Journal of Orthopaedic Research

6878-885 Raven Press, Ltd., New York

0 1988 Orthopaedic Research Society

Geometry of the First Metatarsophalangeal Joint

Yuki Yoshioka, David W. Siu, T. Derek V. Cooke, J. T. Bryant, and Urs Wyss
Clinical Mechanics Group, Department of Mechanical Engineering, Division of Orthopaedics,
Department of Surgery, Queen’s University, Kingston, Ontario, Canada

Summary: This study aimed to define the articular geometry of the metatar-
sophalangeal (MTP) joint of the great toe. Embedded in resin blocks, five pairs
of cadaveric first MTP joints (all from men) were sequentially cut in the sagittal
plane with a milling machine, removing 0.5 mm of bone in each cut. The
photographed cartilaginous outline of each cut was digitized against reference
markers, which enabled a computer system to superimpose each outline in
three dimensions. The intersesamoidal ridge was found to be parallel to the
lateral shaft. The peak of the ridge was just lateral to the midline of the MT
head. The articular outline, through the ridge of each sample, was circular;
however, other surface contours were noncircular. The undulating plantar as-
pect of the MTP head formed by the intersesamoidal ridge and related grooves
was found to have symmetric relationships to the sesamoid bones and a con-
sistent orientation to the shaft. The roiinded distal dorsal aspect of the MTP
head showed consistent differences to the concavity formed by the phalangeal
base. The sample size is too small for the sizing of prostheses but it is adequate
to study the geometry of the MTP joint. More data are needed for the accurate
replication of a resurfacing prosthesis and understanding of joint kinematics.
Key Words: Geometry-Metatarsophalangeal joint-Prosthesis.

The purpose of this study was to define Metatar-
sophalangeal (MTP) joint geometry accurately, es-
pecially as it reflects articular surfaces involved in
load bearing and their relationships to stabilizing
mechanisms for the joint. The acquisition of these
data is considered as an essential prerequisite to the
development of an anatomical resurfacing prosthet-
ic replacement.
Clinically, many symptomatic disorders affect
the first MTP joint. These include congenital and
acquired malalignments such as hallux valgus, os-
teoarthritis, and rheumatoid arthritis. Surgery for
these problems is common. Although reconstruc-
tions for MTP arthritis have been devised, including
a variety of partial and complete replacement ar-
throplasties (lo), none restore the deranged joint
kinematics to normal.
Address correspondence and reprint requests to Dr. T. D. V .
Cooke, Division of Orthopaedics, Department of Surgery,
Queen’s University, Kingston, Ontario, Canada K7L 3N6.
878
The success of reconstructive surgery for arthrit-
ic derangements of the MTP joint is directly influ-
enced by the factors that control the rotation of the
toe around the long axis of the metatarsal (1). Thus,
features of local geometry between the trochlea and
the sesamoid bones, as well as the articulations to
the phalanx, directly influence the kinematics and
stability.
MATERIALS AND METHODS
Eighteen great toe MTP joints were excised as
intact samples from nine male, disease-free fresh
cadavers obtained from the Department of Pathol-
ogy, Queen’s University (Table 1). Of the 18 MTP
joint samples obtained, nine were used for geomet-
rical analysis and nine for studies of macrohistol-
ogy. Each sample was obtained en block via a prox-
imal incision through the first metatarsocuneiform
joint and a distal resection through middle of the
 FIRST METATARSOPHALANGEAL JOINT GEOMETRY 879

TABLE 1. Clinical data of the first The joint sample was carefully aligned in an alu-
metatarsophalangeal joint samples minum frame with three pairs of threaded alignment
~~

