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Subtalar JointArthrodesisTarsal JointsTalusCalcaneusFlatfootFoot Deformities, AcquiredAnkle JointArthroscopesFoot DeformitiesClubfootRange of Motion, ArticularFootAnkleMuscle Stretching ExercisesJointsTarsal BonesShoesFractures, BoneCadaverInjections, Intra-ArticularAnkle InjuriesFoot InjuriesFracture Fixation, InternalJoint Deformities, AcquiredOrthotic DevicesFoot JointsMetatarsophalangeal JointKnee JointCasts, SurgicalPronationJoint InstabilityBone ScrewsDislocationsEquinus DeformityPosterior Tibial Tendon DysfunctionFibulaWrist JointOsteoarthritisArthroplasty, Replacement, AnkleFoot DiseasesPodiatryIntra-Articular FracturesFracture Healing
HindfootDistraction ArthrodesisArthroplastyArthritisFracturesTripleFusionsCartilageMedialFlexorValgusTibiotalarTalonavicular jointStabilizeTalusArthroscopyArthroscopic ankleProcedureBelow the ankle jointArthrosisNeed to undergoNitinolLateralScrewsFusionTotal Ankle ReplacementMidfootFixationSinus Tarsi ApproachTibiotalocalcanealLigamentBone graftAnkle jointsMetatarsophalangeal jointUndergoRelieveProceduresCalcaneocuboid jointBony unionDeformitySurgeryArticularOsteoarthritisDegenerateFoot
Hindfoot10
  • Triple arthrodesis is indicated for patients who have a deformity of the hindfoot, such as acquired adult flatfoot deformity , where there is arthritis or stiffness in the involved joints. (footeducation.com)
  • Once all the joints have been prepared and the bone graft has been placed, the hindfoot position is corrected to a neutral position. (footeducation.com)
  • Subtalar pathology can cause chronic pain in the hindfoot, but it is often. (koreamed.org)
  • Seven years after the initial injury, imaging prompted by progressive hindfoot pain during weight-bearing or following activity revealed progressive degeneration of the subtalar joint, for which he was treated with orthoses, corticosteroid injections, and arthroscopic debridement. (jomi.com)
  • The rigidity of the talonavicular, subtalar, and calcaneocuboid joints leads to fixed hindfoot valgus and midfoot abduction. (clinicalpainadvisor.com)
  • Patients with rigid hindfoot valgus and forefoot abduction deformities require a fusion procedure, most commonly a triple arthrodesis. (clinicalpainadvisor.com)
  • Lateral hindfoot pain, in the region of the fibular tip, can occur secondary to subtalar fibrosis, subtalar arthritis or lateral wall impingement, or all of these. (orthoracle.com)
  • A new type of nitinol based compression staples has been successfully used in arthrodesis of the hindfoot. (atticfirearchitecture.com)
  • New-generation Nitinol compression staples are been shown to be secure and effective in treating arthrodesis of the hindfoot. (atticfirearchitecture.com)
  • A new generation of nitinol compression staples has shown to be successful in hindfoot arthrodesis. (nxgf.com)
Distraction Arthrodesis3
  • Scholars@Duke publication: Subtalar distraction arthrodesis through a posterior approach. (duke.edu)
  • CONCLUSION: The posterior approach for distraction arthrodesis is an alternative to the standard lateral approach technique. (duke.edu)
  • Subtalar distraction arthrodesis plus insertion of a bony block and rigid internal fixation The lateral calcaneal artery provides blood supply to the lateral flap associated with the calcaneal extensile approach. (freemedicalvideos.com)
Arthroplasty5
  • Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented. (wjgnet.com)
  • The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle, subtalar, first metatarsophalangeal, and second tarsometatarsal joints, and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty. (wjgnet.com)
  • Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing. (utah.edu)
  • Familial Clustering Identified in Periprosthetic Joint Infection Following Primary Total Joint Arthroplasty: A Population-Based Cohort Study. (utah.edu)
  • Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. (wheelessonline.com)
Arthritis23
  • However, if there is enough arthritis or dysfunction in the involved joints where preservation is improbable, then a triple arthrodesis may be effective. (footeducation.com)
  • Ankle arthrodesis is the fusion of the tibiotalar joint most commonly performed for end-stage arthritis of the joint. (orthobullets.com)
  • The most common complications are development of subtalar arthritis and nonunion. (orthobullets.com)
