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Patil M, Kulkarni MS, Sinha A, Ghorpade RR. Biomechanical variations in patients with flatfoot deformity: Impact of gender, age, and BMI on foot kinetics and kinematics. J Orthop 2024; 57:90-97. [PMID: 39006208 PMCID: PMC11245944 DOI: 10.1016/j.jor.2024.06.018] [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: 06/08/2024] [Accepted: 06/15/2024] [Indexed: 07/16/2024] Open
Abstract
Background Flatfoot is considered by the collapse of the foot arch, altered biomechanics and impacting functional abilities. The biomechanical gait alteration of foot kinematics and kinetics in individuals with flatfoot, based on gender, age and Body mass index (BMI) in each cohort is unclear. This study explores how gender, age, and body mass index (BMI) impact distinct foot biomechanical characteristics, including ankle joint angle (Jc°), Ground force reaction angle (GFR°), Achilles tendon force (T), Ankle joint force (Jc) and vertical ground reaction force (VGRF) during the gait stance phase, in flatfoot versus normal-foot individuals on Indian Population. Method A foot pressure test and sagittal plane motion analysis were performed on 142 individuals with normal-foot arches and 102 with flatfoot, stratified by gender, age, and BMI. Calculations of the magnitude and direction of forces in ankle joint equilibrants relied on inverse dynamic analysis, vertical ground force reaction and mapping motion data of the gait stance phases. Result In the midstance phase, females with high BMI (HBMI) in the middle and older age group (p = 0.029 and p = 0.014), and males with HBMI in the older age group (p = 0.039) demonstrate significantly higher V G R F . Females and males with HBMI in middle and older age groups, along with males with normal BMI in the older age cohort, show positive and negative ranges of GFR°, indicating gait instability. In the push-off phase, females with HBMI in a middle-aged group exhibit significantly lower T a n d J c (p = 0.023 and p = 0.026) respectively. Conclusion The biomechanical issues in individuals with flatfoot, while accounting for the influence of gender, age and BMI, are crucial for tailored interventions and precise solutions to biomechanical issues, thereby enhancing foot function and reducing discomfort.
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Affiliation(s)
- Mrudula Patil
- Dr. Vishwanath Karad MIT World Peace University Pune, India
| | - Mrudula S Kulkarni
- Department of Civil Engineering, Dr. Vishwanath Karad MIT World Peace University Pune, India
| | - Avijan Sinha
- Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Ratnakar R Ghorpade
- Department of Mechanical Engineering, Dr. Vishwanath Karad MIT World Peace University Pune, India
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Filardi V, Vaishya R. Comparative Finite Element (FE) Analysis of the Mechanical Behavior in an Innovative Nitinol Staple for Arthrodesis in Distal Interphalangeal Joint. J Hand Microsurg 2024; 16:100040. [PMID: 38855509 PMCID: PMC11144644 DOI: 10.1055/s-0043-1769091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Objective Osteoarthritis (OA) is a source of significant limitations for individuals, health systems, and economies. The most common complications of OA are often associated with risk factors related to chronic diseases, cardiovascular disease, and depression. In this article, a new kind of staple is proposed, designed to provide better strength when subjected to bending and torque loads. Methods This innovative staple has been numerically tested and compared to a MEMOFIX staple by Smith + Nephew, in order to evaluate its mechanical behavior. The radius and ulna were fixed at the lower extremity, while the distal interphalangeal of the little finger was loaded with a bending load of 50 N and a torque moment of 500 N/mm2. Results For the bending load, a maximum value of stress of 120 MPa in the traditional staple, while 90 MPa are registered in the innovative one. The torsional load produces a value of 107 MPa in the traditional staple and 85 MPa in the innovative one. Conclusion Computational simulations showed the biomechanical performance of a new type of nitinol staple compared with a traditional one. This staple is designed with an elliptical shape in order to support different kinds of loads. Our results confirm an optimal mechanical behavior, compared to the traditional staple, in terms of the evaluated Equivalent Von Mises stress; also the contact force exerted by the innovative staple was increased.
