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Peng Y, Wang Y, Zhang Q, Chen SF, Zhang M, Li G. Custom orthotic design by integrating 3D scanning and subject-specific FE modelling workflow. Med Biol Eng Comput 2024; 62:2059-2071. [PMID: 38446392 PMCID: PMC11189969 DOI: 10.1007/s11517-024-03067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
The finite element (FE) foot model can help estimate pathomechanics and improve the customized foot orthoses design. However, the procedure of developing FE models can be time-consuming and costly. This study aimed to develop a subject-specific scaled foot modelling workflow for the foot orthoses design based on the scanned foot surface data. Six participants (twelve feet) were collected for the foot finite element modelling. The subject-specific surface-based finite element model (SFEM) was established by incorporating the scanned foot surface and scaled foot bone geometries. The geometric deviations between the scaled and the scanned foot surfaces were calculated. The SFEM model was adopted to predict barefoot and foot-orthosis interface pressures. The averaged distances between the scaled and scanned foot surfaces were 0.23 ± 0.09 mm. There was no significant difference for the hallux, medial forefoot, middle forefoot, midfoot, medial hindfoot, and lateral hindfoot, except for the lateral forefoot region (p = 0.045). The SFEM model evaluated slightly higher foot-orthoses interface pressure values than measured, with a maximum deviation of 7.1%. These results indicated that the SFEM technique could predict the barefoot and foot-orthoses interface pressure, which has the potential to expedite the process of orthotic design and optimization.
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Affiliation(s)
- Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, 999077, SAR, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, 999077, SAR, China
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518057, China
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Qida Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Shane Fei Chen
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, 999077, SAR, China
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518057, China
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, 999077, SAR, China.
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518057, China.
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong, SAR, China.
| | - Guanglin Li
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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Su Z, Ding M, Zhu N, Cheung JCW, Wong DWC, Sun W, Ni M. Biomechanical role of bone grafting for calcaneal fracture fixation in the presence of bone defect: A finite element analysis. Clin Biomech (Bristol, Avon) 2024; 116:106278. [PMID: 38821036 DOI: 10.1016/j.clinbiomech.2024.106278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/28/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The purpose of this study was to compare the biomechanical stress and stability of calcaneal fixations with and without bone defect, before and after bone grafting, through a computational approach. METHODS A finite element model of foot-ankle complex was reconstructed, impoverished with a Sanders III calcaneal fracture without bone defect and with moderate and severe bone defects. Plate fixations with and without bone grafting were introduced with walking stance simulated. The stress and fragment displacement of the calcaneus were evaluated. FINDINGS Moderate and severe defect increased the calcaneus stress by 16.11% and 32.51%, respectively and subsequently decreased by 10.76% and 20.78% after bone grafting. The total displacement was increased by 3.99% and 24.26%, respectively by moderate and severe defect, while that of posterior joint facet displacement was 86.66% and 104.44%. The former was decreased by 25.73% and 35.96% after grafting, while that of the latter was reduced by 88.09% and 84.78% for moderate and severe defect, respectively. INTERPRETATION Our finite element prediction supported that bone grafting for fixation could enhance the stability and reduce the risk of secondary stress fracture in cases of bone defect in calcaneal fracture.
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Affiliation(s)
- Zhihao Su
- The Ninth People's Hospital of Wuxi Affiliated to Soochow University, Wuxi 214023, China; School of Medical Instrument, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China; Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
| | - Ming Ding
- The Ninth People's Hospital of Wuxi Affiliated to Soochow University, Wuxi 214023, China; School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China.
| | - Ning Zhu
- School of Medical Instrument, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China; Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Wanju Sun
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
| | - Ming Ni
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China; Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
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Kamal Z, Hekman EEG, Verkerke GJ. A combined musculoskeletal and finite element model of a foot to predict plantar pressure distribution. Biomed Phys Eng Express 2024; 10:035024. [PMID: 38277697 DOI: 10.1088/2057-1976/ad233d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/26/2024] [Indexed: 01/28/2024]
Abstract
In this study, a combined subject-specific numerical and experimental investigation was conducted to explore the plantar pressure of an individual. The research utilized finite element (FE) and musculoskeletal modelling based on computed tomography (CT) images of an ankle-foot complex and three-dimensional gait measurements. Muscle forces were estimated using an individualized multi-body musculoskeletal model in five gait phases. The results of the FE model and gait measurements for the same subject revealed the highest stress concentration of 0.48 MPa in the forefoot, which aligns with previously-reported clinical observations. Additionally, the study found that the encapsulated soft tissue FE model with hyper-elastic properties exhibited higher stresses compared to the model with linear-elastic properties, with maximum ratios of 1.16 and 1.88 MPa in the contact pressure and von-Mises stress, respectively. Furthermore, the numerical simulation demonstrated that the use of an individualized insole caused a reduction of 8.3% in the maximum contact plantar pressure and 14.7% in the maximum von-Mises stress in the encapsulated soft tissue. Overall, the developed model in this investigation holds potential for facilitating further studies on foot pathologies and the improvement of rehabilitation techniques in clinical settings.
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Affiliation(s)
- Zeinab Kamal
- Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Edsko E G Hekman
- Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Gijsbertus J Verkerke
- Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
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Zhou H, Xu D, Quan W, Ugbolue UC, Gu Y. Effects of different contact angles during forefoot running on the stresses of the foot bones: a finite element simulation study. Front Bioeng Biotechnol 2024; 12:1337540. [PMID: 38390360 PMCID: PMC10882086 DOI: 10.3389/fbioe.2024.1337540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction: The purpose of this study was to compare the changes in foot at different sole-ground contact angles during forefoot running. This study tried to help forefoot runners better control and improve their technical movements by comparing different sole-ground contact angles. Methods: A male participant of Chinese ethnicity was enlisted for the present study, with a recorded age of 25 years, a height of 183 cm, and a body weight of 80 kg. This study focused on forefoot strike patterns through FE analysis. Results: It can be seen that the peak von Mises stress of M1-5 (Metatarsal) of a (Contact angle: 9.54) is greater than that of b (Contact angle: 7.58) and c (Contact angle: 5.62) in the three cases. On the contrary, the peak von Mises stress of MC (Medial Cuneiform), IC (Intermediate Cuneiform), LC (Lateral Cuneiform), C (Cuboid), N (Navicular), T (Tarsal) in three different cases is opposite, and the peak von Mises stress of c is greater than that of a and b. The peak von Mises stress of b is between a and c. Conclusion: This study found that a reduced sole-ground contact angle may reduce metatarsal stress fractures. Further, a small sole-ground contact angle may not increase ankle joint injury risk during forefoot running. Hence, given the specialized nature of the running shoes designed for forefoot runners, it is plausible that this study may offer novel insights to guide their athletic pursuits.
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Affiliation(s)
- Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, University of the West of Scotland, Paisley, United Kingdom
| | - Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Wenjing Quan
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Ukadike Chris Ugbolue
- School of Health and Life Sciences, University of the West of Scotland, Paisley, United Kingdom
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Cen X, Song Y, Yu P, Sun D, Simon J, Bíró I, Gu Y. Effects of plantar fascia stiffness on the internal mechanics of idiopathic pes cavus by finite element analysis: implications for metatarsalgia. Comput Methods Biomech Biomed Engin 2023:1-9. [PMID: 37817665 DOI: 10.1080/10255842.2023.2268231] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023]
Abstract
Metatarsalgia occurring in individuals with pes cavus is typically associated with abnormal loading patterns in the forefoot resulting from structural alterations. Simultaneously, the frequent overstress of the plantar fascia (PF) caused by the persistence of this foot deformity may further exacerbate the chronic pain induced by metatarsal overload. We aimed to investigate and quantify the effects of PF stiffness on the internal biomechanics of pes cavus using a computational modelling approach. A patient-specific finite element model of the foot-ankle complex using the actual three-dimensional geometry of idiopathic pes cavus bones and soft tissues was reconstructed. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0-700 MPa) of the PF on the metatarsal stress distribution, and force transmission through the metatarsophalangeal (MTP) and tarsometatarsal (TMT) joints in the pes cavus. The results indicated that variations in PF stiffness led to stress redistribution in the metatarsal region. Peak stress gradually reduced with decreasing stiffness until the PF was released, eventually resulting in a reduction of 22.39% compared to the reference value of 350 MPa. Furthermore, adjusting the PF stiffness to twice the reference value (700 MPa) increased the contact forces through the TMT and MTP joints by up to 23% and 116%, respectively. The reduction of PF stiffness alleviated focal metatarsal loading, and therefore, surgical fascia release can be considered to alleviate metatarsalgia in patients with pes cavus.
