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Kamal Z, Hekman EEG, Verkerke GJ. A combined musculoskeletal and finite element model of a foot to predict plantar pressure distribution. Biomed Phys Eng Express 2024; 10:035024. [PMID: 38277697 DOI: 10.1088/2057-1976/ad233d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/26/2024] [Indexed: 01/28/2024]
Abstract
In this study, a combined subject-specific numerical and experimental investigation was conducted to explore the plantar pressure of an individual. The research utilized finite element (FE) and musculoskeletal modelling based on computed tomography (CT) images of an ankle-foot complex and three-dimensional gait measurements. Muscle forces were estimated using an individualized multi-body musculoskeletal model in five gait phases. The results of the FE model and gait measurements for the same subject revealed the highest stress concentration of 0.48 MPa in the forefoot, which aligns with previously-reported clinical observations. Additionally, the study found that the encapsulated soft tissue FE model with hyper-elastic properties exhibited higher stresses compared to the model with linear-elastic properties, with maximum ratios of 1.16 and 1.88 MPa in the contact pressure and von-Mises stress, respectively. Furthermore, the numerical simulation demonstrated that the use of an individualized insole caused a reduction of 8.3% in the maximum contact plantar pressure and 14.7% in the maximum von-Mises stress in the encapsulated soft tissue. Overall, the developed model in this investigation holds potential for facilitating further studies on foot pathologies and the improvement of rehabilitation techniques in clinical settings.
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Affiliation(s)
- Zeinab Kamal
- Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Edsko E G Hekman
- Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Gijsbertus J Verkerke
- Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
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Hou X, Tian Y, Xu N, Li H, Yan M, Wang S, Li W. Overstrain on the longitudinal band of the cruciform ligament during flexion in the setting of sandwich deformity at the craniovertebral junction: a finite element analysis. Spine J 2023; 23:1721-1729. [PMID: 37385409 DOI: 10.1016/j.spinee.2023.06.387] [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: 11/30/2022] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND CONTEXT In the setting of "sandwich deformity" (concomitant C1 occipitalization and C2-3 nonsegmentation), the C1-2 joint becomes the only mobile joint in the craniovertebral junction. Atlantoaxial dislocation develops earlier with severer symptoms in sandwich deformity, which has been hypothesized to be due to the repetitive excessive tension in the ligaments between C1 and C2. PURPOSE To elucidate whether and how the major ligaments of the C1-2 joint are affected in sandwich deformity, and to find out the ligament most responsible for the earlier development and severer symptoms of atlantoaxial dislocation in sandwich deformity. STUDY DESIGN A finite element (FE) analysis study. METHODS A three-dimensional FE model from occiput to C5 was established using anatomical data from a thin-slice CT scan of a healthy volunteer. Sandwich deformity was simulated by eliminating any C0-1 and C2-3 segmental motion respectively. Flexion torque was applied, and the range of motion of each segment and the tension sustained by the major ligaments of C1-2 (including the transverse and longitudinal bands of the cruciform ligament, the alar ligaments, and the apical ligament) were analyzed. RESULTS Tension sustained by the longitudinal band of the cruciform ligament and the apical ligament during flexion is significantly larger in the FE model of sandwich deformity. In contrast, tension in the other ligaments is not significantly changed in the sandwich deformity model compared with the normal model. CONCLUSIONS Considering the importance of the longitudinal band of the cruciform ligament to the stability of the C1-2 joint, our findings implicate that the early onset, severe dislocation, and unique clinical manifestations of atlantoaxial dislocation in patients with sandwich deformity are mainly due to the enlarged force loaded on the longitudinal band of the cruciform ligament. CLINICAL SIGNIFICANCE The enlarged force loaded on the longitudinal band of the cruciform ligament can add to its laxity and thus reducing its ability to restrict the cranial migration of the odontoid process. This is in accordance with our clinical experience that dislocation of the atlantoaxial joint in patients with sandwich deformity is mainly craniocaudal, which means severer cranial neuropathy, Chiari deformity, and syringomyelia, and more difficult surgical treatment.
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Affiliation(s)
- Xiangyu Hou
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplants, Building 1, Yard 9, Chengwan Street, Haidian District, Beijing, China
| | - Ming Yan
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
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Shih KS, Hsu CC, Huang GT. Biomechanical Investigation of Hallux Valgus Deformity Treated with Different Osteotomy Methods and Kirschner Wire Fixation Strategies Using the Finite Element Method. Bioengineering (Basel) 2023; 10:bioengineering10040499. [PMID: 37106686 PMCID: PMC10135764 DOI: 10.3390/bioengineering10040499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/20/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
The aim of this study was to propose a finite element method based numerical approach for evaluating various hallux valgus treatment strategies. We developed three-dimensional hallux valgus deformity models, with different metatarsal osteotomy methods and Kirschner wire fixation strategies, under two types of standing postures. Ten Kirschner wire fixations were analyzed and compared. The fixation stability, bone stress, implant stress, and contact pressure on the osteotomy surface were calculated as the biomechanical indexes. The results showed that the biomechanical indexes of the osteotomy and Kirschner wire fixations for hallux valgus deformity could be effectively analyzed and fairly evaluated. The distal metatarsal osteotomy method provided better biomechanical indexes compared to the proximal metatarsal osteotomy method. This study proposed a finite element method based numerical approach for evaluating various osteotomy and Kirschner wire fixations for hallux valgus deformity before surgery.
