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Doğan K, Selçuk T, Yılmaz A. A Novel Model Based on CNN-ViT Fusion and Ensemble Learning for the Automatic Detection of Pes Planus. J Clin Med 2024; 13:4800. [PMID: 39200942 PMCID: PMC11355061 DOI: 10.3390/jcm13164800] [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: 06/12/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Pes planus, commonly known as flatfoot, is a condition in which the medial arch of the foot is abnormally low or absent, leading to the inner part of the foot having less curvature than normal. Symptom recognition and errors in diagnosis are problems encountered in daily practice. Therefore, it is important to improve how a diagnosis is made. With the availability of large datasets, deep neural networks have shown promising capabilities in recognizing foot structures and accurately identifying pes planus. Methods: In this study, we developed a novel fusion model by combining the Vgg16 convolutional neural network (CNN) model with the vision transformer ViT-B/16 to enhance the detection of pes planus. This fusion model leverages the strengths of both the CNN and ViT architectures, resulting in improved performance compared to that in reports in the literature. Additionally, ensemble learning techniques were employed to ensure the robustness of the model. Results: Through a 10-fold cross-validation, the model demonstrated high sensitivity, specificity, and F1 score values of 97.4%, 96.4%, and 96.8%, respectively. These results highlight the effectiveness of the proposed model in quickly and accurately diagnosing pes planus, making it suitable for deployment in clinics or healthcare centers. Conclusions: By facilitating early diagnosis, the model can contribute to the better management of treatment processes, ultimately leading to an improved quality of life for patients.
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Affiliation(s)
- Kamil Doğan
- Radiology Department, Bursa City Hospital, 16110 Bursa, Turkey;
| | - Turab Selçuk
- Department of Electrical and Electronics Engineering, Kahramanmaras Sutcu Imam University, 46200 Kahramanmaraş, Turkey
| | - Abdurrahman Yılmaz
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey;
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Rodríguez-Sanz J, Roche-Seruendo LE, López-de-Celis C, Canet-Vintró M, Ordoyo-Martin J, Fernández-Gibello A, Labata-Lezaun N, Pérez-Bellmunt A. Effects of Plantar Fascia Release and the Use of Foot Orthoses Affect Biomechanics of the Medial Longitudinal Arch of the Foot: A Cadaveric Study. Am J Phys Med Rehabil 2024; 103:595-602. [PMID: 38261788 DOI: 10.1097/phm.0000000000002414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The aim of the study is to evaluate the effect of minimally invasive ultrasound-guided fascial release and a foot orthoses with first metatarsal head cutout on the biomechanics of the medial longitudinal arch of the foot in cadaveric specimens. DESIGN A cross-sectional study was designed (20 body donors). Anthropometric measurements of the foot, foot posture index, and the windlass test and force were measured in different conditions: unloaded, loaded position, with foot orthoses, after a 25% plantar fascia release and after a 50% release. RESULTS For the anthropometric measurements of the foot, differences were found in foot length ( P = 0.009), arch height ( P < 0.001), and midfoot width ( P = 0.019) when comparing the unloaded versus foot orthoses condition. When foot orthoses were compared with 25% plantar fascial release, differences were found in foot length ( P = 0.014) and arch height ( P < 0.001). In the comparison with 50% plantar fascial release, differences were found in the arch height ( P < 0.001). A significant interaction between foot orthoses condition and grades was found in the arch height during the windlass test ( P = 0.021). CONCLUSIONS The results indicate that the presence of foot orthoses leads to a significant increase in arch height compared with other conditions. Furthermore, when plantar fascia release is performed, the arch does not exhibit any signs of collapse.
