Introduction: The motion of the distal syndesmosis correlates highly with the instability, while an accurate kinematic\ndescription of the distal tibiofibular joint during normal gait has not previously been presented.\nMaterial and methods: Sixteen healthy syndesmoses of sixteen living subjects (8 male and 8 female) were studied\nduring stance phase of the normal gait. Data of CT scanning were collected first and used to create the 3D models\nof the distal tibia and fibula. The lateral X-ray images of the syndesmosis were captured by fluoroscopy when the\nsubject was walking. Seven key-pose images were selected for subsequent 3D to 2D bone model registration and six\ndegrees-of-freedom (DOF) motions of syndesmosis were then calculated. A validation experiment was also conducted\nto confirm the accuracy of the 3D/2D technique for the syndesmosis.\nResults: During the stance phase, the distal tibiofibular joint exhibited with 2.98 �± 1.10�° of dorsi/plantarflexion, 5.94 �±\n1.52�° of inversion/eversion, and 5.99 �± 2.00�° of internal/external rotation; 2.63 �± 1.05 mm on medial/lateral, 3.86 �±\n1.65 mm on anterior/posterior, and 4.12 �± 1.53 mm on superior/inferior translation. From heel strike to mid-stance,\nthe syndesmosis demonstrated 1.69�° of dorsiflexion, 3.61�° of eversion, and 3.95�° of external rotation. Likewise, from\nmid-stance to heel-off, the syndesmosis presented 1.04�° of plantarflexion, 4.95�° of inversion, and 5.13�° of internal rotation.\nConclusion: During the stance phase of normal gait, internal/external rotation and vertical motion play dominant roles\nin terms of rotation and translation, respectively.
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