Sample Age (yr) Sex Height (cm) pins that extended from each side wall. Each meta-
1 59 M 173
tarsal was set with the lateral aspect of the bone
2 71 M 173 parallel to the bottom surface of the frame and the
3 73 M 173 superolateral border of the bone set parallel to a
4 79 M 176
5 82 M 172
side wall (Fig. 1); each position was checked by
6 85 M 167 vernier-caliper measurements, a protractor, and a
7 60 M 162 square set to a tolerance of 1 mm and 1".
8 68 M 168
9 74 M 162
Once firmly held by the pins, the sample was
Mean 73.3 169.5 completely covered with liquid polyester resin
mixed with a catalyst. Fiberglass was used to rein-
force the medium and lessen cracking during poly-
proximal phalanx; thus included were the whole merization. The samples were cured for 24 h at
first metatarsal bone, the proximal phalangeal base, room temperature. Once the resin block had hard-
the intra-articular structures, and both sesamoids. ened, it was removed from the aluminum frame and
Each specimen was fixed in 10% formalin for a trimmed to size before mounting on the tissue mill-
week prior to processing. Each sample was pre- ing machine. The sample was oriented with one side
pared in three steps: removal of soft tissues and of the block (dorsal or plantar) and the top part of
articular surface staining, alignment in a reference the block close to the joint sample outline.
frame, and embedding in polyester resin. All extra- The equipment used in the slicing has been dis-
articular soft tissues (muscles, tendons, and perios- cussed by Shiba et al. (8). The resin block with the
teum), except the joint capsule and ligaments, were joint sample was sequentially milled; each cut re-
removed. This allowed good adherence between moved 0.5 mm (0.020) of bone. After each cut, the
bone and polyester embedding resin during slicing. exposed surfaces were cleaned and photographed.
Staining of the articular surfaces was used to in- About 40 sagittally cut surfaces were obtained from
crease the contrast between cartilage and other tis- each specimen.
sues for better definition and subsequent photo- The developed photographs or slides (frames),
graphic reproduction. The staining used was varied taken by a Minolta XG9 camera on Ektachrome
among the following solutions: toluidine blue, saf- films, were analyzed in a Bell and Howell Mark I1
ranin 0, and alizarin red (7,ll). In three joints, the film analyzer. Each frame showed the cartilaginous
stain was injected with a 26-gauge needle through outline of the metatarsal (MT) head with its refer-
the joint capsule into the joint space. The other ence x and y coordinates projected onto a Hi-Pad
joints were opened, and the articular surfaces were digitizer. The cartilaginous outline of the MT head
immersed in stain mixed with formalin for 24 h. and the reference coordinates were digitized using a

FIG. 1. Sample alignment. The superolateral border was set to b e parallel to side walls (left), with the lateral surface parallel t o
t h e bottom of the frame (right). (Key: 1, bone; 2, alignment frame; and 3, holding pin.)

J Orthop Res, Vol. 6 , No. 6, 1988

880
cursor. About 70 points were digitized from each
cut surface (outline) and stored on the magnetic
tape of a Hewlett-Packard desktop computer for
further computer analysis and graphical representa-
tion (9). After completion of the digitization, the
outlines of each frame were superimposed along the
z coordinate and stored as a complete file for that
joint sample. These curved outlines could be clas-
sified into four main types: circular (Fig. 2), ellipti-
cal, spiral (Fig. 2), and combined. To determine the
geometric center of any circle, at least three points
of the arc have to be known. When this rule was
applied to the digitized information, a series of es-
timated centers were calculated. Depending on the
degree of conformity of a particular profile to an arc
of a circle, the distribution of these calculated cen-
ters might be localized around a central point. An
average of a series of such loci provided an estimate
for the presence or absence of a central geometric
relationship for that particular cartilaginous outline.
The accuracy that could be achieved with the cho-
sen method was better than t0.5 mm for dimen-
sions and better than ?I" for angles.
RESULTS
The dimensional data of the bony specimens are
summarized in Table 2. The transverse diameter of
the head is the distance between the medial and
lateral sides when viewed from the dorsal aspect.
The diameter had a mean of 22.9 mm and a standard
Z 11.4 mm (Table 3; Fig. 6). The trochlear surface,
T *' 11.18
TI -
:
10.39
Y, = 4.78 z, = 3.45
.Y
FIG. 2. Computerized analysis. Top: A cut section made
through the intersesamoidal ridge. Note the circular outline
with a tightly localized geometric center, C. Bottom: Away
from the ridge, the cut outline was noncircular.
J Orthop Res, Vol. 6 , No. 6 , 1988
Y. YOSHIOKA ET AL.
deviation of 1.5 mm. The dorsoplantar diameter,
which is the distance between the dorsal and the
plantar surfaces at the middle of the intersesamoidal
ridge, had a mean of 22.8 mm. All dimensions are
labeled in Fig. 3; however, the actual values for
each sample as well as the mean values and stan-
dard deviations are listed in Table 2. The three-
dimensional composite of each MT head was recon-
structed by superimposing all the digitized slices. In
so doing, a graphical display of the joint sample at
any orientation was obtained from the computer
plotter. Figure 4 represents four different views
of the same MT head. Figure 4A is a side-
view-oriented parallel to the yz plane. The geomet-
ric center of the intersesamoid ridge is shown as C.
An oblique view is shown in Fig. 4D. The configu-
rations of the ridge and sesamoid articulations were
reconstructed as aggregations or diversions of the
curves. When the reconstructed image was viewed
from its dorsal aspect (Fig. 4B), the peak of the
articular surface was located more laterally than the
mid-point of the tibia1 and fibular borders. The pro-
file of the intersesamoid ridge as viewed from its
lateral perspective is shown in Fig. 5. The ridge was
found to be perpendicular to the transverse axis (T-
F in Fig. 5 ) and parallel to the lateral surface of
metatarsus.
In the plane through the intersesamoid ridge, the
articular outline had a rounded appearance, and
analysis suggested the presence of a geometric cen-
ter. The radius of curvature for the intersesamoid
ridge ranged from 10.0 to 13.4 mm with a mean of
however, closely approximated a series of spirals.
To estimate the extent of the cartilaginous cover,
the angle formed between limits of the cartilaginous
surface about the geometric center, C, was mea-
sured in the plane through the ridge. It was found to
have a mean of 161" (75" dorsal and 86" plantar)
(Table 4).
The skyline outline of the trochlear surfaces was
examined from the dorsal aspect at lo" increments
of flexion (r) within the range of 10--8o", as illus-
trated in Figs. 7 and 8. The angles a and b, formed
by the tangents drawn on cartilaginous projections
of the trochlea on its respective medial and lateral
sides to the ridge, were measured (Fig. 7). The an-
gle b on the fibular plantar face had a minimum
value at 50" and a maximum at 80". Relatively little
change was noted for angle a during varying degrees
of flexion. --
When the skyline outlines of the MT head were
examined from the dorsal aspect, the grooves (each
 FIRST METATARSOPHALANGEAL JOINT GEOMETR Y 881

