Work

Biomechanical effects of lateral ankle ligament injury and repair on the midfoot and hindfoot joints

Year: 2025

Type: article

Abstract: BACKGROUND: The foot's tarsal bones primarily consist of four joints: the subtalar joint, talonavicular joint, calcaneocuboid joint, and naviculocuboid joint. These tarsal joints are associated with each other and exhibit complex kinematic features. The kinematic characteristics of these tarsal bones following injury and the repair of the lateral ankle ligaments throughout the normal gait cycle are still not fully understood. MATERIALS AND METHODS: The aim of the study was to analyze the effect of lateral ankle ligament injury on the four midfoot and hindfoot joints using specimen models of different lateral ankle ligament injuries and repairs, and to perform biomechanical experiments with axial loading on each model. The biomechanical properties of the four midfoot and hindfoot joints were compared under different conditions of lateral ankle ligament injury and repair. This study provides a reference for future clinical research and treatment strategies. RESULTS: Biomechanical analysis under multiple loading conditions revealed that anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) cut reduced peak stress in subtalar joint (neutral: P = 0.01 vs. normal, eversion: P = 0.01 vs. normal), talonavicular (neutral: P < 0.01 vs. normal), calcaneocuboid joints (eversion: P <0.05 vs. normal), and naviculocuboid joint (plantarflexion: P = 0.03 vs. normal). Only the group that underwent ATFL repair and the group receiving repairs to both ATFL and CFL can notably restore the peak stress across the four joints, particularly in the subtalar and talonavicular joints. The stress recovery effect of ATFL and CFL repair group was relatively better than only ATFL repair group. CONCLUSION: This biomechanical study demonstrates that combined ATFL and CFL repair effectively restores near-normal stress distributions across midfoot and hindfoot joints, particularly optimizing load transfer in the subtalar and talonavicular joints. The findings integrate biomechanical evidence with clinical relevance, providing a foundation for refining ligament repair protocols in ankle instability treatment.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000003718