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Xu C, Liu H, Li M, Li H, Pan C. Biomechanical effects of Evans versus Hintermann osteotomy for treating adult acquired flatfoot deformity: a patient-specific finite element investigation. J Orthop Surg Res 2024; 19:107. [PMID: 38303071 PMCID: PMC10835985 DOI: 10.1186/s13018-024-04584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/26/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Evans and Hintermann lateral column lengthening (LCL) procedures are both widely used to correct adult acquired flatfoot deformity (AAFD), and have both shown good clinical results. The aim of this study was to compare these two procedures in terms of corrective ability and biomechanics influence on the Chopart and subtalar joints through finite element (FE) analysis. METHODS Twelve patient-specific FE models were established and validated. The Hintermann osteotomy was performed between the medial and posterior facets of the subtalar joint; while, the Evans osteotomy was performed on the anterior neck of the calcaneus around 10 mm from the calcaneocuboid joint surface. In each procedure, a triangular wedge of varying size was inserted at the lateral edge. The two procedures were then compared based on the measured strains of superomedial calcaneonavicular ligaments and planter facia, the talus-first metatarsal angle, and the contact characteristics of talonavicular, calcaneocuboid and subtalar joints. RESULTS The Hintermann procedure achieved a greater correction of the talus-first metatarsal angle than Evans when using grafts of the same size, indicating that Hintermann had stronger corrective ability. However, its distributions of von-Mises stress in the subtalar, talonavicular and calcaneocuboid joints were less homogeneous than those of Evans. In addition, the strains of superomedial calcaneonavicular ligaments and planter facia of Hintermann were also greater than those of Evans, but both generally within the safe range (less than 6%). CONCLUSION This FE analysis study indicates that both Evans and Hintermann procedures have good corrective ability for AAFD. Compared to Evans, Hintermann procedure can provide a stronger corrective effect while causing greater disturbance to the biomechanics of Chopart joints, which may be an important mechanism of arthritis. Nevertheless, it yields a better protection to the subtalar joint than Evans osteotomy. CLINICAL RELEVANCE Both Evans and Hintermann LCL surgeries have a considerable impact on adjacent joints and ligament tissues. Such effects alongside the overcorrection problem should be cautiously considered when choosing the specific surgical method. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Can Xu
- Department of Orthopedics, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Hua Liu
- Department of Orthopedics, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Mingqing Li
- Department of Orthopedics, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplants, Beijing, People's Republic of China
| | - Chun'ang Pan
- Beijing Engineering and Technology Research Center for Medical Endoplants, Beijing, People's Republic of China
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Gu S, Wang S, Gong Y, Ren Y, Feng H. Numerical simulations of the effect of lateral malleolus fracture malunion on ankle biomechanics: Different offset directions and offsets. Foot Ankle Surg 2024; 30:135-144. [PMID: 37919180 DOI: 10.1016/j.fas.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/24/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Ankle fractures account for approximately 10 % of all fractures. Approximately 5-68 % of patients with ankle fractures may suffer from malunion. Besides, suboptimal reduction of fracture fragments can affect the biomechanics of the ankle joint, ultimately leading to damage to the ankle joint. However, there are certain controversies over the conclusion of previous cadaveric studies. METHODS In this study, a three-dimensional model of the ankle joint was established based on CT image data. In addition, the effects of backward offset (1-2 mm) and outward offset (0.5-1 mm) of the fracture fragment on the contact area, contact pressure, and ligament force of the ankle joint were investigated via the finite element method. Moreover, lateral malleolus fracture malunion in five ankle positions (neutral, 10° dorsiflexion, 10° plantarflexion, 20° dorsiflexion, and 20° plantarflexion) was investigated. RESULTS This model predicted an overall increased contact area in the ankle joint in patients with lateral malleolus fracture malunion compared with the normal ankle joint. The results demonstrated that the outward offset had a more significant effect than the backward one. The larger the dorsiflexion-plantarflexion angle, the more pronounced the effect of malunion. Further, an outward offset can cause the fibula to lose its function. CONCLUSION Post-traumatic osteoarthritis occurs under the action of unaccustomed cartilage forces due to altered tibial talar joint contact patterns, rather than increased contact pressure reported in previous studies. Malunion leads to an increase or decrease in force on the affected ligament, while the cause of malunion can be envisioned based on a decrease in the force on the ligaments.
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Affiliation(s)
- Shibo Gu
- School of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, China
| | - Shuanzhu Wang
- Department of Orthopedics, The Fourth Hospital of Baotou, Baotou 014030, Inner Mongolia, China
| | - Yongzhi Gong
- School of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, China
| | - Yueying Ren
- School of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, China
| | - Haiquan Feng
- School of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, China.