  • The addition of pulsed electromagnetic fields to nutritional supplementation for cartilage and bone matrix regeneration in arthritis and other long standing joint / bone issues provides synergistic effects. (earthpulse.net)
  • Subtalar arthrodesis is recommended for the treatment of severe end stage arthritis that has not responded to conservative treatment measures such as medications, injections, and bracing. (morelandsurgery.com)
  • The patient in this case is a 45-year-old male who developed post-traumatic arthritis of the subtalar joint 14 years following a work-related injury in which he sustained a comminuted, joint-depression type calcaneal fracture after a 10-foot fall from a ladder. (jomi.com)
  • Subtalar arthritis is a common complication following arthrodesis of the ankle, but there is little increase in the incidence of arthritis following total ankle replacement. (cuanschutz.edu)
  • Radiographs have been used to attempt to classify subtalar arthritis extrapolating the Kellgren Lawrence scale for the knee weight to the subtalar joint but do not sufficiently indicate the load on the subtalar joint. (cuanschutz.edu)
  • We propose that the expression of the fibroblast is different in post-traumatic arthritis than those ankles with other etiologies and we aim to prospectively investigate patients with post-traumatic and other etiologies for ankle arthritis who are undergoing either arthrodesis or replacement. (cuanschutz.edu)
  • Arthroscopic ankle arthrodesis (AAA) is a recognized salvage procedure for end-stage arthritis. (acumed.net)
  • The goal of ankle arthrodesis (also known as ankle fusion) is to relieve pain and maintain or improve function for patients with ankle arthritis. (bhosc.com)
  • Ankle arthritis is degeneration of the cartilage that covers the ends of the bones that form the ankle joint. (bhosc.com)
  • While this may be a sign of early ankle arthritis, an ankle cheilectomy is a joint preserving option that may help with pain and function and buy time before additional treatment is needed. (bhosc.com)
  • Patients should be carefully examined for the underlying ligamentous laxity and evidence of MTP joint arthritis because this can influence surgical management. (musculoskeletalkey.com)
  • An MTP fusion should be considered in severe bunions or if there is evidence of MTP joint arthritis because deformity correction will not improve arthritic pain. (musculoskeletalkey.com)
  • Arthroscopic ankle arthrodesis (AAA) is a successful treatment for end-stage ankle arthritis. (libsyn.com)
  • In some cases, the ankle joint disorder may be related to extra-articular anomalies, which may be regional (eg, mechanical malalignment in the lower extremity) or systemic (eg, inflammatory arthritis). (orthosurgeonujjwal.com)
  • Where a joint of the lower extremity has reparative, reconstructive surgery and a part of the joint removed or repaired with resultant osteoarthritis or traumatic arthritis anticipated, consider a minimum of 10% impairment of the joint. (nc.gov)
  • What is arthritis of the 1st metatarsophalangeal joint? (drpettas.gr)
  • What are the causes and risk factors for the development of arthritis of the 1st metatarsophalangeal joint? (drpettas.gr)
  • What are the symptoms of developing arthritis of the 1st metatarsophalangeal joint? (drpettas.gr)
  • How is arthritis of the 1st metatarsophalangeal joint diagnosed? (drpettas.gr)
  • How is arthritis of the 1st metatarsophalangeal joint treated? (drpettas.gr)
Fractures6
  • PURPOSE: The study examined the fusion site and characteristics of the subtalar arthrodesis after intraarticular calcaneal fractures using computed tomography. (koreamed.org)
  • Designed for the fixation of small bone fractures and joint fusions, where a 3.5 mm - 4.0 mm headed screw or an equivalent-sized headless screw would otherwise be required. (acumed.net)
  • Fractures are very often complicated with dislocation of talo-navicular or subtalar or talo-tibial joint. (faoj.org)
  • In 1939, Miller and Baker recommended subtalar or pantalar fusion for the fractures with poor reductions. (faoj.org)
  • 5,6,7] Fractures of the neck associated with subtalar subluxation or dislocation had an incidence of avascular necrosis of 36 per cent in Kenwright and Taylor's series. (faoj.org)
  • The sustentacular screw is essential to maintain the stability of the subtalar joint during ORIF (open reduction with internal fixation) of calcaneal fractures. (biomedcentral.com)
