A Biomechanical Investigation of Ankle Injury Under Excessive External Foot Rotation in the Human Cadaver

Numerous studies on the mechanisms of ankle injury deal with injuries to the syndesmosis and anterior ligamentous structures but a previous sectioning study also describes the important role of the posterior talofibular ligament (PraFL) in the ankle's resistance to external rotation of the foot. It was hypothesized that failure level external rotation of the foot would lead to injury of the PraFL. Ten ankles were tested by externally rotating the foot until gross injury. Two different frequencies of rotation were used in this stud 0.5 Hz and 2 Hz. The mean failure torque of the ankles was 69.5 +/- 11.7 Nm with a mean failure angle of 40.7 +/- 7.3 degrees. No effects of rotation frequency or flexion angle were noted. The most commonly injured structure was the PTaFL. Visible damage to the syndesmosis only occurred in combination with fibular fracture in these experiments. The constraint of the subtalar joint in the current study may have affected the mechanics of the foot and led to the resultant strain in the PTaFL. In the real world, talus rotations may be affected by athletic footwear that may influence the location and potential for an ankle injury under external rotation of the foot. [DOI: 10.1115/1.4002025]