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Li Y, Tong J, Wang H, Ji X, Hua Y, Cheng CK. Investigation into the effect of deltoid ligament injury on rotational ankle instability using a three-dimensional ankle finite element model. Front Bioeng Biotechnol 2024; 12:1386401. [PMID: 38751867 PMCID: PMC11094218 DOI: 10.3389/fbioe.2024.1386401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background Injury to the lateral collateral ligament of the ankle may cause ankle instability and, when combined with deltoid ligament (DL) injury, may lead to a more complex situation known as rotational ankle instability (RAI). It is unclear how DL rupture interferes with the mechanical function of an ankle joint with RAI. Purpose To study the influence of DL injury on the biomechanical function of the ankle joint. Methods A comprehensive finite element model of an ankle joint, incorporating detailed ligaments, was developed from MRI scans of an adult female. A range of ligament injury scenarios were simulated in the ankle joint model, which was then subjected to a static standing load of 300 N and a 1.5 Nm internal and external rotation torque. The analysis focused on comparing the distribution and peak values of von Mises stress in the articular cartilages of both the tibia and talus and measuring the talus rotation angle and contact area of the talocrural joint. Results The dimensions and location of insertion points of ligaments in the finite element ankle model were adopted from previous anatomical research and dissection studies. The anterior drawer distance in the finite element model was within 6.5% of the anatomical range, and the talus tilt angle was within 3% of anatomical results. During static standing, a combined rupture of the anterior talofibular ligament (ATFL) and anterior tibiotalar ligament (ATTL) generates new stress concentrations on the talus cartilage, which markedly increases the joint contact area and stress on the cartilage. During static standing with external rotation, the anterior talofibular ligament and anterior tibiotalar ligament ruptured the ankle's rotational angle by 21.8% compared to an intact joint. In contrast, static standing with internal rotation led to a similar increase in stress and a nearly 2.5 times increase in the talus rotational angle. Conclusion Injury to the DL altered the stress distribution in the tibiotalar joint and increased the talus rotation angle when subjected to a rotational torque, which may increase the risk of RAI. When treating RAI, it is essential to address not only multi-band DL injuries but also single-band deep DL injuries, especially those affecting the ATTL.
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Affiliation(s)
- Yuandong Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
| | - Jiahui Tong
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Huizhi Wang
- Center for Intelligent Medical Equipment and Devices, Institute for Innovative Medical Devices, University of Science and Technology of China, Hefei, China
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
| | - Xiaoxi Ji
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
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2
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Isvilanonda V, Li EY, Williams ED, Cavanagh PR, Haynor DR, Chu B, Ledoux WR. Subject-specific material properties of the heel pad: An inverse finite element analysis. J Biomech 2024; 165:112016. [PMID: 38422775 DOI: 10.1016/j.jbiomech.2024.112016] [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: 09/26/2023] [Revised: 01/01/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Individuals with diabetes are at a higher risk of developing foot ulcers. To better understand internal soft tissue loading and potential treatment options, subject-specific finite element (FE) foot models have been used. However, existing models typically lack subject-specific soft tissue material properties and only utilize subject-specific anatomy. Therefore, this study determined subject-specific hindfoot soft tissue material properties from one non-diabetic and one diabetic subject using inverse FE analysis. Each subject underwent cyclic MRI experiments to simulate physiological gait and to obtain compressive force and three-dimensional soft tissue imaging data at 16 phases along the loading-unloading cycles. The FE models consisted of rigid bones and nearly-incompressible first-order Ogden hyperelastic skin, fat, and muscle (resulting in six independent material parameters). Then, calcaneus and loading platen kinematics were computed from imaging data and prescribed to the FE model. Two analyses were performed for each subject. First, the skin, fat, and muscle layers were lumped into a single generic soft tissue material and optimized to the platen force. Second, the skin, fat, and muscle material properties were individually determined by simultaneously optimizing for platen force, muscle vertical displacement, and skin mediolateral bulging. Our results indicated that compared to the individual without diabetes, the individual with diabetes had stiffer generic soft tissue behavior at high strain and that the only substantially stiffer multi-material layer was fat tissue. Thus, we suggest that this protocol serves as a guideline for exploring differences in non-diabetic and diabetic soft tissue material properties in a larger population.
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Affiliation(s)
- Vara Isvilanonda
- Center for Limb Loss and MoBility (CLiMB), Department of Veterans Affairs, Seattle, WA, USA; Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Ellen Y Li
- Center for Limb Loss and MoBility (CLiMB), Department of Veterans Affairs, Seattle, WA, USA; Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Evan D Williams
- Center for Limb Loss and MoBility (CLiMB), Department of Veterans Affairs, Seattle, WA, USA; Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Peter R Cavanagh
- Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA; Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Baocheng Chu
- Radiology, University of Washington, Seattle, WA, USA
| | - William R Ledoux
- Center for Limb Loss and MoBility (CLiMB), Department of Veterans Affairs, Seattle, WA, USA; Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA; Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA.
