0196-6011/85/0703-0091$02.

00/0
THEJOURNAL OF ORTHOPAED~C AND SPORTSPHYSICAL THERAPY
Copyright 0 1985 by The Orthopaedc and Sports Physical Therapy Sections of the
American Physical Therapy Association

Normal Biomechanics of the Foot and

Ankle
ROBERT DONATELLI, MA, PT'

The biomechanics of the foot and ankle are important to the normal function of the
lower extremity. The foot is the terminal joint in the lower kinetic chain that opposes
external resistance. Proper arthrokinematic movement within the foot and ankle
influences the ability of the lower limb to attenuate the forces of weightbearing. It is
important for the lower extremity to distribute and dissipate compressive, tensile,
shearing, and rotatory forces during the stance phase of gait. Inadequate distribution
of these forces could lead to abnormal stress and the eventual breakdown of
connective tissue and muscle. The combined effect of muscle, bone, ligaments, and
normal foot biomechanics will result in the most efficient force attenuation in the
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

lower limb. This article will look specifically at the normal biomechanics of the foot
and ankle.
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Normal biomechanics of the foot and ankle can ing effect increases the tension of the tissue,
be divided into static and dynamic components. allowing the plantar aponeurosis to take on
The static structures include the bones, joint sur- greater amounts of stress.15 Tension within the
face congruity, ligaments, and fascia. The dy- plantar aponeurosis, in addition to absorbing more
namic components include the arthrokinematics stress, assists in supination of the subtalar joint.4
of the tarsal bones and muscle function. The short and long plantar ligaments and the
calcaneonavicular ligament (spring ligament), also
assist in the passive maintenance of the arch?
The beam action of the metatarsals, as described
Journal of Orthopaedic & Sports Physical Therapy®

STATIC STRUCTURES
by Hicks, represents the supportive aspect of the
Muscle activity is not necessary to support the long bones of the foot. Hicks4 has not directly
fully loaded foot at rest.12.15The maintenance of measured the amount of stress the metatarsals
the arch in the static foot is attributed to passive absorb. The bones, however, are major stabilizers
ligamentous and osseous support.15 Hicks3s4was of the foot. This is obvious when observing the
the first to emphasize the importance of the beam trabecular patterns which indicate the direction of
action of the metatarsals and the tensile strength force transmission into the foot. The trabecular
of the plantar aponeurosis. He indicated that in systems follow the alignment of the medial and
the static stance position the plantar aponeurosis lateral arch.g Root et a1.16 describe surface con-
takes up approximately 60% of the stress of gruity as a stabilizing factor of the tarsal bones.
weightbearing and the beam action of the meta- Joint congruity has classically been described as
tarsals approximately 25%. The ability of the plan- a stabilizing influence in synovial joints.'' The joint
tar aponeurosis to absorb stress increases as the alignment and congruity of the metatarsal and
aponeurosis becomes taut with toe extension. tarsal bones are critical in establishing the medial
This mechanism has been described by several and lateral arches. This joint relationship is also
authors as the windlass effect (Fig. 1).'~4.1'~'6 At important for normal arthrokinematics of the foot
maximum extension of the toes, during the push- and ankle.
off phase of gait, the aponeurosis winds around In summary, the static mechanisms responsible
the metatarsophalangealjoints (MTP). This twist- for force attenuation within the foot include the
windlass effect of the plantar aponeurosis, the
* Instructor. Emoly U I i i t y Master Degree Program. Orthopaedic
tensile strength of the plantar ligaments, the beam
Physical Therapy. effect of the metatarsals, and the joint congruity
 92 DONATELLI JOSPT Vol. 7, No. 3

Fig. 2. Open kinetic chain pronation and supination. S, Supi-

nation two third's from neutral; N, neutral; P, pronation one-
third from neutral;A, oblique axis of motion of the subtalar joint
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

(anterior, superior, and medial to posterior inferior and lateral).

abduction, dorsiflexion, and eversion occur simul-

Fig. 1 . Windlass effect of toe extension. 1, Plantar aponeurosis taneously. (Fig. 2, P).3.6.16Supination is the tri-
in a slack position with the foot in neutral; 2, increased tension plane motion including adduction, plantar flexion,
of the plantar aponeurosis as the toes extend, raising the
medial arch facilitating supination.
and inversion (Fig. 2, S).3,6.16 Supination and pro-
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

nation as described above occur in an open kinetic

of the tarsal and metatarsal bones. The dynamic chain. Root et a1.16describe this open kinetic chain
aspects of foot and ankle biomechanics work in movement by observing the calcaneous in the
conjunction with, and are dependent upon, the nonweightbearing position. The functional bio-
static mechanisms. mechanics of the foot and ankle are important in
the weightbearing position or the closed kinetic
DYNAMIC STRUCTURES chain. Sixty percent of the gait cycle is weight-
bearing, better described as the stance phase of
Movement of the foot and ankle is a complex gait.7-16Supination and pronation occur at certain
Journal of Orthopaedic & Sports Physical Therapy®