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Affiliation(s)
- Jacobo Rodríguez-Sanz
- From the Faculty of Medicine and Health Science of Universitat Internacional de Catalunya, Barcelona, Spain (JR-S, CL-D-C, MC-V, NL-L, AP-B); ACTIUM Functional Anatomy Group, Barcelona, Spain (JR-S, CL-D-C, MC-V, NL-L, AP-B); San Jorge University, Zaragoza, Spain (LER-S); Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain (CL-D-C); Departamento Técnico y Desarrollo, Podotec3D, Barcelona, Spain (JO-M); Clínica Vitruvio, Madrid, Spain (AF-G); and La Salle Centro Universitario, Madrid, Spain (AF-G)
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Moisan G, Chicoine D, McBride S, Farahpour N, Isabelle PL, Dagenais C, Griffiths I. Supination resistance variations in foot and ankle musculoskeletal disorders: implications for diagnosis and customised interventions with wedged insoles. J Foot Ankle Res 2023; 16:91. [PMID: 38129924 PMCID: PMC10740238 DOI: 10.1186/s13047-023-00681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Supination resistance is a clinical outcome that estimates the amount of external force required to supinate the foot. A greater supination resistance may indicate greater loads on structures responsible for generating internal supination moments across the subtalar joint during static and dynamic tasks. As such, greater supination resistance may be an expected finding in medial foot and ankle musculoskeletal disorders, such as plantar fasciopathy (PF) and posterior tibial tendon dysfunction (PTTD), whereas reduced supination resistance may be present in lateral ankle disorders, such as chronic ankle instability (CAI). However, no studies have yet investigated the changes in supination resistance across these foot and ankle musculoskeletal disorders. This study aimed to quantify supination resistance in individuals with PF, PTTD and CAI compared to healthy controls. Additionally, this study aimed to explore the changes in supination resistance following the simulation of varus and valgus wedges, which are commonly used interventions for these disorders. METHODS Fourteen participants with PF, fourteen with PTTD, fourteen with CAI and fourteen healthy controls were recruited. Supination resistance was quantified on a level surface and on a 10-degree inclined surface with varus and valgus positions. RESULTS Supination resistance was lower for the injured foot for CAI (p < 0.001) and greater for PTTD (p < 0.001) compared to the healthy foot. There was no significant between-foot difference observed for PF (p = 0.275) and controls (p = 0.970). In the injured foot, CAI exhibited lower supination resistance compared to controls (p < 0.001), PF (p = 0.012) and PTTD (p = 0.014). Regardless of the groups, supination resistance increased when tested on a surface with valgus inclination (p < 0.001) and decreased when tested on a surface with varus inclination (p < 0.001). CONCLUSIONS Varus and valgus inclinations to the surface were effective in modifying supination resistance in PTTD and CAI, respectively. Supination resistance seemed unchanged in PF, and thus inclining the standing surface leads to greater between-feet asymmetries. This study also highlights the potential of wedged insoles as a mean to customise treatments and modify tissue stresses in these disorders. The findings contribute to the understanding of foot and ankle biomechanics and may aid in the development of more effective management and rehabilitation strategies.
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Affiliation(s)
- Gabriel Moisan
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Groupe de recherche sur les affections neuro-musculo-squelettiques (GRAN), Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Dominic Chicoine
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Sean McBride
- Department of Physical Therapy, University of Findlay, Findlay, OH, USA
| | - Nader Farahpour
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
- Department of Sport Biomechanics, Faculty of Sport Sciences, Bu Ali Sina University, Hamedan, Iran
| | - Pier-Luc Isabelle
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Camille Dagenais
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | - Ian Griffiths
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK.
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Pflüger P, Valderrabano V. Sprain of the Medial Ankle Ligament Complex. Foot Ankle Clin 2023; 28:355-367. [PMID: 37137629 DOI: 10.1016/j.fcl.2023.01.009] [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] [Indexed: 05/05/2023]
Abstract
Injuries of the medial ankle ligament complex (MALC; deltoid and spring ligament) are more common following ankle sprains than expected, especially in eversion-external rotation mechanisms. Often these injuries are associated with concomitant osteochondral lesions, syndesmotic lesions, or fractures of the ankle joint. The clinical assessment of the medial ankle instability together with a conventional radiological and MR imaging is the basis for the definition of the diagnosis and therefore the optimal treatment. This review aims to provide an overview as well as a basis to successfully manage MALC sprains.
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Affiliation(s)
- Patrick Pflüger
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Swiss Medical Network, Schmerzklinik Basel, University of Basel, Hirschgässlein 15, Basel 4010, Switzerland.