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Choi JH, Choi YH, Kim DH, Lee DY, Koo S, Lee KM. Effect of flatfoot correction on the ankle joint following lateral column lengthening: A radiographic evaluation. PLoS One 2023; 18:e0286013. [PMID: 37917738 PMCID: PMC10621939 DOI: 10.1371/journal.pone.0286013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 05/05/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES The effects of foot deformities and corrections on the ankle joint without osteoarthritis has received little attention. This study aimed to investigate the effect of flatfoot correction on the ankle joint of patients without osteoarthritis. METHODS Thirty-five patients (24 men and 11 women; mean age 17.5 years) who underwent lateral column lengthening for flatfoot deformities were included. The mean postoperative follow-up period was 20.5 months (standard deviation [SD]: 15.7 months). Radiographic indices were measured pre- and postoperatively, including anteroposterior (AP) and lateral talo-first metatarsal angles, naviculocuboid overlap, position of the articulating talar surface, and lateral talar center migration. Postoperative changes in the radiographic indices were statistically analyzed. RESULTS There was significant postoperative improvement in flatfoot deformity in terms of AP and lateral talo-first metatarsal angles (p<0.001 and p<0.001, respectively) and naviculocuboid overlap (p<0.001). On lateral radiographs, the talar articulating surface dorsiflexed by 7.3% (p<0.001), and the center of the talar body shifted anteriorly by 0.85 mm (p<0.001) postoperatively. CONCLUSIONS Flatfoot correction using lateral column and Achilles tendon lengthening caused dorsiflexion and an anterior shift of the articular talar body in patients without osteoarthritis. Correction of flatfoot deformity might affect the articular contact area at the ankle joint. The biomechanical effects of this change need to be investigated further.
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Affiliation(s)
- Ji Hye Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yoon Hyo Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dae Hyun Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute for Science and Technology, Daejon, South Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Cen X, Song Y, Yu P, Sun D, Simon J, Bíró I, Gu Y. Effects of plantar fascia stiffness on the internal mechanics of idiopathic pes cavus by finite element analysis: implications for metatarsalgia. Comput Methods Biomech Biomed Engin 2023:1-9. [PMID: 37817665 DOI: 10.1080/10255842.2023.2268231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023]
Abstract
Metatarsalgia occurring in individuals with pes cavus is typically associated with abnormal loading patterns in the forefoot resulting from structural alterations. Simultaneously, the frequent overstress of the plantar fascia (PF) caused by the persistence of this foot deformity may further exacerbate the chronic pain induced by metatarsal overload. We aimed to investigate and quantify the effects of PF stiffness on the internal biomechanics of pes cavus using a computational modelling approach. A patient-specific finite element model of the foot-ankle complex using the actual three-dimensional geometry of idiopathic pes cavus bones and soft tissues was reconstructed. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0-700 MPa) of the PF on the metatarsal stress distribution, and force transmission through the metatarsophalangeal (MTP) and tarsometatarsal (TMT) joints in the pes cavus. The results indicated that variations in PF stiffness led to stress redistribution in the metatarsal region. Peak stress gradually reduced with decreasing stiffness until the PF was released, eventually resulting in a reduction of 22.39% compared to the reference value of 350 MPa. Furthermore, adjusting the PF stiffness to twice the reference value (700 MPa) increased the contact forces through the TMT and MTP joints by up to 23% and 116%, respectively. The reduction of PF stiffness alleviated focal metatarsal loading, and therefore, surgical fascia release can be considered to alleviate metatarsalgia in patients with pes cavus.