action involving many joints. Functionally, the foot points in the stance phase to assist movement,
and ankle are similar to a closed kinetic chain. stabilize joints, and reduce forces within the foot
Steindler17 defines a closed kinetic chain as ". . . and lower limb. Root et a1.16 have identified five
a combination of several successively arranged triplane joints within the foot that allow pronation
joints constituting a complex motor unit, where and supination to occur. The triplane joints include
the terminal joint of the chain meets with consid- the talocrual, the subtalar, the midtarsal, the first
erable resistance." The lower extremity is fre- ray (first metatarsal/cuneiform), and the fifth ray
quently described as a closed kinetic chain during (fifth metatarsal).
the gait cycle. However, the foot, independent of
the lower extremity, may also be considered as a PRONATION: HEEL STRIKEITOE STRIKE
unit so arranged that motion at one joint influ-
ences mechanisms of other joints within the chain. Pronation occurs in the stance phase of gait to
The complex motions of the foot and ankle which allow for shock absorption, ground terrain
promote the interdependence of joint movement changes, and eq~ilibrium.l~-'~ From heel strike to
are called pronation and supination. Root et a1.16 toe strike there are four basic forces acting on the
describe pronation and supination as triplane mo- foot and lower limb which need to be attenuated.
tions. For example, pronation includes the body Upon heel strike, 8O0/0 of body weight is directly
plane movements of abduction, dorsiflexion, and over the calcaneous, producing a vertical force
eversion (Fig. 2).6.16These three motions are de- against the g r ~ u n d . ~Bone
. ' ~ is a specialized con-
rived from the transverse, sagittal, and frontal nective tissue designed to reduce compressive
planes, respectively. However, because the axes forces. The alignment of the tibia, talus, and cal-
of motion of the triplane joints are oblique, trav- caneous at heel strike (Fig. 6) are important to
ersing all three body planes, the movement of distribute the vertical compressive forces safely.
 JOSPT November 1985 NORMAL BIOMECHANICS OF THE FOOT AND ANKLE 93
From heel strike to toe strike the compressive subtalar joint.' During the stance phase of gait
force of weightbearing is distributed between the the foot does not rotate. The tibia rotates medially
calcaneous and the metatarsal^.^ The tarsals and at heel strike and the talus follows resulting in
the metatarsals at footflat are in a mutual pronation of the subtalar joint or a valgus heel
compression, very similiar to a stone arch.5 The (Fig. 3). The transverse rotations of the lower limb
midfoot carries virtually no weight during the are converted into the triplane motions of prona-
stance phase.5 There is also an anterior shearing tion and supination. The midtarsal joint, which
force, within the foot, of the tibia on the t a l ~ s . ' ~ . ' ~consists of the talonavicular and the calcaneal
This anterior movement is decelerated mainly by cuboid articulations, unlocks with subtalar joint
the gastroc/soleus muscle group.'.16 Mann,l0 de- pronation.l3.l6The cuboid and the navicular be-
scribes a medial shearing to the foot resulting come more parallel allowing the forefoot to be-
from an internal rotation of the lower limb. The come a loose bag of bones.16The forefoot is now
subtalar joint, consisting of the talus and the a more efficient mobile adaptor to changes in
calcaneous, responds to the internal rotation and ground terrain, thus facilitating equilibrium. The
medial shear by allowing the calcaneous to move midtarsal area is where we can observe the low-
laterally or into ~ a l g u s . ' ~The
. ' ~ talus rolls in a ering and raising of the medial arch.'
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

medial direction (plantarflexes and adducts) to In summary, there are many forces acting on
fully articulate with the middle facet on the calca- the foot and lower limb from heel strike to toe
n e o ~ s . ' ~This
. ' ~ middle facet is formed by the strike. The four we have reviewed include
medial process on the calcaneous called the sus- compression, rotation, anterior shear, and medial
tentaculum tali. Therefore, as the posterior aspect shear. Normal pronation is important in attenua-
of the calcaneous rolls laterally, the sustentacu- tion of these forces. It is a passive activity, in the
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

lum tali falls medially along with the talus (Fig. closed kinetic chain, that results from intemal
3).14.16This rotation of the talus and the calca- rotation of the lower limb and a medial shear to
neous has been described as the torque converter the foot. Pronation is initiated at heel strike and
of the lower limb.', 14. l6 controlled by an eccentric contraction of the su-
Ambulation is a series of rotations, starting in pinators. The three muscles that are active from
the lumbar spine, that propel the body through heel strike to toe strike, include anterior tibialis.
space.' The transverse rotations of the tibia and extensor digitorium longus, and extensor hallicus
the femur are transmitted and reduced at the longus.15Root et a1.16 classify the above muscles
as supinators of the foot.
Journal of Orthopaedic & Sports Physical Therapy®