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Affiliation(s)
- V. Filardi
- Administrative Department of Research and Internationalization, University of Messina, Messina, Italy
| | - R. Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
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3
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Lavoie-Turcotte T, Ménard AL, Begon M, Nault ML. Flatfoot arch correction with generic 3D-printed orthoses at different body weight percentages. Foot (Edinb) 2024; 59:102093. [PMID: 38520781 DOI: 10.1016/j.foot.2024.102093] [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: 09/12/2023] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Flatfoot can be associated with foot pathologies and treated conservatively with foot orthoses to correct arch collapse and alleviate painful symptoms. Recently, 3D printing has become more popular and is widely used for medical device manufacturing, such as orthoses. This study aims at quantifying the effect of generic 3D-printed foot orthoses on flatfoot arch correction under different static loading conditions. METHODS Participants with normal and flatfeet were recruited for this cross-sectional study. Clinical evaluation included arch height, foot posture index, and Beighton flexibility score. Surface imaging was performed in different loading conditions: 1) 0% when sitting, 2) 50% when standing on both feet, and 3) 125% when standing on one foot with a weighted vest. For flatfoot participants, three configurations were tested: without an orthosis, with a soft generic 3D printed orthosis, and with a rigid 3D printed orthosis. Arch heights and medial arch angles were calculated and compared for the different loading conditions and with or without orthoses. The differences between groups, with and without orthoses, were analyzed with Kruskal-Wallis tests, and a p < 0.05 was considered significant. RESULTS A total of 10 normal feet and 10 flatfeet were analyzed. The 3D printed orthosis significantly increased arch height in all loading conditions, compared to flatfeet without orthosis. Wearing an orthosis reduced the medial arch angle, although not significantly. Our technique was found to have good to excellent intra and interclass correlation coefficients. CONCLUSIONS Generic 3D printed orthoses corrected arch collapse in static loading conditions, including 125% body weight to simulate functional tasks like walking. Our protocol was found to be reliable and easier to implement in a clinical setting compared to previously reported methods. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Tommy Lavoie-Turcotte
- Faculty of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | - Anne-Laure Ménard
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada
| | - Mickael Begon
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada; CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5. Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5. Canada; University of Montreal, 2900 boul. Edouard-Montpetit, Montréal, QC H3T 1J4. Canada; CIUSSS Hôpital du Sacré-Cœur de Montréal (HSCM), Department of Orthopedic Surgery, 5400 boul. Gouin Ouest, Montreal, QC H4J 1C5, Canada.
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4
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Bavil AY, Eghan-Acquah E, Diamond LE, Barrett R, Carty CP, Barzan M, Nasseri A, Lloyd DG, Saxby DJ, Feih S. Effect of different constraining boundary conditions on simulated femoral stresses and strains during gait. Sci Rep 2024; 14:10808. [PMID: 38734763 PMCID: PMC11088641 DOI: 10.1038/s41598-024-61305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
Finite element analysis (FEA) is commonly used in orthopaedic research to estimate localised tissue stresses and strains. A variety of boundary conditions have been proposed for isolated femur analysis, but it remains unclear how these assumed constraints influence FEA predictions of bone biomechanics. This study compared the femoral head deflection (FHD), stresses, and strains elicited under four commonly used boundary conditions (fixed knee, mid-shaft constraint, springs, and isostatic methods) and benchmarked these mechanics against the gold standard inertia relief method for normal and pathological femurs (extreme anteversion and retroversion, coxa vara, and coxa valga). Simulations were performed for the stance phase of walking with the applied femoral loading determined from patient-specific neuromusculoskeletal models. Due to unrealistic biomechanics observed for the commonly used boundary conditions, we propose a novel biomechanical constraint method to generate physiological femur biomechanics. The biomechanical method yielded FHD (< 1 mm), strains (approaching 1000 µε), and stresses (< 60 MPa), which were consistent with physiological observations and similar to predictions from the inertia relief method (average coefficient of determination = 0.97, average normalized root mean square error = 0.17). Our results highlight the superior performance of the biomechanical method compared to current methods of constraint for both healthy and pathological femurs.
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Affiliation(s)
- Alireza Y Bavil
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia
| | - Emmanuel Eghan-Acquah
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia
| | - Rod Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia
| | - Christopher P Carty
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia
| | - Martina Barzan
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia
| | - Azadeh Nasseri
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia
| | - David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia.
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia.
| | - Stefanie Feih
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Australia.