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Affiliation(s)
- Kao-Shang Shih
- Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Ching-Chi Hsu
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Guan-Ting Huang
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan
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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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Wong DWC, Cheung JCW, Zhao JG, Ni M, Yang ZY. Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement. J Clin Med 2023; 12:jcm12041384. [PMID: 36835920 PMCID: PMC9965975 DOI: 10.3390/jcm12041384] [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: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
While hallux valgus (HV) surgeries are useful for correcting skeletal alignment problems, their effects on plantar load, which reflects forefoot functions, are less understood. The objective of this study is to conduct a systematic review and meta-analysis on the plantar load change after HV surgeries. A systematic search of Web of Science, Scopus, PubMed, CENTRAL, EMBASE, and CINAHL was performed. Studies that assessed the pre- and post-operative plantar pressure of HV patients undergoing surgeries and reported load-related parameters over the hallux, medial metatarsal, and/or central metatarsal regions were included. Studies were appraised by using the modified NIH quality assessment tool for before-after study. Studies suitable for meta-analysis were pooled with the random-effects model, using the standardized mean difference of the before-after parameters as an effect measure. Twenty-six studies containing 857 HV patients and 973 feet were included for the systematic review. Meta-analysis was conducted on 20 of them, and most studies did not favor HV surgeries. Overall, HV surgeries reduced the plantar load over the hallux region (SMD -0.71, 95% CI, -1.15 to -0.26), indicating that forefoot function worsened after surgeries. For the other five outcomes, the overall estimates were not statistically significant, indicating that surgeries did not improve them either. There was substantial heterogeneity among the studies, which in most cases could not be resolved by pre-planned subgroup analyses by surgical classification, year of publication, median age of patients, and length of follow-up. Sensitivity analysis removing lower-quality studies showed that the load integrals (impulse) over the central metatarsal region significantly increased (SMD 0.27, 95% CI, 0 to 0.53), indicating that surgeries increased the risk of transfer metatarsalgia. There is no solid evidence that HV surgeries could improve forefoot functions from a biomechanical point perspective. Currently available evidence even suggests that surgeries might reduce the plantar load over the hallux and adversely affect push-off function. The reasons behind and the effectiveness of alternative surgical methods warrant further investigation.
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Affiliation(s)
- Duo Wai-Chi Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - James Chung-Wai Cheung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Jia-Guo Zhao
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Ming Ni
- Department of Science Development, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Orthopaedics, Pudong New Area People’s Hospital, Shanghai 201299, China
| | - Zu-Yao Yang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Correspondence: ; Tel.: +852-2252-8739
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Xu Z, Sun W, Li P, Wang Y, Wong DWC, Cheung JCW, Niu W, Zhang H, Ni M. Modified Ni-Nail and C-Nail systems for intra-articular fractures of the calcaneus: A biomechancial study. Injury 2022; 53:3904-3911. [PMID: 36182591 DOI: 10.1016/j.injury.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We have proposed a novel intramedullary nail (Ni-Nail) by incorporating a sustentaculum tali screw to improve the fixation stability of minimally invasive treatment for calcaneal fractures. This study aimed to evaluate the biomechanical characters of the Ni-Nail system and compare it with traditional C-Nail system. METHODS A finite element model of a Sanders type-IIIAB calcaneal fracture was reconstructed and fixed using two intramedullary nail systems, which was validated by a cadaver study. A vertical loading of 700 N was applied to the subtalar joint surfaces, and 525 N Achilles tendon tension was applied to the superior border of the Achilles tuberosity. The von Mises stresses and fracture displacements of both fixation models were evaluated. RESULTS The maximum von Mises stress of the screws of Ni-Nail and C-Nail were 27.92 MPa and 57.42 MPa, respectively, while that of the main nail were 67.44 MPa and 53.01 MPa. In addition, the maximum fracture displacement of the Ni-Nail was larger than that of C-Nail by 15.6% (0.37 mm vs.0.32 mm). CONCLUSIONS Our static simulation analysis showed that both Ni-Nail and C-Nail demonstrated similar biomechanical stability for calcaneal fixation. The Ni-Nail features a simple structure that is easier to operate and less traumatizing. Future studies may consider to further evaluate the clinical effectiveness by clinical trials and follow-ups.
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Affiliation(s)
- Zihuan Xu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Wanju Sun
- Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China
| | - Pengfei Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yongqin Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Wenxin Niu
- Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai 201619 China; Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Haowei Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Ming Ni
- Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China; Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Lv ML, Ni M, Sun W, Wong DWC, Zhou S, Jia Y, Zhang M. Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures. Front Bioeng Biotechnol 2022; 10:791554. [PMID: 35356772 PMCID: PMC8959616 DOI: 10.3389/fbioe.2022.791554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022] Open
Abstract
The development of minimally invasive procedures and implant materials has improved the fixation strength of implants and is less traumatic in surgery. The purpose of this study was to propose a novel “double-point fixation” for calcaneal fractures and compare its biomechanical stability with the traditional “three-point fixation.” A three-dimensional finite element foot model with a Sanders type IIIAB calcaneal fracture was developed based on clinical images comprising bones, plantar fascia, ligaments, and encapsulated soft tissue. Double-point and three-point fixation resembled the surgical procedure with a volar distal radius plate and calcaneal locking plate, respectively. The stress distribution, fracture displacement, and change of the Böhler angle and Gissane’s angle were estimated by a walking simulation using the model, and the predictions between the double-point and three-point fixation were compared at heel-strike, midstance, and push-off instants. Double-point fixation demonstrated lower bone stress (103.3 vs. 199.4 MPa), but higher implant stress (1,084.0 vs. 577.9 MPa). The model displacement of double-point fixation was higher than that of three-point fixation (3.68 vs. 2.53 mm). The displacement of the posterior joint facet (0.127 vs. 0.150 mm) and the changes of the Böhler angle (0.9° vs. 1.4°) and Gissane’s angle (0.7° vs. 0.9°) in double-point fixation were comparably lower. Double-point fixation by volar distal radius plates demonstrated sufficient and favorable fixation stability and a lower risk of postoperative stress fracture, which may potentially serve as a new fixation modality for the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Ming Ni