Triple4
  • A triple arthrodesis involves fusion of the talonavicular, subtalar, and calcaneocuboid joints. (clinicalpainadvisor.com)
  • B) Radiograph obtained 3 months after triple arthrodesis with bony union. (medscape.com)
  • 1] Triple or subtalar arthrodesis as treatment of improperly reduced fracture dislocation of talus was suggested by Schrock, et al. (faoj.org)
  • Functionally patients with their triple arthrodesis can perform very well during standard activities of daily living although they may encounter some stiffness and difficulty on uneven ground. (orthoracle.com)
Fusions1
  • Compression staples are also utilized for fixing subtalar joints and talonavicular Fusions. (nxgf.com)
Cartilage7
  • Once exposed, all of the remaining cartilage from the joints is removed and prepared for fusion. (footeducation.com)
  • Objective: To quantitatively assess biochemical alterations in the cartilage of the subtalar and midtarsal joints in chronic lateral ankle instability (CLAI) patients with isolated anterior talofibular ligament (ATFL) injuries and. (koreamed.org)
  • Arthrodesis or fusion of joints in the foot ankle ankle is a procedure that is intended to decrease pain coming from arthritic joints (loss of cartilage and joint space) or to correct a deformity of the foot or ankle. (calsportsortho.com)
  • The access is gained to the joint surface and is followed by removal of the degenerated cartilage tissue. (morelandsurgery.com)
  • After an Ollier approach was used to expose the subtalar joint, the arthritic cartilage was removed and the subchondral plate was perforated. (jomi.com)
  • This is usually due to a painful area within the joint such as a synovitis (inflammed tissue in the joint), a plica or arthrofibrosis(scar tissue in the joint) or a chondral or osteochondral injury (damage to the bone & cartilage lining of the joint). (orthosurgeonujjwal.com)
  • Loose bodies are pieces of bone and cartilage which either float freely between a joint or sit loosely attached at the margin of the joint. (orthosurgeonujjwal.com)
Medial4
  • one is made on the inside (medial) to expose the talonavicular joint, and the other is made on the outside to expose the subtalar joint, the calcaneal-cuboid joint, and the outside (lateral) aspect of the talonavicular joint. (footeducation.com)
  • The progression of hallux valgus deformity is a gradual failure of the medial capsule of the MTP joint, leading to varus of the metatarsal. (musculoskeletalkey.com)
  • It was observed that the talar head was now articulating with the medial cuneiform, forming a pseudo joint. (faoj.org)
  • The mechanical aim of this was to apply forces to the medial longitudinal arch in an attempt to modify compressive stresses assumed to be occurring at the midfoot and talo-cuneiform pseudo-joint, and tensile stresses assumed to be occurring in soft tissues at the plantar foot [9]. (faoj.org)
Flexor2
  • Subtalar arthrodesis with flexor digitorum longus transfer and spring ligament repair for treatment of posterior tibial tendon insufficiency. (wheelessonline.com)
  • 2 As a result, the flexor hallucis longus and extensor hallucis longus are laterally deviated relative to the MTP joint axis, and the pull of the adductor hallucis provides a valgus and pronating force on the proximal phalanx. (musculoskeletalkey.com)
Valgus3
  • It allows safe exposure with the ability to distract while also correcting varus or valgus deformity of the subtalar joint. (duke.edu)
  • An overview of management of foot and ankle injuries and the chronic conditions that are most commonly encountered by orthopaedic surgeons should include hallux valgus, the most common deformity of the metatarsophalangeal joint. (musculoskeletalkey.com)
  • Hallux valgus is the most common deformity of the metatarsophalangeal (MTP) joint and can result from both intrinsic and extrinsic factors. (musculoskeletalkey.com)
Tibiotalar3
  • Thirty-three patients were included in analysis and 81% of patients had successful union of both tibiotalar and subtalar joints. (orthocarolinaresearch.org)
  • The ankle complex (Figure 1 ) mainly formed by the ankle (or tibiotalar) and subtalar (or talocalcanear) joints plays a fundamental role in the human locomotor system, being involved in virtually every locomotion activity. (biomedcentral.com)