SUPINATION-TOE STRIKE/PUSH-OFF
Supination occurs at the end of the stance
phase of gait. It enables the extrinsic muscles to
function more efficiently and sets up a rigid lever
from which to push off.l0.l6 This rigid lever is
established by a locking of the bones of the foot
and ankle.16 The fixed position of the tarsals and
metatarsals allow for a muscle pulley system to
be set up. Several of the extrinsic muscles are
dependent upon bony levers for proper function.
For example, the peroneus longus during push-
off stabilizes the first ray.16 The ability of the
muscle to act in this manner is dependent upon
the cuboid pulley. (Fig. 4).
Supination of the foot results from several
mechanisms. First, from toe strike to push-off
(midstance) the activity of the extrinsic muscles
Fig. 3. Closed kinetic chain pronation. A, Anterior view of the initiate supination.1° EMG studies have shown
subtalar joint and the talocrual joint; B, posterior view of the
subtalar joint and the talocural joint. 1 , Calcaneal/cuboidartic-
during midstance the increase in activity of the
ulation; 2, talo/navicular articulation; 3, sustentaculum tali; 4, gastroc/soleus, posterior tibialis, flexor digitorium
calcaneous; 5, talus; 6, tibia; 7, fibula. longus, and the flexor hallicus longus.15 Mann and
 DONATELLI JOSPT Vol. 7, No. 3

Supination
Cuboid Pulley
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

Fg. 5. Closed kinetic chain supination. A, Anterior view of the

subtalar joint and the talwrural joint; 8,posterior view of the
Fig. 4. Cuboid pulley. A and F represent the vectors of the subtalar joint and the talocrural joint. 1, Calcaneal/cuboid
peroneus longus action. A, Abduction vector; F, plantarflexion articulation;2, talo/navicular articulation;3, sustentaculum tali;
vector; P, peroneus longus tendon. 1, Cuboid; 2, cuneiforms; 4, calcaneous; 5 , talus; 6, tibia; 7, fibula.
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

3, talus; 4, fibula; 5, tibia.

neurosis assisting subtalar joint supination.'. l1
This mechanism was described previously as the
Inman1*have demonstrated with EMG studies the
windlass effect (Fig. 1). The normal amount of
significance of the intrinsic muscles from toe strike
joint range of motion needed to facilitate this
to push-off. The abductor digiti quinti, flexor digi-
mechanism is 60-70' of passive MTP dorsiflex-
torium brevis, flexor hallicus brevis, abductor hal- ion.l.ll.16
licus brevis, dorsal interossei, and the extensor
In summary, supination of the foot is dependent
digitorium brevis are all important in stabilization
upon a combination of dynamic and static mech-
of the midtarsal joint during the final 50% of the
anisms. The activity of the intrinsic and extrinsic
Journal of Orthopaedic & Sports Physical Therapy®

stance phase.12 The second factor influencing

muscles, in conjunction with external rotation and
supination of the foot is the external rotation of
MTP extension produce a supination movement.
the lower limb.'' The contralateral limb swings
forward past the weightbearing limb initiating an NEUTRAL
external rotation force.'' This external rotation
causes a lateral shearing force within the foot Root et a1.16 describe a neutral position of the
promoting supination." The subtalar joint initiates subtalar joint which is two-thirds from inversion
supination by inversion of the calcaneous. The and one-third from eversion of the calcaneous
talus is pushed into a lateral position (abduction (Fig. 2). The normal foot needs to pronate and
and dorsiflexion) by the sustentaculum tali (Fig. supinate 6-8O from the neutral position.'' The
5).16 The midtarsal joint locks upon supination of amount of supination and pronation that is avail-
the subtalar joint.l3.l6 This locking mechanism able can be measured by lining up the longitudinal
occurs when the cuboid and the navicular are axis of the lower limb and the vertical axis of the
perpendicular to each other. (Fig. 5). The bones calcaneous (Fig. 6).'316 Passive movement of the
now act as rigid levers for more efficient pull of calcaneous into inversion is normally 20°.16 This
peroneus longus and the posterior tibialis, respec- represents the amount of supination available at
tively. Thus, a synergistic contraction of these two the subtalar joint. Conversely, the amount of
muscle groups stabilize the midfoot and first ray. eversion is normally 10°.16 This represents the
First ray stabilization affords good alignment of amount of pronation available. Another method of
the first MTP joint and a rigid lever for push-off. determining neutral is described by James.' Ac-
The third factor influencing supination is the mo- cording to James,' the talar head in a pronated
bility of the first MTP joint. Dorsiflexion of the MTP foot can be palpated as a medial bulge. Con-
produces increased tension of the plantar apo- versely, in a supinated foot the talar head bulges
 JOSPT November 1985 NORMAL BIOMECHANICS OF THE FOOT AND ANKLE 95
triplane motions act as shock absorbers, assist in
maintaining balance, improve the efficiency of
muscle contraction, assist in distribution of normal
forces through the lower kinetic chain, and help
establish a stable structure at push off, enabling
us to propel ourselves through space very effi-
ciently.
Acknowledgments: Michael Wooden whom I have taught with over
the last three years. He has been an inspiration to me. The graduate
students from Emory University. espec~allyTom Bartdino. for their
continued rnotivatlon to learn. Dr. Sandy Gruskin, for his assistance
and friendship.