TABLE 2. Bony dimensions of each MTP joint sample

Metatarsal diameter Phalangeal diameter Tibia1 sesarnoid Fibular sesamoid
Sample Side Transverse Dorsoplantar Transverse Dorsoplantar Length Width Length Width
1 L 25.0 21.0 23.5 17.4 9.3 11.6 10.0 9.7
R 24.8 22.0 19.6 15.0 11.0 10.5 10.0 10.1
2 L 22.5 22.0 18.5 16.2 12.4 7.0 10.6 9.0
R 22.9 22.6 - - - - - -
3 L 22.2 21.8 20.8 19.2 12.3 9.6 11.5 9.5
R 22.0 22.2 19.3 13.0 11.5 9.0 9.6 9.7
4 L 24.2 25.2 22.5 16.7 11.0 7.8 11.8 10.0
R 22.0 24.2 20.3 14.3 10.5 8.8 12.2 9.5
5 L 23.0 23.3 19.0 13.2 10.8 9.8 10.0 8.7
R 23.5 23.9 19.0 13.0 11.2 8.8 10.0 8.8
6 L 22.7 24.8 22.0 17.5 11.0 7.6 11.8 8.4
R 22.5 24.5 20.4 16.9 9.0 8.2 11.5 9.2
7 L 22.0 22.5 17.2 12.0 9.2 7.8 7.8 7.3
R 20.8 22.8 17.4 13.8 11.0 7.2 7.3 4.7
8 L 22.7 22.0 19.2 15.8 10.8 9.6 8.7 7.5
R 22.4 22.2 20.4 16.4 10.0 10.2 7.8 8.3
9 L 22.6 19.6 17.8 12.8 10.7 8.0 10.8 7.5
R 23.8 21.8 19.2 15.4 9.2 8.8 10.5 8.8
Mean 22.9 22.8 19.8 15.2 10.6 8.8 10.I 8.6
(SD) (1.1) (1.4) (1.7) (2.0) (1 .O) (1.2) (1.5) (1.3)
Values are given in millimeters.