- Advanced Design and Prototyping Technologies (ADaPT) Institute, Griffith University, Gold Coast, Australia.
- School of Engineering and Built Environment, Griffith University, Gold Coast, Australia.
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Tang M, Zeng Z, Li C, Hu X, Wang L. Acute effects of athletic taping on arch deformity and plantar pressure in young female adults with flexible flatfoot. Gait Posture 2024; 108:250-256. [PMID: 38150945 DOI: 10.1016/j.gaitpost.2023.12.013] [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: 05/19/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE This work aimed to explore the acute effects of athletic taping techniques on foot arch deformity and plantar pressure in young female adults with flexible flatfoot (FFT). METHODS Twenty young female adults with FFT were recruited in the current study. Each participant was randomly divided into two taping groups, namely, augmented low-dye (ALD) and modified low-dye (MLD). The foot arch deformity and plantar pressure were measured at baseline, after taping and after 20 min of walking. The foot arch deformity was determined based on navicular drop distance (NDD) and resting calcaneal stance position (RCSP). RESULTS Compared with baseline, the NDD values were significantly lower after taping. After 20 min of walking, ALD taping resulted in a lower NDD value than MLD (p < 0.001). ALD maintained a higher RCSP than baseline after 20 min of walking (p = 0.004). Furthermore, compared with baseline, medial midfoot force-time integration (p = 0.013) and contact area (p = 0.022) increased after taping with MLD, and peak pressure in the medial midfoot increased after walking for 20 min with MLD (p = 0.026). Peak pressure in the second to fifth toes significantly decreased after 20 min of walking with ALD compared with that after taping immediately (p = 0.002). CONCLUSIONS ALD and MLD taping could improve FFT arch deformity and plantar pressure distribution, prospectively changing peak pressure of the second to fifth toe area and medial midfoot after 20 min of walking, integrated contact area and force-time integration medial midfoot during walking in young female adults. Furthermore, ALD taping could improve FFT deformity more than using MLD after 20 min of walking. Thus, when treating FFT in young female adults, ALD taping should be considered adaptively to guide arch support production and correct midfoot pronation.
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Affiliation(s)
- Meihua Tang
- Shanghai Fire Research Institute of Mem, Zhongshan South 2nd Rd.601, Xuhui District, Shanghai, China
| | - Ziwei Zeng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Chengliang Li
- Rail Transit Department, Shanghai Fire and Rescue, South Xizang Rd.1, Huangpu District, Shanghai, China
| | - Xiaoyue Hu
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Hengren Rd.188, Yangpu District, Shanghai, China
| | - Lin Wang
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Hengren Rd.188, Yangpu District, Shanghai, China.
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Ram LM, Schippers P, Neun O, Gramlich Y, Herrmann E, Klug A, Hoffmann R, Fischer S. Radiographic Evidence of Sufficient Transverse Plane Alignment after Weil Osteotomy without Screw Fixation. J Clin Med 2024; 13:331. [PMID: 38256465 PMCID: PMC10816324 DOI: 10.3390/jcm13020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Weil osteotomy is a proven procedure to restore the harmonic distal parabola of the forefoot. In addition to the proximal displacement of the head in the sagittal plane, a displacement in the transverse plane may be necessary, with the refixation of the displaced metatarsal head historically performed by screw fixation. We aimed to determine the radiological differences among 136 feet of 127 patients with 256 Weil osteotomies retrospectively enrolled and divided into groups with (n = 182) and without (n = 74) screw fixation. Demographic data, radiographic union, pre- and postoperative metatarsal angles, and differences in the dorsoplantar view were evaluated. The mean follow-up period was 3.6 months. The mean preoperative metatarsophalangeal angle was 9.24°, and the mean postoperative angle was 12.99°. The restoration of the transversal alignment plane was equally successful in both groups, with a mean extent of angle correction of 10.58°. No nonunions of the osteotomized metatarsals were observed. The radiographic comparisons revealed no significant difference between the groups (p > 0.05). However, visibility of the joint space of the metatarsophalangeal joint was achieved significantly more often in the group without screw fixation (p < 0.05). In the absence of bony malunion and the satisfactory restoration of a harmonious parabola of the forefoot, apparently there does not appear to be a necessity for regular screw fixation after Weil osteotomy based on the available data from the present study.