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Affiliation(s)
- Xuanzhen Cen
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yang Song
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Peimin Yu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Dong Sun
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - János Simon
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - István Bíró
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Cheng ESW, Lai DKH, Mao YJ, Lee TTY, Lam WK, Cheung JCW, Wong DWC. Computational Biomechanics of Sleep: A Systematic Mapping Review. Bioengineering (Basel) 2023; 10:917. [PMID: 37627802 PMCID: PMC10451553 DOI: 10.3390/bioengineering10080917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Biomechanical studies play an important role in understanding the pathophysiology of sleep disorders and providing insights to maintain sleep health. Computational methods facilitate a versatile platform to analyze various biomechanical factors in silico, which would otherwise be difficult through in vivo experiments. The objective of this review is to examine and map the applications of computational biomechanics to sleep-related research topics, including sleep medicine and sleep ergonomics. A systematic search was conducted on PubMed, Scopus, and Web of Science. Research gaps were identified through data synthesis on variants, outcomes, and highlighted features, as well as evidence maps on basic modeling considerations and modeling components of the eligible studies. Twenty-seven studies (n = 27) were categorized into sleep ergonomics (n = 2 on pillow; n = 3 on mattress), sleep-related breathing disorders (n = 19 on obstructive sleep apnea), and sleep-related movement disorders (n = 3 on sleep bruxism). The effects of pillow height and mattress stiffness on spinal curvature were explored. Stress on the temporomandibular joint, and therefore its disorder, was the primary focus of investigations on sleep bruxism. Using finite element morphometry and fluid-structure interaction, studies on obstructive sleep apnea investigated the effects of anatomical variations, muscle activation of the tongue and soft palate, and gravitational direction on the collapse and blockade of the upper airway, in addition to the airflow pressure distribution. Model validation has been one of the greatest hurdles, while single-subject design and surrogate techniques have led to concerns about external validity. Future research might endeavor to reconstruct patient-specific models with patient-specific loading profiles in a larger cohort. Studies on sleep ergonomics research may pave the way for determining ideal spine curvature, in addition to simulating side-lying sleep postures. Sleep bruxism studies may analyze the accumulated dental damage and wear. Research on OSA treatments using computational approaches warrants further investigation.
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Affiliation(s)
- Ethan Shiu-Wang Cheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Department of Electronic and Information Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Derek Ka-Hei Lai
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Ye-Jiao Mao
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Timothy Tin-Yan Lee
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong
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Malakoutikhah H, de Cesar Netto C, Madenci E, Latt LD. Evaluation of assumptions in foot and ankle biomechanical models. Clin Biomech (Bristol, Avon) 2022; 100:105807. [PMID: 36370588 DOI: 10.1016/j.clinbiomech.2022.105807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND A variety of biomechanical models have been used in studies of foot and ankle disorders. Assumptions about the element types, material properties, and loading and boundary conditions are inherent in every model. It was hypothesized that the choice of these modeling assumptions could have a significant impact on the findings of the model. METHODS We investigated the assumptions made in a number of biomechanical models of the foot and ankle and evaluated their effects on the results of the studies. Specifically, we focused on: (1) element choice for simulation of ligaments and tendons, (2) material properties of ligaments, cortical and trabecular bones, and encapsulating soft tissue, (3) loading and boundary conditions of the tibia, fibula, tendons, and ground support. FINDINGS Our principal findings are: (1) the use of isotropic solid elements to model ligaments and tendons is not appropriate because it allows them to transmit unrealistic bending and twisting moments and compressive forces; (2) ignoring the difference in elastic modulus between cortical and trabecular bones creates non-physiological stress distribution in the bones; (3) over-constraining tibial motion prevents anticipated deformity within the foot when simulating foot deformities, such as progressive collapsing foot deformity; (4) neglecting the Achilles tendon force affects almost all kinetic and kinematic parameters through the foot; (5) the axial force applied to the tibia and fibula is not equal to the ground reaction force due to the presence of tendon forces. INTERPRETATION The predicted outcomes of a foot model are highly sensitive to the model assumptions.
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Affiliation(s)
- Hamed Malakoutikhah
- Department of Aerospace and Mechanical Engineering, University of Arizona, Tucson, AZ, USA.
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
| | - Erdogan Madenci
- Department of Aerospace and Mechanical Engineering, University of Arizona, Tucson, AZ, USA.
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Xu Z, Sun W, Li P, Wang Y, Wong DWC, Cheung JCW, Niu W, Zhang H, Ni M. Modified Ni-Nail and C-Nail systems for intra-articular fractures of the calcaneus: A biomechancial study. Injury 2022; 53:3904-3911. [PMID: 36182591 DOI: 10.1016/j.injury.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We have proposed a novel intramedullary nail (Ni-Nail) by incorporating a sustentaculum tali screw to improve the fixation stability of minimally invasive treatment for calcaneal fractures. This study aimed to evaluate the biomechanical characters of the Ni-Nail system and compare it with traditional C-Nail system. METHODS A finite element model of a Sanders type-IIIAB calcaneal fracture was reconstructed and fixed using two intramedullary nail systems, which was validated by a cadaver study. A vertical loading of 700 N was applied to the subtalar joint surfaces, and 525 N Achilles tendon tension was applied to the superior border of the Achilles tuberosity. The von Mises stresses and fracture displacements of both fixation models were evaluated. RESULTS The maximum von Mises stress of the screws of Ni-Nail and C-Nail were 27.92 MPa and 57.42 MPa, respectively, while that of the main nail were 67.44 MPa and 53.01 MPa. In addition, the maximum fracture displacement of the Ni-Nail was larger than that of C-Nail by 15.6% (0.37 mm vs.0.32 mm). CONCLUSIONS Our static simulation analysis showed that both Ni-Nail and C-Nail demonstrated similar biomechanical stability for calcaneal fixation. The Ni-Nail features a simple structure that is easier to operate and less traumatizing. Future studies may consider to further evaluate the clinical effectiveness by clinical trials and follow-ups.
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Affiliation(s)
- Zihuan Xu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Wanju Sun
- Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China
| | - Pengfei Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yongqin Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Wenxin Niu
- Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai 201619 China; Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Haowei Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Ming Ni
- Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China; Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Chhikara K, Singh G, Gupta S, Chanda A. Progress of Additive Manufacturing in Fabrication of Foot Orthoses for Diabetic Patients: A Review. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Song Y, Shao E, Bíró I, Baker JS, Gu Y. Finite element modelling for footwear design and evaluation: A systematic scoping review. Heliyon 2022; 8:e10940. [PMID: 36247144 PMCID: PMC9563159 DOI: 10.1016/j.heliyon.2022.e10940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/04/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Finite element modelling has become an efficient tool for an in-depth understanding of the foot, footwear biomechanics and footwear optimization. The aim of this paper was to provide an updated overview in relation to the footwear finite element (FE) analysis published since 2000. The paper will attempt to outline the main challenges and research gaps that need confronting in the further development of realistic and accurate models for clinical and industrial applications. English databases of the Web of Science and PubMed were used to search (‘finite element’ OR ‘FEA’ OR ‘computational model’) AND (‘shoe’ OR ‘footwear’) until 16 December 2021. Articles that conducted FE analyses on the whole foot and footwear structures were included in this review. Twelve articles met the eligibility criteria, and were grouped into three categories for further analysis, (1) finite element modelling of the foot and high-heeled shoes; (2) finite element modelling of the foot and boot; (3) finite element modelling of the foot and sports shoe. Even though most of the existing foot-shoe FE analyses were performed under certain simplifications and assumptions, they have provided essential contributions in identifying the mechanical response of the foot in casual or athletic footwear. Further to this, the results have provided information in relation to optimizing footwear design to enhance functional performance. Nevertheless, further simulations still present several challenges, including reliable data information for geometry reconstruction, the balance between accurate details and computational cost, accurate representations of material properties, realistic boundary and loading conditions, and thorough model validation. In addition, some research gaps in terms of the coverage of footwear design, the consideration of insole/orthosis and socks, and the internal and external validity of the FE design should be fully covered.
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Affiliation(s)
- Yang Song
- Faculty of Sports Science, Ningbo University, Ningbo, China,Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary,Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Enze Shao
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - István Bíró
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary,Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Julien Steven Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China,Corresponding author.
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11
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Peng Y, Wang Y, Wong DWC, Chen TLW, Chen SF, Zhang G, Tan Q, Zhang M. Different Design Feature Combinations of Flatfoot Orthosis on Plantar Fascia Strain and Plantar Pressure: A Muscle-Driven Finite Element Analysis With Taguchi Method. Front Bioeng Biotechnol 2022; 10:853085. [PMID: 35360398 PMCID: PMC8960448 DOI: 10.3389/fbioe.2022.853085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
Customized foot orthosis is commonly used to modify foot posture and relieve foot pain for adult acquired flexible flatfoot. However, systematic investigation of the influence of foot orthotic design parameter combination on the internal foot mechanics remains scarce. This study aimed to investigate the biomechanical effects of different combinations of foot orthoses design features through a muscle-driven flatfoot finite element model. A flatfoot-orthosis finite element model was constructed by considering the three-dimensional geometry of plantar fascia. The plantar fascia model accounted for the interaction with the bulk soft tissue. The Taguchi approach was adopted to analyze the significance of four design factors combination (arch support height, medial posting inclination, heel cup height, and material stiffness). Predicted plantar pressure and plantar fascia strains in different design combinations at the midstance instant were reported. The results indicated that the foot orthosis with higher arch support (45.7%) and medial inclination angle (25.5%) effectively reduced peak plantar pressure. For the proximal plantar fascia strain, arch support (41.8%) and material stiffness (37%) were strong influencing factors. Specifically, higher arch support and softer material decreased the peak plantar fascia strain. The plantar pressure and plantar fascia loading were sensitive to the arch support feature. The proposed statistics-based finite element flatfoot model could assist the insole optimization and evaluation for individuals with flatfoot.
