1
|
Chen F, Yuan C, Liang M, Le G, Xu J. Comparison of different surgical treatments for stage II progressive collapsing foot deformity: a finite element analysis. J Orthop Surg Res 2023; 18:719. [PMID: 37741994 PMCID: PMC10518082 DOI: 10.1186/s13018-023-04216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND This study analyzed the advantages and disadvantages of different procedures for stage IIA progressive collapsing foot deformity (PCFD) through three-dimensional finite element models. METHODS A previous validated stage IIA PCFD FEA model was established consisting of 16 bones, 56 ligaments, 5 muscles and soft tissues. The ligament properties of the spring, deltoid, short plantar and long plantar ligaments, and plantar fascia were attenuated according to a previous publication. Medial column fusion (MCF), medializing calcaneal osteotomy (MCO), lateral column lengthening (LCL), and subtalar joint arthroereisis (SJA) operations were simulated in this model. The indexes of plantar stress distribution, maximum von Mises of the medial and lateral columns, strain of the medial ligaments and plantar fascia that supported the medial longitudinal arch, arch height, talo-first metatarsal angle, calcaneus pitch angle, and talonavicular coverage angle were all compared before and after simulated single-foot weight loading. RESULTS The maximum plantar stress of PCFD decreased with MCO and SJA but increased with MCF and LCL. MCF and LCL failed to significantly reduce the stress on the medial column fragments, thereby increasing their stress. Both MCO and SJA relieved medial plantar stress. MCF had no significant effect on stress relief of the medial ligament. MCO, LCL, and SJA were all shown to reduce the pressure on the medial plantar ligament, with LCL having the most obvious effect. All four procedures corrected the arch deformity; however, MCF was not as effective as the other methods. SJA is the best method for restoring arch height and correcting arch deformities. For stage IIA PCFD, isolated MCF failed to reduce pressure on the medial column; however, isolated MCO significantly reduced the pressure on the medial plantar and ligamentous soft tissues while restoring the foot's arch and correcting the hindfoot valgus. CONCLUSION SJA with type II sinus tarsi implant effectively transferred pressure from the medial plantar tract to the lateral side and restored the arch. Isolated LCL was not found suitable for stage IIA PCFD.
Collapse
Affiliation(s)
- Fanglin Chen
- Department of Orthopedics, Liuzhou Workers' Hospital, Liuzhou, Guangxi, China
| | - Chengjie Yuan
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mian Liang
- Department of Clinical Laboratory, Liuzhou Traditional Chinese Medical Hospital, The Third Affiliated Hospital of Guangxi University of Chinese Medicine, Liuzhou, Guangxi, China
| | - Guoping Le
- Department of Orthopedics, Liuzhou Workers' Hospital, Liuzhou, Guangxi, China
| | - Jian Xu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| |
Collapse
|
2
|
Zhu J, Forman J. A Review of Finite Element Models of Ligaments in the Foot and Considerations for Practical Application. J Biomech Eng 2022; 144:1133332. [PMID: 35079785 DOI: 10.1115/1.4053401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE Finite element (FE) modeling has been used as a research tool for investigating underlying ligaments biomechanics and orthopedic applications. However, FE models of the ligament in the foot have been developed with various configurations, mainly due to their complex 3D geometry, material properties, and boundary conditions. Therefore, the purpose of this review was to summarize the current state of finite element modeling approaches that have been used in the ?eld of ligament biomechanics, to discuss their applicability to foot ligament modeling in a practical setting, and also to acknowledge current limitations and challenges. METHODS A comprehensive literature search was performed. Each article was analyzed in terms of the methods used for: (a) ligament geometry, (b) material property, (c) boundary and loading condition related to its application, and (d) model verification and validation. RESULTS Of the reviewed studies, 80% of the studies used simplified representations of ligament geometry, the non-linear mechanical behavior of ligaments was taken into account in only 19.2% of the studies, 33% of included studies did not include any kind of validation of the FE model. CONCLUSION Further refinement in the functional modeling of ligaments, the micro-structure level characteristics, nonlinearity, and time-dependent response, may be warranted to ensure the predictive ability of the models.