- Department of Orthopedics, Pudong New Area People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Wanju Sun
- Department of Orthopedics, Pudong New Area People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Shuren Zhou
- School of Computer and Communication Engineering, Changsha University of Science and Technology, Changsha, China
| | - Yongwei Jia
- Department of Spine Surgery, Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Yongwei Jia,
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Morgan O, Hillstrom H, Bitar R, Sturnick D, Koff MF, Ellis S, Deland J, Hillstrom R. Finite Element Modelling of Planus and Rectus Foot Types for the Study of First Metatarsophalangeal and First Metatarsocuneiform Joint Contact Mechanics. J Biomech Eng 2022; 144:1135615. [PMID: 35147162 DOI: 10.1115/1.4053791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 11/08/2022]
Abstract
Evaluating the contact mechanics of human joints is an important element in understanding the pathomechanics of orthopaedic diseases. Although physical testing is essential in the evaluation process, reliable computational models can augment these experiments by non-invasive predictions of biomechanical or surgical variables. The objective of this study was to perform verification of a framework for developing a medial forefoot finite element. Verification was conducted by comparing computational predictions to experimental measurements of first metatarsophalangeal and first metatarsocuneiform joint contact mechanics. A custom-built force-controlled cadaveric test-rig was used to derive measurements of contact pressure, force, and area. A quasi-static finite element was developed and driven under the same boundary and loading conditions. Calibration of cartilage moduli and mesh sensitivity analyses were performed. Mean errors in contact pressures, forces, and areas were 24%, 4%, and 40% at the first metatarsophalangeal joint and 23%, 12%, and 19% at the first Metatarsocuneiform joint, respectively. Verification of a medial forefoot finite element model development framework was presented and found to be within 30% for contact pressure and contact force of both joints. This study presents a method to verify and simulate realistic physiological loading to investigate orthopaedic diseases of the medial forefoot.
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Affiliation(s)
- Oliver Morgan
- Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Howard Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Rogerio Bitar
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Sturnick
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Scott Ellis
- Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Deland
- Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
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Xiang L, Mei Q, Wang A, Shim V, Fernandez J, Gu Y. Evaluating function in the hallux valgus foot following a 12-week minimalist footwear intervention: A pilot computational analysis. J Biomech 2022; 132:110941. [DOI: 10.1016/j.jbiomech.2022.110941] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/11/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
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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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Zhang Q, Zhang Y, Huang J, Teo EC, Gu Y. Effect of Displacement Degree of Distal Chevron Osteotomy on Metatarsal Stress: A Finite Element Method. BIOLOGY 2022; 11:127. [PMID: 35053125 PMCID: PMC8772834 DOI: 10.3390/biology11010127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2-4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2-4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient's age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.
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Affiliation(s)
- Qiaolin Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
| | - Ee Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (Q.Z.); (Y.Z.); (J.H.)
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
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Peng Y, Niu W, Wong DWC, Wang Y, Chen TLW, Zhang G, Tan Q, Zhang M. Biomechanical comparison among five mid/hindfoot arthrodeses procedures in treating flatfoot using a musculoskeletal multibody driven finite element model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106408. [PMID: 34537493 DOI: 10.1016/j.cmpb.2021.106408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Mid/hindfoot arthrodesis could modify the misalignment of adult-acquired flatfoot and attenuate pain. However, the long-term biomechanical effects of these surgical procedures remain unclear, and the quantitative evidence is scarce. Therefore, we aimed to investigate and quantify the influences of five mid/hindfoot arthrodeses on the internal foot biomechanics during walking stance. METHODS A young participant with flexible flatfoot was recruited for this study. We reconstructed a subject-specific musculoskeletal multibody driven-finite element (FE) foot model based on the foot magnetic resonance imaging. The severe flatfoot model was developed from the flexible flatfoot through the attenuation of ligaments and the unloading of the posterior tibial muscle. The five mid/hindfoot arthrodeses simulations (subtalar, talonavicular, calcaneocuboid, double, and triple arthrodeses) and a control condition (no arthrodesis) were performed simultaneously in the detailed foot multibody dynamics model and FE model. Muscle forces calculated by a detailed multi-segment foot model and ground reaction force were used to drive the foot FE model. The internal foot loadings were compared among control and these arthrodeses conditions at the first and second vertical ground reaction force (VGRF) peak and VGRF valley instants. RESULTS The results indicated that the navicular heights in double and triple arthrodeses were higher than other surgical procedures, while the subtalar arthrodesis had the smallest values. Five mid/hindfoot arthrodeses reduced the peak plantar fascia stress compared to control. However, double and triple arthrodeses increased the peak medial cuneo-navicular joint contact pressures and peak foot pressures as well as the metatarsal bones stresses. CONCLUSION Although mid/hindfoot arthrodesis generally reduced the collapse of medial longitudinal arch and plantar fascia loading during the stance phase, the increased loading in the adjacent unfused joint and metatarsal bones for double and triple arthrodeses should be noted. These findings could account for some symptoms experienced by flatfoot patients after surgery, which may facilitate the optimization of surgical protocols.
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Affiliation(s)
- Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China; Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Wenxin Niu
- Shanghai Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai 201619, China; Clinical Center for Intelligent Rehabilitation Research, Tongji University, Shanghai 201619, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China; Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China; Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Guoxin Zhang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Qitao Tan
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong SAR 999077, China; Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China.