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Malakoutikhah H, Madenci E, Latt LD. A computational model of force within the ligaments and tendons in progressive collapsing foot deformity. J Orthop Res 2023; 41:396-406. [PMID: 35579076 DOI: 10.1002/jor.25380] [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: 01/21/2022] [Revised: 04/17/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
Progressive collapsing foot deformity results from degeneration of the ligaments and posterior tibial tendon (PTT). Our understanding of the relationship between their failures remains incomplete. We sought to improve this understanding through computational modeling of the forces in these soft tissues. The impact of PTT and ligament failures on force changes in the remaining ligaments was investigated by quantifying ligament force changes during simulated ligament and tendon cutting in a validated finite element model of the foot. The ability of the PTT to restore foot alignment was also evaluated by increasing the PTT force in a foot with attenuated ligaments and comparing the alignment angles to the intact foot. We found that failure of any one of the ligaments led to overloading the remaining ligaments, except for the plantar naviculocuneiform, first plantar tarsometatarsal, and spring ligaments, where removing one led to unloading the other two. The combined attenuation of the plantar fascia, long plantar, short plantar, and spring ligaments significantly overloaded the deltoid and talocalcaneal ligaments. Isolated PTT rupture had no effect on foot alignment but did increase the force in the deltoid and spring ligaments. Moreover, increasing the force within the PTT to 30% of body weight was effective at restoring foot alignment during quiet stance, primarily through reducing hindfoot valgus and forefoot abduction as opposed to improving arch collapse. Our findings suggest that early intervention might be used to prevent the progression of deformity. Moreover, strengthening the PTT through therapeutic exercise might improve its ability to restore foot alignment.
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Affiliation(s)
- Hamed Malakoutikhah
- Department of Aerospace and Mechanical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Erdogan Madenci
- Department of Aerospace and Mechanical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Leonard Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
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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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Ling H, Balasubramanian R. A novel implantable mechanism-based tendon transfer surgery for adult acquired flatfoot deformity: Evaluating feasibility in biomechanical simulation. PLoS One 2022; 17:e0270638. [PMID: 36166431 PMCID: PMC9514661 DOI: 10.1371/journal.pone.0270638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Adult acquired flatfoot deformity becomes permanent with stage III posterior tibialis tendon dysfunction and results in foot pain and difficulty walking and balancing. To prevent progression to stage III posterior tibialis tendon dysfunction when conservative treatment fails, a flexor digitorum longus to posterior tibialis tendon transfer is often conducted. However, since the flexor digitorum longus only has one-third the force-capability of the posterior tibialis, an osteotomy is typically also required. We propose the use of a novel implantable mechanism to replace the direct attachment of the tendon transfer with a sliding pulley to amplify the force transferred from the donor flexor digitorum longus to the foot arch. In this work, we created four OpenSim models of an arched foot, a flatfoot, a flatfoot with traditional tendon transfer, and a flatfoot with implant-modified tendon transfer. Paired with these models, we developed a forward dynamic simulation of the stance phase of gait that reproduces the medial/lateral distribution of vertical ground reaction forces. The simulation couples the use of a fixed tibia, moving ground plane methodology with simultaneous activation of nine extrinsic lower limb muscles. The arched foot and flatfoot models produced vertical ground reaction forces with the characteristic double-peak profile of gait, and the medial/lateral distribution of these forces compared well with the literature. The flatfoot model with implant-modified tendon transfer produced a 94.2% restoration of the medial/lateral distribution of vertical ground reaction forces generated by our arched foot model, which also represents a 2.1X improvement upon our tendon transfer model. This result demonstrates the feasibility of a pulley-like implant to improve functional outcomes for surgical treatment of adult acquired flatfoot deformity with ideal biomechanics in simulation. The real-world efficacy and feasibility of such a device will require further exploration of factors such as surgical variability, soft tissue interactions and healing response.
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Affiliation(s)
- Hantao Ling
- School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis, Oregon, United States of America
- * E-mail:
| | - Ravi Balasubramanian
- School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis, Oregon, United States of America
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Richie DH. Injuries to the Spring Ligament: Nonoperative Treatment. Clin Podiatr Med Surg 2022; 39:461-476. [PMID: 35717063 DOI: 10.1016/j.cpm.2022.02.007] [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: 11/03/2022]
Abstract
The fibrocartilage within the superomedial calcaneonavicular (spring) ligament is part of an interwoven complex of ligaments that span the ankle, subtalar, and talonavicular joints. Acute isolated rupture of the spring ligament has been reported in association with an eversion ankle sprain. Attenuation and failure of the spring ligament causes complex 3D changes called the progressive collapsing foot deformity (PCFD). This deformity is characterized by hindfoot eversion, forefoot supination, collapse of the medial longitudinal arch, and forefoot abduction. Nonoperative treatment of an isolated spring ligament rupture and PCFD using various designs of orthoses have shown promising results.