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Affiliation(s)
- Leona Marleen Ram
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
| | - Oliver Neun
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Yves Gramlich
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Eva Herrmann
- Institut für Biostatistik und Mathematische Modellierung, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Alexander Klug
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Reinhard Hoffmann
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
| | - Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt, Germany
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Markowicz M, Skrobot W, Łabuć A, Poszytek P, Orlikowska A, Perzanowska E, Krasowska K, Drewek K, Kaczor JJ. The Rehabilitation Program Improves Balance Control in Children with Excessive Body Weight and Flat Feet by Activating the Intrinsic Muscles of the Foot: A Preliminary Study. J Clin Med 2023; 12:jcm12103364. [PMID: 37240471 DOI: 10.3390/jcm12103364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND determining the appropriate rehabilitation protocol is essential to influence the correction of flat feet, e.g., by activating the intrinsic muscles of the foot. Therefore, this study aimed to determine the impact of the exercises activating the intrinsic foot muscles for postural control in children with flat feet, with normal and excessive body weight. METHODS Fifty-four children aged 7 to 12 were enrolled in the research. Forty-five children were qualified for the final evaluation. Each child in the experimental group was demonstrated an appropriate technique for performing a short foot exercise without compensation by extrinsic muscle. The participants then performed a supervised short foot training session once a week and on other days of the week under the supervision of caregivers for 6 weeks. Flat feet were scored on the foot posture index scale. A postural test was evaluated with a Biodex balance system SD. Statistical significance in the foot posture index scale and postural test were evaluated using an analysis of variance (ANOVA) with Tukey's post-hoc test. RESULTS according to the six indices of the foot posture index scale, five indicators showed statistically significant improvement after rehabilitation. At the 8-12 platform mobility level, it was revealed that the excessive body weight group had significant improvements in the overall stability index and medio-lateral stability index, with eyes closed. CONCLUSION our results indicate that a 6-week rehabilitation program based on the activation of the intrinsic muscles of the foot resulted in an improvement in the foot position. This, in turn, affected balance control, especially in children with excess body weight in conditions of closed eyes.
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Affiliation(s)
- Maria Markowicz
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Wojciech Skrobot
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Agnieszka Łabuć
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Paulina Poszytek
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Agnieszka Orlikowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Ewelina Perzanowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Katarzyna Krasowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Konrad Drewek
- Cathedral and Clinic for Orthopaedics and Traumatology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jan J Kaczor
- Division of Bioenergetics and Physiology of Exercise, Medical University of Gdansk, 80-210 Gdansk, Poland
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Chapman J, Higginson K, Singh A, Sirikonda S, Molloy AP, Mason L. Association of Fusion of the First Metatarsophalangeal Joint and Pes Planus Deformity Correction. Foot Ankle Int 2023; 44:443-450. [PMID: 36995134 DOI: 10.1177/10711007231159098] [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] [Indexed: 03/31/2023]
Abstract
BACKGROUND There has been scant investigation on the relationship between the distal aspect of the medial longitudinal arch and pes planus deformity. The aim of this study was to investigate whether the reduction and stabilization of the distal aspect of the medial longitudinal arch through fusion of the first metatarsophalangeal joint (MTPJ) can subsequently improve pes planus deformity parameters. This could be useful in both further understanding the role of the distal medial longitudinal arch in patients with pes planus and planning operative intervention in patients with multifactorial medial longitudinal arch problems. METHODS A retrospective cohort study was undertaken between January 2011 and October 2021, including patients undergoing first MTPJ fusion with a pes planus deformity on weightbearing preoperative radiographs. These were compared to postoperative images, and multiple pes planus measurements were taken for comparison. RESULTS A total of 511 operations were identified for further analysis, with 48 feet meeting the inclusion criteria. There was a statistically significant reduction identified between the pre- and postoperative measurements of Meary angle (3.75 degrees, 95% CI 2.9-6.47 degrees) and talonavicular coverage angle (1.48 degrees, 95% CI 1.09-3.44 degrees). There was a statistically significant increase between the pre- and postoperative measurements of calcaneal pitch angle (2.32 degrees, 95% CI 0.24-4.41 degrees) and medial cuneiform height (1.25 mm, 95% CI 0.6-1.92 mm). Reduced intermetatarsal angle was significantly associated with an increase in first MTPJ angle postfusion. Many of the measurements made were found "almost perfectly" reproducible by the Landis and Koch description. CONCLUSION Our results demonstrate that fusion of the first MTPJ is associated with improvement of medial longitudinal arch parameters of a pes planus deformity but not to levels considered to be clinically normal. Therefore, the distal aspect of the medial longitudinal arch could, to some degree, be a feature in the pes planus deformity etiology. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- James Chapman