  • Pain is typically provoked by dorsiflexion of the ankle and palpation of the tibiotalar anterior joint space. (orthosurgeonujjwal.com)
Talonavicular joint2
  • This surgical procedure involves the fusion of three joints: the talonavicular joint, the subtalar joint, and the calcaneal-cuboid joint (See Figure 1). (footeducation.com)
  • However, the talonavicular joint is challenging to become fully healed, so the healing process could be longer. (footeducation.com)
Stabilize2
Talus7
  • The subtalar joint is a complex joint located below the ankle joint and is formed by the union of the heel (calcaneus) and the talus (ankle) bone. (morelandsurgery.com)
  • An ankle cheilectomy is a surgery that removes a bone spur from the talus or tibia, which are the lower and upper bones of the ankle joint. (bhosc.com)
  • Fracture of the neck of the talus with dislocation of talo-tibial joint and subtalar joint might be one of the worst injuries that can happen around the ankle joint. (faoj.org)
  • Non-displaced fracture of the body of the talus, subtalar or talonavicular subluxation or dislocation can be treated with closed manipulation and plastering. (faoj.org)
  • In 1969, Detenbeck and Kelley recommended talectomy and tibiocalcaneal compression arthrodesis as the primary treatment for fracture-dislocation of the talus. (faoj.org)
  • In Group III, the fracture fragments are displaced and the body of the talus is dislocated from both the ankle and subtalar joints. (faoj.org)
  • Bone loss and impaction of the posterior facet of the subtalar joint that may leave bone voids and also effect produce dorsi-flexion of the talar body, leading to anterior ankle impingement (that needs to be addressed by resupporting the talus with a structural bone graft inserted intothe posterior aspect of the subtalar joint). (orthoracle.com)
Arthroscopy6
  • This book has brought the experts in the field of the arthroscopy who have written the chapters concerning various regions viz Temporomandibular joint, Shoulder, Wrist, Lumbar Spine, Knee, Ankle, and the Subtalar Joint. (intechopen.com)
  • Ankle arthroscopy is a minimally invasive surgical procedure that orthopaedic surgeons use to treat problems in the ankle joint. (bhosc.com)
  • Arthroscopy can be used to diagnose and treat different disorders of the ankle joint. (bhosc.com)
  • The contours of the articular surfaces and the neurovascular and tendinous structures in the surrounding soft tissue, is vital for planning and performing arthroscopy in this joint. (orthosurgeonujjwal.com)
  • To produce sufficient space in which to perform the ankle arthroscopy procedure and avoid damaging the joint surfaces with instruments, it is necessary to "stretch open" the joint. (orthosurgeonujjwal.com)
  • Ankle arthroscopy can be usefully used to debride (tidy up) mild or moderately arthritic joints. (orthosurgeonujjwal.com)
Arthroscopic ankle2
  • For the arthroscopic fusion procedure, the development of arthroscopic techniques of joint preparation for fusion have made arthroscopic ankle arthrodesis popular, and foot and ankle surgeons also have gained considerable. (koreamed.org)
  • Using a headless screw fixation for arthroscopic ankle arthrodesis prevents symptomatic metalwork prominence and the requirement for removal. (acumed.net)
Procedure7
  • The main drawback of the procedure is the high rate of later arthrosis in adjacent joints, reported between 10 and 60% [ 11 - 13 ]. (hindawi.com)
  • Because of the importance of preserving all the joints in the foot, this procedure is done a lot less often than it used to be. (footeducation.com)
  • Subtalar arthrodesis is usually a safe procedure and complications are uncommon. (morelandsurgery.com)
  • BACKGROUND: Subtalar arthrodesis is a common procedure for treating subtalar arthrosis. (duke.edu)
  • We present an alternative method, using a posterior Achilles tendon-splitting procedure, that gives excellent subtalar exposure and the ability to obtain distraction with angular correction and bone grafting. (duke.edu)
  • Key to the procedure is joint preparation and correction of the deformity, aiming to achieve a solidly united foot in the correct alignment in order to restore the mechanical axis and provide a foot the fits adequately it into a shoe. (orthoracle.com)
  • Partial unions associated with the fracture, such as of the anterior process, may need to be addressed at the same time as the arthrodesis procedure. (orthoracle.com)