presenting a slightly concave profile) were found to
change continuously for flexion angles 0-90" (Fig.
7). The tibial groove was usually wider and deeper
than the fibular groove. Both grooves tended to in-
crease in depth as angle Y increased from 40 to 70";
LATERAL
thereafter, they decreased in both width and depth.
The cross-section at the tibial groove at the ridge
featured a milder and longer slope than that at the
epicondyle, which was steeper and shorter. The fib-
ular groove showed only a simple shallow valley,
which was 1.5-2 mm shallower than the tibial
groove at its deepest section. The proximal pha-
langes had oval (width greater than height) concave
articular surfaces. The concavities were shallower

c4- 'IF 3 - 1

'\
(larger radii of curvature) than the curvature of the
MT intersesamoidal ridge.
The mean transverse diameter of the phalanx was
19.8 mm, and the mean dorsoplantar diameter was
15.2 mm. The ratio of the vertical to transverse di-
PLANTAR ameters of the phalanges had a mean of 0.77. Both

qe-3
AXIAL
4 1 51

?
F

T
sesamoids were linked to the proximal phalanx by
short sesamophalangeal ligaments. The tibial sesa-
mophalangeal ligament was shorter than the fibular,
i.e., the tibial sesamoid was located closer to the
phalangeal articulation than the fibular counterpart.
The shape and size of the sesamoids differed; the
tibial sesamoid was usually larger and more elon-
gated than the fibular side (Table 2). Similar fea-
tures were reported by Sarrafian (6). The dimen-
sions of the tibial sesamoid were 10.6 (longitudinal)
x 8.8 mm (transverse) and 10.1 x 8.6 mm for fibular
FIG. 3. Measured dimensions of a sample MTP joint. Top:
Dorsoplantar diameter (key: 1, phalanx; 2, metatarsal head; sesamoid. Analysis of the sectional outlines of the
3, metatarsal length). Center: Transverse diameter of phalanx sesamoids showed that the longitudinal section had
(4) and metatarsal head (5), with widths (66')and lengths a navicular form while the transverse section was
(7-7') of sesamoids. Bottom: Dorsoplantar (8) and transverse
(9) diameters of metatarsal head. The dimensions are shown convex with a central crest. A firm ligamentous
in Table 2. structure, the intersesamoid transverse ligament,

J Orthop Res, Vol. 6 , N o . 6, 1988

882 Y. YOSHIOKA ET AL.
linked the two sesamoids; it provided the gutter-like
articulation for the intersesamoid ridge. When ses-
amoids were compared, the trochlea articulation of
the tibial sesamoid was wider and deeper than that
of the fibula. The weight-bearing surface of the tib-
ial trochlea was found to be 78" deviated from the
dorsoplantar axis of the MTP. When this orienta-
tion was combined with the medial rotation of the
MT, as defined by Sarrafian (6) at 13", the weight-
bearing surface of the tibial sesamoid became par-
allel to the ground (Fig. 9).
DISCUSSION
The body of the first metatarsal, which is the
shortest and thickest of the five metatarsals, has a
well-marked prismatic form with three characteris-
tic surfaces and borders (12): dorsomedial, lateral,
and inferior surfaces with superolateral, inferolat-
eral, and inferomedial borders. The lateral surface
is consistently flat and appears in line with the ver-
tical orientation of the tarsometatarsal joint (Fig.
J Orthop Res, Vol. 6,No. 6, 1988
FIG. 4. Computer reconstruction of metatarsal
head articular surfaces of sample 6 (right). C is
the center of the intersesamoid ridge. Top left:
Lateral view; top right: computer graphic recon-
struction of MT head viewed from its dorsal as-
pect. Note that the peak of the articular profile
was shifted laterally. (Key: T, tibial end of carti-
lage surface; F, fibular side; 0-o', transverse
axis; C, center of the ridge.) Bottom left: Distal
aspect; bottom right: oblique tibial view.
IA). Compared with lesser metatarsal heads, the
first MT head is larger and quadrilateral in general
outline. The articular surface has three distinct
bearing areas: a distal superior phalangeal surface
and two inferior side-by-side sesamoidal surfaces
(tibial and fibular) (Fig. 10). These overlap and in-
terrelate with each other closely, so that separate
borders for territorial motion of each cannot be pre-
cisely identified. The phalangeal bearing area of the
head is smooth and convex. From the plantar as-
pect, a longitudinal crest, the intersesamoid ridge
rises between two grooves (trochlea). The grooves
articulate with dorsal biconcave articular surfaces
of the tibial and fibular sesamoids and, in flexion,
with the inferior portion of the proximal phalanx. In
its proximal plantar extent, the ridge becomes less
distinct, but the grooves continue the side-by-side
articular surfaces for the sesamoids proximally
(Fig. 10). Distally, the ridge and grooves merge with
the rounded form of the head at a point in line with
the bony axis of the bone. The outer (lateral) as-
pects of the MT head show bony protrusions (epi-
 FIRST METATARSOPHALANGEAL JOINT GEOMETRY 883