REFERENCES
1. Bojsen-Mdkr F, LamOreux L: Significance of free dorsi fiexion of
Neutral position the toes in walking. Acta Ortho(, Scand 50:471-479. 1979
2. Elftman H: The transverse tarsal joint and its control. Clin Orthop
16:41-46. 1960
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

3. Hidts JH: The mechanics of the foot. I.The joints. J Anat 87:345-
Fig. 6. Neutral position of the subtalar joint showing the longi- 357.1953
tudinal axis of the lower limb and the vertical axis of the 4. Hicks JH: The mechanii of the foot. It. The plantar aponeurosis.
calcaneous. 5, Talus; 4, calcaneous. J Anat 88:25-30.1954
5. Hutton WC. Dehanendran: The mechanics of m l and halux
laterally.a In the neutral position, the talar head valgus feet-A quantitive study. Clin Ortho(, 157:7-13. 1981
can be palpated equally on the medial and lateral 6. lnman VT: The Joints of the Ankle. Baltimore: Williams 8 Wilkms.
1976
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

aspect of the ankle.' The neutral position de- 7. lnman VT. Rdston KI. Todd F: Human Walking. pp 1-21. Wfliams
scribed above, is usually present when the longi- 8 W~lkins.1981
tudinal axis of the lower limb and the vertical axis 8. James SL: Chondromalacia of the patella in the edolescent. In:
Kennedy JC. (ed) The Injured Adolescent Knee. pp 214-228.
of the calcaneous are parallel (Fig. 6).' Wilharns 8 Wilkins. 1979
9. Kapandji IA: The Phsidogy of the Joints. V d 11. The Lower Limb,
CONCLUSION pp. 200-210. Churchill Livingstone. London. 1970
10. Mann RA: B i i a n i s of running. In: Mack (ed).Symposium on
Understanding the functional biomechanics of the Foot and Leg in running sports, pp 1-29. St Louis: CV Mosby.
1982
the foot and ankle has profound clinic applica- 11. Mann RA: Hagy JL: The function of the toes in walking. jogging
tions. For example, the inability of the lower limb and running. Clin Orthop 142:24-29.1979
Journal of Orthopaedic & Sports Physical Therapy®

to convert transverse rotations at the subtalar 12. Mann RA, lnman VT: Phasic activity of intrinsic mu& of the
foot. J Bone Joint Surg (Am) 46:469. 1964
joint could have detrimental effects on other joints 13. Manter JT: Movements of the subtalar and transverse tarsal joints.
in the chain such as the knee, the midtarsal, and Anat Rec 80:397-409.1941
the forefoot. The pelvis and the lumbar spine are 14. Peny J: Anatomy and biomechanics of the h i i o o t . Clin Orthop
l77:9-l5.l983
influenced by functional leg length discrepancies 15. Reeser LA. Susman RL. Stem JT: Electromyographiistudies of
which could be related to abnormal pronation and the human foot: Experimental approaches to hominid evduation.
supination. Evaluation of the foot and ankle takes Foot Ankle 3391-406.1983
16. Root ML. Orien WP. Weed JN: Clinical B i a n i c s . Vd. 11:
on a different meaning when considering the neu- Normal and Abnormal Function of the Foot. Los Aangles: Clinical
tral position of the subtalar joint. Physical thera- Biomechanics Corp. 1977
pists need to understand the normal biomechan- 17. Steindler A: Kineslology of the HumanBody. Springfield. IL: Charles
C Thomas. 1977
ics of the foot and ankle and it's relationship to 18. Warwick R. Williams P (4s): Gray's Anatomy. 35th British Ed, pp
the normal function of the lower kinetic chain. 338-407. Philadelphia: WE Saunders. 1973
Pronation and supination are dynamic terms. The
foot is pronating at heel strike and passes through
neutral and starts to supinate at midstance. The
 This article has been cited by:

