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Axial loading of the foot/ankle complex is an important injury mechanism in vehicular trauma that is responsible for severe injuries such as calcaneal and tibia pilon fractures. Axial loading may be applied to the leg externally, by the toepan and/or pedals, as well as internally, by active muscle tension applied through the Achilles tendon during pre-impact bracing. In order to evaluate the effect of active muscle tension on the injury tolerance of the foot/ankle complex, blunt axial impact tests were performed on 44 isolated lower legs with and without experimentally simulated Achilles tension. The primary fracture mode was calcaneal fracture in both groups, but tibia pilon fractures occurred more frequently with the addition of Achilles tension. Acoustic emission demonstrated that fracture initiated at the time of peak local axial force.

Though rotation is thought to be the most common mechanism of foot and ankle injury in both automobile crashes and in everyday life, axial impact loading is considered responsible for most severe lower extremity injuries. In this study, dynamic axial impact tests were conducted on 92 isolated human lower limbs. The test apparatus delivered the impact via a pendulum-driven plate which intruded longitudinally to simulate the motion of the toepan in an automobile crash. Magneto-hydrodynamic (MHD) angular rate sensors fixed to the limbs measured ankle rotations during the impact event. Malleolar or fibula fractures, which are commonly considered to be caused by excessive ankle rotation, were present in 38% (12 out of 32) of the injured specimens. Ankle rotations in these tests were always within 10° of neutral at the time of peak axial load and seldom exceeded failure boundaries reported in the literature at any point during the impact event.