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Affiliation(s)
- Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Shane Fei Chen
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Guoxin Zhang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Qitao Tan
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
- *Correspondence: Ming Zhang,
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Lv ML, Ni M, Sun W, Wong DWC, Zhou S, Jia Y, Zhang M. Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures. Front Bioeng Biotechnol 2022; 10:791554. [PMID: 35356772 PMCID: PMC8959616 DOI: 10.3389/fbioe.2022.791554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022] Open
Abstract
The development of minimally invasive procedures and implant materials has improved the fixation strength of implants and is less traumatic in surgery. The purpose of this study was to propose a novel “double-point fixation” for calcaneal fractures and compare its biomechanical stability with the traditional “three-point fixation.” A three-dimensional finite element foot model with a Sanders type IIIAB calcaneal fracture was developed based on clinical images comprising bones, plantar fascia, ligaments, and encapsulated soft tissue. Double-point and three-point fixation resembled the surgical procedure with a volar distal radius plate and calcaneal locking plate, respectively. The stress distribution, fracture displacement, and change of the Böhler angle and Gissane’s angle were estimated by a walking simulation using the model, and the predictions between the double-point and three-point fixation were compared at heel-strike, midstance, and push-off instants. Double-point fixation demonstrated lower bone stress (103.3 vs. 199.4 MPa), but higher implant stress (1,084.0 vs. 577.9 MPa). The model displacement of double-point fixation was higher than that of three-point fixation (3.68 vs. 2.53 mm). The displacement of the posterior joint facet (0.127 vs. 0.150 mm) and the changes of the Böhler angle (0.9° vs. 1.4°) and Gissane’s angle (0.7° vs. 0.9°) in double-point fixation were comparably lower. Double-point fixation by volar distal radius plates demonstrated sufficient and favorable fixation stability and a lower risk of postoperative stress fracture, which may potentially serve as a new fixation modality for the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Ming Ni
- Department of Orthopedics, Pudong New Area People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Wanju Sun
- Department of Orthopedics, Pudong New Area People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Shuren Zhou
- School of Computer and Communication Engineering, Changsha University of Science and Technology, Changsha, China
| | - Yongwei Jia
- Department of Spine Surgery, Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Yongwei Jia,
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Wu J, Liu H, Xu C. Biomechanical Effects of Graft Shape for the Evans Lateral Column Lengthening Procedure: A Patient-Specific Finite Element Investigation. Foot Ankle Int 2022; 43:404-413. [PMID: 34549634 DOI: 10.1177/10711007211043822] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Evans calcaneal lengthening osteotomy procedure is widely used for correcting progressive collapsing foot deformity. However, it can result in overcorrection and degenerations of the calcaneocuboid joint. Different shapes of graft have been used in the Evans calcaneal osteotomy, but potential differences in their biomechanical effects is still unclear. The present study was designed to explore the biomechanical effects of graft shape and improve the Evans procedure to avoid or minimize detrimental effects. METHODS Twelve patient-specific finite element models were established and validated. A triangular or rectangular wedge of varying size was inserted at the lateral edge of calcaneus, and the degree of correction was quantified. The stress in spring ligaments and plantar fascia and the contact characteristics of the talonavicular and calcaneocuboid joints were calculated and compared accordingly. RESULTS The rectangular graft provided a much higher degree of correction than triangular grafts did. However, the contact characteristics of the calcaneocuboid joint and talonavicular joint were abnormal, with clear sensitivity to increased graft size, and the modeled strain of the spring ligament increased. CONCLUSION The finite element analysis predicts that the rectangular grafts provide a higher degree of correction, but risks overcorrection compared with triangular grafts. The triangular graft may have a lower degree of disturbance to the biomechanical behaviors of the midtarsal joint. CLINICAL RELEVANCE The model shows that both the shape and size of an Evans osteotomy bone wedge can have effects on the contiguous joints and ligamentous structures. Those effects should be considered when selecting a bone wedge for an Evans calcaneal osteotomy. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Jiajun Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Can Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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Zhang Q, Zhang Y, Huang J, Teo EC, Gu Y. Effect of Displacement Degree of Distal Chevron Osteotomy on Metatarsal Stress: A Finite Element Method. BIOLOGY 2022; 11:127. [PMID: 35053125 PMCID: PMC8772834 DOI: 10.3390/biology11010127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2-4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2-4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient's age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.
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Affiliation(s)
- Qiaolin Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Ee Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
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Caggiari G, Talesa GR, Toro G, Jannelli E, Monteleone G, Puddu L. What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. J Orthop Traumatol 2021; 22:51. [PMID: 34878594 PMCID: PMC8655046 DOI: 10.1186/s10195-021-00616-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/27/2021] [Indexed: 02/08/2023] Open
Abstract
Energy spent during daily activities is recuperated by humans through sleep, ensuring optimal performance on the following day. Sleep disturbances are common: a meta-analysis on sleep quality showed that 15–30% of adults report sleep disorders, such as sleep onset latency (SOL), insufficient duration of sleep and frequently waking up at night. Low back pain (LBP) has been identified as one of the main causes of poor sleep quality. Literature findings are discordant on the type of mattress that might prevent onset of back pain, resulting in an improved quality of sleep. We conducted a systematic literature review of articles published until 2019, investigating the association of different mattresses with sleep quality and low back pain. Based on examined studies, mattresses were classified according to the European Committee for Standardization (2000) as: soft, medium-firm, extra-firm or mattresses customized for patients affected by supine decubitus. A total of 39 qualified articles have been included in the current systematic review. Results of this systematic review show that a medium-firm mattress promotes comfort, sleep quality and rachis alignment.
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Affiliation(s)
- Gianfilippo Caggiari
- Orthopaedic and Traumatology Department, Università degli Studi di Sassari, 07100, Sassari, Italy.
| | - Giuseppe Rocco Talesa
- Orthopaedic and Traumatologic Clinic, University of Perugia, Santa Maria della Misericordia Hospital, 06129, Perugia, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Eugenio Jannelli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100, Pavia, Italy
| | - Gaetano Monteleone
- Orthopaedic, Trauma and Spine Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, AOU Policlinico Consorziale, University of Bari "Aldo Moro", 70100, Bari, Italy
| | - Leonardo Puddu
- Orthopaedic and Traumatology Department, Rovereto - Arco Hospital, 38068, Rovereto, Italy
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Wong DWC, Chen TLW, Peng Y, Lam WK, Wang Y, Ni M, Niu W, Zhang M. An instrument for methodological quality assessment of single-subject finite element analysis used in computational orthopaedics. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100067] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Analysis of the main soft tissue stress associated with flexible flatfoot deformity: a finite element study. Biomech Model Mechanobiol 2021; 20:2169-2177. [PMID: 34331169 DOI: 10.1007/s10237-021-01500-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/25/2021] [Indexed: 01/01/2023]
Abstract
A better understanding of soft tissue stress and its role in supporting the medial longitudinal arch in flexible flatfoot could help to guide the clinical treatment. In this study, a 3-Dimensional finite element (FE) foot model was reconstructed to measure the stress of the soft tissue, and its variation in different scenarios related to flexible flatfoot. All bones, cartilages, ligaments and related tendons around the ankle, and fat pad were included in the finite element model. The equivalent stress on the articular surface of the joints in the medial longitudinal arch and the maximum principal stress of the ligaments around the ankle were obtained. The results show that the plantar fascia (PF) is the main tissue in maintaining the medial longitudinal arch. The equivalent stress of all the joints in the medial longitudinal arch increases when the PF attenuation and the talonavicular joint increases, while other joints decreases when all the three tissue attenuation. Moreover, the maximum principal stress variation of calcaneofibular ligament is largest when the PF attenuation and the tibionavicular ligament and posterior tibiotalar ligament are largest when the posterior tibial tendon (PTT) attenuation. The maximum principal stress variation of tibionavicular ligament and posterior tibiotalar ligament are even larger when all the three tissue attenuation. These findings support that the PF is the main factor in maintaining the medial longitudinal arch. The medial longitudinal arch collapse mainly affects the talonavicular joint and the calcaneofibular ligament, the tibionavicular ligament and the posterior tibiotalar ligament. This approach could help to improve the understanding of adult-acquired flatfoot deformity (AAFD).
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Tarrade T, Dakhil N, Behr M, Salin D, Llari M. Real-Time Analysis of the Dynamic Foot Function: A Machine Learning and Finite Element Approach. J Biomech Eng 2021; 143:041005. [PMID: 33156350 DOI: 10.1115/1.4049024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Indexed: 11/08/2022]
Abstract
Finite element analysis (FEA) has been widely used to study foot biomechanics and pathological functions or effects of therapeutic solutions. However, development and analysis of such foot modeling is complex and time-consuming. The purpose of this study was therefore to propose a method coupling a FE foot model with a model order reduction (MOR) technique to provide real-time analysis of the dynamic foot function. A generic and parametric FE foot model was developed and dynamically validated during stance phase of gait. Based on a design of experiment of 30 FE simulations including four parameters related to foot function, the MOR method was employed to create a prediction model of the center of pressure (COP) path that was validated with four more random simulations. The four predicted COP paths were obtained with a 3% root-mean-square-error (RMSE) in less than 1 s. The time-dependent analysis demonstrated that the subtalar joint position and the midtarsal joint laxity are the most influential factors on the foot functions. These results provide additionally insight into the use of MOR technique to significantly improve speed and power of the FE analysis of the foot function and may support the development of real-time decision support tools based on this method.