1. Ariana Dann, Ariel Pokhojaev, Marie Anton, Guy Yalovitsky, Ruth Kallevag-Pelleg, Hila May. 2024. Changes in human calcaneal
morphology throughout the Pleistocene-Holocene Levant. Frontiers in Earth Science 12. . [Crossref]
2. McKenna W. Box, Grayson A. Domingue, Neil J. Werthmann, Jan P. Szatkowski, John T. Riehl. Calcaneus Fractures . [Crossref]
3. Toshihiko Sato, Kai Iida, Takahiro Ohkawa, Tsutomu Fukui. 2024. Relationship between ankle–foot-complex mobility during
static loading and frontal moment impulses of knee and hip joints during the stance phase. Gait & Posture 108, 301-306. [Crossref]
4. Kerri Lynne Bell, Brandon William King, Bruce J. Sangeorzan. 2023. Acute and Chronic Subtalar Joint Instability. Foot and Ankle
Clinics 28:2, 427-444. [Crossref]
5. Güllü Aydin Yağcioğlu, Merve Karapınar. 2023. Translation, validity, and reliability of the Foot Posture Index (FPI-6) – Turkish
version. Physiotherapy Theory and Practice 111, 1-7. [Crossref]
6. Patricia K. Wellborn, Joshua N. Tennant, Trapper A. J. Lalli. Biomechanics of the Ankle 21-33. [Crossref]
7. Chen Zhao, Jing Chen, Yi Deng, Wenping Huang, Shanzhi Ma, Songchuan Su, Zhi Zhao, Jing Tang, Jiawei Wang, Wei Huang,
Li Tang, Ning Hu. 2022. Arch volume：a new method for medial longitudinal arch measurement. Foot and Ankle Surgery 28:7,
962-967. [Crossref]
8. Sampat Dumbre Patil, Rohil Singh Kakkar, Sumit Saxena, Prachi Dumbre Patil. 2022. Reconstruction of large midfoot bone loss
using titanium spinal mesh cage with bone graft: A case report. Orthoplastic Surgery 9, 106-110. [Crossref]
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

9. Wen Fan, Yasuhiko Hatanaka. 2022. Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase.
Applied Bionics and Biomechanics 2022, 1-10. [Crossref]
10. Óscar Agudelo-Varela, Julio Vargas-Riaño, Ángel Valera. 2022. Turmell-Meter: A Device for Estimating the Subtalar and
Talocrural Axes of the Human Ankle Joint by Applying the Product of Exponentials Formula. Bioengineering 9:5, 199. [Crossref]
11. Stefan Vermeulen, Sophie De Mits, Roel De Ridder, Patrick Calders, Joris De Schepper, Fransiska Malfait, Lies Rombaut.
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

2022. Altered Multisegment Ankle and Foot Kinematics During Gait in Patients With Hypermobile Ehlers‐Danlos Syndrome/
Hypermobility Spectrum Disorder: A Case–Control Study. Arthritis Care & Research 74:5, 841-848. [Crossref]
12. Alessandra B. Matias, Ricky Watari, Ulisses T. Taddei, Paolo Caravaggi, Rafael S. Inoue, Raissa B. Thibes, Eneida Y. Suda,
Marcus F. Vieira, Isabel C. N. Sacco. 2022. Effects of Foot-Core Training on Foot-Ankle Kinematics and Running Kinetics in
Runners: Secondary Outcomes From a Randomized Controlled Trial. Frontiers in Bioengineering and Biotechnology 10. . [Crossref]
13. Claude Pierre-Jerome, Patrick Battaglia, Norman W. Kettner. Biomechanics of the ankle-foot unit: derangements and radiological
signs 1-45. [Crossref]
14. Amber N. Heard-Booth, Sharon Kuo, Ellison J. McNutt, Jeremy M. DeSilva. The Primate Midfoot and Human Longitudinal
Journal of Orthopaedic & Sports Physical Therapy®

Arch 47-72. [Crossref]