Collapse
Affiliation(s)
- Junjun Zhu
- School of Mechatronic Engineering and Automation, Shanghai University, 333 Nanchen Rd., Shanghai, China, 200444
| | - Jason Forman
- Center for Applied Biomechanics, Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA 22911, USA
| |
Collapse
|
3
|
Guo J, Wang L, Mao R, Chang C, Wen J, Fan Y. Biomechanical evaluation of the first ray in pre-/post-operative hallux valgus: A comparative study. Clin Biomech (Bristol, Avon) 2018; 60:1-8. [PMID: 30292061 DOI: 10.1016/j.clinbiomech.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/18/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deformity of the first ray in hallux valgus patient has been deemed to mainly contribute to instability of the metatarsophalangeal joint. However, it is not clear whether the fixation of the distal osteotomy fragment and transposition of the sesamoid represent the best method for hallux valgus treatment. The aim of this study was to examine how postoperative hallux valgus osteotomy affects the stability of the first ray. METHODS To accurately investigate the biomechanical behavior of the first ray in pre-/postoperative hallux valgus patients, we described the relative displacement and stress distribution of the first metatarsal bone and sesamoid by imageology, test measurement and foot finite element model. FINDINGS Compared with the preoperative hallux valgus, the plantar pressure decreased by 47.8% and was redistributed on second metatarsal region. The peak stress and relative displacement of the distal osteotomy fragment increased by +55.7% and -59.9%, respectively. The movement of this component shifted toward the positive sagittal axis direction. In addition, the relative displacement of sesamoid decreased by 87.4% (0.18 mm) in vertical axis direction and the stress was also redistributed on medial and lateral region. Moreover, the strain of the medial main ligament was more favorable to reconstruct function of the first ray. INTERPRETATION The findings showed that the osteotomy method was helpful for stability of the first ray. This would provide the stability suggestions for postoperative hallux valgus fixation and guide further rehabilitation.
Collapse
Affiliation(s)
- Junchao Guo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China
| | - Rui Mao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China
| | - Cheng Chang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, PR China
| | - Jianmin Wen
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, PR China.
| | - Yubo Fan
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China; Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China.
| |
Collapse
|
4
|
Xu J, Ma X, Wang D, Lu W, Zhu W, Ouyang K, Liu H, Li H, Jiang L. Comparison of Extraosseous Talotarsal Stabilization Implants in a Stage II Adult-Acquired Flatfoot Model: A Finite Element Analysis. J Foot Ankle Surg 2018. [PMID: 28623061 DOI: 10.1053/j.jfas.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Subtalar arthroereisis has been proved to be an efficient method for correcting flexible adult flatfoot. However, the optimal sinus tarsi implant is still debated and yet to be determined. In the present study, we compared the biomechanical effects of type I and II sinus tarsi implants in stage II adult-acquired flatfoot deformity (AAFD). First, a finite element model of stage II AAFD was established in which virtual surgery of subtalar arthroereisis was simulated. The indexes of plantar stress distribution, peak von Mises of the medial and lateral columns, strain of the medial ligaments and plantar fascia, arch height, talo-first metatarsal angle, calcaneus pitch angle, talonavicular coverage angle, and hindfoot valgus angle were all compared and analyzed. The results of the present study have validated the stage II AAFD finite element model by comparing the simulation results with the same parameters measured from weightbearing radiographs in the midstance phase. All the indexes showed that both types of arthroereisis can lower the plantar pressure and the strain of the medial ligaments that support the medial longitudinal arch and can shift the load of the medial column to the lateral column. They can also help to correct the deformity and restore the arch. However, the type II sinus tarsi implant design exhibited a more obvious effect than that of type I.
Collapse
Affiliation(s)
- Jian Xu
- Orthopedist, Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xin Ma
- Professor, Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Daping Wang
- Professor, Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei Lu
- Professor, Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen, China.
| | - Weimin Zhu
- Professor, Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen, China
| | - Kan Ouyang
- Professor, Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen, China
| | - Haifeng Liu
- Associate Professor, Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hao Li
- Associate Professor, Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen, China
| | - Luoyong Jiang
- Surgeon, Department of Sports Medicine, Shenzhen Second People's Hospital, Shenzhen, China
| |
Collapse
|
5
|
Guo J, Liu X, Ding X, Wang L, Fan Y. Biomechanical and mechanical behavior of the plantar fascia in macro and micro structures. J Biomech 2018; 76:160-166. [PMID: 29909926 DOI: 10.1016/j.jbiomech.2018.05.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/16/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022]
Abstract
Plantar fascia (PF) is a heterogeneous thickness structure across plantar foot. It is important significance to investigate the biomechanical behavior of the medial, middle and lateral PF regions. To investigate the non-uniform macro/micro structures of the different PF regions, the uniaxial tensile test of PF strips were performed to assess the mechanical behavior of PF. A scanning electron microscope (SEM) was used to visualize and measure the micro morphology of PF associated with collagen fibers. A three-dimensional foot finite element (FE) model was developed to quantify the tensile behavior of the internal PF. The elastic modulus of the lateral PF component (1560 MPa) was observed, followed by the medial (701 MPa), the central (1100 MPa) and the lateral (714 MPa) portions in the central component. Elongation of the central portion (0.192) was lower than the medial (0.223) and the lateral (0.227) portions. The corresponding SEM images showed that the fibers of the central portion were more densely packed and thicker compared to the ambilateral portions in the central component. While the FE model prediction also suggested that the greater elastic modulus of the central PF portion had lower strain (0.192) versus the ambilateral portions. Therefore, the lower elongation and greater elastic modulus at the central portion of PF would probably have a high risk of PF injury. The findings showed a relation between the mechanical tension and fibrous morphology of PF. This information would have a better understanding of the PF pathophysiology diseases related to tear and injury of PF.