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Affiliation(s)
- Douglas H Richie
- California School of Podiatric Medicine at Samuel Merritt University, 450 30th Street Suite 2860, Oakland, CA 94609, USA.
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Structural assessment of pre-flexion in silicone implants for arthroplasty of the first metatarsophalangeal joint. Proc Inst Mech Eng H 2022; 236:909-919. [DOI: 10.1177/09544119221093473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The development of numerical models to analyze pathologies and implants related to the first metatarsophalangeal joint of the foot remains an issue for attention. The structural effects of implants pre-flexion have been discarded in several finite elements analyses due to complexities to achieve these positions. This work aims to evaluate if the pre-flexion stress state should be included or could be discarded when only flexion is applied in two different silicone commercial implants, Swanson and Tornier, during a gait cycle. Finite element models were created for silicone implants. Both models were discretized using high-order finite elements. The hyperelasticity constitutive material model of Arruda-Boyce was used, based on experimental data; its behavior was compared with linear elastic models reported and used frequently assuming small and large deformations and applying to the Swanson and Tornier implants a flexion angle of 64°, which corresponds to in vivo measurements reported after implantation. Comparison between models, regarding hyperelastic model, showed mean variations of up to 32.5% for stresses and 14.01% for bending moment in Swanson implant, while for Tornier implant mean variations of 29.73% and 632.55% was obtained for stress and bending moment respectively. The maximum stress value obtained for the hyperelastic model in the Swanson implant reached a value of 22.82% of the tensile strength of the implant material while in the Tornier implant reached a value of 25.92%, the above values were evaluated at a flexion angle of 64°. The results suggest considering in finite element analyses not only the stress state generated to achieve critical flexion position in pleflexed implants models but also the hyperelastic material behavior of silicone for implants to avoid dismissing the non-linear structural behavior of hyperelastic materials.
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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: 9] [Impact Index Per Article: 4.5] [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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Hirakawa K, Tsutsumi M, Kudo S. Investigation of the relationship between the thickness of the plantar calcaneonavicular ligament and plantar fascia in patients with plantar fasciitis. Foot (Edinb) 2022; 50:101890. [PMID: 34990973 DOI: 10.1016/j.foot.2021.101890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although patients with plantar fasciitis show spring ligament laxity, the thickness of the spring ligament in patients with plantar fasciitis remains unclear. This study aimed to elucidate the morphological characteristics of the spring ligament in patients with plantar fasciitis based on an ultrasound imaging system (US). METHODS Thirty feet of 30 patients (painful group) diagnosed with plantar fasciitis at our hospital and thirty feet of 30 healthy volunteers (healthy group) without plantar pain were investigated. The thicknesses of both the spring ligament and plantar fascia were assessed via a US statistical comparison of the spring ligament and plantar fascia thickness between the painful and healthy groups. This was performed using Welch's t-test, and the significance level was set at p < 0.01. In addition, Pearson's correlation coefficient was calculated to assess the correlation between the spring ligament and plantar fascia thickness in the two groups, and the significance level was set at p < 0.01. RESULTS The spring ligament thickness in the painful group was significantly lower than that in the healthy group (p < 0.001). The thickness of the plantar fascia in the painful group was significantly greater than that in the healthy group (p = 0.03). In addition, the correlation between the spring ligament and plantar fascia thickness was moderately negative (r = -0.42, p = 0.001). The thicker the plantar fascia in the subjects, the thinner was the spring ligament. CONCLUSIONS The thickness of the spring ligament in patients with plantar fasciitis decreased. The thinning of the spring ligament was negatively correlated with the thickening of the plantar fascia as per the US evaluation. Based on the spring ligament thinning determined via US evaluation, interventions such as insoles from an early stage could prevent the onset of plantar fasciitis.