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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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Wong DWC, Chen TLW, Peng Y, Lam WK, Wang Y, Ni M, Niu W, Zhang M. An instrument for methodological quality assessment of single-subject finite element analysis used in computational orthopaedics. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100067] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Zhang H, Lv ML, Liu Y, Sun W, Niu W, Wong DWC, Ni M, Zhang M. Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: Implications to early weight-bearing rehabilitation. Clin Biomech (Bristol, Avon) 2020; 80:105143. [PMID: 32829234 DOI: 10.1016/j.clinbiomech.2020.105143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/13/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive fixation using crossing screws was believed to produce satisfactory clinical outcome whereas its stability in early weight-bearing remained controversial. This study aimed to analyze the biomechanical stability of minimally invasive fixation during balanced standing and walking stance, and provide evidence for early rehabilitation. METHODS A finite element model of foot-ankle-shank complex was reconstructed based on computed tomography and magnetic resonance images, and validated by plantar pressure of the model participant. A Sanders III calcaneal fracture was created on the model, and then fixed using crossing screws. The predicted stress distribution, fracture displacement, Bohler's angle and Gissane's angle were compared between the intact calcaneus and fracture model with the fixation. FINDINGS Postoperatively, the concentrated stress appeared at the junction of the calcaneus and its surrounding tissues (especially Achilles tendon, plantar fascia and ligaments) during standing and walking stances, and the stress exceeded the yield strength of trabecular bone. The longitudinal screws sustained the highest stresses and concentrated at the tips and the calcaneal tuberosity junction. The displacement of posterior joint facet, Bohler's angle, and Gissane's angle were within the acceptable range either standing or walking after the fixation. INTERPRETATION Early weight-bearing standing and walking after minimally invasive fixation may cause high stress concentration thereby induce calcaneus stress fractures and other complications like plantar fasciitis and heel pain, so it should not be supported. The peri-calcaneus tendons, i.e., Achilles tendon and plantar fascia, play key roles in the stabilization of the calcaneal fracture after operation.
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Affiliation(s)
- Haowei Zhang
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yin Liu
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Wanju Sun
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201299, China
| | - Wenxin Niu
- Department of Rehabilitation, Medical College of Tongji University, Shanghai 200092, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201299, China.
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
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Wong DWC, Wang Y, Chen TLW, Yan F, Peng Y, Tan Q, Ni M, Leung AKL, Zhang M. Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion). Front Bioeng Biotechnol 2020; 8:571192. [PMID: 33015022 PMCID: PMC7505935 DOI: 10.3389/fbioe.2020.571192] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Hallux valgus is a common foot problem affecting nearly one in every four adults. Generalized ligament laxity was proposed as the intrinsic cause or risk factor toward the development of the deformity which was difficult to be investigated by cohort clinical trials. Herein, we aimed to evaluate the isolated influence of generalized ligament laxity on the deterioration using computer simulation (finite element analysis). We reconstructed a computational foot model from a mild hallux valgus participant and conducted a gait analysis to drive the simulation of walking. Through parametric analysis, the stiffness of the ligaments was impoverished at different degrees to resemble different levels of generalized ligament laxity. Our simulation study reported that generalized ligament laxity deteriorated hallux valgus by impairing the load-bearing capacity of the first metatarsal, inducing higher deforming force, moment and malalignment at the first metatarsophalangeal joint. Besides, the deforming moment formed a deteriorating vicious cycle between hallux valgus and forefoot abduction and may result in secondary foot problems, such as flatfoot. However, the metatarsocuneiform joint did not show a worsening trend possibly due to the overriding forefoot abduction. Controlling the deforming load shall be prioritized over the correction of angles to mitigate deterioration or recurrence after surgery.
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Affiliation(s)
- Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fei Yan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qitao Tan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples’ Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Aaron Kam-Lun Leung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
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Classification of Hallucal Sesamoid Bone Correlated with Hallux Valgus Severity. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9658916. [PMID: 32685550 PMCID: PMC7336200 DOI: 10.1155/2020/9658916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022]
Abstract
The hallucal sesamoid bones (HSBs), having an important role in reducing load per unit area on the first metatarsal head, can be injured commonly which also affected the first metatarsophalangeal joint and the surrounding structure. Meanwhile, differences among each HSB type may be a major factor affecting the occurrence and development of HV. So far, many researchers had learned that there are three different conditions in hallucal sesamoid bone affecting the choice of clinical surgery corresponding to different solutions in clinic. Thus, it is necessary to study the anatomical morphological characteristics of the HSB which can be helpful in clinical diagnosis and treatment, especially hallux valgus (HV). 150 X-ray and three-dimensional (3D) computed tomographic (CT) images consist of 72 left and 78 right metatarsals were applied in this anatomic study between two variables and showed by a simple scatter plot. The first metatarsophalangeal joint is divided into four different types: type I (no HSB, 1.3%), type II (with one HSB, 0.07%), type IIIa (with two HSBs when THB is bigger, 28%), type IIIb (with two HSBs when FHB is bigger, 65.3%), and type IV (with three HSBs, 4.7%). There was no statistical difference between the left and right sides, except HVA, Meary, and pitch (P < 0.05); all a, b, c, d, and i have statistical difference between male and female (P < 0.05). Meanwhile, HVA and IMA and HVA and type group have a significant correlation. In summary, HVA and IMA and HVA and classification of HSBs have significant correlations. The classification and location of HSBs can be an important basis to choose operation methods and postoperation evaluation.