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Kieren Higginson
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Anjani Singh
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Siva Sirikonda
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew P Molloy
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Lyndon Mason
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
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9
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Padrón L, Bayod J, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias M, López-López D, Casado-Hernández I. Influence of the center of pressure on baropodometric gait pattern variations in the adult population with flatfoot: A case-control study. Front Bioeng Biotechnol 2023; 11:1147616. [PMID: 36970626 PMCID: PMC10035659 DOI: 10.3389/fbioe.2023.1147616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Adult flatfoot is considered an alteration in the foot bone structure characterized by a decrease or collapse of the medial arch during static or dynamic balance in the gait pattern. The aim of our research was to analyze the center of pressure differences between the population with adult flatfoot and the population with normal feet.Methods: A case-control study involving 62 subjects was carried out on 31 adults with bilateral flatfoot and 31 healthy controls. The gait pattern analysis data were collected employing a complete portable baropodometric platform with piezoresistive sensors.Results: Gait pattern analysis showed statistically significant differences in the cases group, revealing lower levels in the left foot loading response of the stance phase in foot contact time (p = 0.016) and contact foot percentage (p = 0.019).Conclusion: The adult population with bilateral flatfoot evidenced higher contact time data in the total stance phase compared to the control group, which seems to be linked to the presence of foot deformity in the adult population.
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Affiliation(s)
- Luis Padrón
- Applied Mechanics and Bioengineering Group (AMB), Aragon Institute of Engineering Research (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Bayod
- Applied Mechanics and Bioengineering Group (AMB), Aragon Institute of Engineering Research (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | | | | | - Daniel López-López
- Research Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, Ferrol, Spain
- *Correspondence: Daniel López-López,
| | - Israel Casado-Hernández
- Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
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Khan F, Chevidikunnan MF, BinMulayh EA, Al-Lehidan NS. Plantar pressure distribution in the evaluation and differentiation of flatfeet. Gait Posture 2023; 101:82-89. [PMID: 36758426 DOI: 10.1016/j.gaitpost.2023.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 08/03/2022] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although foot diseases are common, only a few studies have detailed the biomechanical and anatomical components of each disorder. The most reliable diagnostic tool for flatfoot is X-ray radiography. Achieving a similar accurate and objective diagnosis using another assessment tool, such as plantar pressure measurements, can be more convenient in clinical practice. RESEARCH QUESTION To identify foot plantar pressure characteristics that primarily detect flatfoot based on X-ray, which addresses the use of such assessments for flatfoot diagnosis. In addition, to compare between the normal foot, flatfoot with positive Foot Posture Index-6 (FPI), and flatfoot with positive FPI and radiographic measures. METHODS Sixty-two feet were examined from healthy female subjects aged 20.38 ± 1.10 years. According to the results of FPI and X-ray, each sample was assigned to one of the three groups (normal: negative FPI; FPI+: FPI ≥ +6; X-ray and FPI+: Arch Angle ≥ 165°, CP ≤ 12.3° and FPI ≥ +6) and compared using plantar pressure variables. RESULTS As per normal group compared to X-ray and FPI+ group, there was a significant difference in the surface area (P-value: 0.01, 95 % CI: -26.58 to -3.62), force (P-value: 0.04, 95 % CI: -10.37 to -0.09), and pressure (P-value: 0.01, 95 % CI: -56.78 to -6.35) in the medial foot. Similarly, the arch index among the normal group and the X-ray and FPI+ group showed significant differences (Static AI; P-value: 0.003, 95 % CI: -0.21 to -0.04). CONCLUSION There was a significant difference in plantar pressure between the normal feet and flatfeet with positive FPI and X-ray in the medial foot area. SIGNIFICANCE To attain a consensus among diagnostic approaches to identify flatfoot, the combined comparison of observational, foot pressure, and radiographic methods that have shown considerable reliability can be useful for clinical practice.