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Affiliation(s)
- Keisuke Hirakawa
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16 Nankouminami Suminoeku, Osaka-city, Osaka, Japan; Amano Orthopadaedic Clinic, 4-1-5 Komagawa Higashisumiyoshi, Osaka-city, Osaka, Japan
| | - Masahiro Tsutsumi
- Inclusive Medical Science Research Institute, 1-26-16 Nankouminami Suminoeku, Osaka-city, Osaka, Japan
| | - Shintarou Kudo
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16 Nankouminami Suminoeku, Osaka-city, Osaka, Japan; AR-Ex Medical Research Center, 4-13-1 Todoroki Setagaya, Tokyo, Japan; Inclusive Medical Science Research Institute, 1-26-16 Nankouminami Suminoeku, Osaka-city, Osaka, Japan.
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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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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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Gross CE, Jackson JB. The Importance of the Medial Column in Progressive Collapsing Foot Deformity: Osteotomies and Stabilization. Foot Ankle Clin 2021; 26:507-521. [PMID: 34332732 DOI: 10.1016/j.fcl.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Adult acquired flatfoot deformity is a complex pathologic condition that requires considerate and thoughtful surgical solutions. Medial column procedures are often supplemented by a medializing calcaneal osteotomy and/or a lateral column lengthening because of the complex nature of progressive collapsing foot deformity and its resultant peritalar instability. Other osteotomies and fusions include a Cotton osteotomy and first tarsometatarsal fusion.
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Affiliation(s)
- Christopher E Gross
- Medical University of South Carolina, 96 Jonathon Lucas Drive, Charleston, SC 209403, USA.
| | - J Benjamin Jackson
- University of South Carolina, Prisma Orthopaedics, 2 medical park, Suite 404, Columbia, SC 29203, USA
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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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Abstract
The deltoid and spring ligaments are the primary restraints against pronation and valgus deformity of the foot, and in preserving the medial arch. The posterior tibial tendon has a secondary role in plantar arch maintenance, and its biomechanical stress increases considerably when other tissues fail. A thorough understanding of the anatomy and biomechanics of the deltoid-spring ligament is crucial for successful reconstruction of the tibiocalcanealnavicular ligament, hence, to restore ankle and medial peritalar stability. Although effective in correcting the deformity, tibionavicular tenodesis might be critical, as it blocks physiologic pronation of the hindfoot, which may result in dysfunction and pain.
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Affiliation(s)
- Beat Hintermann
- Center of Excellence for Foot and Ankle Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
| | - Roxa Ruiz
- Center of Excellence for Foot and Ankle Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
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Peroneus Longus overload caused by soft tissue deficiencies associated with early adult acquired flatfoot: A finite element analysis. Clin Biomech (Bristol, Avon) 2021; 86:105383. [PMID: 33992889 DOI: 10.1016/j.clinbiomech.2021.105383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 04/03/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peroneus Longus tendinopathy has been related to overload from cavus and ankle instability. The etiology of isolated Peroneus Longus tendon synovitis has not been elucidated. Loss of foot arch integrity as a cause of isolated Peroneus Longus overload is difficult to establish using cadaver modeling. Our objective was to analyze Peroneus Longus stress changes in pathological scenarios related to flatfoot development. METHODS A three-dimensional finite element foot model which included the foot bones and main soft tissues that maintain the arch was used. Simulations were performed in midstance of gait. Tendon's maximum principal stress and von Mises were calculated in scenarios where the plantar fascia, spring ligament and the posterior tibial tendon were weakened. FINDINGS Decreasing plantar fascia stiffness thus weakening arch integrity increases Peroneus Longus stresses by over three times. Additional failure of tissues that support arch, such as the spring ligament and tibialis posterior tendon further overloads this tendon. The absence of Peroneus Longus also affects stresses in tissues that maintain the arch. Stress concentrations increase in the plantar component of the Peroneus Longus. INTERPRETATION Results offer an explanation into isolated Peroneus Longus overload synovitis. Recognition of failing medial arch structures that occur in early acquired flatfoot as a cause of Peroneus Longus overload could help in its treatment. We caution the practice of transfer of peroneus brevis to longus in surgical treatment of flatfoot as it may further overload an overloaded tendon and focus should be on restoration of arch stability to offload stresses within it.
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Abstract
Flatfoot deformity consists of a loss of medial arch, hindfoot valgus, and forefoot abduction. Historically considered a posterior tendon insufficiency, multiple ligament damage and subsequent incompetence explain the different clinical presentations with varying degrees of deformity. When surgery is deemed necessary, depending on the apex of the deformity, skeletal and soft tissue procedures are considered to keep motion and restore function. Osteotomies are considered at every level where an apex of deformity is found. The recently designated tibiocalcaneonavicular ligament comprises the older superficial and deep deltoid and spring ligaments; its repair or reconstruction should be considered in most flatfoot cases.
