arm.

studies
After

need to be made,
this procedure,

such as
endurance

of left
proved

ditional

weaknesses

of the left arm as compared

19

with
therapy

the right.
of multiple
patients with

Dim. JOHN 1-phenylalanine

H. MOON
mustard

discussed
treat
in

a current
fourteen

myeloma
multiple

to

consecutive

in wimicim myelolmma in (3) cell this

he at

used the or

Medical College of Virginia. thrombopenia, (2) reduction

in bone pain or healing of

The criteria for judging results were: ( 1 ) improvement the amount of abnormal protein in the serum or urine, bone lesions, or both, (4) decrease in the amoummt of plasma
resistance to significant claimed for infection, degree urethane. and (6) survival. which This series In

anemia decrease infiltraseries better nmustard

tion patients patients,

of

marrow, was 43 per

(5)
compared

increased

of ulmselected of is is

with
achieved

a published
some

series

in regard

to the response
Although

rate.

cent

of palliation,

is considerably best agent

than the 20 per cent remission rate not the complete answer to the therapy currently available.
DR. EDWIN

1-phenylalanine

of multiple

myeloma,

it seems

to he the

that

M.

HAKALA of

20

discussed
Richmond,

the problems
Virginia.

of

fitting

prostheses

in

juvenile

amputees.

19. 20.

Medical College 2222 Monument

Virginia,

Richmond,

Avenue,

Virginia.

REFERENCES AevIoN
OF THE SUBTALAR AND ANKLE-JOINT COMPLEX DURING STANCE PHASE OF \SALKING

(Continued 3.
CALIFORNIA, Activity to thel in the Advisory UNIVERSITY OF, Prosthetic

from
Devices

page

38)
Project:

Research

The

Pattern

Lower

Extremity
on

During
Artificial

Walking.
Limbs,

A Presentation
National Research

of Summarized
Council.

Committee

of Muscular 1)ata. lReport Series 11, Issue

25, September 1953. 4. CLOSE, J. R., and INMAN, V. T.: The mittee on Artificial Limbs, National
University of

5. CLOSE,
Committee Project,

J. It.,
S.

California, and INMAN,

Action of the Ankle Joint. [Report to thel Advisory ComResearch Council. Prosthetic Devices Research Project, Berkeley, Series 11, Issue 22, April 1952. V. T.: The Action of the Subtalar Joint. [Report to timej Advisor?
National Berkeley,

on University

6. DESAI,
mechanics No. 45. 7.

M., Laboratory, October 1961.

Artificial Limbs. of California, and HENDERSON,

W.

H. :

Research Series Engineering

Council.

Prosthetic

1)evices

Researc

1 1, Issue
Design

24, 1ay
of

University

of California,

San

Francisco

and

1953. an Orthopedic Brace. BioBerkeley. Technical Report

8.
9.

HICKs, MANTER,

397-410,
RYKER,

J. H.: The Mechanics of the Foot: I. The Joints. J. Anat., 87 : 345-357, 1953. J. T. : Movements of the Subtalar and Transverse Tarsal Joints. Anat. Rec., 80: 1941. N. J., JR.: Glass Walkway Studies of Normal Subjects During Normal Level Walking.
to

[Report

thel

Advisory

Committee

on

Artificial

Limbs,

National

Research

Council.

Prosthetic

Devices

Research

Project,

University

of California,

Berkeley,

Series

1 1, Issue

20,

January

1952.

THE

JOURNAL

OF

BONE

AND

JOINT

SURGERY