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Finite element analysis of subtalar joint arthroereisis on adult-acquired flexible flatfoot deformity using customised sinus tarsi implant. J Orthop Translat 2020; 27:139-145. [PMID: 33981572 PMCID: PMC8071640 DOI: 10.1016/j.jot.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Subtalar arthroereisis may cause sinus tarsi pain complications. In this study, we aimed to introduce a customised implant that facilitated treatment effect and less impingement. The biomechanical outcome between the intact and implant conditions was compared using finite element analysis. Methods A female patient with flatfoot (age: 36 years, height: 156 cm, body mass: 51 kg) was recruited as the model patient. The customised implant was designed from the extracted geometry. Boundary and loading conditions were assumed from the data of a normal participant. Four gait instants, including the ground reaction force first peak (25% stance), valley (45%), initial push-off (60%) and second peak (75%) were analyzed. Results The navicular height was elevated by 4.2% at 25% stance, whereas the strain of the spring, plantar cuneonavicular and plantar cuboideonavicular ligaments were reduced. The talonavicular joint force decreased and the calcaneocuboid joint increased by half and 67%, respectively, representing a lateralised load pathway. There was a stress concentration at the sulcus tali reaching 15.29 MPa Conclusion Subtalar arthroereisis using a customised implant may produce some positive treatment effects in terms of navicular height elevation, ligament strain relief and lateralised joint loading pathway. Although the concentrated stress at the sulcus tali did not exceed the threshold of bone breakdown, we could not rule out the potential of vascular disturbance owing to the remarkable elevation of stress. Future study may enlarge the contact area of the bone–implant interface by considering customisation based on the dynamic change of the sinus tarsi during walking gait. The translational potential of this article Geometry mismatch of prefabricated implants could be the reason for complications. With the advancement of 3D printing, customising implant becomes possible and may improve treatment outcome. This study implemented a theoretical model approach to explore its potential under a simulation of walking.
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Abstract
The evolution of Lapidus fixation has been strongly associated with the understanding of the anatomy and function of the first tarsometatarsal joint, the mechanism of hypermobility of the first tarsometatarsal joint, and cause of the hallux valgus deformity in 3 dimensions. Some methods, such as plantar plating, nitinol staples, and intramedullary fixation, have proven to be stronger biomechanically in cadaveric testing. Theoretically, stable fixation will reduce the rate of complications, in particular, that of nonunion and allow for early postoperative weight-bearing. Further clinical studies are needed to examine whether current biomechanical studies will translate to relevant clinical outcomes.
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Affiliation(s)
- Shuyuan Li
- Steps2Walk, 1209 Harbor Island Walk, Baltimore, MD 21230, USA.
| | - Mark S Myerson
- Steps2Walk, 1209 Harbor Island Walk, Baltimore, MD 21230, USA
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Nakai K, Zeidan H, Suzuki Y, Kajiwara Y, Shimoura K, Tatsumi M, Nishida Y, Bitoh T, Yoshimi S, Aoyama T. Relationship between forefoot structure, including the transverse arch, and forefoot pain in patients with hallux valgus. J Phys Ther Sci 2019; 31:202-205. [PMID: 30858663 PMCID: PMC6382484 DOI: 10.1589/jpts.31.202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/19/2018] [Indexed: 12/19/2022] Open
Abstract
[Purpose] Hallux valgus occurs in the forefoot where the transverse arch is located and
may be a factor involved in forefoot pain. The relationship between forefoot pain and
forefoot structure is unknown. This study aimed to analyze the relationship between
forefoot pain and the transverse arch in patients with hallux valgus. [Participants and
Methods] In this study, 122 (197 feet) adult females (46 to 86 years old) with hallux
valgus were studied. By using questionnaires, the females were divided into two groups
depending on whether or not they had forefoot pain (a group with forefoot pain [P group]
and a group without forefoot pain [NP group]). The hallux valgus angle was measured using
a goniometer, and the transverse arch was measured using a weight-bearing plantar
ultrasonography imaging device. The transverse arch measurements included the transverse
arch height and length. [Results] Only the transverse arch length, even after adjustment,
was significantly greater in the P group. No significant difference was found between the
hallux valgus angle and the transverse arch height. [Conclusion] The greater transverse
arch length in the P group was possibly due to the collapsing transverse arch support
muscles. Increased width probably caused inadequate impact absorption which in turn led to
forefoot pain.
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Affiliation(s)
- Kengo Nakai
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hala Zeidan
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yusuke Suzuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuu Kajiwara
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masataka Tatsumi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuichi Nishida
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tsubasa Bitoh
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Soyoka Yoshimi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Zhang Y, Awrejcewicz J, Szymanowska O, Shen S, Zhao X, Baker JS, Gu Y. Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: A finite element analysis. Comput Biol Med 2018; 97:1-7. [DOI: 10.1016/j.compbiomed.2018.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/14/2018] [Accepted: 04/14/2018] [Indexed: 11/26/2022]
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Wong DWC, Wang Y, Leung AKL, Yang M, Zhang M. Finite element simulation on posterior tibial tendinopathy: Load transfer alteration and implications to the onset of pes planus. Clin Biomech (Bristol, Avon) 2018; 51:10-16. [PMID: 29144991 DOI: 10.1016/j.clinbiomech.2017.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posterior tibial tendinopathy is a challenging foot condition resulting in pes planus, which is difficult to diagnose in the early stage. Prior to the deformity, abnormal internal load transfer and soft tissue attenuation are anticipated. The objective of this study was to investigate the internal load transfer and strain of the ligaments with posterior tibial tendinopathy, and the implications to pes planus and other deformities. METHODS A three-dimensional finite element model of the foot and ankle was reconstructed from magnetic resonance images of a 28-year-old normal female. Thirty bones, plantar fascia, ligaments and tendons were reconstructed. With the gait analysis data of the model subject, walking stance was simulated. The onset of posterior tibial tendinopathy was resembled by unloading the tibialis posterior and compared to the normal condition. FINDINGS The load transfer of the joints at the proximal medial column was weaken by posterior tibial tendinopathy, which was compromised by the increase along the lateral column and the intercuneiforms during late stance. Besides, the plantar tarsometatarsal and cuboideonavicular ligaments were consistently over-stretched during stance. Particularly, the maximum tensile strain of the plantar tarsometatarsal ligament was about 3-fold higher than normal at initial push-off. INTERPRETATION Posterior tibial tendinopathy altered load transfer of the medial column and unbalanced the load between the proximal and distal side of the medial longitudinal arch. Posterior tibial tendinopathy also stretched the midfoot plantar ligaments that jeopardized midfoot stability, and attenuated the transverse arch. All these factors potentially contributed to the progress of pes planus and other foot deformities.