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Affiliation(s)
- Xuanzhen Cen
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yang Song
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Peimin Yu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Dong Sun
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - János Simon
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - István Bíró
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Efrima B, Barbero A, Ramalingam K, Indino C, Maccario C, Usuelli FG. Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening. Foot Ankle Int 2023; 44:1061-1069. [PMID: 37542418 DOI: 10.1177/10711007231185328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
BACKGROUND Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets and endangers specific os calcis subtalar joint (OCST) subtypes without distinct facets. H-LCL is oriented between the posterior and middle facets and should be suitable for all OCSTs. Both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between 2 articular surfaces represented by color patterns. This study aims to measure the safe zones for LCL using 3-dimensional (3D) models and DM; we hypothesize that it could be measured with high reproducibility. METHODS Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. Four angles were measured independently. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies; similarly, the proximal and distal extents of the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. Consequently, the surface available for safe osteotomies were calculated. An interclass correlation was used to assess the agreement between the 2 raters. Additionally, analysis of variance and Mann-Whitney U test were used to compare the safe zones between OCSTs. RESULTS The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees from a line parallel to the lateral border of the calcaneus, respectively, and the proximal and distal extent of the ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. There were no statistically significant differences between the OCSTs. Two raters measured the angles with good to excellent interrater and intrarater agreement. In 18 cases, we were unable to plan for H-LCL or E-LCL osteotomies. CONCLUSION Distance mapping could be used to measure the safe zone, tailor a preoperative plan, and potentially reduce the risk for iatrogenic damage in LCL. 3D models and DM can increase the reliability of preoperative plans in bones with complex 3D structures. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ben Efrima
- Foot and Ankle Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Agustin Barbero
- Foot and Ankle Unit, Humanitas San Pio X Hospital, Milan, Italy
| | | | - Cristian Indino
- Foot and Ankle Unit, Humanitas San Pio X Hospital, Milan, Italy
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Talbott H, Jha S, Gulati A, Brockett C, Mangwani J, Pegg EC. Clinically useful finite element models of the natural ankle - A review. Clin Biomech (Bristol, Avon) 2023; 106:106006. [PMID: 37245282 DOI: 10.1016/j.clinbiomech.2023.106006] [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: 12/23/2022] [Revised: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Biomechanical simulation of the foot and ankle complex is a growing research area but compared to simulation of joints such as hip and knee, it has been under investigated and lacks consistency in research methodology. The methodology is variable, data is heterogenous and there are no clear output criteria. Therefore, it is very difficult to correlate clinically and draw meaningful inferences. METHODS The focus of this review is finite element simulation of the native ankle joint and we will explore: the different research questions asked, the model designs used, ways the model rigour has been ensured, the different output parameters of interest and the clinical impact and relevance of these studies. FINDINGS The 72 published studies explored in this review demonstrate wide variability in approach. Many studies demonstrated a preference for simplicity when representing different tissues, with the majority using linear isotropic material properties to represent the bone, cartilage and ligaments; this allows the models to be complex in another way such as to include more bones or complex loading. Most studies were validated against experimental or in vivo data, but a large proportion (40%) of studies were not validated at all, which is an area of concern. INTERPRETATION Finite element simulation of the ankle shows promise as a clinical tool for improving outcomes. Standardisation of model creation and standardisation of reporting would increase trust, and enable independent validation, through which successful clinical application of the research could be realised.
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Affiliation(s)
| | - Shilpa Jha
- University Hospitals of Leicester, Leicester, UK
| | - Aashish Gulati
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Claire Brockett
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | | | - Elise C Pegg
- Department of Mechanical Engineering, University of Bath, Bath, UK.
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Dibbern K, Vivtcharenko V, Salomao Barbachan Mansur N, Lalevée M, Alencar Mendes de Carvalho K, Lintz F, Barg A, Goldberg AJ, de Cesar Netto C. Distance mapping and volumetric assessment of the ankle and syndesmotic joints in progressive collapsing foot deformity. Sci Rep 2023; 13:4801. [PMID: 36959355 PMCID: PMC10036322 DOI: 10.1038/s41598-023-31810-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023] Open
Abstract
The early effects of progressive collapsing foot deformity (PCFD) on the ankle and syndesmotic joints have not been three-dimensionally quantified. This case-control study focused on using weight bearing CT (WBCT) distance (DM) and coverage maps (CM) and volumetric measurements as 3D radiological markers to objectively characterize early effects of PCFD on the ankle and syndesmotic joints. Seventeen consecutive patients with symptomatic stage I flexible PCFD and 20 matched controls that underwent foot/ankle WBCT were included. Three-dimensional DM and CM of the ankle and syndesmotic joints, as well volumetric assessment of the distal tibiofibular syndesmosis was performed as possible WBCT markers of early PCFD. Measurements were compared between PCFD and controls. Significant overall reductions in syndesmotic incisura distances were observed in PCFD patients when compared to controls, with no difference in the overall syndesmotic incisura volume at 1, 3, 5 and 10 cm proximally to the ankle joint. CMs showed significantly decreased articular coverage of the anterior regions of the tibiotalar joint as well as medial/lateral ankle joint gutters in PCFD patients. This study showed syndesmotic narrowing and decreased articular coverage of the anterior aspect of the ankle gutters and talar dome in stage I PCFD patients when compared to controls. These findings are consistent with early plantarflexion of the talus within the ankle Mortise, and absence of true syndesmotic overload in early PCFD, and support DM and CM as early 3D PCFD radiological markers.
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Affiliation(s)
- Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Victoria Vivtcharenko
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Service d'orthopédie Traumatologie, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
| | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Malakoutikhah H, Latt LD. Disease-Specific Finite element Analysis of the Foot and Ankle. Foot Ankle Clin 2023; 28:155-172. [PMID: 36822685 DOI: 10.1016/j.fcl.2022.10.007] [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: 01/03/2023]
Abstract
Finite-element analysis is a computational modeling technique that can be used to quantify parameters that are difficult or impossible to measure externally in a geometrically complex structure such as the foot and ankle. It has been used to improve our understanding of pathomechanics and to evaluate proposed treatments for several disorders, including progressive collapsing foot deformity, ankle arthritis, syndesmotic injury, ankle fracture, plantar fasciitis, diabetic foot ulceration, hallux valgus, and lesser toe deformities. Parameters calculated from finite-element models have been widely used to make predictions about their biomechanical correlates.