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Affiliation(s)
- Tristan Tarrade
- Laboratoire de Biomécanique Appliquée, Faculté de Médecine secteur Nord, Aix-Marseille Univ., Univ. Gustave Eiffel, IFSTTAR, LBA, UMR T24, 51 Boulevard Pierre Dramard, Marseille cedex 20 F-13016, France; Podo 3D, 1 Rue Chappe, Les Mureaux 78130, France
| | - Nawfal Dakhil
- Technical Institute of Dewaniya, Al-Furat Al-Awsat Technical University-Kufa, Babylon-najaf Street, Al-Kuf 54003, Iraq
| | - Michel Behr
- Laboratoire de Biomécanique Appliquée, Faculté de Médecine secteur Nord, Aix-Marseille Univ., Univ. Gustave Eiffel, IFSTTAR, LBA, UMR T24, 51 Boulevard Pierre Dramard, Marseille cedex 20 F-13016, France
| | - Dorian Salin
- CADLM, 32 Rue Victor Baloche, Wissous 91320, France
| | - Maxime Llari
- Laboratoire de Biomécanique Appliquée, Faculté de Médecine secteur Nord, Aix-Marseille Univ, Univ Gustave Eiffel, IFSTTAR, LBA, UMR T24, Laboratoire de Biomécanique Appliquée, 51 Boulevard Pierre Dramard, Marseille cedex 20 F-13016, France
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Peng Y, Wong DWC, Chen TLW, Wang Y, Zhang G, Yan F, Zhang M. Influence of arch support heights on the internal foot mechanics of flatfoot during walking: A muscle-driven finite element analysis. Comput Biol Med 2021; 132:104355. [PMID: 33812264 DOI: 10.1016/j.compbiomed.2021.104355] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/05/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Different arch support heights of the customized foot orthosis could produce different effects on the internal biomechanics of the foot. However, quantitative evidence is scarce. Therefore, we aimed to investigate and quantify the influence of arch support heights on the internal foot biomechanics during walking stance. METHODS We reconstructed a foot finite element model from a volunteer with flexible flatfoot. The model enabled a three-dimensional representation of the plantar fascia and its interactions with surrounding osteotendinous structures. The volunteer walked in foot orthosis with different arch heights (low, neutral, and high). Muscle forces during gaits were calculated by a multibody model and used to drive a foot finite element model. The foot contact pressures and plantar fascia strains in different regions were compared among the insole conditions at the first and second vertical ground reaction force (VGRF) peak and VGRF valley instants. RESULTS The results indicated that peak foot pressures decreased in balanced standing and second VGRF as the arch support height increased. However, peak midfoot pressures increased during all simulated instants. Meanwhile, high arch support decreased the plantar fascia loading by 5%-15.4% in proximal regions but increased in the middle and distal regions. CONCLUSION Although arch support could generally decrease the plantar foot pressure and plantar fascia loading, the excessive arch height may induce high midfoot pressure and loadings at the central portion of the plantar fascia. The consideration of fascia-soft tissue interaction in modeling could improve the prediction of plantar fascia strains towards design optimization for orthoses.
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Affiliation(s)
- Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Guoxin Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fei Yan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
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20
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Computational models of flatfoot with three-dimensional fascia and bulk soft tissue interaction for orthosis design. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2020.100050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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21
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Lv ML, Zhang H, Chen L, Liu Y, Wang F, Wong DWC, Sun L, Ni M. Finite element method based parametric study of Gastrocnemius-soleus recession: implications to the treatment of midfoot-forefoot overload syndrome. Comput Methods Biomech Biomed Engin 2020; 24:913-921. [PMID: 33320018 DOI: 10.1080/10255842.2020.1858817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gastrocnemius-soleus recession has been used to treat midfoot-forefoot overload syndrome and plantar fasciitis induced by equinus of the ankle joint. A controlled and selective amount of recession is imperative to maintain muscle strength and stability. The objective of this study was to conduct a parametric study to quantify the relationship between the level of recession and plantar fascia stress. A finite element model of the foot-ankle-shank complex was reconstructed from magnetic resonance and computed tomography images of a 63-year-old normal female. The model was validated by comparing modeled stresses to the measured plantar pressure distribution of the model participant during balanced standing. The midstance and push-off instants of walking stance were simulated with different levels and combinations of gastrocnemius-soleus recession resembled by different amounts of muscle forces. Halving the muscle forces at midstance reduced the average plantar fascia stress by a quarter while reducing two-third of the muscle forces at push-off reduced the average fascia stress by 18.2%. While the first ray of the plantar fascia experienced the largest stress among the five fasciae, the stress was reduced by 77.8% and 16.9% when the load was halved and reduced by two-third at midstance and push-off instants, respectively. Reduction in fascia stress implicates a lower risk of plantar fasciitis and other midfoot-forefoot overload syndromes. The outcome of this study can aid physicians to determine the amount of gastrocnemius-soleus recession towards patients with vdifferent levels of plantar fascia overstress. A detailed three-dimensional modelling on the plantar fascia is warranted in future study.
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Affiliation(s)
- Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Department of Mechanical Engineering, University of Houston, Houston, TX, USA
| | - Haowei Zhang
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Liang Chen
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Ying Liu
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Fei Wang
- Department of Mechanical Engineering, University of Houston, Houston, TX, USA
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Li Sun
- Department of Mechanical Engineering, University of Houston, Houston, TX, USA
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples' Hospital, affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
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Zhang H, Lv ML, Liu Y, Sun W, Niu W, Wong DWC, Ni M, Zhang M. Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: Implications to early weight-bearing rehabilitation. Clin Biomech (Bristol, Avon) 2020; 80:105143. [PMID: 32829234 DOI: 10.1016/j.clinbiomech.2020.105143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/13/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive fixation using crossing screws was believed to produce satisfactory clinical outcome whereas its stability in early weight-bearing remained controversial. This study aimed to analyze the biomechanical stability of minimally invasive fixation during balanced standing and walking stance, and provide evidence for early rehabilitation. METHODS A finite element model of foot-ankle-shank complex was reconstructed based on computed tomography and magnetic resonance images, and validated by plantar pressure of the model participant. A Sanders III calcaneal fracture was created on the model, and then fixed using crossing screws. The predicted stress distribution, fracture displacement, Bohler's angle and Gissane's angle were compared between the intact calcaneus and fracture model with the fixation. FINDINGS Postoperatively, the concentrated stress appeared at the junction of the calcaneus and its surrounding tissues (especially Achilles tendon, plantar fascia and ligaments) during standing and walking stances, and the stress exceeded the yield strength of trabecular bone. The longitudinal screws sustained the highest stresses and concentrated at the tips and the calcaneal tuberosity junction. The displacement of posterior joint facet, Bohler's angle, and Gissane's angle were within the acceptable range either standing or walking after the fixation. INTERPRETATION Early weight-bearing standing and walking after minimally invasive fixation may cause high stress concentration thereby induce calcaneus stress fractures and other complications like plantar fasciitis and heel pain, so it should not be supported. The peri-calcaneus tendons, i.e., Achilles tendon and plantar fascia, play key roles in the stabilization of the calcaneal fracture after operation.
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Affiliation(s)
- Haowei Zhang
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yin Liu
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Wanju Sun
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201299, China
| | - Wenxin Niu
- Department of Rehabilitation, Medical College of Tongji University, Shanghai 200092, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201299, China.
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
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Wong DWC, Wang Y, Chen TLW, Yan F, Peng Y, Tan Q, Ni M, Leung AKL, Zhang M. Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion). Front Bioeng Biotechnol 2020; 8:571192. [PMID: 33015022 PMCID: PMC7505935 DOI: 10.3389/fbioe.2020.571192] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Hallux valgus is a common foot problem affecting nearly one in every four adults. Generalized ligament laxity was proposed as the intrinsic cause or risk factor toward the development of the deformity which was difficult to be investigated by cohort clinical trials. Herein, we aimed to evaluate the isolated influence of generalized ligament laxity on the deterioration using computer simulation (finite element analysis). We reconstructed a computational foot model from a mild hallux valgus participant and conducted a gait analysis to drive the simulation of walking. Through parametric analysis, the stiffness of the ligaments was impoverished at different degrees to resemble different levels of generalized ligament laxity. Our simulation study reported that generalized ligament laxity deteriorated hallux valgus by impairing the load-bearing capacity of the first metatarsal, inducing higher deforming force, moment and malalignment at the first metatarsophalangeal joint. Besides, the deforming moment formed a deteriorating vicious cycle between hallux valgus and forefoot abduction and may result in secondary foot problems, such as flatfoot. However, the metatarsocuneiform joint did not show a worsening trend possibly due to the overriding forefoot abduction. Controlling the deforming load shall be prioritized over the correction of angles to mitigate deterioration or recurrence after surgery.