15. Buket Büyükturan, Senem Şaş, Caner Kararti, İsmail Özsoy, Aida Habibzadeh, Öznur Büyükturan. 2022. Effects of Subtalar Joint
Mobilization with Movement on Muscle Strength, Balance, Functional Performance, and Gait Parameters in Patients with Chronic
Stroke: A Single-Blind Randomized Controlled Study. Journal of the American Podiatric Medical Association 112:1. . [Crossref]
16. Dong Hun Suh, Hak Jun Kim, Jung Ho Park, Young Hwan Park, Bong Mo Koo, Gi Won Choi. 2021. Relationship between
Hallux Valgus and Pes Planus in Adult Patients. The Journal of Foot and Ankle Surgery 60:2, 297-301. [Crossref]
17. N F Cofaru, A H Brănescu. 2021. A review on biomechanics of the hallux valgus pathology and its surgical treatments. IOP
Conference Series: Materials Science and Engineering 1009:1, 012015. [Crossref]
18. Carla van der Merwe, Sarah P. Shultz, G. Robert Colborne, Kim Hébert-Losier, Philip W. Fink. 2020. The coordination patterns
of the foot segments in relation to lateral ankle sprain injury mechanism during unanticipated changes of direction. The Foot
45, 101745. [Crossref]
19. Harald Böhm, Leonhard Döderlein, Albert Fujak, Chakravarty U. Dussa. 2020. Is there a correlation between static radiographs
and dynamic foot function in pediatric foot deformities?. Foot and Ankle Surgery 26:7, 801-809. [Crossref]
20. Wen-Ming Chen, Jie-Wen Li, Xiang Geng, Chen Wang, Li Chen, Xin Ma. 2020. The potential influence of stochastic resonance
vibrations on neuromuscular strategies and center of pressure sway during single-leg stance. Clinical Biomechanics 77, 105069.
[Crossref]
21. Harvi F. Hart, Kay M. Crossley, Jason Bonacci, David C. Ackland, Marcus G. Pandy, Natalie J. Collins. 2020. Immediate effects
of foot orthoses on gait biomechanics in individuals with persistent patellofemoral pain. Gait & Posture 77, 20-28. [Crossref]
22. Xuanzhen Cen, Datao Xu, Julien S. Baker, Yaodong Gu. 2020. Association of Arch Stiffness with Plantar Impulse Distribution
during Walking, Running, and Gait Termination. International Journal of Environmental Research and Public Health 17:6, 2090.
[Crossref]
 23. Salih Angin, İlkşan Demirbüken. Ankle and foot complex 411-439. [Crossref]
24. Beth Jarrett, Timothy Cheung, Elizabeth Oh. 2020. The Lateral Column. Clinics in Podiatric Medicine and Surgery 37:1, 53-60.
[Crossref]
25. Ana M. Azevedo, Raúl Oliveira, João R. Vaz, Nelson Cortes. 2019. Foot modeling affects ankle sagittal plane kinematics during
jump-landing. Journal of Biomechanics 96, 109337. [Crossref]
26. Shiwei Mo, Sam H.S. Leung, Zoe Y.S. Chan, Louis K.Y. Sze, Kam-Ming Mok, Patrick S.H. Yung, Reed Ferber, Roy T.H.
Cheung. 2019. The biomechanical difference between running with traditional and 3D printed orthoses. Journal of Sports Sciences
37:19, 2191-2197. [Crossref]
27. Yongjin Cho, Jin-Woo Park, Kiyeun Nam. 2019. The relationship between foot posture index and resting calcaneal stance position
in elementary school students. Gait & Posture 74, 142-147. [Crossref]
28. Catherine Reyes Rodriguez, David Alejandro Borda Sanchez, Monica Alexandra Bustamante Rubio, Francisco Garcia, Luis Santiago
Mejia. 2019. Etiologia y fisopatologia del hallux valgus. Revista Colombiana de Ortopedia y Traumatología 33, 2-12. [Crossref]
29. R. K. P. S. Ranaweera, R. A. M. Abayasiri, R. A. R. C. Gopura, T. S. S. Jayawardena, G. K. I. Mann. Design and Analysis of
An Anthropomorphic Two-DoF Ankle-Foot Orthosis 802-807. [Crossref]
30. K. Al-Hourani, M. Stoddart, T.J.S. Chesser. 2019. Syndesmotic fixation in unstable ankle fractures: Does early post-operative
weight bearing affect radiographic outcomes?. Injury 50:3, 790-795. [Crossref]
31. Juan C Zuil-Escobar, Carmen B Martínez-Cepa, Jose A Martín-Urrialde, Antonia Gómez-Conesa. 2019. Evaluating the Medial
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

Longitudinal Arch of the Foot: Correlations, Reliability, and Accuracy in People With a Low Arch. Physical Therapy 99:3,
364-372. [Crossref]
32. Momoko Yamagata, Hiroshige Tateuchi, Itsuroh Shimizu, Noriaki Ichihashi. 2019. The effects of fall history on kinematic
synergy during walking. Journal of Biomechanics 82, 204-210. [Crossref]
33. Hyun-Ju Noh, Chan-Myeong Kim, Ji-Won Park. 2019. A study on muscle activity based on the ankle posture for effective
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

exercise with indoor horse riding machine. Journal of Physical Therapy Science 31:2, 170-174. [Crossref]
34. S. Hauser, M. Mutlu, P. Banzet, A.J. Ijspeert. 2018. Compliant universal grippers as adaptive feet in legged robots. Advanced
Robotics 32:15, 825-836. [Crossref]
35. Niall A. Smyth, Amiethab A. Aiyer. 2018. Introduction: Why Are There so Many Different Surgeries for Hallux Valgus?. Foot
and Ankle Clinics 23:2, 171-182. [Crossref]
36. Hanatsu Nagano, Rezaul Begg. 2018. Shoe-Insole Technology for Injury Prevention in Walking. Sensors 18:5, 1468. [Crossref]
37. Morgan E. Chaney, Tung V. Dao, Benjamin S. Brechtel, Stephanie J. Belovich, Kathy J. Siesel, John R. Fredieu. 2018. The
fibularis digiti quinti tendon: A cadaveric study with anthropological and clinical considerations. The Foot 34, 45-47. [Crossref]
Journal of Orthopaedic & Sports Physical Therapy®