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3
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Sun D, Song Y, Cen X, Wang M, Baker JS, Gu Y. Workflow assessing the effect of Achilles tendon rupture on gait function and metatarsal stress: Combined musculoskeletal modeling and finite element analysis. Proc Inst Mech Eng H 2022; 236:676-685. [PMID: 35311405 DOI: 10.1177/09544119221085795] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Achilles tendon rupture (ATR) incidence has increased among badminton players in recent years. The foot internal stress was hard to obtain through experimental testing. The purpose of the current research is to develop a methodology that could improve the finite element model derived foot internal stress prediction for ATR clinical and rehabilitation applications. A subject-specific musculoskeletal model was combined with a 3D finite element model to predict the metatarsal stress. The 80% point during the push-off phase of walking was selected for the comparing between injured and uninjured sides. The surgical repaired Achilles tendon (AT) after 12 months was elongated by 5.5% than the uninjured tendon. At 80% point of stance phase, the ankle plantarflexion angle and AT force decreased by 39.6% and 21.9% on the injured side, respectively. The foot inversion degree increased by 22.9% and was accompanied by the redistribution of metatarsals von Mises stress. The stresses on the fourth and fifth metatarsals were increased by 59.5% and 85.9% on the injured side. The workflow is available to assess musculoskeletal disorders and obtain foot internal stress after ATR. The decreased ankle plantar flexor force may be affected by triceps surae muscle atrophy and weakened force transmission ability of elongated AT. The increased von Mises stress on fourth and fifth metatarsals accompanied by higher foot inversion may increase the ankle lateral sprain injury risk.
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Affiliation(s)
- Dong Sun
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yang Song
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Doctoral School on Safety and Security Sciences, Obuda University, Budapest, Hungary.,Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Xuanzhen Cen
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Doctoral School on Safety and Security Sciences, Obuda University, Budapest, Hungary.,Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Meizi Wang
- Faculty of Sports Science, Ningbo University, Ningbo, China.,Doctoral School on Safety and Security Sciences, Obuda University, Budapest, 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
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Morgan O, Hillstrom H, Bitar R, Sturnick D, Koff MF, Ellis S, Deland J, Hillstrom R. Finite Element Modelling of Planus and Rectus Foot Types for the Study of First Metatarsophalangeal and First Metatarsocuneiform Joint Contact Mechanics. J Biomech Eng 2022; 144:1135615. [PMID: 35147162 DOI: 10.1115/1.4053791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 11/08/2022]
Abstract
Evaluating the contact mechanics of human joints is an important element in understanding the pathomechanics of orthopaedic diseases. Although physical testing is essential in the evaluation process, reliable computational models can augment these experiments by non-invasive predictions of biomechanical or surgical variables. The objective of this study was to perform verification of a framework for developing a medial forefoot finite element. Verification was conducted by comparing computational predictions to experimental measurements of first metatarsophalangeal and first metatarsocuneiform joint contact mechanics. A custom-built force-controlled cadaveric test-rig was used to derive measurements of contact pressure, force, and area. A quasi-static finite element was developed and driven under the same boundary and loading conditions. Calibration of cartilage moduli and mesh sensitivity analyses were performed. Mean errors in contact pressures, forces, and areas were 24%, 4%, and 40% at the first metatarsophalangeal joint and 23%, 12%, and 19% at the first Metatarsocuneiform joint, respectively. Verification of a medial forefoot finite element model development framework was presented and found to be within 30% for contact pressure and contact force of both joints. This study presents a method to verify and simulate realistic physiological loading to investigate orthopaedic diseases of the medial forefoot.
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Affiliation(s)
- Oliver Morgan
- Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Howard Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Rogerio Bitar
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Scott Ellis
- Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Deland
- Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
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5
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Zhu J, Forman J. A Review of Finite Element Models of Ligaments in the Foot and Considerations for Practical Application. J Biomech Eng 2022; 144:1133332. [PMID: 35079785 DOI: 10.1115/1.4053401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE Finite element (FE) modeling has been used as a research tool for investigating underlying ligaments biomechanics and orthopedic applications. However, FE models of the ligament in the foot have been developed with various configurations, mainly due to their complex 3D geometry, material properties, and boundary conditions. Therefore, the purpose of this review was to summarize the current state of finite element modeling approaches that have been used in the ?eld of ligament biomechanics, to discuss their applicability to foot ligament modeling in a practical setting, and also to acknowledge current limitations and challenges. METHODS A comprehensive literature search was performed. Each article was analyzed in terms of the methods used for: (a) ligament geometry, (b) material property, (c) boundary and loading condition related to its application, and (d) model verification and validation. RESULTS Of the reviewed studies, 80% of the studies used simplified representations of ligament geometry, the non-linear mechanical behavior of ligaments was taken into account in only 19.2% of the studies, 33% of included studies did not include any kind of validation of the FE model. CONCLUSION Further refinement in the functional modeling of ligaments, the micro-structure level characteristics, nonlinearity, and time-dependent response, may be warranted to ensure the predictive ability of the models.