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Affiliation(s)
- Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fei Yan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qitao Tan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples’ Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Aaron Kam-Lun Leung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
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Cifuentes-De la Portilla C, Pasapula C, Larrainzar-Garijo R, Bayod J. Finite element analysis of secondary effect of midfoot fusions on the spring ligament in the management of adult acquired flatfoot. Clin Biomech (Bristol, Avon) 2020; 76:105018. [PMID: 32413775 DOI: 10.1016/j.clinbiomech.2020.105018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/22/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical treatment of adult acquired flatfoot deformity can involve arthrodesis of the midfoot to stabilize the medial column. Few experimental studies have assessed the biomechanical effects of these fusions, because of the difficulty of measuring these parameters in cadavers. Our objective was to quantify the biomechanical stress caused by various types of midfoot arthrodesis on the Spring ligament. To date this is not known. METHODS An innovative finite element model was used to evaluate flatfoot scenarios treated with various combinations of midfoot arthrodesis. All the bones, cartilages and tissues related to adult acquired flatfoot deformity were included, respecting their biomechanical characteristics. The stress changes on the Spring ligament were quantified. Both foot arch lengthening and falling were measured for each of the midfoot arthrodeses evaluated. FINDINGS Arthrodesis performed for stabilization of the talonavicular joint leads to a higher decrease in stress on the Spring ligament. Talonavicular fusion generated a Spring ligament stress decrease of about 61% with respect to the reference case (without any fusion). However, fusing the naviculocuneiform joints leads to an increase in the stress on the Spring ligament. INTERPRETATION This important finding has been unknown to date. We advocate caution regarding fusion of the naviculocuneiform joint as it leads to increased stresses across the Spring ligament and therefore accelerates the development of planovalgus.
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Affiliation(s)
| | | | - Ricardo Larrainzar-Garijo
- Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain.
| | - Javier Bayod
- Orthopaedics and Trauma Department, Surgery Department - Hospital Universitario Infanta Leonor, Madrid, Spain
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Cifuentes-De la Portilla C, Larrainzar-Garijo R, Bayod J. Analysis of biomechanical stresses caused by hindfoot joint arthrodesis in the treatment of adult acquired flatfoot deformity: A finite element study. Foot Ankle Surg 2020; 26:412-420. [PMID: 31138491 DOI: 10.1016/j.fas.2019.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Treatments of adult acquired flatfoot deformity in early stages (I-IIa-IIb) are focused on strengthening tendons, in isolation or combined with osteotomies, but in stage III, rigidity of foot deformity requires more restrictive procedures such as hindfoot joint arthrodesis. Few experimental studies have assessed the biomechanical effects of these treatments, because of the difficulty of measuring these parameters in cadavers. Our objective was to quantify the biomechanical stress caused by both isolated hindfoot arthrodesis and triple arthrodesis on the main tissues that support the plantar arch. METHODS An innovative finite element model was used to evaluate some flatfoot scenarios treated with isolated hindfoot arthrodesis and triple arthrodesis. RESULTS AND CONCLUSIONS When arthrodeses are done in situ, talonavicular seems a good option, possible superior to subtalar and at least equivalent to triple. Calcaneocuboid arthrodesis reduces significantly both fascia plantar and spring ligament stresses but concentrates higher stresses around the fused joint.
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Affiliation(s)
- Christian Cifuentes-De la Portilla
- Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain; Facultad de Ciencias Médicas, Universidad Espíritu Santo, Ecuador
| | - Ricardo Larrainzar-Garijo
- Orthopaedics and Trauma Department, Medicine School, Universidad Complutense Hospital Universitario Infanta Leonor, Madrid, Spain.
| | - Javier Bayod
- Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain
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Immediate Effects of Medially Posted Insoles on Lower Limb Joint Contact Forces in Adult Acquired Flatfoot: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072226. [PMID: 32224985 PMCID: PMC7178021 DOI: 10.3390/ijerph17072226] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022]
Abstract
Flatfoot is linked to secondary lower limb joint problems, such as patellofemoral pain. This study aimed to investigate the influence of medial posting insoles on the joint mechanics of the lower extremity in adults with flatfoot. Gait analysis was performed on fifteen young adults with flatfoot under two conditions: walking with shoes and foot orthoses (WSFO), and walking with shoes (WS) in random order. The data collected by a vicon system were used to drive the musculoskeletal model to estimate the hip, patellofemoral, ankle, medial and lateral tibiofemoral joint contact forces. The joint contact forces in WSFO and WS conditions were compared. Compared to the WS group, the second peak patellofemoral contact force (p < 0.05) and the peak ankle contact force (p < 0.05) were significantly lower in the WSFO group by 10.2% and 6.8%, respectively. The foot orthosis significantly reduced the peak ankle eversion angle (p < 0.05) and ankle eversion moment (p < 0.05); however, the peak knee adduction moment increased (p < 0.05). The reduction in the patellofemoral joint force and ankle contact force could potentially inhibit flatfoot-induced lower limb joint problems, despite a greater knee adduction moment.
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Finite element analysis of subtalar joint arthroereisis on adult-acquired flexible flatfoot deformity using customised sinus tarsi implant. J Orthop Translat 2020; 27:139-145. [PMID: 33981572 PMCID: PMC8071640 DOI: 10.1016/j.jot.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Subtalar arthroereisis may cause sinus tarsi pain complications. In this study, we aimed to introduce a customised implant that facilitated treatment effect and less impingement. The biomechanical outcome between the intact and implant conditions was compared using finite element analysis. Methods A female patient with flatfoot (age: 36 years, height: 156 cm, body mass: 51 kg) was recruited as the model patient. The customised implant was designed from the extracted geometry. Boundary and loading conditions were assumed from the data of a normal participant. Four gait instants, including the ground reaction force first peak (25% stance), valley (45%), initial push-off (60%) and second peak (75%) were analyzed. Results The navicular height was elevated by 4.2% at 25% stance, whereas the strain of the spring, plantar cuneonavicular and plantar cuboideonavicular ligaments were reduced. The talonavicular joint force decreased and the calcaneocuboid joint increased by half and 67%, respectively, representing a lateralised load pathway. There was a stress concentration at the sulcus tali reaching 15.29 MPa Conclusion Subtalar arthroereisis using a customised implant may produce some positive treatment effects in terms of navicular height elevation, ligament strain relief and lateralised joint loading pathway. Although the concentrated stress at the sulcus tali did not exceed the threshold of bone breakdown, we could not rule out the potential of vascular disturbance owing to the remarkable elevation of stress. Future study may enlarge the contact area of the bone–implant interface by considering customisation based on the dynamic change of the sinus tarsi during walking gait. The translational potential of this article Geometry mismatch of prefabricated implants could be the reason for complications. With the advancement of 3D printing, customising implant becomes possible and may improve treatment outcome. This study implemented a theoretical model approach to explore its potential under a simulation of walking.
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Palazzi E, Siegler S, Balakrishnan V, Leardini A, Caravaggi P, Belvedere C. Estimating the stabilizing function of ankle and subtalar ligaments via a morphology-specific three-dimensional dynamic model. J Biomech 2020; 98:109421. [PMID: 31653506 DOI: 10.1016/j.jbiomech.2019.109421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/05/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Knowledge of the stabilizing role of the ankle and subtalar ligaments is important for improving clinical techniques such as ligament repair and reconstruction. However, this knowledge is incomplete. The goal of this study was to expand this knowledge by investigating the stabilizing function of the ligaments using multiple morphologically subject-specific computational models. Nine models were created from the lower extremities of nine donors. Each model consisted of the articulating bones, articular cartilage, and ligaments. Simulations were conducted in ADAMS™ - a dynamic simulation program. During simulation, tibia and fibula were fixed while cyclic moments in all three anatomical planes were applied to the calcaneus one-at-a-time. The resulting displacements between the bones and the forces in each ligament were computed. Simulations were conducted with all ligaments intact and after simulated ligament serial sectioning. Each model was validated by comparing the simulation results to experimental data obtained from the specimen used to construct the model. From the results the stabilizing role of each ligament was established and the effect of ligament sectioning on Range of Motion and Overall Laxity was identified. On the lateral side, ATFL provided stabilization in supination, CFL restrained inversion, external rotation and dorsiflexion and PTFL limited dorsiflexion and external rotation. On the medial side, PTTL restrained dorsiflexion and internal rotation, ATTL limited plantarflexion and external rotation, and TCL limited dorsiflexion, eversion and external rotation. At the subtalar joint, ITCL limited plantarflexion and its posterior-lateral bundle restrained subtalar inversion. CL restrained plantarflexion/dorsiflexion, and internal and external rotation. The large inter-model variability observed in the results indicate the importance of using multiple subject-specific models rather than relying on one "representative" model.
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Affiliation(s)
- Emanuele Palazzi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Industrial Engineering, University of Bologna, Italy; Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA.
| | | | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Zhang Y, Chen Z, Zhao H, Liang X, Sun C, Jin Z. Musculoskeletal modeling of total ankle arthroplasty using force-dependent kinematics for predicting in vivo joint mechanics. Proc Inst Mech Eng H 2019; 234:210-222. [PMID: 31752588 DOI: 10.1177/0954411919890724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In vivo load and motion in the ankle joint play a key role in the understanding of the failure mechanism and function outcomes of total ankle arthroplasty. However, a thorough understanding of the biomechanics of the ankle joint in daily activities is lacking. The objective of this study was to develop a novel lower extremity musculoskeletal multibody dynamics model with total ankle arthroplasty considering the 6 degrees of freedom of the ankle joint motions and the deformable contact mechanics of the implant, based on force-dependent kinematics method. A patient who underwent total ankle arthroplasty surgery was considered. The walking gait data of the patient was measured in a gait laboratory and used as the input for the patient-specific musculoskeletal modeling. The predictions from the musculoskeletal model of total ankle arthroplasty included dorsiflexion-plantar flexion, inversion-eversion, internal-external rotation, anterior-posterior translation, inferior-superior translation, and medial-lateral translation of the tibiotalar joint, the ankle contact forces, the muscle activations, and the ligament forces. The magnitudes and tendencies of the predicted results were all within reasonable ranges, as compared with the data available in the literature. The predicted peak total ankle contact force was 6.55 body weight. In addition, the peak contact forces of the lateral and medial compartments were 4.22 body weight and 2.59 body weight, respectively. This study provides a potential new platform for the design of a better ankle prosthesis, the improvement of the operation techniques of the clinicians, and the accelerated postoperative recovery of the patients.