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Affiliation(s)
- Hamed Malakoutikhah
- Department of Aerospace and Mechanical Engineering, University of Arizona, 1130 North Mountain Avenue, Tucson, AZ 85721, USA.
| | - Leonard Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, 1501 N. Campbell Ave, Suite 8401, Tucson, AZ, 85724 USA
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Biomechanical responses of the human lumbar spine to vertical whole-body vibration in normal and osteoporotic conditions. Clin Biomech (Bristol, Avon) 2023; 102:105872. [PMID: 36610268 DOI: 10.1016/j.clinbiomech.2023.105872] [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: 08/15/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The prevalence of osteoporosis is continuing to escalate with an aging population. However, it remains unclear how biomechanical behavior of the lumbar spine is affected by osteoporosis under whole-body vibration, which is considered a significant risk factor for degenerative spinal disease and is typically present when driving a car. Accordingly, the objective of this study was to compare the spine biomechanical responses to vertical whole-body vibration between normal and osteoporotic conditions. METHODS A three-dimensional finite-element model of the normal human lumbar spine-pelvis segment was developed using computed tomographic scans and was validated against experimental data. Osteoporotic condition was simulated by modifying material properties of bone tissues in the normal model. Transient dynamic analyses were conducted on the normal and osteoporotic models to compute deformation and stress in all lumbar motion segments. FINDINGS When osteoporosis occurred, vibration amplitudes of the vertebral axial displacement, disc bulge, and disc stress were increased by 32.1-45.4%, 25.7-47.1% and 23.0-42.7%, respectively. In addition, it was found that for both the normal and osteoporotic models, the response values (disc bugle and disc stress) were higher in L4-L5 and L5-S1 intervertebral discs than in other discs. INTERPRETATION Osteoporosis deteriorates the effect of whole-body vibration on lumbar spine, and the lower lumbar segments might have a higher likelihood of disc degeneration under whole-body vibration.
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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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Behrens A, Dibbern K, Lalevée M, Alencar Mendes de Carvalho K, Lintz F, Barbachan Mansur NS, de Cesar Netto C. Coverage maps demonstrate 3D Chopart joint subluxation in weightbearing CT of progressive collapsing foot deformity. Sci Rep 2022; 12:19367. [PMID: 36371449 PMCID: PMC9653439 DOI: 10.1038/s41598-022-23638-3] [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: 08/30/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022] Open
Abstract
A key element of the peritalar subluxation (PTS) seen in progressive collapsing foot deformity (PCFD) occurs through the transverse tarsal joint complex. However, the normal and pathological relations of these joints are not well understood. The objective of this study to compare Chopart articular coverages between PCFD patients and controls using weight-bearing computed tomography (WBCT). In this retrospective case control study, 20 patients with PCFD and 20 matched controls were evaluated. Distance and coverage mapping techniques were used to evaluate the talonavicular and calcaneocuboid interfaces. Principal axes were used to divide the talar head into 6 regions (medial/central/lateral and plantar/dorsal) and the calcaneocuboid interface into 4 regions. Repeated selections were performed to evaluate reliability of joint interface identification. Surface selections had high reliability with an ICC > 0.99. Talar head coverage decreases in plantarmedial and dorsalmedial (- 79%, p = 0.003 and - 77%, p = 0.00004) regions were seen with corresponding increases in plantarlateral and dorsolateral regions (30%, p = 0.0003 and 21%, p = 0.002) in PCFD. Calcaneocuboid coverage decreased in plantar and medial regions (- 12%, p = 0.006 and - 9%, p = 0.037) and increased in the lateral region (13%, p = 0.002). Significant subluxation occurs across the medial regions of the talar head and the plantar medial regions of the calcaneocuboid joint. Coverage and distance mapping provide a baseline for understanding Chopart joint changes in PCFD under full weightbearing conditions.
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Affiliation(s)
- Andrew Behrens
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Kevin Dibbern
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Matthieu Lalevée
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA ,grid.41724.340000 0001 2296 5231Service d’orthopédie Traumatologie, Centre Hospitalier Universitaire de Rouen, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Kepler Alencar Mendes de Carvalho
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Francois Lintz
- Clinique de L’Union, Bd Ratalens, 31240 Saint-Jean, France
| | - Nacime Salomao Barbachan Mansur
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA ,grid.411249.b0000 0001 0514 7202Department of Orthopedics and Traumatology, Escola Paulista de Medicina UNIFESP, São Paulo, SP Brazil
| | - Cesar de Cesar Netto
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
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