Below the ankle joint2
Arthrosis3
Need to undergo1
  • About 10-20% of people will need to undergo removal of the screws, usually in the subtalar joint, due to discomfort, once the bones have healed. (footeducation.com)
Nitinol1
  • Shortening of the pseudoelastic nitinol element occurs early in the postoperative period, indicating continued unloading of the nitinol compression element through the arthrodesis sites after initial implantation. (orthocarolinaresearch.org)
Lateral5
  • An isolated lateral incision can be used as an approach to subtalar fusion alone. (duke.edu)
  • When surgically salvaging a malunited calcaneal fracture there can be a number of novel challenges, including a "blown-out", widened lateral calcaneal wall that can make access to the subtalar joint difficult and causes subfibular impingement. (orthoracle.com)
  • The same extensile approach can be utilised for a subtalar arthrodesis where the dorsal flap is elevated along with the peroneal tendons up to the tip of the fibula to expose the lateral wall of the calcaneum and the subtalar joint. (orthoracle.com)
  • The subtalar joint is often obscured in cases where the lateral wall has been particularly blown-out and once the lateral wall is excised an excellent exposure to the subtalar joint can be achieved. (orthoracle.com)
  • Ankle joint, lateral view. (medscape.com)
Screws5
  • Once repositioned, the foot is first provisionally fixed with wires, and then definitively fixed with screws or plates in each joint. (footeducation.com)
  • Pain may be associated with the screws that are used to secure the joints. (footeducation.com)
  • The joints are then fused together with the help of screws, wires, plates, or rods. (morelandsurgery.com)
  • However, apart from general complications related to any surgery, complications after subtalar arthrodesis can include infection, nerve damage, unresolved pain, non-union and malunion of bones, and irritation from foreign material such as pins or screws. (morelandsurgery.com)
  • Finally, an autogenous bone graft was harvested from the proximal tibia and inserted into the joint space, and compression was achieved by two lag screws. (jomi.com)
Fusion16
  • A retired nurse, Nancy, 67, had been on her feet and on the go for five decades, and many of her last years in the field were spent suffering from ankle pain that required subtalar joint fusion surgery, a type of ankle fusion. (ibji.com)
  • Nancy had subtalar joint fusion surgery to relieve ankle pain from a 50-year nursing career. (ibji.com)
  • All of her protective COVID outerwear, gowns, face shields, goggles, double masking, and more were minor inconveniences while working as a nurse compared to her agonizing ankle pain requiring a subtalar joint fusion surgery. (ibji.com)
  • Nancy didn't know that her long walking route of home care visits in the city of Chicago was worsening her symptoms, but all of that changed with subtalar joint fusion surgery, which completely solved her ankle pain. (ibji.com)
  • Then in 2020, she had corrective surgery to address a torn ligament but this was prior to having subtalar joint fusion surgery. (ibji.com)
  • The ankle pain that led to subtalar joint fusion surgery grew worse in the spring of 2021 when she and her sisters - who often go on weekend trips together - were walking and shopping but Nancy couldn't seem to keep up. (ibji.com)
  • Just before finding Dr. League and undergoing subtalar joint fusion surgery, Nancy's pain had peaked. (ibji.com)
  • She was very discouraged that after her surgeries and getting fitted for various boots, she was still suffering from ankle pain, so she is glad she decided to have subtalar joint fusion surgery. (ibji.com)
  • She conducted an online search to find solutions to her ankle pain, which ultimately led to her finding the surgeon who would perform the subtalar joint fusion surgery she needed. (ibji.com)
  • It was then that she learned about Dr. League's solution: subtalar joint fusion surgery, which he performed in June of 2021. (ibji.com)
  • What Exactly Is Subtalar Joint Fusion Surgery? (ibji.com)
  • This results in a subsequent subtalar fusion rate at 5 years of 2.8% which is higher than the 0.7% after TAR [ 14 ]. (hindawi.com)
  • Subtalar arthrodesis is the surgical fusion of bones that form the subtalar joint. (morelandsurgery.com)
  • MATERIALS AND METHODS: Six consecutive patients underwent subtalar fusion with a posterior approach. (duke.edu)