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Affiliation(s)
- Junjun Zhu
- School of Mechatronic Engineering and Automation, Shanghai University, 333 Nanchen Rd., Shanghai, China, 200444
| | - Jason Forman
- Center for Applied Biomechanics, Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA 22911, USA
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6
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CHEN WENMING, CAI YIHENG, YU YUE, GENG XIANG, MA XIN. OPTIMAL MESH CRITERIA IN FINITE ELEMENT MODELING OF HUMAN FOOT: THE DEPENDENCE FOR MULTIPLE MODEL OUTPUTS ON MESH DENSITY AND LOADING BOUNDARY CONDITIONS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The use of finite element models has gained popularity in the field of foot and footwear biomechanics to predict the stress–strain distribution and the treatment effectiveness of therapeutic insoles for pathological foot conditions. However, a comprehensive evaluation of mesh quality is often ignored, meanwhile no golden standard exists for the mesh density and selection of element size at an acceptable accuracy. Here, we make a convergence test and established anatomically-realistic foot models at different mesh densities. The study compared the discrepancy in output variables to the changes of element type and mesh density under barefoot and footwear conditions with compressive and shear loads, which are commonly encountered in foot and footwear biomechanics simulations. For a range of loading conditions simulated in 125 finite element models, the peak plantar pressure consistently converged with optimal mesh size determined at 2.5[Formula: see text]mm. The convergence variable of principal strains and stress tensors, however, varies significantly. The max von-Mises stress showed strong sensitive behavior to the changes of the mesh density. The pattern for contact pressure distribution became less accurate when the element sizes increase to 6.0[Formula: see text]mm; in particular, the locations of the pressure peak do not show remarkable changes, but the size of the area of contact still changes. The current study could offer a general guideline when generating a reasonable accurate finite element models for the analysis of plantar pressure distributions and stress/strain states employed for foot and footwear biomechanics evaluations.
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Affiliation(s)
- WEN-MING CHEN
- Academy for Engineering & Technology, Fudan University, 220 Handan Road, Shanghai, P. R. China
| | - YI-HENG CAI
- Department of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, P. R. China
| | - YUE YU
- Department of medical imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, P. R. China
| | - XIANG GENG
- Department of Orthopaedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, P. R. China
| | - XIN MA
- Department of Orthopaedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, P. R. China
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7
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Moayedi M, Arshi AR, Salehi M, Akrami M, Naemi R. Associations between changes in loading pattern, deformity, and internal stresses at the foot with hammer toe during walking; a finite element approach. Comput Biol Med 2021; 135:104598. [PMID: 34346320 DOI: 10.1016/j.compbiomed.2021.104598] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
Over the past decade, Finite Element (FE) modelling has been used as a method to understand the internal stresses within the diabetic foot. Foot deformities such as hammer toe have been associated with increased risk of foot ulcers in diabetic patients. Hence the aim of this study is to investigate the influence of hammer toe deformity on internal stresses during walking. A 3D finite element model of the human foot was constructed based on capturing Magnetic Resonance Imaging (MRI) of a diabetic neuropathic volunteer exhibiting hammer toe. 3D gait measurements and a multi-body musculoskeletal model for the same participant were used to define muscle forces. FE simulations were run at five different instances during the stance phase of gait. Peak plantar pressure and pressure distribution results calculated from the model showed a good agreement with the experimental measurement having less than 11% errors. Maximum von Mises internal stresses in the forefoot hard tissue were observed at the 3rd and 5th metatarsals and 4th proximal phalanx. Moreover, presence of hammer toe deformity was found to shift the location of maximum internal stresses on the soft tissue to the forefoot by changing the location of centre of pressure with internal stress 1.64 times greater than plantar pressure. Hammer toe deformity also showed to reduce the involvement of the first phalanx in internal/external load-bearing during walking. The findings of this study support the association between changes in loading pattern, deformity, and internal stresses in the soft tissue that lead to foot ulceration.
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Affiliation(s)
- M Moayedi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - A R Arshi
- Biomechanics and Sports Engineering Groups, Biomedical Engineering Department, Amirkabir University of Technology, Iran.
| | - M Salehi
- Department of Mechanical Engineering, Amirkabir University of Technology, Iran.
| | - M Akrami
- Department of Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, UK.
| | - R Naemi
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, UK.