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Affiliation(s)
- Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Ejlal Abdullah BinMulayh
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Nada Saleh Al-Lehidan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
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Filardi V, Risitano G, Vaishya R. Numerical investigation of patellar instability during knee flexion due to an unbalanced medial retinaculum loading effect. J Orthop 2023; 36:57-64. [PMID: 36605460 PMCID: PMC9807748 DOI: 10.1016/j.jor.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background and aim Healthy patellofemoral (PF) joint mechanics are critical to optimal knee joint function. Patella plays a vital role in distributing quadriceps load during the knee extension. Patellar tracking, not physiological tracking, causes an increase of strains in PF ligaments, peaks of localized stress of soft tissues and articular cartilage and bony parts, and knee pain; these problems lead to complications such as bone abnormalities and osteoarthritis. This research aimed to develop a Finite Element (FE) model to evaluate patellar instability due to the medial retinaculum asymmetric loading effect. Methods A numerical model of the knee was obtained by matching nuclear magnetic resonance (MRI) for soft tissues and computerized tomography (CT) for bones, carried on a normal adult. Loading setup was chosen by using literature data. The intensity of the muscle forces was calculated by a static optimization taking into account ground reaction and knee flexion/extension during walking. The effect of patellar instability was obtained by gradually unbalancing this symmetry, one side was unloaded till 90 N, and the other loaded till 110 N. Results Unbalanced forces of 10 N acting on the retinaculum alone can produce a real difference in displacements of about 7 mm, and an increment of about 44% on patellar contact forces. Conclusion This research demonstrated how an unbalanced forces acting on the retinaculum can produce significant patellar instability. Patellar instability starts at 25-30° of the knee flexion angle but tends to appear at 15° when the unbalanced muscular loading conditions are acting.
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Affiliation(s)
- V. Filardi
- University of Messina, D.A. Research and Internationalization, V. C. Del Mare 41, 98100, Messina, Italy
| | - G. Risitano
- University of Messina, Department of Engineering, Contrada di Dio (S. Agata), 98166, Messina, Italy
| | - R. Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, 110076, India
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12
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Tropea A, Tisano A, Bruschetta A, Borzelli D, Migliorato A, Nirta G, Leonardi G, Trimarchi F, Alito A. Comparative FE biomechanical and microbial adhesion analyses on an implanted humerus. J Orthop 2022; 32:78-84. [DOI: 10.1016/j.jor.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
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Adult-Acquired Flatfoot Deformity: Combined Talonavicular Arthrodesis and Calcaneal Displacement Osteotomy versus Double Arthrodesis. J Clin Med 2022; 11:jcm11030840. [PMID: 35160291 PMCID: PMC8837164 DOI: 10.3390/jcm11030840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Adult-acquired flatfoot deformity due to posterior tibial tendon dysfunction (PTTD) is one of the most common foot deformities among adults. Hypothesis: Our study aimed to confirm that the combined procedures of calcaneal displacement osteotomy and talonavicular arthrodesis are equivalent to double arthrodesis. Methods: Between 2016 and 2020, 41 patients (13 male and 28 females, mean age of 63 years) were retrospectively enrolled in the comparative study. All deformities were classified into Stages II and III of PTTD, according to Johnson and Strom. All patients underwent isolated bony realignment of the deformity: group A (n = 19) underwent calcaneal displacement osteotomy and talonavicular arthrodesis, and group B (n = 23) underwent double arthrodesis. Measurements from the Foot Function Index-D (FFI-D) and the SF-12 questionnaire were collected, with a comparison of pre- and post-operative radiographs conducted. The mean follow-up period for patients was 3.4 years. Results: The mean FFI-D was 33.9 (group A: 34.5; group B: 33.5), the mean SF-12 physical component summary was 43.13 (group A: 40.9; group B: 44.9), and the mean SF-12 mental component summary was 43.13 (group A: 40.9; group B: 44.9). The clinical data and corrected angles showed no significant intergroup differences. Conclusion: Based on the available data, our study confirmed that the combined procedures of talonavicular arthrodesis and calcaneal shift, with preservation of the subtalar joint, can be considered equivalent to the established double arthrodesis, with no significant differences in terms of clinical and radiological outcomes.