  • Probably will need subtalar fusion. (freemedicalvideos.com)
  • Longer term, there is concern that it predisposes to subtalar joint (STJ) fusion. (libsyn.com)
Total Ankle Replacement2
Midfoot2
  • In the midfoot, deformities such as progressive collapsing flatfoot or cavovarus also can be initially managed with bracing and physical therapy, but, if unsuccessful, joint-sparing bone and soft-tissue balancing procedures can correct deformity to lessen pain and improve function. (musculoskeletalkey.com)
  • Fracture or disruption of the Lisfranc joint complex is included in the discussion because it may represent a serious injury that results in midfoot instability. (musculoskeletalkey.com)
Fixation1
  • The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. (hindawi.com)
Sinus Tarsi Approach1
Tibiotalocalcaneal1
Ligament2
  • The current separate practises of ligament reconstruction and joint replacement for the ankle suggests that these geometric relationships are not yet fully understood. (biomedcentral.com)
  • Such understanding could lead to concurrent ligament reconstruction and joint replacement, when necessary. (biomedcentral.com)
Bone graft1
  • Typically, the joint is then packed with bone graft from other bones, such as the proximal tibia or the iliac crest (located at the top of the pelvic bone). (footeducation.com)
Ankle joints2
Metatarsophalangeal joint3
Undergo1
  • After exhausting both conservative and minimally invasive treatment measures at 14 years post-injury, he finally elected to undergo subtalar arthrodesis. (jomi.com)
Relieve1
Procedures1
  • It all began with the knee surgeries and even today the most common arthroscopic procedures are performed in knee and yet arthroscopic surgeries performed for other regions right from temperomandibular joint down to the subtalar joint have replicated the success shown in knee surgeries. (intechopen.com)
Calcaneocuboid joint1
  • The joints addressed in this operation are the subtalar, the talonavicular and the calcaneocuboid joint. (orthoracle.com)
Bony union1
  • Sagittal computed tomographic scan reformats were reviewed to calculate a percentage of joint surface bony union. (orthocarolinaresearch.org)
Deformity2
  • The purpose of this study was to investigate the radiologic and clinical outcomes of SMOT for the treatment of traumatic ankle joint varus deformity (TAVD) in adolescents. (bvsalud.org)
  • Physical examination reveals a rigid flat foot deformity with tenderness along the posterior tibial tendon and pain with subtalar motion. (clinicalpainadvisor.com)
Surgery4
  • Patients will not bear any weight on the operated leg for the first 6-8 weeks after surgery, in order for the joints to heal. (footeducation.com)
  • Subtalar arthrodesis can be performed as an arthroscopic or open traditional surgery. (morelandsurgery.com)
  • For joint depression fracture, wait for swelling to go down before surgery. (freemedicalvideos.com)
  • Careful consideration should be given to accessing the relevant joints, malunions, and nonunions prior to surgery, in order to plan the optimal approach to address each of these issues. (orthoracle.com)
Articular3
  • Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation within the synovial membrane of the articular joint. (koreamed.org)
  • Rational design and surgical implantation of prostheses therefore demands understanding of the natural interactions between ligaments and articular surfaces of the two joints which control ankle complex mobility. (biomedcentral.com)
  • Restoration of normal joint function and range of motion should benefit from re-establishment of the natural relationships between the geometry of the articular surfaces and the geometry of the ligaments [ 3 ]. (biomedcentral.com)
Osteoarthritis3
Degenerate2
Foot4
  • PTOA can affect any of the 33 joints in the foot and the ankle. (wjgnet.com)
  • The subtalar joint allows side-side movement of the foot. (morelandsurgery.com)
  • The increased body weight will have increased the ground reaction forces experienced by the foot, and the resultant internal stresses on tissues such as ligamentous tissue which normally help to maintain joint congruency [7,8]. (faoj.org)
  • The human shank and foot complex is an intricate, multi-joint mechanism, which is fundamental for the interaction between the lower limb and ground during locomotion. (biomedcentral.com)