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Affiliation(s)
- Yanwei Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang'an University, Xi'an, China
| | - Hongmou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaojun Liang
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Cheng Sun
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, China.,Xi'an Medical University, Xi'an, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China.,Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Chen TLW, Wong DWC, Peng Y, Zhang M. Prediction on the plantar fascia strain offload upon Fascia taping and Low-Dye taping during running. J Orthop Translat 2019; 20:113-121. [PMID: 31908942 PMCID: PMC6938939 DOI: 10.1016/j.jot.2019.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background Taping is commonly prescribed to treat plantar fasciitis for runners by virtue of its alleged ability to offload the plantar fascia and facilitate positive injury prognosis. Our study aimed to investigate how different taping methods could change the loading on the plantar fascia during running using computational simulations. Methods A finite element foot model was modified from a previous version to fit the study's purpose. The model featured twenty bones, bulk soft tissue, foot muscles, ligaments/tendons, and a solid part representing the plantar fascia. A runner performed several running trials under one untaped condition and two taped conditions—Low-Dye taping and Fascia taping, which were implemented by a physiotherapist using the Kinesio tapes. The captured motion data were processed to drive a scaled musculoskeletal model and calculate segmental kinematics, foot muscle force, and joint reaction force. These variables were then input as the boundary/loading conditions for finite element analyses of running. The principal tensile strain on the plantar fascia, subtalar eversion, and navicular height during the stance phase were averaged across five trials of each condition and compared using Friedman's test. Results Maximal subtalar eversion did not differ among conditions (p = 0.449). Fascia taping significantly reduced maximal strains on the fascia band (p = 0.034, Kendall's W = 0.64–0.76) and increased the navicular height (p = 0.013, Kendall's W = 0.84) compared with nontaping. There were no significant differences in all outcome variables between Low-Dye taping and nontaping (p = 0.173–0.618). Conclusion From a mechanical point of view, our study provided quantitative evidence to support the application of taping treatments for overstrained plantar fascia. The untensed fascia band by Fascia taping could be a potential indicator of pain relief for the runners. However, a prospective study targeting the patient population would be needed to address the point. The Translational Potential of this Article The study quantified the loading status of the plantar fascia during running and provided mechanical evidence to support the usage of taping as a mean to reduce fascial strain, thus possibly controlling injury risks for the runners. The results of the study also highlighted the importance of selecting specific taping methods based on individuals' needs.
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Affiliation(s)
- Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
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Ni M, Wong DWC, Niu W, Wang Y, Mei J, Zhang M. Biomechanical comparison of modified Calcanail system with plating fixation in intra-articular calcaneal fracture: A finite element analysis. Med Eng Phys 2019; 70:55-61. [DOI: 10.1016/j.medengphy.2019.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/11/2019] [Accepted: 06/09/2019] [Indexed: 11/16/2022]
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Kim HK, Mirjalili A, Doyle A, Fernandez J. Tibiotalar cartilage stress corresponds to T2 mapping: application to barefoot running in novice and marathon-experienced runners. Comput Methods Biomech Biomed Engin 2019; 22:1153-1161. [DOI: 10.1080/10255842.2019.1645133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hyun Kyung Kim
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ali Mirjalili
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Doyle
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Radiology Department, Auckland District Health Board, Auckland, New Zealand
| | - Justin Fernandez
- Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Larrainzar-Garijo R, Cifuentes de la Portilla C, Gutiérrez-Narvarte B, Díez-Nicolás E, Bayod J. Effect of the calcaneal medializing osteotomy on soft tissues supporting the plantar arch: A computational study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cifuentes-De la Portilla C, Larrainzar-Garijo R, Bayod J. Analysis of the main passive soft tissues associated with adult acquired flatfoot deformity development: A computational modeling approach. J Biomech 2019; 84:183-190. [DOI: 10.1016/j.jbiomech.2018.12.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/14/2018] [Accepted: 12/29/2018] [Indexed: 11/26/2022]
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Osagie-Clouard L, Kaufmann J, Blunn G, Coathup M, Pendegrass C, Meeson R, Briggs T, Moazen M. Biomechanics of two external fixator devices used in rat femoral fractures. J Orthop Res 2019; 37:293-298. [PMID: 29727021 DOI: 10.1002/jor.24034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/27/2018] [Indexed: 02/04/2023]
Abstract
The use of external fixators allows for the direct investigation of newly formed interfragmentary bone, and the radiographic evaluation of the fracture. We validated the results of a finite element (FE) model with the in vitro stiffness' of two widely used external fixator devices used for in vivo analysis of fracture healing in rat femoral fractures with differing construction (Ti alloy ExFix1 and PEEK ExFix2). Rat femoral fracture fixation was modeled using two external fixators. For both constructs an osteotomy of 2.75 mm was used, and offset maintained at 5 mm. Tufnol, served as standardized substitutes for rat femora. Constructs were loaded under axial compression and torsion. Overall axial and torsional stiffness were compared between the in vitro models and FE results. FE models were also used to compare the fracture movement and overall pattern of von Mises stress across the external fixators. In vitro axial stiffness of ExFix1 was 29.26 N/mm ± 3.83 compared to ExFix2 6.31 N/mm ± 0.67 (p* < 0.05). Torsional stiffness of ExFix1 was 47.5 Nmm/° ± 2.71 compared to ExFix2 at 19.1 Nmm/° ±1.18 (p* < 0.05). FE results predicted similar comparative ratios between the ExFix1 and 2 as the in vitro studies. FE results predicted considerably larger interfragmentary motion in the ExFix2 comparing to ExFix1. We demonstrated significant differences in the stiffness' of the two external fixators as one would expect from such variable designs; yet, importantly we validated the utility of an FE model for the analysis and prediction of changes in fracture mechanics dependent on fixator choice. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:293-298, 2019.
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Affiliation(s)
| | - Joshua Kaufmann
- Division of Surgery, University College London, Stanmore, UK
| | - Gordon Blunn
- Division of Surgery, University College London, Stanmore, UK.,University of Portsmouth, Portsmouth, UK
| | | | | | - Richard Meeson
- Division of Surgery, University College London, Stanmore, UK
| | | | - Mehran Moazen
- Mechanical Engineering, University College London, London, UK
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Wong DWC, Wang Y, Lin J, Tan Q, Chen TLW, Zhang M. Sleeping mattress determinants and evaluation: a biomechanical review and critique. PeerJ 2019; 7:e6364. [PMID: 30701143 PMCID: PMC6348954 DOI: 10.7717/peerj.6364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/30/2018] [Indexed: 11/20/2022] Open
Abstract
Background Sleeping mattress parameters significantly influence sleeping comfort and health, as reflected by the extensive investigations of sleeping support biomechanics to prevent sleep-related musculoskeletal problems. Methodology Herein, we review the current trends, research methodologies, and determinants of mattress biomechanics research, summarizing evidence published since 2008. In particular, we scrutinize 18 articles dealing with the development of new designs, recommendation criteria, instruments/methods of spine alignment evaluation, and comparative evaluation of different designs. Results The review demonstrated that mattress designs have strived for customization, regional features, and real-time active control to adapt to the biomechanical features of different body builds and postures. However, the suggested threshold or target values for desirable spine alignment and body pressure distribution during sleep cannot yet be justified in view of the lack of sufficient evidence. Conclusions It is necessary to formulate standard objectives and protocols for carrying out mattress evaluation.
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Affiliation(s)
- Duo Wai-Chi Wong
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.,Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Wang
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.,Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Jin Lin
- Product Development-R&D Life Nurturing Products, Infinitus (China) Company Limited, Guangzhou, China
| | - Qitao Tan
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.,Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Tony Lin-Wei Chen
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.,Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Zhang
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.,Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
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Biomechanical stress analysis of the main soft tissues associated with the development of adult acquired flatfoot deformity. Clin Biomech (Bristol, Avon) 2019; 61:163-171. [PMID: 30580098 DOI: 10.1016/j.clinbiomech.2018.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adult acquired flatfoot deformity (AAFD) is traditionally related to a tibialis posterior tendon deficiency. In the intermediate stages, treatments are commonly focused on reinforcing this tissue, but sometimes the deformation appears again over time, necessitating the use of more aggressive options. Tissue stress cannot be consistently evaluated through traditional experimental trials. Computational foot modeling extends knowledge of the disease and could help guide the clinical decisions. This study analyzes the biomechanical stress of the main tissues related to AAFD and their capacity to support the plantar arch. METHODS A FE foot model was reconstructed. All the bones, cartilages and tissues related to AAFD were included, respecting their biomechanical characteristics. The biomechanical tissue stress was quantified. The capacity of each soft tissue to support the plantar arch was measured, following clinical criteria. FINDINGS Biomechanical stress of the tibialis posterior tendon is considerably superior to both the plantar fascia and spring ligament stress. However, it cannot maintain the plantar arch by itself. Both the tibialis posterior tendon and spring ligament act in reducing the hindfoot pronation, while the plantar fascia is the main tissue that prevents arch elongation. The Achilles tendon action increases the plantar tissue stress. INTERPRETATION The tibialis posterior tendon stress increases when the spring ligament or the fascia plantar fails. These findings are consistent with the theory that regards the tibialis posterior tendon as a secondary actor because it cannot support the plantar arch and claudicates when the hindfoot has rotated around the talonavicular joint.