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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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15
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Wang CS, Tzeng YH, Yang TC, Lin CC, Chang MC, Chiang CC. First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction. Foot Ankle Int 2022; 43:55-65. [PMID: 34350795 DOI: 10.1177/10711007211034516] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adult acquired flatfoot deformity (AAFD) and hallux valgus (HV) are common foot and ankle deformities. Few studies have reported the changes in radiographic parameters of HV after reconstructive surgery for AAFD. This study aimed to evaluate the changes in radiographic parameters of HV and analyze the risk factors for increased HV after correction of AAFD. METHODS Adult patients with flexible AAFD who underwent similar bony procedures including medializing calcaneal osteotomy and Cotton osteotomy were included. Radiographic parameters were measured on weightbearing radiographs preoperatively, postoperatively, and at the final follow-up. Patients were divided into hallux valgus angle (HVA) increased and HVA nonincreased groups; logistic regression analysis was performed to identify risk factors affecting increased HV. RESULTS Forty-six feet of 43 patients were included. After AAFD reconstructive surgery, the tibial sesamoid position improved by 1 grade, but the HVA increased 4 degrees in average. Further, 21 of 46 feet (46%) showed an HVA increase ≥5 degrees immediately after AAFD correction surgery. Preoperative talonavicular coverage angle <21.6 degrees was a risk factor associated with HV increase immediately after the surgery. CONCLUSION In this case series, using plain radiographs to measure standard parameters of foot alignment, we found the association between AAFD correction and HV deformity measures somewhat paradoxical. Correction of overpronation of the hindfoot and midfoot appears to improve the first metatarsal rotational deformity but may also increase HVA. A lower preoperative talonavicular coverage angle was associated with an increase of the HVA after surgery. LEVEL OF EVIDENCE Level IV, case series study.
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Affiliation(s)
- Chien-Shun Wang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei.,Department of Radiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Cheng Yang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chun-Cheng Lin
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ming-Chau Chang
- Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics; School of Medicine, National Yang Ming Chiao Tung University, Taipei
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16
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Alito A, Filardi V, Famà F, Bruschetta D, Ruggeri C, Basile G, Stancanelli L, D'Amico C, Bianconi S, Tisano A. Traumatic and non-traumatic spinal cord injury: Demographic characteristics, neurological and functional outcomes. A 7-year single centre experience. J Orthop 2021; 28:62-66. [PMID: 34880567 PMCID: PMC8627899 DOI: 10.1016/j.jor.2021.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/03/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023] Open
Abstract
Objective The aim of this study is to evaluate demographic and clinical characteristics of a population affected by traumatic and non-traumatic spinal cord injury (SCI) and to analyze functional outcomes after rehabilitation. Methods This study involved 112 SCI patients (75 male and 37 female) admitted at the Neurorehabilitation Unit of the University Hospital of Messina. The neurological outcomes were evaluated according to the American Spinal Injury Association Impairment Scale (AIS) and by using length of stay, Functional Independence Measure (FIM) and Barthel Index (BI). Results NT-SCI patients were significantly older, numerous (75,89%) and affected by greater lesions when admitted, than T-SCI ones. Most of lesions were incomplete (93%) and associated with paraplegia (71%). FIM and BI outcomes are similar in both groups, even if T-SCI patients showed greater improvement when discharged. No significant differences were found in the length of stay. The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (29,41%). Linear regression models explained 26% of the variance of LOS and 38% of the variance of functional outcome. Functional status on admission was the strongest determinant of LOS and completeness of the lesion was the strongest determinant of functional outcome. Etiology (traumatic versus non-traumatic) was a weak independent determinant of LOS but was not an independent determinant of functional outcome. Conclusion SCI patient's rehabilitation should be carried out by taking into account etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program. In particular, older age negatively influence the degree of disability on admission and the entity of functional recovery in both populations. Non-traumatic lesions could have minor benefits after rehabilitation therapy if compared with traumatic ones.