DISTAL VIEW

PLANTAR LATERAL VIEW

FIG. 5. Linear reconstruction of computer graphic outlines
from the MT head as viewed from their distal (front), dorsal, FIG. 6. Diagram of the cartilage cover in an axial cut through
and lateral aspects. Note the orientation of the ridge project- the ridge. (Key: D, dorsal arc; P, plantar arc; r, radius of the
ing from the plantar aspect. (Key: F, fibular side; T, tibial side; ridge curvature; data of each sample are shown in Table 3.)
D, dorsal; P, plantar; A-F, increments of flexion by 10" from
the z axis [long].)
adduction movement in the first MTP. Rotation, al-
condyles), which Sarrafin (6) reported as well- though likely to occur during push-off from uneven
developed bony tubercles from which the collateral surfaces, is not defined. The usual position of the
ligaments arise. phalanx is 15" valgus to the first ray (5). This is
The recorded range of motion for the first MTP influenced by the degree of varus of the first ray,
has been reported as 45 and 70" of passive flexion/ which is greater in the splayed forefoot than in the
extension (2) with 21 and 51" of active flexion/ narrow foot.
extension ( 3 ) . In stance, which may be considered There are three specific features of the first MTP
to be a neutral position of the MTP, the joint lies at joint not seen in any other joints. First, the exten-
some 16-20" of extension (1,3). This position is de- sion motion range is of more importance than the
pendent on the elevation of the medial longitudinal flexion range, since the joint is, in almost all activ-
arch of the foot. Hoppenfeld (2) reported that nor- ities, in extension. Second, it has a complex config-
mal toe-off required a minimum of 35-40" of exten- uration which continues a multiaxial distal part with
sion. There is a limited degree of abduction and a saddle-shaped plantar part forming three closely
related articulations; all influence joint function.
TABLE 3. Dimensions of intersesamoid ridge, Third, the maximal loads in stance and gait are ex-
intersesamoid ridge radii of curvature ( m m ) , and the erted on the joint perpendicular to the long axis of
angular extent of dorsal and plantar cartilage surfaces
(degrees) of the first MT head samples the metatarsal head; loads apply directly between
the MT trochlea and the (tibial) sesamoid.
Radius of Our findings indicate that the intersesamoid
intersesamoid Dorsal Plantar Combined
Sample Side ridge arc arc arc ridge, which was the most striking anatomic struc-
I L 10.7 89 87 176 ture of the MT articular surface, was oriented par-
R 11.1 91 84 165 allel to the lateral surface of the metatarsal shaft and
2 L 11.4 90 97 187
R 11.5 87 85 172 in line with the MT superolateral border. In other
3 L 11.2 I1 81 158 words, the plane of the ridge is sagittal with respect
R 12.3 67 67 134
4 L 10.4 57 81 138 to the MT long axis but is rotated medially by 13" in
R 10.0 65 107 172 stance. A single geometric center was found in the
5 L 12.2 73 92 165
R 13.4 68 78 146 parallel cuts of the MT head made in the area of the
Mean 11.4 75 86 161 ridge, the contour of which was circular. The arcs
(SD) (1.0) (1 1) (11) (17)
of the articular outlines out of the plane of the in-

J Orthop Res, Vol. 6 , No. 6 , 1988

884 Y . YOSHIOKA ET A L .

TABLE 4. Mearz values and standard deviations of tibia1 andfibular tangential angles of the ridge in relation to
flexion angle (degrees)
Flexion angle (R) 10 20 30 40 50 60 70 80 90
Tibial angle (a) 77.6 71.3 77.4 76.5 76.9 76.8 77.3 78.5 -
(4.5) (4.3) (5.3) (5.3) (6.5) (5.7) (5.6) (5.7)
Fibular (b) 64.7 65.7 65.1 64.3 63.6 66.8 69.1 73.8 -
(8.8) (9.3) (7.6) (7.4) (6.9) (7.3) (7.7) (7.4)
Combined angle (a + b) 142.3 143.0 142.5 140.8 140.5 143.1 146.0 151.8 -
(9.1) (9.5) (7.5) (7.6) (7.6) (6.7) (5.7) (5.3)