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8
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Faudot B, Milan JL, Goislard de Monsabert B, Le Corroller T, Vigouroux L. Estimation of joint contact pressure in the index finger using a hybrid finite element musculoskeletal approach. Comput Methods Biomech Biomed Engin 2020; 23:1225-1235. [PMID: 32678683 DOI: 10.1080/10255842.2020.1793965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The knowledge of local stress distribution in hand joints is crucial to understand injuries and osteoarthritis occurrence. However, determining cartilage contact stresses remains a challenge, requiring numerical models including both accurate anatomical components and realistic tendon force actuation. Contact forces in finger joints have frequently been calculated but little data is available on joint contact pressures. This study aimed to develop and assess a hybrid biomechanical model of the index finger to estimate in-vivo joint contact pressure during a static maximal strength pinch grip task. A finite element model including bones, cartilage, tendons, and ligaments was developed, with tendon force transmission based on a tendon-pulley system. This model was driven by realistic tendon forces estimated from a musculoskeletal model and motion capture data for six subjects. The hybrid model outputs agreed well with the experimental measurement of fingertip forces and literature data on the physiological distribution of tendon forces through the index finger. Mean contact pressures were 6.9 ± 2.7 MPa, 6.2 ± 1.0 MPa and 7.2 ± 1.3 MPa for distal, proximal interphalangeal and metacarpophalangeal joints, respectively. Two subjects had higher mean contact pressure in the distal joint than in the other two joints, suggesting a mechanical cause for the prevalence of osteoarthritis in the index distal joint. The inter-subject variability in joint contact pressure could be explained by different neuromuscular strategies employed for the task. This first application of an effective hybrid model to the index finger is promising for estimating hand joint stresses under daily grip tasks and simulating surgical procedures.
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Affiliation(s)
- Barthélémy Faudot
- Aix Marseille University, CNRS, ISM, Marseille, France.,APHM, Institute for Locomotion, Department of Orthopaedics and Traumatology, St Marguerite Hospital, Marseille, France
| | - Jean-Louis Milan
- Aix Marseille University, CNRS, ISM, Marseille, France.,APHM, Institute for Locomotion, Department of Orthopaedics and Traumatology, St Marguerite Hospital, Marseille, France
| | | | - Thomas Le Corroller
- Aix Marseille University, CNRS, ISM, Marseille, France.,APHM, Institute for Locomotion, Department of Radiology, St Marguerite Hospital, Marseille, France
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9
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Kathirgamanathan B, Silva P, Fernandez J. Implication of obesity on motion, posture and internal stress of the foot: an experimental and finite element analysis. Comput Methods Biomech Biomed Engin 2018; 22:47-54. [PMID: 30398076 DOI: 10.1080/10255842.2018.1527320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Obesity causes increased loading on the foot which can damage the soft tissue and bone ultimately leading to foot problems. Experimental and computational methods were used to analyse the chain of biomechanical changes in the lower limb due to obesity. The experimental study shows some changes in foot posture and gait where obese subjects were more likely to have pronated feet, smaller joint angles in the sagittal and frontal planes, smaller cadence, and smaller stride length. Anatomically correct finite element models generated on obese subjects showed increased and altered internal and plantar stress. Altered foot posture was identified as a key indicator of increased internal stress indicating the importance of foot posture correction.
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Affiliation(s)
- B Kathirgamanathan
- a Department of Electronic and Telecommunication Engineering , University of Moratuwa , Moratuwa , Sri Lanka
| | - P Silva
- a Department of Electronic and Telecommunication Engineering , University of Moratuwa , Moratuwa , Sri Lanka
| | - J Fernandez
- b Auckland Bioengineering Institute , University of Auckland , Auckland , New Zealand.,c Department of Engineering Science , University of Auckland , Auckland , New Zealand
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10
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Region-specific constitutive modeling of the plantar soft tissue. Biomech Model Mechanobiol 2018; 17:1373-1388. [DOI: 10.1007/s10237-018-1032-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
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11
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Wang Z, Kido M, Imai K, Ikoma K, Hirai S. Towards patient-specific medializing calcaneal osteotomy for adult flatfoot: a finite element study. Comput Methods Biomech Biomed Engin 2018; 21:332-343. [PMID: 29544347 DOI: 10.1080/10255842.2018.1452202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Clinically in medializing calcaneal osteotomy (MCO), foot and ankle surgeons are facing difficulties in choosing appropriate surgical parameters due to the individual differences in deformities among flatfoot patients. Traditional cadaveric studies have provided important information regarding the biomechanical effects of tendons, ligaments, and plantar fascia, but limitations have been reached when dealing with individual differences and tailoring patient-specific surgeries. Therefore, this study aimed at implementing the finite element (FE) method to investigate the effect of different MCO parameters to help foot and ankle surgeons performing patient-specific surgeries. This study constructed FE models of a flatfoot and a healthy foot based on computed tomography (CT) images. After validating the FE models with experimental measurements, differences in plantar stress were compared between two models and a criterion was established for evaluating the performance of surgical simulations. Four MCO parameters were then studied through FE simulations. Results suggested that the transverse angle, β, and translation distance, d, affected surgical performance. Therefore, special attentions may be recommended when choosing these two parameters clinically. However, the sagittal angle, α, and osteotomy position, p, were found to have less effect on the MCO performance.