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Affiliation(s)
- Emilio Wagner
- Universidad del Desarrollo, Clinica Alemana de Santiago, Vitacura 5951, Santiago, Chile.
| | - Pablo Wagner
- Universidad del Desarrollo, Clinica Alemana de Santiago, Vitacura 5951, Santiago, Chile
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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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Pasapula C, Kiliyanpilakkil B, Khan DZ, Di Marco Barros R, Kim S, Ali AMES, Hardcastle A, Cutts S. Plantar fasciitis: Talonavicular instability/spring ligament failure as the driving force behind its histological pathogenesis. Foot (Edinb) 2021; 46:101703. [PMID: 33386208 DOI: 10.1016/j.foot.2020.101703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/19/2020] [Indexed: 02/04/2023]
Abstract
The aetiology of plantar fasciitis (PF) remains uncertain and to date, it is not known if there is an association with spring ligament laxity. In this study, 28 patients with unilateral plantar fasciitis were evaluated. A digital Klaumeter was used to assess first ray for instability and lateral plane translation was used as a measure of spring ligament laxity in the affected vs unaffected foot (internal control). Retromalleolar tenderness as a sign of a reactive tibialis posterior tendon was also assessed. The mean lateral translation score for symptomatic feet was 67.2 (95% CI [63.26-71.14]), compared to asymptomatic feet mean of 33.0 (95% CI [27.35-38.65] p < 0.05). The mean TMT instability score for symptomatic feet was 11.3 (95% CI [10.29-12.3]), compared to the asymptomatic feet mean of 5.9 (95% CI [4.49-7.31] p < 0.05). 100% of symptomatic feet had a retromalleolar tenderness over the tibialis posterior compared to 14% of asymptomatic feet. This is the first study to demonstrate a statistically significant increase in spring ligament strain in feet affected with PF using internal controls. The study postulates that tensile overload at the medial plantar fascia develops secondary to spring ligament failure regardless of foot shape. Furthermore, this condition can be regarded as an early warning sign of adult acquired flat foot disorder (AAFD). Future treatments for PF should not further destabilise the medial arch. This understanding may allow development of new treatment strategies in restoring spring ligament integrity to offload the plantar fascia strain.
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Affiliation(s)
| | | | | | | | - Suewan Kim
- Queen Elizabeth Hospital, Kings Lynn, United Kingdom
| | | | | | - Steven Cutts
- James Paget Hospital, Great Yarmouth, United Kingdom
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[Etiology, pathogenesis, clinical features, diagnostics and conservative treatment of adult flatfoot]. DER ORTHOPADE 2020; 49:942-953. [PMID: 33034668 DOI: 10.1007/s00132-020-03995-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND On average, one in six adults is affected by an acquired flatfoot. This foot deformity is characterized by its progression of stages and in 10% of cases causes complaints that require treatment. Untreated, the loss of walking ability may result in the final stage. Correct staging is crucial to being able to offer a specific course of therapy including a wide spectrum of conservative and operative treatments. MATERIAL AND METHODS This review is based on pertinent publications retrieved from a selective search in PubMed and Medline and on the authors' clinical experience. DIAGNOSTICS The loss of function of static (spring ligament complex) and dynamic (tibialis posterior tendon) stabilizers causes the characteristic deformity with loss of the medial arch, hind foot valgus and forefoot abduction. In the late stage, severe secondary osteoarthritis in upper and lower ankle joints occurs and impedes walking ability. The essential physical examination is supplemented by weight-bearing dorsoplantar and lateral radiographs, which provide further information about axial malalignment (Meary's angle, Kite's angle). The long axis hind foot view allows analysis of the hindfoot valgus. MRI provides further information about the integrity of the tibialis posterior tendon, spring ligament complex and cartilage damage. THERAPY The therapy aims to reduce pain, regain function and avoid development of secondary osteoarthritis and degenerative tendon disorders. Progress of the deformity should be stopped. Therefore, the main aspects of the deformity-loss of medial arch, hindfoot valgus and forefoot abduction should be addressed and corrected. In the acute phase, tendovaginitis of the tibialis posterior tendon can be treated sufficiently by anti-inflammatory measures, relieving mechanical loads on the tendon and muscle and physiotherapy.
