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Foot and Ankle Motion Analysis Using Dynamic Radiographic Imaging Benjamin Donald Mchenry Marquette University

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Foot and Ankle Motion Analysis Using Dynamic Radiographic Imaging Benjamin Donald Mchenry Marquette University Marquette University e-Publications@Marquette Dissertations (2009 -) Dissertations, Theses, and Professional Projects Foot and Ankle Motion Analysis Using Dynamic Radiographic Imaging Benjamin Donald McHenry Marquette University Recommended Citation McHenry, Benjamin Donald, "Foot and Ankle Motion Analysis Using Dynamic Radiographic Imaging" (2013). Dissertations (2009 -). Paper 276. http://epublications.marquette.edu/dissertations_mu/276 FOOT AND ANKLE MOTION ANALYSIS USING DYNAMIC RADIOGRAPHIC IMAGING by Benjamin D. McHenry, B.S. A Dissertation submitted to the Faculty of the Graduate School, Marquette University, in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Milwaukee, Wisconsin May 2013 ABSTRACT FOOT AND ANKLE MOTION ANALYSIS USING DYNAMIC RADIOGRAPHIC IMAGING Benjamin D. McHenry, B.S. Marquette University, 2013 Lower extremity motion analysis has become a powerful tool used to assess the dynamics of both normal and pathologic gait in a variety of clinical and research settings. Early rigid representations of the foot have recently been replaced with multi-segmental models capable of estimating intra-foot motion. Current models using externally placed markers on the surface of the skin are easily implemented, but suffer from errors associated with soft tissue artifact, marker placement repeatability, and rigid segment assumptions. Models using intra-cortical bone pins circumvent these errors, but their invasive nature has limited their application to research only. Radiographic models reporting gait kinematics currently analyze progressive static foot positions and do not include dynamics. The goal of this study was to determine the feasibility of using fluoroscopy to measure in vivo intra-foot dynamics of the hindfoot during the stance phase of gait. The developed fluoroscopic system was synchronized to a standard motion analysis system which included a multi-axis force platform. Custom algorithms were created to translate points of interest from 2D fluoroscopic image space to global tri-axial space. From these translated points of interest, a hindfoot specific model was developed to quantify sagittal plane talocrural and subtalar dynamics. The new hindfoot model was evaluated and applied to a pilot population of thirteen healthy adults during barefoot and toe-only rocker walking conditions. The barefoot kinematic and kinetic results compared favorably with barefoot dynamics reported by other authors. As a result of the barefoot study, it was concluded that inter- subject variability in sagittal plane kinematics was higher for the talocrural joint than the subtalar joint. The toe-only rocker analysis was the first report of hindfoot kinematics within a rocker sole shoe modification. Hindfoot kinematic inter-subject variability was significantly lower in the toe-only rocker condition when compared to barefoot results. This study represents the first use of fluoroscopy to quantify in vivo intra-foot dynamics during the stance phase of gait. Talocrural and subtalar dynamics of healthy adult subjects are reported. The technology developed for this study is capable of examining soft tissue and bony abnormalities associated with the pathologic foot. Based on the overall results of this study, it is recommended that development continue for further analysis within the clinical environment, and examination of complex in vivo foot and ankle dynamics. i ACKNOWLEDGMENTS Benjamin D. McHenry, B.S. The list of people who have guided my journey towards the completion of this dissertation is far too long to be succinctly made. The experience has been a truly humbling one. While proud of the personal accomplishment, it is with regret that only my name adorns the cover of this text. I would like to thank my dissertation director Dr. Gerald Harris, a teacher and mentor whose influence on my life has been far beyond academic. I am grateful for the ability to seek his council as I begin my career. I would additionally like to thank the other members of my dissertation committee—Dr. Jason Long, Dr. Philip Voglewede, Dr. Taly Gilat-Schmidt, and Dr. Peter Smith. Your wide spectrum of expertise in the field illuminated my path, and your encouragement during the final few months was invaluable. I would like to thank my best friend Edyta Brania, a woman who continues to show me the true meaning of strength. I would additionally like to thank Bill Powers, a teacher and friend whose fellowship has been cherished as I trudge the road of happy destiny. Finally, I would like to thank my family for their unconditional love and encouragement—my father Richard, my brother Calen, and my sister Colleen. Above all, I would like to thank my mother Petronella, a woman whose support for me goes far beyond maternal. ii TABLE OF CONTENTS ACKNOWLEDGMENTS ................................................................................................... i LIST OF TABLES .............................................................................................................. v LIST OF FIGURES ........................................................................................................... vi 1. Introduction .............................................................................................................. 1 1.1 Statement of Problem ....................................................................................... 3 1.2 External Marker Based Models ........................................................................ 3 1.2.1 Skin Motion Artifact ................................................................................. 4 1.2.2 Marker Placement Sensitivity ................................................................... 5 1.2.3 Rigid Segment Assumption ....................................................................... 7 1.3 Bone Marker Based Models ............................................................................. 8 1.3.1 Invasive Nature ......................................................................................... 9 1.3.2 Gait Pattern Alteration .............................................................................. 9 1.4 Fluoroscopic Models ...................................................................................... 10 1.4.1 Anatomic Limitations .............................................................................. 11 1.4.2 Fluoroscopic Technology ........................................................................ 12 1.4.3 Foot and Ankle Fluoroscopy ................................................................... 13 1.5 Hindfoot Specific Modeling ........................................................................... 14 1.5.1 Axes of Motion........................................................................................ 14 1.5.2 Kinematic Methodologies ....................................................................... 15 1.6 Kinetic Modeling ............................................................................................ 17 1.6.1 Force Measurement Technology ............................................................. 17 1.6.2 Body Segment Parameters ...................................................................... 19 1.7 Hypotheses and Specific Aims ....................................................................... 20 2. A Model for Assessment of In vivo Hindfoot Motion During Gait .................... 22 2.1 Introduction .................................................................................................... 22 2.2 Materials and Methods ................................................................................... 24 2.2.1 System Configuration .............................................................................. 24 2.2.2 System Synchronization .......................................................................... 26 2.2.3 Image Construction ................................................................................. 26 2.2.4 Global Referencing ................................................................................. 27 iii 2.2.5 Kinematic Model ..................................................................................... 28 2.2.6 Kinematic Model Sensitivity ................................................................... 30 2.2.7 Kinetic Model .......................................................................................... 31 2.2.8 Body Segment Parameters ...................................................................... 34 2.2.9 Subject Selection ..................................................................................... 35 2.3 Results ............................................................................................................ 36 2.3.1 Global Referencing ................................................................................. 36 2.3.2 Joint Kinematics ...................................................................................... 37 2.3.3 Kinematic Model Sensitivity ................................................................... 38 2.3.4 Joint Kinetics ........................................................................................... 39 2.3.5 Kinetic Body Segment Parameter Effects ............................................... 40 2.4 Discussion ....................................................................................................... 41 2.5 Conclusion .....................................................................................................
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