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Affiliation(s)
- Zhongkui Wang
- a Department of Robotics , Ritsumeikan University , Shiga , Japan
| | - Masamitsu Kido
- b Department of Orthopaedics , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Kan Imai
- b Department of Orthopaedics , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Kazuya Ikoma
- b Department of Orthopaedics , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Shinichi Hirai
- a Department of Robotics , Ritsumeikan University , Shiga , Japan
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12
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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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13
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Non-linear finite element model to assess the effect of tendon forces on the foot-ankle complex. Med Eng Phys 2017; 49:71-78. [DOI: 10.1016/j.medengphy.2017.07.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 06/18/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
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14
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Chen WM, Lee SJ, Lee PVS. Strategies towards rapid generation of forefoot model incorporating realistic geometry of metatarsals encapsulated into lumped soft tissues for personalized finite element analysis. Comput Methods Biomech Biomed Engin 2017; 20:1421-1430. [PMID: 28872350 DOI: 10.1080/10255842.2017.1370458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Use of finite element (FE) foot model as a clinical diagnostics tool is likely to improve the specificity of foot injury predictions in the diabetic population. Here we proposed a novel workflow for rapid construction of foot FE model incorporating realistic geometry of metatarsals encapsulated into lumped forefoot's soft tissues. Custom algorithms were implemented to perform unsupervised segmentation and mesh generation to directly convert CT data into a usable FE model. The automatically generated model provided higher efficiency and comparable numerical accuracy when compared to the model constructed using a traditional solid-based mesh process. The entire procedure uses MATLAB as the main platform, and makes the present approach attractive for creating personalized foot models to be used in clinical studies.
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Affiliation(s)
- Wen-Ming Chen
- a Department of Prosthetics & Orthotics , University of Shanghai for Science and Technology , Shanghai , China.,b Shanghai Engineering Research Center for Assistive Devices , Shanghai , China
| | - Sung-Jae Lee
- c Department of Biomedical Engineering , Inje University , Gimhae , South Korea
| | - Peter Vee Sin Lee
- d Department of Mechanical Engineering, Melbourne School of Engineering , University of Melbourne , Melbourne , Australia
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15
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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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16
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Maganaris CN, Chatzistergos P, Reeves ND, Narici MV. Quantification of Internal Stress-Strain Fields in Human Tendon: Unraveling the Mechanisms that Underlie Regional Tendon Adaptations and Mal-Adaptations to Mechanical Loading and the Effectiveness of Therapeutic Eccentric Exercise. Front Physiol 2017; 8:91. [PMID: 28293194 PMCID: PMC5328946 DOI: 10.3389/fphys.2017.00091] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/02/2017] [Indexed: 12/23/2022] Open
Abstract
By virtue of their anatomical location between muscles and bones, tendons make it possible to transform contractile force to joint rotation and locomotion. However, tendons do not behave as rigid links, but exhibit viscoelastic tensile properties, thereby affecting the length and contractile force in the in-series muscle, but also storing and releasing elastic stain energy as some tendons are stretched and recoiled in a cyclic manner during locomotion. In the late 90s, advancements were made in the application of ultrasound scanning that allowed quantifying the tensile deformability and mechanical properties of human tendons in vivo. Since then, the main principles of the ultrasound-based method have been applied by numerous research groups throughout the world and showed that tendons increase their tensile stiffness in response to exercise training and chronic mechanical loading, in general, by increasing their size and improving their intrinsic material. It is often assumed that these changes occur homogenously, in the entire body of the tendon, but recent findings indicate that the adaptations may in fact take place in some but not all tendon regions. The present review focuses on these regional adaptability features and highlights two paradigms where they are particularly evident: (a) Chronic mechanical loading in healthy tendons, and (b) tendinopathy. In the former loading paradigm, local tendon adaptations indicate that certain regions may “see,” and therefore adapt to, increased levels of stress. In the latter paradigm, local pathological features indicate that certain tendon regions may be “stress-shielded” and degenerate over time. Eccentric exercise protocols have successfully been used in the management of tendinopathy, without much sound understanding of the mechanisms underpinning their effectiveness. For insertional tendinopathy, in particular, it is possible that the effectiveness of a loading/rehabilitation protocol depends on the topography of the stress created by the exercise and is not only reliant upon the type of muscle contraction performed. To better understand the micromechanical behavior and regional adaptability/mal-adaptability of tendon tissue it is important to estimate its internal stress-strain fields. Recent relevant advancements in numerical techniques related to tendon loading are discussed.