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Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Aaron Kam-Lun Leung
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Ming Yang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Department of Pediatric Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
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Li S, Zhang Y, Gu Y, Ren J. Stress distribution of metatarsals during forefoot strike versus rearfoot strike: A finite element study. Comput Biol Med 2017; 91:38-46. [DOI: 10.1016/j.compbiomed.2017.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 11/25/2022]
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Akrami M, Qian Z, Zou Z, Howard D, Nester CJ, Ren L. Subject-specific finite element modelling of the human foot complex during walking: sensitivity analysis of material properties, boundary and loading conditions. Biomech Model Mechanobiol 2017; 17:559-576. [PMID: 29139051 PMCID: PMC5845092 DOI: 10.1007/s10237-017-0978-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/31/2017] [Indexed: 01/03/2023]
Abstract
The objective of this study was to develop and validate a subject-specific framework for modelling the human foot. This was achieved by integrating medical image-based finite element modelling, individualised multi-body musculoskeletal modelling and 3D gait measurements. A 3D ankle-foot finite element model comprising all major foot structures was constructed based on MRI of one individual. A multi-body musculoskeletal model and 3D gait measurements for the same subject were used to define loading and boundary conditions. Sensitivity analyses were used to investigate the effects of key modelling parameters on model predictions. Prediction errors of average and peak plantar pressures were below 10% in all ten plantar regions at five key gait events with only one exception (lateral heel, in early stance, error of 14.44%). The sensitivity analyses results suggest that predictions of peak plantar pressures are moderately sensitive to material properties, ground reaction forces and muscle forces, and significantly sensitive to foot orientation. The maximum region-specific percentage change ratios (peak stress percentage change over parameter percentage change) were 1.935-2.258 for ground reaction forces, 1.528-2.727 for plantar flexor muscles and 4.84-11.37 for foot orientations. This strongly suggests that loading and boundary conditions need to be very carefully defined based on personalised measurement data.
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Affiliation(s)
- Mohammad Akrami
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering, Jilin University, Changchun, 130022, People's Republic of China
| | - Zhemin Zou
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - David Howard
- School of Computing, Science and Engineering, University of Salford, Salford, M5 4WT, UK
| | - Chris J Nester
- Centre for Health Sciences Research, School of Health Sciences, University of Salford, Salford, M5 4WT, UK
| | - Lei Ren
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, M13 9PL, UK. .,Key Laboratory of Bionic Engineering, Jilin University, Changchun, 130022, People's Republic of China.
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Wong DWC, Wang Y, Chen TLW, Leung AKL, Zhang M. Biomechanical consequences of subtalar joint arthroereisis in treating posterior tibial tendon dysfunction: a theoretical analysis using finite element analysis. Comput Methods Biomech Biomed Engin 2017; 20:1525-1532. [DOI: 10.1080/10255842.2017.1382484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
| | - Tony Lin-Wei Chen
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Aaron Kam-Lun Leung
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Shenzhen Research Institute, The Hong Kong Polytechnic University, Shenzhen, China
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Mao R, Guo J, Luo C, Fan Y, Wen J, Wang L. Biomechanical study on surgical fixation methods for minimally invasive treatment of hallux valgus. Med Eng Phys 2017; 46:21-26. [PMID: 28527835 DOI: 10.1016/j.medengphy.2017.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/18/2017] [Accepted: 04/26/2017] [Indexed: 02/03/2023]
Abstract
Hallux valgus (HV) was one of the most frequent female foot deformities. The aim of this study was to evaluate mechanical responses and stabilities of the Kirschner, bandage and fiberglass fixations after the distal metatarsal osteotomy in HV treatment. Surface traction of different forefoot regions in bandage fixation and the biomechanical behavior of fiberglass bandage material were measured by a pressure sensor device and a mechanical testing, respectively. A three-dimensional foot finite element (FE) model was developed to simulate the three fixation methods (Kirschner, bandage and fiberglass fixations) in weight bearing. The model included 28 bones, sesamoids, ligaments, plantar fascia, cartilages and soft tissue. The peak Von Mises stress (MS) and compression stress (CS) of the distal fragment were predicted from the three fixation methods: Kirschner fixation (MS=6.71MPa, CS=1.232MPa); Bandage fixation (MS=14.90MPa, CS=9.642MPa); Fiberglass fixation (MS=15.83MPa, CS=19.70MPa). Compared with the Kirschner and bandage fixation, the fiberglass fixation reduced the relative movement of osteotomy fragments and obtained the maximum CS. We concluded that fiberglass fixation in HV treatment was helpful to the bone healing of distal fragment. The findings were expected to guide further therapeutic planning of HV patient.
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Affiliation(s)
- Rui Mao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China
| | - Junchao Guo
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, 100176 Beijing, China
| | - Chenyu Luo
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China; Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, 100176 Beijing, China
| | - Jianmin Wen
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China.