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Zhang Y, Awrejcewicz J, Baker JS, Gu Y. Cartilage Stiffness Effect on Foot Biomechanics of Chinese Bound Foot: A Finite Element Analysis. Front Physiol 2018; 9:1434. [PMID: 30364272 PMCID: PMC6193066 DOI: 10.3389/fphys.2018.01434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/20/2018] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study is to investigate the effect of cartilage stiffness on inner foot biomechanics of Chinese bound foot while balanced standing using finite element method. A three-dimensional FE model of bound foot involving 28 bones, 72 ligaments, 5 plantar fascia, cartilages, and encapsulated soft tissue was constructed and validated. To conduct the sensitivity analysis of cartilage stiffness, the incremental Young’s modulus of 1, 5, 10, and 15 MPa were assigned to the cartilage. 25% of the body weight was applied to the Achilles tendon to adjust the anterior- posterior displacement of center of pressure agreeable with the measured result. As the Young’s modulus of cartilage increased, the peak von Mises stress in the fifth metatarsal increased obviously, while that in the calcaneus remains unchanged. The plantar fascia experienced reduced total tension with stiffer cartilage. The cartilage stiffening also caused a general increase of contact pressure at mid- and forefoot joints. Cartilage stiffening due to foot binding gave rise to risks of foot pain and longitude arch damage. Knowledge of this study contributes to the understanding of bound foot biomechanical behavior and demonstrating the mechanism of long-term injury and function damage in terms of weight-bearing due to foot binding.
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Affiliation(s)
- Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Department of Automation, Biomechanics and Mechatronics, Lodz University of Technology, Lódź, Poland
| | - Jan Awrejcewicz
- Department of Automation, Biomechanics and Mechatronics, Lodz University of Technology, Lódź, Poland
| | - Julien S Baker
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Paisley, United Kingdom
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Larrainzar-Garijo R, Cifuentes de la Portilla C, Gutiérrez-Narvarte B, Díez-Nicolás E, Bayod J. Effect of the calcaneal medializing osteotomy on soft tissues supporting the plantar arch: A computational study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 63:155-163. [PMID: 29907523 DOI: 10.1016/j.recot.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/07/2018] [Accepted: 04/16/2018] [Indexed: 10/14/2022] Open
Abstract
Medializing calcaneal osteotomy forms part of the treatment options for adult acquired flat foot. The structural correction that is achieved is widely known. However, the effect of this procedure on the soft tissues that support the plantar arch has been little studied, since it is not possible to quantify experimentally the tension and deformation variations generated. Therefore, the objective of this study was to evaluate the effect of medializing calcaneal osteotomy on the soft tissue that supports the plantar arch, using a computational model of the human foot designed with a clinical approach. The proposed finite element model was reconstructed from computerized tomography images of a healthy patient. All the bones of the foot, the plantar fascia, cartilages, plantar ligaments and the calcaneus-navicular ligament were included, respecting their anatomical distribution and biomechanical properties. Simulations were performed emulating the monopodal support phase of the human walk of an adult. The effect on each tissue was evaluated according to clinical and biomechanical criteria. The results show that calcaneal osteotomy reduces the tension normally generated on the evaluated tissues, with the effect on the calcaneus-navicular ligament and the plantar fascia being the most notable. The deformation results obtained are consistent with experimental tests and clinical knowledge. The versatility of this model allows the objective assessment of different conditions and supports decision making for the treatment of adult acquired flat foot in middle and advanced stages.
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Affiliation(s)
- R Larrainzar-Garijo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España; Departamento de Cirugía, Facultad Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - C Cifuentes de la Portilla
- Grupo de Mecánica aplicada y Bioingeniería (AMB), Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, España; Facultad de Ciencias médicas - Escuela de Medicina, Universidad Espíritu Santo, Samborondón, Ecuador
| | - B Gutiérrez-Narvarte
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - E Díez-Nicolás
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - J Bayod
- Grupo de Mecánica aplicada y Bioingeniería (AMB), Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, España
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Zhang Y, Awrejcewicz J, Szymanowska O, Shen S, Zhao X, Baker JS, Gu Y. Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: A finite element analysis. Comput Biol Med 2018; 97:1-7. [DOI: 10.1016/j.compbiomed.2018.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/14/2018] [Accepted: 04/14/2018] [Indexed: 11/26/2022]
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Chen TLW, Wong DWC, Xu Z, Tan Q, Wang Y, Luximon A, Zhang M. Lower limb muscle co-contraction and joint loading of flip-flops walking in male wearers. PLoS One 2018; 13:e0193653. [PMID: 29561862 PMCID: PMC5862437 DOI: 10.1371/journal.pone.0193653] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/15/2018] [Indexed: 11/18/2022] Open
Abstract
Flip-flops may change walking gait pattern, increase muscle activity and joint loading, and predispose wearers to foot problems, despite that quantitative evidence is scarce. The purpose of this study was to examine the lower limb muscle co-contraction and joint contact force in flip-flops gait, and compare with those of barefoot and sports shoes walking. Ten healthy males were instructed to perform over-ground walking at self-selected speed under three footwear conditions: 1) barefoot, 2) sports shoes, and 3) thong-type flip-flops. Kinematic, kinetic and EMG data were collected and input to a musculoskeletal model to estimate muscle force and joint force. One-way repeated measures ANOVA was conducted to compare footwear conditions. It was hypothesized that flip-flops would induce muscle co-contraction and produce different gait kinematics and kinetics. Our results demonstrated that the musculoskeletal model estimation had a good temporal consistency with the measured EMG. Flip-flops produced significantly lower walking speed, higher ankle and subtalar joint range of motion, and higher shear ankle joint contact force than sports shoes (p < 0.05). There were no significant differences between flip-flops and barefoot conditions in terms of muscle co-contraction index, joint kinematics, and joint loading of the knee and ankle complex (p > 0.05). The variance in walking speed and footwear design may be the two major factors that resulted in the comparable joint biomechanics in flip-flops and barefoot walking. From this point of view, whether flip-flops gait is potentially harmful to foot health remains unclear. Given that shod walking is more common than barefoot walking on a daily basis, sports shoes with close-toe design may be a better footwear option than flip-flops for injury prevention due to its constraint on joint motion and loading.
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Affiliation(s)
- Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, Guangdong, China
| | - Zhi Xu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, Sichuan University, Chengdu, Sichuan, China
| | - Qitao Tan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, Guangdong, China
| | - Ameersing Luximon
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, Guangdong, China
- * E-mail:
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Wong DWC, Wang Y, Leung AKL, Yang M, Zhang M. Finite element simulation on posterior tibial tendinopathy: Load transfer alteration and implications to the onset of pes planus. Clin Biomech (Bristol, Avon) 2018; 51:10-16. [PMID: 29144991 DOI: 10.1016/j.clinbiomech.2017.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posterior tibial tendinopathy is a challenging foot condition resulting in pes planus, which is difficult to diagnose in the early stage. Prior to the deformity, abnormal internal load transfer and soft tissue attenuation are anticipated. The objective of this study was to investigate the internal load transfer and strain of the ligaments with posterior tibial tendinopathy, and the implications to pes planus and other deformities. METHODS A three-dimensional finite element model of the foot and ankle was reconstructed from magnetic resonance images of a 28-year-old normal female. Thirty bones, plantar fascia, ligaments and tendons were reconstructed. With the gait analysis data of the model subject, walking stance was simulated. The onset of posterior tibial tendinopathy was resembled by unloading the tibialis posterior and compared to the normal condition. FINDINGS The load transfer of the joints at the proximal medial column was weaken by posterior tibial tendinopathy, which was compromised by the increase along the lateral column and the intercuneiforms during late stance. Besides, the plantar tarsometatarsal and cuboideonavicular ligaments were consistently over-stretched during stance. Particularly, the maximum tensile strain of the plantar tarsometatarsal ligament was about 3-fold higher than normal at initial push-off. INTERPRETATION Posterior tibial tendinopathy altered load transfer of the medial column and unbalanced the load between the proximal and distal side of the medial longitudinal arch. Posterior tibial tendinopathy also stretched the midfoot plantar ligaments that jeopardized midfoot stability, and attenuated the transverse arch. All these factors potentially contributed to the progress of pes planus and other foot deformities.
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Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Aaron Kam-Lun Leung
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Ming Yang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Department of Pediatric Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
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Akrami M, Qian Z, Zou Z, Howard D, Nester CJ, Ren L. Subject-specific finite element modelling of the human foot complex during walking: sensitivity analysis of material properties, boundary and loading conditions. Biomech Model Mechanobiol 2017; 17:559-576. [PMID: 29139051 PMCID: PMC5845092 DOI: 10.1007/s10237-017-0978-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/31/2017] [Indexed: 01/03/2023]
Abstract
The objective of this study was to develop and validate a subject-specific framework for modelling the human foot. This was achieved by integrating medical image-based finite element modelling, individualised multi-body musculoskeletal modelling and 3D gait measurements. A 3D ankle-foot finite element model comprising all major foot structures was constructed based on MRI of one individual. A multi-body musculoskeletal model and 3D gait measurements for the same subject were used to define loading and boundary conditions. Sensitivity analyses were used to investigate the effects of key modelling parameters on model predictions. Prediction errors of average and peak plantar pressures were below 10% in all ten plantar regions at five key gait events with only one exception (lateral heel, in early stance, error of 14.44%). The sensitivity analyses results suggest that predictions of peak plantar pressures are moderately sensitive to material properties, ground reaction forces and muscle forces, and significantly sensitive to foot orientation. The maximum region-specific percentage change ratios (peak stress percentage change over parameter percentage change) were 1.935-2.258 for ground reaction forces, 1.528-2.727 for plantar flexor muscles and 4.84-11.37 for foot orientations. This strongly suggests that loading and boundary conditions need to be very carefully defined based on personalised measurement data.