Collapse
Affiliation(s)
- Junchao Guo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China
| | - Xiaoyu Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China
| | - Xili Ding
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China.
| | - Yubo Fan
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China; Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, PR China.
| |
Collapse
|
6
|
Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial. INTERNATIONAL ORTHOPAEDICS 2017; 42:109-116. [DOI: 10.1007/s00264-017-3681-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/27/2017] [Indexed: 11/25/2022]
|
7
|
The Effect of Arch Height and Material Hardness of Personalized Insole on Correction and Tissues of Flatfoot. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:8614341. [PMID: 29065655 PMCID: PMC5485326 DOI: 10.1155/2017/8614341] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 03/31/2017] [Accepted: 04/09/2017] [Indexed: 11/17/2022]
Abstract
Flat foot is one of the common deformities in the youth population, seriously affecting the weight supporting and daily exercising. However, there is lacking of quantitative data relative to material selection and shape design of the personalized orthopedic insole. This study was to evaluate the biomechanical effects of material hardness and support height of personalized orthopedic insole on foot tissues, by in vivo experiment and finite element modeling. The correction of arch height increased with material hardness and support height. The peak plantar pressure increased with the material hardness, and these values by wearing insoles of 40° were apparently higher than the bare feet condition. Harder insole material results in higher stress in the joint and ligament stress than softer material. In the calcaneocuboid joint, the stress increased with the arch height of insoles. The material hardness did not apparently affect the stress in the ankle joints, but the support heights of insole did. In general, insole material and support design are positively affecting the correction of orthopedic insole, but negatively resulting in unreasonable stress on the stress in the joint and ligaments. There should be an integration of improving correction and reducing stress in foot tissues.
Collapse
|
8
|
Mao R, Guo J, Luo C, Fan Y, Wen J, Wang L. Biomechanical study on surgical fixation methods for minimally invasive treatment of hallux valgus. Med Eng Phys 2017; 46:21-26. [PMID: 28527835 DOI: 10.1016/j.medengphy.2017.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/18/2017] [Accepted: 04/26/2017] [Indexed: 02/03/2023]
Abstract
Hallux valgus (HV) was one of the most frequent female foot deformities. The aim of this study was to evaluate mechanical responses and stabilities of the Kirschner, bandage and fiberglass fixations after the distal metatarsal osteotomy in HV treatment. Surface traction of different forefoot regions in bandage fixation and the biomechanical behavior of fiberglass bandage material were measured by a pressure sensor device and a mechanical testing, respectively. A three-dimensional foot finite element (FE) model was developed to simulate the three fixation methods (Kirschner, bandage and fiberglass fixations) in weight bearing. The model included 28 bones, sesamoids, ligaments, plantar fascia, cartilages and soft tissue. The peak Von Mises stress (MS) and compression stress (CS) of the distal fragment were predicted from the three fixation methods: Kirschner fixation (MS=6.71MPa, CS=1.232MPa); Bandage fixation (MS=14.90MPa, CS=9.642MPa); Fiberglass fixation (MS=15.83MPa, CS=19.70MPa). Compared with the Kirschner and bandage fixation, the fiberglass fixation reduced the relative movement of osteotomy fragments and obtained the maximum CS. We concluded that fiberglass fixation in HV treatment was helpful to the bone healing of distal fragment. The findings were expected to guide further therapeutic planning of HV patient.
Collapse
Affiliation(s)
- Rui Mao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China
| | - Junchao Guo
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, 100176 Beijing, China
| | - Chenyu Luo
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China; Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, 100176 Beijing, China
| | - Jianmin Wen
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China.
| |
Collapse
|
9
|
Finite element modelling of the foot for clinical application: A systematic review. Med Eng Phys 2017; 39:1-11. [DOI: 10.1016/j.medengphy.2016.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 10/13/2016] [Accepted: 10/23/2016] [Indexed: 11/20/2022]
|