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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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Flores DV, Mejía Gómez C, Fernández Hernando M, Davis MA, Pathria MN. Adult Acquired Flatfoot Deformity: Anatomy, Biomechanics, Staging, and Imaging Findings. Radiographics 2020; 39:1437-1460. [PMID: 31498747 DOI: 10.1148/rg.2019190046] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Adult acquired flatfoot deformity (AAFD) is a common disorder that typically affects middle-aged and elderly women, resulting in foot pain, malalignment, and loss of function. The disorder is initiated most commonly by degeneration of the posterior tibialis tendon (PTT), which normally functions to maintain the talonavicular joint at the apex of the three arches of the foot. PTT degeneration encompasses tenosynovitis, tendinosis, tendon elongation, and tendon tearing. The malaligned foot is initially flexible but becomes rigid and constant as the disorder progresses. Tendon dysfunction commonly leads to secondary damage of the spring ligament and talocalcaneal ligaments and may be associated with injury to the deltoid ligament, plantar fascia, and other soft-tissue structures. Failure of multiple stabilizers appears to be necessary for development of the characteristic planovalgus deformity of AAFD, with a depressed plantar-flexed talus bone, hindfoot and/or midfoot valgus, and an everted flattened forefoot. AAFD also leads to gait dysfunction as the foot is unable to change shape and function adequately to accommodate the various phases of gait, which require multiple rapid transitions in foot position and tone for effective ambulation. The four-tier staging system for AAFD emphasizes physical examination findings and metrics of foot malalignment. Mild disease is managed conservatively, but surgical procedures directed at the soft tissues and/or bones become necessary and progressively more invasive as the disease progresses. Although much has been written about the imaging findings of AAFD, this article emphasizes the anatomy and function of the foot's stabilizing structures to help the radiologist better understand this disabling disorder. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Philippine Orthopedic Center, St. Luke's Medical Center-Global City, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.); Department of Radiology, Diagnóstico Médico Cantabria, Santander, Spain (M.F.H.); Department of Radiology, University of Texas Health Science Center, San Antonio, Texas (M.A.D.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Catalina Mejía Gómez
- From the Department of Radiology, Philippine Orthopedic Center, St. Luke's Medical Center-Global City, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.); Department of Radiology, Diagnóstico Médico Cantabria, Santander, Spain (M.F.H.); Department of Radiology, University of Texas Health Science Center, San Antonio, Texas (M.A.D.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Moisés Fernández Hernando
- From the Department of Radiology, Philippine Orthopedic Center, St. Luke's Medical Center-Global City, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.); Department of Radiology, Diagnóstico Médico Cantabria, Santander, Spain (M.F.H.); Department of Radiology, University of Texas Health Science Center, San Antonio, Texas (M.A.D.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Michael A Davis
- From the Department of Radiology, Philippine Orthopedic Center, St. Luke's Medical Center-Global City, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.); Department of Radiology, Diagnóstico Médico Cantabria, Santander, Spain (M.F.H.); Department of Radiology, University of Texas Health Science Center, San Antonio, Texas (M.A.D.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mini N Pathria
- From the Department of Radiology, Philippine Orthopedic Center, St. Luke's Medical Center-Global City, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.); Department of Radiology, Diagnóstico Médico Cantabria, Santander, Spain (M.F.H.); Department of Radiology, University of Texas Health Science Center, San Antonio, Texas (M.A.D.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
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Abstract
The adult acquired flatfoot deformity resulting from posterior tibial tendon dysfunction is the result of rupture of the posterior tibial tendon as well as key ligaments of the ankle and hindfoot. Kinematic studies have verified certain levels of deformity causing hindfoot eversion, lowering of the medial longitudinal arch and forefoot abduction. The condition is progressive and left untreated will cause significant disability. Bracing with ankle-foot orthoses has shown promising results in arresting progression of deformity and avoiding debilitating surgery. Various types of ankle-foot orthoses have been studied in terms of effects on gait as well as efficacy in treatment.
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Affiliation(s)
- Douglas Richie
- Applied Biomechanics, California School of Podiatric Medicine, Samuel Merritt University, Oakland, CA, USA.
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