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Affiliation(s)
| | | | - Neil D Reeves
- School of Healthcare Science, Manchester Metropolitan University Manchester, UK
| | - Marco V Narici
- Faculty of Medicine and Health Sciences, School of Medicine, University of Nottingham Derby, UK
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17
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Biomechanical evaluation of reconstruction plates with locking, nonlocking, and hybrid screws configurations in calcaneal fracture: a finite element model study. Med Biol Eng Comput 2017; 55:1799-1807. [DOI: 10.1007/s11517-017-1623-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/25/2017] [Indexed: 12/12/2022]
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18
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Telfer S, Kindig MW, Sangeorzan BJ, Ledoux WR. Metatarsal Shape and Foot Type: A Geometric Morphometric Analysis. J Biomech Eng 2017; 139:2579728. [DOI: 10.1115/1.4035077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Indexed: 01/26/2023]
Abstract
Planus and cavus foot types have been associated with an increased risk of pain and disability. Improving our understanding of the geometric differences between bones in different foot types may provide insights into injury risk profiles and have implications for the design of musculoskeletal and finite-element models. In this study, we performed a geometric morphometric analysis on the geometry of metatarsal bones from 65 feet, segmented from computed tomography (CT) scans. These were categorized into four foot types: pes cavus, neutrally aligned, asymptomatic pes planus, and symptomatic pes planus. Generalized procrustes analysis (GPA) followed by permutation tests was used to determine significant shape differences associated with foot type and sex, and principal component analysis was used to find the modes of variation for each metatarsal. Significant shape differences were found between foot types for all the metatarsals (p < 0.01), most notably in the case of the second metatarsal which showed significant pairwise differences across all the foot types. Analysis of the principal components of variation showed pes cavus bones to have reduced cross-sectional areas in the sagittal and frontal planes. The first (p = 0.02) and fourth metatarsals (p = 0.003) were found to have significant sex-based differences, with first metatarsals from females shown to have reduced width, and fourth metatarsals from females shown to have reduced frontal and sagittal plane cross-sectional areas. Overall, these findings suggest that metatarsal bones have distinct morphological characteristics that are associated with foot type and sex, with implications for our understanding of anatomy and numerical modeling of the foot.
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Affiliation(s)
- Scott Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington, Box 356500, 1959 NE Pacific Street, Seattle, WA 98195 e-mail:
| | | | - Bruce J. Sangeorzan
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195; RR&D Center of Excellence, VA Puget Sound, Seattle, WA 98108
| | - William R. Ledoux
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195; RR&D Center of Excellence, VA Puget Sound, Seattle, WA 98108; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
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19
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Finite element modelling of the foot for clinical application: A systematic review. Med Eng Phys 2017; 39:1-11. [DOI: 10.1016/j.medengphy.2016.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 10/13/2016] [Accepted: 10/23/2016] [Indexed: 11/20/2022]
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20
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Suzuki R, Ito K, Lee T, Ogihara N. Parameter identification of hyperelastic material properties of the heel pad based on an analytical contact mechanics model of a spherical indentation. J Mech Behav Biomed Mater 2017; 65:753-760. [DOI: 10.1016/j.jmbbm.2016.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 09/04/2016] [Accepted: 09/21/2016] [Indexed: 11/26/2022]
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21
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Isvilanonda V, Iaquinto JM, Pai S, Mackenzie-Helnwein P, Ledoux WR. Hyperelastic compressive mechanical properties of the subcalcaneal soft tissue: An inverse finite element analysis. J Biomech 2016; 49:1186-1191. [DOI: 10.1016/j.jbiomech.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 02/03/2016] [Accepted: 03/02/2016] [Indexed: 11/26/2022]
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22
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Telfer S, Erdemir A, Woodburn J, Cavanagh PR. Simplified versus geometrically accurate models of forefoot anatomy to predict plantar pressures: A finite element study. J Biomech 2016; 49:289-94. [PMID: 26708965 DOI: 10.1016/j.jbiomech.2015.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022]
Abstract
Integration of patient-specific biomechanical measurements into the design of therapeutic footwear has been shown to improve clinical outcomes in patients with diabetic foot disease. The addition of numerical simulations intended to optimise intervention design may help to build on these advances, however at present the time and labour required to generate and run personalised models of foot anatomy restrict their routine clinical utility. In this study we developed second-generation personalised simple finite element (FE) models of the forefoot with varying geometric fidelities. Plantar pressure predictions from barefoot, shod, and shod with insole simulations using simplified models were compared to those obtained from CT-based FE models incorporating more detailed representations of bone and tissue geometry. A simplified model including representations of metatarsals based on simple geometric shapes, embedded within a contoured soft tissue block with outer geometry acquired from a 3D surface scan was found to provide pressure predictions closest to the more complex model, with mean differences of 13.3kPa (SD 13.4), 12.52kPa (SD 11.9) and 9.6kPa (SD 9.3) for barefoot, shod, and insole conditions respectively. The simplified model design could be produced in <1h compared to >3h in the case of the more detailed model, and solved on average 24% faster. FE models of the forefoot based on simplified geometric representations of the metatarsal bones and soft tissue surface geometry from 3D surface scans may potentially provide a simulation approach with improved clinical utility, however further validity testing around a range of therapeutic footwear types is required.