38. Tadasuke Ohnishi, Mitsumasa Hida, Yukio Nakamura, Chikamune Wada. 2018. Novel method for evaluation of hindfoot
alignment in weight-bearing position using laser beam. Journal of Physical Therapy Science 30:3, 474-478. [Crossref]
39. Julie A. Thompson, Andrew A. Tran, Corey T. Gatewood, Rebecca Shultz, Amy Silder, Scott L. Delp, Jason L. Dragoo. 2017.
Biomechanical Effects of an Injury Prevention Program in Preadolescent Female Soccer Athletes. The American Journal of Sports
Medicine 45:2, 294-301. [Crossref]
40. Juan Carlos Zuil-Escobar, Carmen Belén Martínez-Cepa, Jose Antonio Martín-Urrialde, Antonia Gómez-Conesa. 2016.
Reliability and Accuracy of Static Parameters Obtained From Ink and Pressure Platform Footprints. Journal of Manipulative and
Physiological Therapeutics 39:7, 510-517. [Crossref]
41. Go-Un Jung, U-Young Lee, Dong-Ho Kim, Dai-Soon Kwak, Yong-Woo Ahn, Seung-Ho Han, Yi-Suk Kim. 2016. Selecting
best-fit models for estimating the body mass from 3D data of the human calcaneus. Forensic Science International 262, 37-45.
[Crossref]
42. Amir Putra Bin Md Saad, Ardiyansyah Syahrom, Muhamad Noor Harun, Mohammed Rafiq Abdul Kadir. Introduction 1-17.
[Crossref]
43. A. Toumi, S. Leteneur, C. Gillet, J.-F. Debril, N. Decoufour, F. Barbier, J. M. Jakobi, Emilie Simoneau-Buessinger. 2015.
Enhanced precision of ankle torque measure with an open-unit dynamometer mounted with a 3D force-torque sensor. European
Journal of Applied Physiology 115:11, 2303-2310. [Crossref]
44. Elizabeth E. Painter, Gail D. Deyle, Christopher Allen, Evan J. Petersen, Theodore Croy, Kenneth P. Rivera. 2015. Manual
Physical Therapy Following Immobilization for Stable Ankle Fracture: A Case Series. Journal of Orthopaedic & Sports Physical
Therapy 45:9, 665-674. [Abstract] [Full Text] [PDF] [PDF Plus] [Supplementary Material]
 45. Adoración Villarroya-Aparicio, María Ángeles Franco-Sierra, Isabel García-Muñoz, Yolanda Marcén-Román, Ana Alonso-
Vázquez, Cleofas Rodriguez-Blanco. 2015. Impact of forefoot varus on standing and gait kinematics in children. International
Journal of Osteopathic Medicine 18:3, 171-180. [Crossref]
46. Juan C. Zuil-Escobar, Carmen B. Martínez-Cepa, Jose A. Martín-Urrialde, Antonia Gómez-Conesa. 2015. Prevalence of
Myofascial Trigger Points and Diagnostic Criteria of Different Muscles in Function of the Medial Longitudinal Arch. Archives of
Physical Medicine and Rehabilitation 96:6, 1123-1130. [Crossref]
47. J.M. DeSilva, R. Bonne‐Annee, Z. Swanson, C.M. Gill, M. Sobel, J. Uy, S.V. Gill. 2015. Midtarsal break variation in modern
humans: Functional causes, skeletal correlates, and paleontological implications. American Journal of Physical Anthropology 156:4,
543-552. [Crossref]
48. Fiona Hawke, Vivienne Chuter. Forefoot Entities 70-109. [Crossref]
49. Luke A. Kelly, Glen Lichtwark, Andrew G. Cresswell. 2015. Active regulation of longitudinal arch compression and recoil during
walking and running. Journal of The Royal Society Interface 12:102, 20141076. [Crossref]
50. Luke A. Kelly, Andrew G. Cresswell, Sebastien Racinais, Rodney Whiteley, Glen Lichtwark. 2014. Intrinsic foot muscles have
the capacity to control deformation of the longitudinal arch. Journal of The Royal Society Interface 11:93, 20131188. [Crossref]
51. Ryan H. Fitzgerald, Anuja Vedpathak. 2013. Plantar Pressure Distribution in a Hyperpronated Foot before and after Intervention
with an Extraosseous Talotarsal Stabilization Device—A Retrospective Study. The Journal of Foot and Ankle Surgery 52:4, 432-443.
[Crossref]
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

52. Terry L. Nicola, David J. Jewison. 2012. The Anatomy and Biomechanics of Running. Clinics in Sports Medicine 31:2, 187-201.
[Crossref]
53. Craig P. Hensley, Alicia J. Emerson Kavchak. 2012. Novel use of a manual therapy technique and management of a patient with
peroneal tendinopathy: A case report. Manual Therapy 17:1, 84-88. [Crossref]
54. Carleen Lindsey. Impaired posture 292-315. [Crossref]
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

55. A.M. Perera, Lyndon Mason, M.M. Stephens. 2011. The Pathogenesis of Hallux Valgus. Journal of Bone and Joint Surgery 93:17,
1650-1661. [Crossref]
56. Yi-Ton Hsu, Chi-Chuan Wu, Wei-Cheun Lee, Kuo-Feng Fan, I-Chuan Tseng, Po-Cheng Lee. 2011. Surgical treatment of
syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function. International Orthopaedics 35:3, 359-364.
[Crossref]
57. Katherine E. Bartosik, Michael Sitler, Howard J. Hillstrom, Howard Palamarchuk, Kellie Huxel, Esther Kim. 2010. Anatomical
and Biomechanical Assessments of Medial Tibial Stress Syndrome. Journal of the American Podiatric Medical Association 100:2,
121-132. [Crossref]
Journal of Orthopaedic & Sports Physical Therapy®