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Suzuki R, Ito K, Lee T, Ogihara N. Parameter identification of hyperelastic material properties of the heel pad based on an analytical contact mechanics model of a spherical indentation. J Mech Behav Biomed Mater 2017; 65:753-760. [DOI: 10.1016/j.jmbbm.2016.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 09/04/2016] [Accepted: 09/21/2016] [Indexed: 11/26/2022]
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Yu J, Wong DWC, Zhang H, Luo ZP, Zhang M. The influence of high-heeled shoes on strain and tension force of the anterior talofibular ligament and plantar fascia during balanced standing and walking. Med Eng Phys 2016; 38:1152-6. [DOI: 10.1016/j.medengphy.2016.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 07/20/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
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Mo Z, Li Q, Jia Z, Yang J, Wong DWC, Fan Y. Biomechanical consideration of prosthesis selection in hybrid surgery for bi-level cervical disc degenerative diseases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1181-1190. [PMID: 27652678 DOI: 10.1007/s00586-016-4777-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE Hybrid surgery (HS) coupling total disc replacement and fusion has been increasingly applied for multilevel cervical disc diseases (CDD). However, selection of the optimal disc prosthesis for HS in an individual patient has not been investigated. This study aimed to distinguish the biomechanical performances of five widely used prostheses (Bryan, ProDisc-C, PCM, Mobi-C, and Discover) in HS for the treatment of bi-level CDD. METHODS A finite element model of healthy cervical spine (C3-C7) was developed, and five HS models using different disc prostheses were constructed by arthrodesis at C4-C5 and by arthroplasty at C5-C6. First, the rotational displacements in flexion (Fl), extension, axial rotation, and lateral bending in the healthy model under 1.0 Nm moments combined with 73.6 N follower load were achieved, and then the maximum rotations in each direction combined with the same follower load were applied in the surgical models following displacement control testing protocols. RESULTS The range of motion (ROM) of the entire operative and adjacent levels was close to that of the healthy spine for ball-in-socket prostheses, that is, ProDisc-C, Mobi-C, and Discover, in Fl. For Bryan and PCM, the ROM of the operative levels was less than that of the healthy spine in Fl and resulted in the increase in ROMs at the adjacent levels. Ball-in-socket prostheses produced similar reaction moments (92-99 %) in Fl, which were close to that of the healthy spine. Meanwhile, Bryan and PCM required greater moments (>130 %). The adjacent intradiscal pressures (IDPs) in the models of ball-in-socket prostheses were close to that of the healthy spine. Meanwhile, in the models of Bryan and PCM, the adjacent IDPs were 25 % higher than that of the ball-in-socket models. The maximum facet stress in the model of Mobi-C was the greatest among all prostheses, which was approximately two times that of the healthy spine. Moreover, Bryan produced the largest stress on the bone-implant interface, followed by PCM, Mobi-C, ProDisc-C, and Discover. CONCLUSION Each disc prosthesis has its biomechanical advantages and disadvantages in HS and should be selected on an individual patient basis. In general, ProDisc-C, Mobi-C, and Discover produced similar performances in terms of spinal motions, adjacent IDPs, and driving moments, whereas Bryan and PCM produced similar biomechanical performances. Therefore, HS with Discover, Bryan, and PCM may be suitable for patients with potential risk of facet joint degeneration, whereas HS with ProDisc-C, Mobi-C, and Discover may be suitable for patients with potential risk of vertebral osteoporosis.
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Affiliation(s)
- Zhongjun Mo
- National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China.,Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Joint Research Center of Aerospace Biotechnology and Medical Engineering of Ministry of Science and Technology, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Qi Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Joint Research Center of Aerospace Biotechnology and Medical Engineering of Ministry of Science and Technology, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Zhiwei Jia
- Department of Orthopaedics, The 306th Hospital of People's Liberation Army, Beijing, People's Republic of China
| | - Jiemeng Yang
- National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China
| | - Yubo Fan
- National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China. .,Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, International Joint Research Center of Aerospace Biotechnology and Medical Engineering of Ministry of Science and Technology, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China.
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Ren S, Wong DWC, Yang H, Zhou Y, Lin J, Zhang M. Effect of pillow height on the biomechanics of the head-neck complex: investigation of the cranio-cervical pressure and cervical spine alignment. PeerJ 2016; 4:e2397. [PMID: 27635354 PMCID: PMC5012320 DOI: 10.7717/peerj.2397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/02/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND While appropriate pillow height is crucial to maintaining the quality of sleep and overall health, there are no universal, evidence-based guidelines for pillow design or selection. We aimed to evaluate the effect of pillow height on cranio-cervical pressure and cervical spine alignment. METHODS Ten healthy subjects (five males) aged 26 ± 3.6 years were recruited. The average height, weight, and neck length were 167 ± 9.3 cm, 59.6 ± 11.9 kg, and 12.9 ± 1.2 cm respectively. The subjects lay on pillows of four different heights (H0, 110 mm; H1, 130 mm; H2, 150 mm; and H3, 170 mm). The cranio-cervical pressure distribution over the pillow was recorded; the peak and average pressures for each pillow height were compared by one-way ANOVA with repeated measures. Cervical spine alignment was studied using a finite element model constructed based on data from the Visible Human Project. The coordinate of the center of each cervical vertebra were predicted for each pillow height. Three spine alignment parameters (cervical angle, lordosis distance and kyphosis distance) were identified. RESULTS The average cranial pressure at pillow height H3 was approximately 30% higher than that at H0, and significantly different from those at H1 and H2 (p < 0.05). The average cervical pressure at pillow height H0 was 65% lower than that at H3, and significantly different from those at H1 and H2 (p < 0.05). The peak cervical pressures at pillow heights H2 and H3 were significantly different from that at H0 (p < 0.05). With respect to cervical spine alignment, raising pillow height from H0 to H3 caused an increase of 66.4% and 25.1% in cervical angle and lordosis distance, respectively, and a reduction of 43.4% in kyphosis distance. DISCUSSION Pillow height elevation significantly increased the average and peak pressures of the cranial and cervical regions, and increased the extension and lordosis of the cervical spine. The cranio-cervical pressures and cervical spine alignment were height-specific, and they were believed to reflect quality of sleep. Our results provide a quantitative and objective evaluation of the effect of pillow height on the biomechanics of the head-neck complex, and have application in pillow design and selection.