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Affiliation(s)
- Scott Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA; Institute for Applied Health Research, Glasgow Caledonian University, Glasgow G4 0BA, UK.
| | - Ahmet Erdemir
- Computational Biomodeling (CoBi) Core & Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Woodburn
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Peter R Cavanagh
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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23
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Wang Y, Wong DWC, Zhang M. Computational Models of the Foot and Ankle for Pathomechanics and Clinical Applications: A Review. Ann Biomed Eng 2015; 44:213-21. [DOI: 10.1007/s10439-015-1359-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/09/2015] [Indexed: 01/01/2023]
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24
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A method for subject-specific modelling and optimisation of the cushioning properties of insole materials used in diabetic footwear. Med Eng Phys 2015; 37:531-8. [DOI: 10.1016/j.medengphy.2015.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 02/03/2015] [Accepted: 03/23/2015] [Indexed: 01/21/2023]
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25
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Wang Z, Imai K, Kido M, Ikoma K, Hirai S. A finite element model of flatfoot (Pes Planus) for improving surgical plan. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:844-7. [PMID: 25570091 DOI: 10.1109/embc.2014.6943723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Flatfoot is a foot condition caused by the collapse of the medial arch of the foot, and it can result in problems such as severe pain, swelling, abnormal gait, and difficulty walking. Despite being a very common foot deformity, flatfoot is one of the least understood orthopaedic problems, and the opinions regarding its optimal treatment vary widely. In this paper, an FE model of a flatfoot is proposed that is based on CT measurements. Surface meshes of the bones and soft tissue were generated from CT images and then simplified to reduce the node density. A total of 62 ligaments, 9 tendons, and the plantar fascia were modeled manually. Volume meshes of the different components were generated and combined to form the completed flatfoot model. A dynamic FE formulation was derived, and a balanced standing simulation was performed. The model was validated by comparing stress distribution results from the simulation to experimental data.
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26
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Chen YN, Chang CW, Li CT, Chang CH, Lin CF. Finite element analysis of plantar fascia during walking: a quasi-static simulation. Foot Ankle Int 2015; 36:90-7. [PMID: 25189539 DOI: 10.1177/1071100714549189] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The plantar fascia is a primary arch supporting structure of the foot and is often stressed with high tension during ambulation. When the loading on the plantar fascia exceeds its capacity, the inflammatory reaction known as plantar fasciitis may occur. Mechanical overload has been identified as the primary causative factor of plantar fasciitis. However, a knowledge gap exists between how the internal mechanical responses of the plantar fascia react to simple daily activities. Therefore, this study investigated the biomechanical responses of the plantar fascia during loaded stance phase by use of the finite element (FE) modeling. METHODS A 3-dimensional (3-D) FE foot model comprising bones, cartilage, ligaments, and a complex-shaped plantar fascia was constructed. During the stance phase, the kinematics of the foot movement was reproduced and Achilles tendon force was applied to the insertion site on the calcaneus. All the calculations were made on a single healthy subject. RESULTS The results indicated that the plantar fascia underwent peak tension at preswing (83.3% of the stance phase) at approximately 493 N (0.7 body weight). Stress concentrated near the medial calcaneal tubercle. The peak von Mises stress of the fascia increased 2.3 times between the midstance and preswing. The fascia tension increased 66% because of the windlass mechanism. CONCLUSION Because of the membrane element used in the ligament tissue, this FE model was able to simulate the mechanical structure of the foot. After prescribing kinematics of the distal tibia, the proposed model indicated the internal fascia was stressed in response to the loaded stance phase. CLINICAL RELEVANCE Based on the findings of this study, adjustment of gait pattern to reduce heel rise and Achilles tendon force may lower the fascia loading and may further reduce pain in patients with plantar fasciitis.