58. K. Karatsolis, C.S. Nikolopoulos, E.S. Papadopoulos, G. Vagenas, E. Terzis, S. Athanasopoulos. 2009. Eversion and inversion
muscle group peak torque in hyperpronated and normal individuals. The Foot 19:1, 29-35. [Crossref]
59. I. Hetsroni, A. Finestone, C. Milgrom, D. Ben Sira, M. Nyska, D. Radeva-Petrova, M. Ayalon. 2006. A prospective biomechanical
study of the association between foot pronation and the incidence of anterior knee pain among military recruits. The Journal of
Bone and Joint Surgery. British volume 88-B:7, 905-908. [Crossref]
60. David J. S. Wadsworth, Nathan T. Eadie. 2005. Conservative Management of Subtle Lisfranc Joint Injury: A Case Report. Journal
of Orthopaedic & Sports Physical Therapy 35:3, 154-164. [Abstract] [PDF] [PDF Plus]
61. Kattia Ochoa-Vigo, Ana Emilia Pace. 2005. Pé diabético: estratégias para prevenção. Acta Paulista de Enfermagem 18:1, 100-109.
[Crossref]
62. Mary K. Allen, Tyler J. Cuddeford, Ward M. Glasoe, Lisa M. DeKam, Pamela J. Lee, Kelli J. Wagner, H. John Yack. 2004.
Relationship between Static Mobility of the First Ray and First Ray, Midfoot, and Hindfoot Motion during Gait. Foot & Ankle
International 25:6, 391-396. [Crossref]
63. Thomas W. Kaminski, Tara M. Gerlach. 2001. The effect of tape and neoprene ankle supports on ankle joint position sense.
Physical Therapy in Sport 2:3, 132-140. [Crossref]
64. Connie Beukeboom, Trevor B. Birmingham, Lorie Forwell, Dave Ohrling. 2000. Asymmetrical Strength Changes and Injuries
in Athletes Training on a Small Radius Curve Indoor Track. Clinical Journal of Sport Medicine 10:4, 245-250. [Crossref]
65. David Stephensen. Biomechanics of the Lower Limb in Haemophilia 77-87. [Crossref]
66. Ward M Glasoe, H John Yack, Charles L Saltzman. 1999. Anatomy and Biomechanics of the First Ray. Physical Therapy 79:9,
854-859. [Crossref]
 67. Ward Mylo Glasoe, Mary Kay Allen, H. John Yack. 1998. Measurement of Dorsal Mobility in the First Ray: Elimination of Fat
Pad Compression as a Variable. Foot & Ankle International 19:8, 542-546. [Crossref]
68. Roger W. Simmons, Charles Richardson, Katherine Deutsch. 1997. Limited joint mobility of the ankle in diabetic patients with
cutaneous sensory deficit. Diabetes Research and Clinical Practice 37:2, 137-143. [Crossref]
69. Thomas W. Kaminski, David H. Perrin, Carl G. Mattacola, Joseph E. Szczerba, Julie N. Bernier. 1995. The Reliability and
Validity of Ankle Inversion and Everson Torque Measurements from the Kin Com II Isokinetic Dynamometer. Journal of Sport
Rehabilitation 4:3, 210-218. [Crossref]
70. James A. Birke, B. Don Franks, James G. Foto. 1995. First Ray Joint Limitation, Pressure, and Ulceration of the First Metatarsal
Head in Diabetes Mellitus. Foot & Ankle International 16:5, 277-284. [Crossref]
71. Judy L. Seto, Clive E. Brewster. 1994. Treatment Approaches Following Foot And Ankle Injury. Clinics in Sports Medicine 13:4,
695-718. [Crossref]
72. Marina U. McCulloch, Denis Brunt, Darl Vander Linden. 1993. The Effect of Foot Orthotics and Gait Velocity on Lower Limb
Kinematics and Temporal Events of Stance. Journal of Orthopaedic & Sports Physical Therapy 17:1, 2-10. [Abstract] [PDF] [PDF
Plus]
73. Peter Marshall. 1989. The Rehabilitation of Overuse Foot Injuries in Athletes and Dancers. Clinics in Podiatric Medicine and
Surgery 6:3, 639-655. [Crossref]
74. Peter Marshall. 1988. The Rehabilitation of Overuse Foot Injuries in Athletes and Dancers. Clinics in Sports Medicine 7:1, 175-191.
Downloaded from www.jospt.org at on February 20, 2024. For personal use only. No other uses without permission.

[Crossref]
Copyright © 1985 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Journal of Orthopaedic & Sports Physical Therapy®