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Affiliation(s)
- Mohammad Akrami
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering, Jilin University, Changchun, 130022, People's Republic of China
| | - Zhemin Zou
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - David Howard
- School of Computing, Science and Engineering, University of Salford, Salford, M5 4WT, UK
| | - Chris J Nester
- Centre for Health Sciences Research, School of Health Sciences, University of Salford, Salford, M5 4WT, UK
| | - Lei Ren
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, M13 9PL, UK. .,Key Laboratory of Bionic Engineering, Jilin University, Changchun, 130022, People's Republic of China.
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Terrier A, Fernandes CS, Guillemin M, Crevoisier X. Fixed and mobile-bearing total ankle prostheses: Effect on tibial bone strain. Clin Biomech (Bristol, Avon) 2017; 48:57-62. [PMID: 28755611 DOI: 10.1016/j.clinbiomech.2017.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total ankle replacement is associated to a high revision rate. To improve implant survival, the potential advantage of prostheses with fixed bearing compared to mobile bearing is unclear. The objective of this study was to test the hypothesis that fixed and mobile bearing prostheses are associated with different biomechanical quantities typically associated to implant failure. METHODS With a validated finite element model, we compared three cases: a prosthesis with a fixed bearing, a prosthesis with a mobile bearing in a centered position, and a prosthesis with mobile bearing in an eccentric position. Both prostheses were obtained from the same manufacturer. They were tested on seven tibias with maximum axial compression force during walking. We tested the hypothesis that there was a difference of bone strain, bone-implant interfacial stress, and bone support between the three cases. We also evaluated, for the three cases, the correlations between bone support, bone strain and bone-implant interfacial stress. FINDINGS There were no statistically significant differences between the three cases. Overall, bone support was mainly trabecular, and less effective in the posterior side. Bone strain and bone-implant interfacial stress were strongly correlated to bone support. INTERPRETATIONS Even if slight differences are observed between fixed and mobile bearing, it is not enough to put forward the superiority of one of these implants regarding their reaction to axial compression. When associated to the published clinical results, our study provides no argument to warn surgeons against the use of two-components fixed bearing implants.
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Affiliation(s)
- Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland.
| | - Caroline Sieger Fernandes
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland
| | - Maïka Guillemin
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland
| | - Xavier Crevoisier
- Service of Orthopaedics and Traumatology, University Hospital Center and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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45
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Wong DWC, Wang Y, Chen TLW, Leung AKL, Zhang M. Biomechanical consequences of subtalar joint arthroereisis in treating posterior tibial tendon dysfunction: a theoretical analysis using finite element analysis. Comput Methods Biomech Biomed Engin 2017; 20:1525-1532. [DOI: 10.1080/10255842.2017.1382484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
| | - Tony Lin-Wei Chen
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Aaron Kam-Lun Leung
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
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46
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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.
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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.
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Yu J, Wong DWC, Zhang H, Luo ZP, Zhang M. The influence of high-heeled shoes on strain and tension force of the anterior talofibular ligament and plantar fascia during balanced standing and walking. Med Eng Phys 2016; 38:1152-6. [DOI: 10.1016/j.medengphy.2016.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 07/20/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
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48
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Ren S, Wong DWC, Yang H, Zhou Y, Lin J, Zhang M. Effect of pillow height on the biomechanics of the head-neck complex: investigation of the cranio-cervical pressure and cervical spine alignment. PeerJ 2016; 4:e2397. [PMID: 27635354 PMCID: PMC5012320 DOI: 10.7717/peerj.2397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/02/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND While appropriate pillow height is crucial to maintaining the quality of sleep and overall health, there are no universal, evidence-based guidelines for pillow design or selection. We aimed to evaluate the effect of pillow height on cranio-cervical pressure and cervical spine alignment. METHODS Ten healthy subjects (five males) aged 26 ± 3.6 years were recruited. The average height, weight, and neck length were 167 ± 9.3 cm, 59.6 ± 11.9 kg, and 12.9 ± 1.2 cm respectively. The subjects lay on pillows of four different heights (H0, 110 mm; H1, 130 mm; H2, 150 mm; and H3, 170 mm). The cranio-cervical pressure distribution over the pillow was recorded; the peak and average pressures for each pillow height were compared by one-way ANOVA with repeated measures. Cervical spine alignment was studied using a finite element model constructed based on data from the Visible Human Project. The coordinate of the center of each cervical vertebra were predicted for each pillow height. Three spine alignment parameters (cervical angle, lordosis distance and kyphosis distance) were identified. RESULTS The average cranial pressure at pillow height H3 was approximately 30% higher than that at H0, and significantly different from those at H1 and H2 (p < 0.05). The average cervical pressure at pillow height H0 was 65% lower than that at H3, and significantly different from those at H1 and H2 (p < 0.05). The peak cervical pressures at pillow heights H2 and H3 were significantly different from that at H0 (p < 0.05). With respect to cervical spine alignment, raising pillow height from H0 to H3 caused an increase of 66.4% and 25.1% in cervical angle and lordosis distance, respectively, and a reduction of 43.4% in kyphosis distance. DISCUSSION Pillow height elevation significantly increased the average and peak pressures of the cranial and cervical regions, and increased the extension and lordosis of the cervical spine. The cranio-cervical pressures and cervical spine alignment were height-specific, and they were believed to reflect quality of sleep. Our results provide a quantitative and objective evaluation of the effect of pillow height on the biomechanics of the head-neck complex, and have application in pillow design and selection.
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Affiliation(s)
- Sicong Ren
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Hui Yang
- Infinitus (China) Company Ltd., China
| | - Yan Zhou
- Infinitus (China) Company Ltd., China
| | - Jin Lin
- Infinitus (China) Company Ltd., China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
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49
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Wong DWC, Niu W, Wang Y, Zhang M. Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture. PLoS One 2016; 11:e0154435. [PMID: 27119740 PMCID: PMC4847902 DOI: 10.1371/journal.pone.0154435] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/13/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction Foot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis. Methods A three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The simulated impact velocities were from 2.0 to 7.0 m/s with 1.0 m/s interval. Results At 5.0 m/s impact velocity, the maximum von Mises stress of the trabecular calcaneus and talus were 3.21MPa and 2.41MPa respectively, while that of the Tresca stress were 3.46MPa and 2.55MPa. About 94% and 84% of the trabecular calcaneus and talus exceeded the shear yielding stress, while 21.7% and 18.3% yielded the compressive stress. The peak stresses were distributed around the talocalcaneal articulation and the calcaneal tuberosity inferiorly, which corresponded to the common fracture sites. Conclusions The prediction in this study showed that axial compressive impact at 5.0 m/s could produce considerable yielding of trabecular bone in both calcaneus and talus, dominantly by shear and compounded with compression that predispose the rearfoot in the risk of fracture. This study suggested the injury pattern and fracture mode of high energy trauma that provides insights in injury prevention and fracture management.
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Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Wenxin Niu
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Shanghai Yang Zhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- * E-mail:
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50
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Wittek A, Grosland NM, Joldes GR, Magnotta V, Miller K. From Finite Element Meshes to Clouds of Points: A Review of Methods for Generation of Computational Biomechanics Models for Patient-Specific Applications. Ann Biomed Eng 2015; 44:3-15. [PMID: 26424475 DOI: 10.1007/s10439-015-1469-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/22/2015] [Indexed: 11/24/2022]
Abstract
It has been envisaged that advances in computing and engineering technologies could extend surgeons' ability to plan and carry out surgical interventions more accurately and with less trauma. The progress in this area depends crucially on the ability to create robustly and rapidly patient-specific biomechanical models. We focus on methods for generation of patient-specific computational grids used for solving partial differential equations governing the mechanics of the body organs. We review state-of-the-art in this area and provide suggestions for future research. To provide a complete picture of the field of patient-specific model generation, we also discuss methods for identifying and assigning patient-specific material properties of tissues and boundary conditions.
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Affiliation(s)
- Adam Wittek
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, Crawley-Perth, Western Australia, Australia.
| | - Nicole M Grosland
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA.,Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, IA, USA.,Center for Computer Aided Design, The University of Iowa, Iowa City, IA, USA
| | - Grand Roman Joldes
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, Crawley-Perth, Western Australia, Australia
| | - Vincent Magnotta
- Department of Radiology, The University of Iowa, Iowa City, IA, USA
| | - Karol Miller
- Intelligent Systems for Medicine Laboratory, The University of Western Australia, Crawley-Perth, Western Australia, Australia.,Institute of Mechanics and Advanced Materials, Cardiff School of Engineering, Cardiff University, Wales, UK
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