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Affiliation(s)
- Yen-Nien Chen
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan Metal Industries Research & Development Centre, Kaohsiung City, Taiwan
| | - Chih-Wei Chang
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Chun-Ting Li
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Chih-Han Chang
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Cheng-Feng Lin
- Department of Physical Therapy, National Cheng Kung University, Tainan City, Taiwan
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27
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Telfer S, Erdemir A, Woodburn J, Cavanagh PR. What has finite element analysis taught us about diabetic foot disease and its management? A systematic review. PLoS One 2014; 9:e109994. [PMID: 25290098 PMCID: PMC4188702 DOI: 10.1371/journal.pone.0109994] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/12/2014] [Indexed: 11/24/2022] Open
Abstract
Background Over the past two decades finite element (FE) analysis has become a popular tool for researchers seeking to simulate the biomechanics of the healthy and diabetic foot. The primary aims of these simulations have been to improve our understanding of the foot’s complicated mechanical loading in health and disease and to inform interventions designed to prevent plantar ulceration, a major complication of diabetes. This article provides a systematic review and summary of the findings from FE analysis-based computational simulations of the diabetic foot. Methods A systematic literature search was carried out and 31 relevant articles were identified covering three primary themes: methodological aspects relevant to modelling the diabetic foot; investigations of the pathomechanics of the diabetic foot; and simulation-based design of interventions to reduce ulceration risk. Results Methodological studies illustrated appropriate use of FE analysis for simulation of foot mechanics, incorporating nonlinear tissue mechanics, contact and rigid body movements. FE studies of pathomechanics have provided estimates of internal soft tissue stresses, and suggest that such stresses may often be considerably larger than those measured at the plantar surface and are proportionally greater in the diabetic foot compared to controls. FE analysis allowed evaluation of insole performance and development of new insole designs, footwear and corrective surgery to effectively provide intervention strategies. The technique also presents the opportunity to simulate the effect of changes associated with the diabetic foot on non-mechanical factors such as blood supply to local tissues. Discussion While significant advancement in diabetic foot research has been made possible by the use of FE analysis, translational utility of this powerful tool for routine clinical care at the patient level requires adoption of cost-effective (both in terms of labour and computation) and reliable approaches with clear clinical validity for decision making.
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Affiliation(s)
- Scott Telfer
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, United Kingdom
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Ahmet Erdemir
- Computational Biomodeling (CoBi) Core, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - James Woodburn
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Peter R. Cavanagh
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, United States of America
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28
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Simple finite element models for use in the design of therapeutic footwear. J Biomech 2014; 47:2948-55. [DOI: 10.1016/j.jbiomech.2014.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/02/2014] [Accepted: 07/13/2014] [Indexed: 11/19/2022]
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29
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A dynamic finite element analysis of human foot complex in the sagittal plane during level walking. PLoS One 2013; 8:e79424. [PMID: 24244500 PMCID: PMC3823660 DOI: 10.1371/journal.pone.0079424] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 09/23/2013] [Indexed: 12/04/2022] Open
Abstract
The objective of this study is to develop a computational framework for investigating the dynamic behavior and the internal loading conditions of the human foot complex during locomotion. A subject-specific dynamic finite element model in the sagittal plane was constructed based on anatomical structures segmented from medical CT scan images. Three-dimensional gait measurements were conducted to support and validate the model. Ankle joint forces and moment derived from gait measurements were used to drive the model. Explicit finite element simulations were conducted, covering the entire stance phase from heel-strike impact to toe-off. The predicted ground reaction forces, center of pressure, foot bone motions and plantar surface pressure showed reasonably good agreement with the gait measurement data over most of the stance phase. The prediction discrepancies can be explained by the assumptions and limitations of the model. Our analysis showed that a dynamic FE simulation can improve the prediction accuracy in the peak plantar pressures at some parts of the foot complex by 10%–33% compared to a quasi-static FE simulation. However, to simplify the costly explicit FE simulation, the proposed model is confined only to the sagittal plane and has a simplified representation of foot structure. The dynamic finite element foot model proposed in this study would provide a useful tool for future extension to a fully muscle-driven dynamic three-dimensional model with detailed representation of all major anatomical structures, in order to investigate the structural dynamics of the human foot musculoskeletal system during normal or even pathological functioning.
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30
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Lui TH. Flexor hallucis longus to extensor hallucis longus transfer for correction of hallux flexus deformity. Foot Ankle Int 2013; 34:1456-9. [PMID: 23598857 DOI: 10.1177/1071100713487338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China
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