tersesamoidal ridge were complex, representing the
combined side-by-side articulations of the sesa-
moids. Geometric centers were not found for the
parallel cut sections of the MT head at any distance
from the ridge.
In the standing plantigrade position, about one
third of body weight is borne by the forepart of the
foot (12); this, carried through the head of the first
metatarsal, equals about one sixth of body weight
(4,6). In walking, the center of gravity passes
through the big toe so that loads of more than the
body weight occur via the plantar articulations.
MTP joint organization may be compared with the
condylar patella organization of the knee; here one
is viewing the MTP in reverse and assuming the two
sesamoids to be patellae, with the phalangosesa-
moid apparatus and flexor hallucis brevis tendons
to be the quadriceps mechanism. The motion of ex-
tension at the MTP corresponds more to the flexion
of the knee. In extension, the convex MT head has
greatest contact with the elliptical concave facet of
the phalanx; here the intersesamoid ridge does not
interrupt this conformity as it occupies the slot
made by the upward projections of the two sesa-
moids on either side of the thick plantar volar plate.
The form of this articulation is akin to a rail and
truck mechanism, which provides side-to-side sta-
bility during flexion/extension motion of the pha-
lanx. In extension beyond about O", the inter-
sesamoid ridge merges with the convex outline of

a+)l
the phalangeal articular surface. In positions of
MTP extension greater than approximately lo", the
sesamoids come to lie on this same surface, now
without sideways restraint (no ridge or groove). Be-

10 30 50 70 90 deg. Id
B '
FLEXION ANGLE
FIG. 8. Tibial (a)and fibular (p) groove tangential angles to
FIG. 7. Tibial (a)and fibular (p) tangential angles were rnea- the intersesarnoid ridge at varying degrees of flexion. The
sured in a plane of flexion (r) from the long axis. mean values and standard deviations are shown in Table 4.

J Orthop Res, Vol. 6, N o . 6, 1988

 FIRST METATARSOPHALANGEAL JOINT GEOMETRY
V ment or disease), the phase of the MTP motion,
DP
\ '
3
' I
v
PARALLEL
FLOOR
FIG. 9. Diagrammatic section through the MTP at epi-
condyles. Note the orientation of the sesarnoid articulations
in relation to the vertical position of the MT instance, i.e.,
rotated medially some 13". (Key: T, tibial; F, fibular sesam-
oids; DP, dorsoplantar axis; Tr, transverse axis; V,vertical; H,
horizontal line.)
yond this point, the sesamoids may be passively
subluxed to either side. In flexion, the phalangeal
surface loses contact with the inferior part of the
MTP head on either side of the ridge. Passive side-
ways angulation is readily achieved in this position.
These observations may have relationships to val-
gus subluxation, deformities, and/or arthritis.
Thus, the projection of the ridge and the angles
formed by both trochlear surfaces of the head, as
well as the congruity of the sesamometatarsal joint,
will directly influence sideways motion or angula-
tion of the phalanx. Lack of the ridge (maldevelop-
FIG. 10. Plantar view of a metatarsal (MT). The cartilage
cover for the sesarnoid articulations (2 and 3) is extended
more proximally than that of the ridge (1) (Key: F, fibular side;
T, tibial side).
885
and/or torsional malalignment of the MT may each
be contributing factors leading to lateral instability
of the sesamoids and subsequent MTP deformity.
In this regard, the chronic use of high-heeled shoes,
perpetuating hyperextension, may chronically lo-
cate the sesamoids at a potentially unstable site,
potentiating their lateral subluxation.
The analysis of the geometry of the first MTP
joint demonstrates the importance of the sesamoid
bones and their guidance by the ridge-and-groove
configuration of the metatarsal head. These findings
might be helpful for biomechanical studies of the
first MTP joint and also for designing a new artifi-
cial first MTP joint.
Acknowledgments: The authors acknowledge the sup-
port, advice and technical assistance given by other mem-
bers of Queen's University, Clinical Mechanics Group,
and the Department of Anatomy as well as the diligent
typing skills of Ms. L. Murphy and Ms. F. Pelletier in the
preparation of the manuscript. This research was funded
by Physicians' Services Incorporated and the Medical
Research Council, PG-17.
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J Orthop Res, Vol. 6, No. 6, 1988