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Affiliation(s)
- Sicong Ren
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Hui Yang
- Infinitus (China) Company Ltd., China
| | - Yan Zhou
- Infinitus (China) Company Ltd., China
| | - Jin Lin
- Infinitus (China) Company Ltd., China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
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Ni M, Niu W, Wong DWC, Zeng W, Mei J, Zhang M. Finite element analysis of locking plate and two types of intramedullary nails for treating mid-shaft clavicle fractures. Injury 2016; 47:1618-23. [PMID: 27311550 DOI: 10.1016/j.injury.2016.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Both plate and intramedullary nail fixations, including straight and anatomic nails, have been clinically adopted for the treatment of displaced mid-shaft clavicle fractures. However, the biomechanical performances of these fixations and implants have not been well evaluated. This study aims to compare the construct stability, stress distribution and fracture micro-motion of three fixations based on finite element (FE) method. METHODS The FE model of clavicle was reconstructed from CT images of a male volunteer. A mid-shaft fracture gap was created in the intact clavicle. Three fixation styles were simulated including locking plate (LP), anatomic intramedullary nail (CRx), and straight intramedullary nail (RCP). Two loading scenarios (axial compression and inferior bending) were applied at the distal end of the clavicle to simulate arm abduction, while the sternal end was fixed. RESULTS Under both conditions, the LP was the stiffest, followed by the CRx, and the RCP was the weakest. LP also displayed a more evenly stress distribution for both implant and bone. RCP had a higher stress compared with CRx in both conditions. Moreover, all implants sustained higher stress level under the loading condition of bending than compression. CONCLUSIONS The plate fixation significantly stabilizes the fracture gap, reduces the implant stress, and serves as the recommended fixation for the mid-shaft clavicle fracture. The CRx is an alternative device to treat clavicle shaft fracture, but the shoulder excessive activities should be avoided after operation.
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Affiliation(s)
- Ming Ni
- Tongji Hospital, Tongji University School of Medicine, Shanghai, China; Pudong New Area People's Hospital, Shanghai 201299, China; Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Wenxin Niu
- Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, China
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Wei Zeng
- CEAS-Biomedical Engineering (BME), University of Cincinnati, 2901 Woodside Dr., Cincinnati, OH 45221, USA; CEAS-School of Aerospace Systems, University of Cincinnati, 2851 Woodside Dr., Cincinnati, OH 45221, USA
| | - Jiong Mei
- Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures. SCIENCE CHINA-LIFE SCIENCES 2016; 59:958-64. [PMID: 27349998 DOI: 10.1007/s11427-016-0010-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/14/2016] [Indexed: 01/30/2023]
Abstract
The locking plate and percutaneous crossing metallic screws and crossing absorbable screws have been used clinically to treat intra-articular calcaneal fractures, but little is known about the biomechanical differences between them. This study compared the biomechanical stability of calcaneal fractures fixed using a locking plate and crossing screws. Three-dimensional finite-element models of intact and fractured calcanei were developed based on the CT images of a cadaveric sample. Surgeries were simulated on models of Sanders type III calcaneal fractures to produce accurate postoperative models fixed by the three implants. A vertical force was applied to the superior surface of the subtalar joint to simulate the stance phase of a walking gait. This model was validated by an in vitro experiment using the same calcaneal sample. The intact calcaneus showed greater stiffness than the fixation models. Of the three fixations, the locking plate produced the greatest stiffness and the highest von Mises stress peak. The micromotion of the fracture fixated with the locking plate was similar to that of the fracture fixated with the metallic screws but smaller than that fixated with the absorbable screws. Fixation with both plate and crossing screws can be used to treat intra-articular calcaneal fractures. In general, fixation with crossing metallic screws is preferable because it provides sufficient stability with less stress shielding.
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Wong DWC, Niu W, Wang Y, Zhang M. Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture. PLoS One 2016; 11:e0154435. [PMID: 27119740 PMCID: PMC4847902 DOI: 10.1371/journal.pone.0154435] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/13/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction Foot and ankle impact injury is common in geriatric trauma and often leads to fracture of rearfoot, including calcaneus and talus. The objective of this study was to assess the influence of foot impact on the risk of calcaneus and talus fracture via finite element analysis. Methods A three-dimensional finite element model of foot and ankle was constructed based on magnetic resonance images of a female aged 28. The foot sustained a 7-kg passive impact through a foot plate. The simulated impact velocities were from 2.0 to 7.0 m/s with 1.0 m/s interval. Results At 5.0 m/s impact velocity, the maximum von Mises stress of the trabecular calcaneus and talus were 3.21MPa and 2.41MPa respectively, while that of the Tresca stress were 3.46MPa and 2.55MPa. About 94% and 84% of the trabecular calcaneus and talus exceeded the shear yielding stress, while 21.7% and 18.3% yielded the compressive stress. The peak stresses were distributed around the talocalcaneal articulation and the calcaneal tuberosity inferiorly, which corresponded to the common fracture sites. Conclusions The prediction in this study showed that axial compressive impact at 5.0 m/s could produce considerable yielding of trabecular bone in both calcaneus and talus, dominantly by shear and compounded with compression that predispose the rearfoot in the risk of fracture. This study suggested the injury pattern and fracture mode of high energy trauma that provides insights in injury prevention and fracture management.
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Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Wenxin Niu
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Shanghai Yang Zhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- * E-mail:
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