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Affiliation(s)
- A. Alito
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - V. Filardi
- D.A. Research and Internationalization, University of Messina, Via Consolato Del Mare 41, 98121, Messina, Italy,Corresponding author.
| | - F. Famà
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - D. Bruschetta
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - C. Ruggeri
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - G. Basile
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - L. Stancanelli
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - C. D'Amico
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - S. Bianconi
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - A. Tisano
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
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Singh G, Gupta S, Chanda A. Biomechanical modelling of diabetic foot ulcers: A computational study. J Biomech 2021; 127:110699. [PMID: 34425420 DOI: 10.1016/j.jbiomech.2021.110699] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 01/13/2023]
Abstract
Diabetic foot problems are widespread globally, resulting in substantial medical, economic, and social challenges for patients and their families. Among diabetic complications, foot ulceration is the most frequent outcome and is more probable to be of neuropathic origin. To date, a plethora of studies has focused on diabetic foot and ulcer prevention. However, limited studies have investigated the biomechanics of diabetic foot post ulceration. In this work, extensive biomechanical modelling of diabetic foot ulcers was attempted. A full-scale foot model was developed using measurements from a human subject, and ulcers of differing sizes and depths were modelled at different plantar sites numerically. Also, the foot model was computationally modified to study the effect of flat foot conditions on the same diabetic ulcers. Standing condition was simulated, and the induced stresses were investigated at the plantar region. The maximum stresses were observed to be similar for all ulcer sizes and depths at the lateral midfoot region of the normal foot. However, the maximum stresses were reported in the lateral heel region for the flat foot, which varied significantly with size and depth. Such results present important information on the foot condition post ulceration and may help identify possibilities of further ulceration in the diabetic foot. These novel findings are anticipated to be indispensable for the development of suitable interventions (e.g., custom orthotics) for diabetic foot ulcer management.
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Affiliation(s)
- Gurpreet Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India.
| | - Shubham Gupta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India.
| | - Arnab Chanda
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), Delhi, India; Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), Delhi, India.
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Wang C, He X, Zhang Z, Lai C, Li X, Zhou Z, Ruan K. Three-Dimensional Finite Element Analysis and Biomechanical Analysis of Midfoot von Mises Stress Levels in Flatfoot, Clubfoot, and Lisfranc Joint Injury. Med Sci Monit 2021; 27:e931969. [PMID: 34455415 PMCID: PMC8411861 DOI: 10.12659/msm.931969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Midfoot deformity and injury can affect the internal pressure distribution of the foot. This study aimed to use 3D finite element and biomechanical analyses of midfoot von Mises stress levels in flatfoot, clubfoot, and Lisfranc joint injury. Material/Methods Normal feet, flatfeet, clubfeet (30 individuals each), and Lisfranc injuries (50 individuals) were reconstructed by CT, and 3D finite element models were established by ABAQUS. Spring element was used to simulate the plantar fascia and ligaments and set hyperelastic coefficients in encapsulated bone and ligaments. The stance phase was simulated by applying 350 N on the top of the talus. The von Mises stress of the feet and ankle was visualized and analyzed. Results The von Mises stress on healthy feet was higher in the lateral metatarsal and ankle bones than in the medial metatarsal bone. Among the flatfoot group, the stress on the metatarsals, talus, and navicular bones was significantly increased compared with that on healthy feet. Among patients with clubfeet, stress was mainly concentrated on the talus, and stress on the lateral metatarsal and navicular bones was significantly lower. The von Mises stress on the fractured bone was decreased, and the stress on the bone adjacent to the fractured bone was higher in Lisfranc injury. During bone dislocation alone or fracture accompanied by dislocation, the von Mises stress of the dislocated bone tended to be constant or increased. Conclusions Prediction of von Mises stress distribution may be used clinically to evaluate the effects of deformity and injury on changes in structure and internal pressure distribution on the midfoot.
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Affiliation(s)
- Chaoqiang Wang
- Department of Orthopedics, Mingdong Hospital affiliated to Fujian Medical University, Ningde, Fujian, China (mainland)
| | - Xiaoyu He
- Department of Orthopedics, Mingdong Hospital affiliated to Fujian Medical University, Ningde, Fujian, China (mainland)
| | - Zhongning Zhang
- Department of Orthopedics, Mingdong Hospital affiliated to Fujian Medical University, Ningde, Fujian, China (mainland)
| | - Caosheng Lai
- Department of Orthopedics, Mingdong Hospital affiliated to Fujian Medical University, Ningde, Fujian, China (mainland)
| | - Xueli Li
- Department of Dermatology, Mingdong Hospital affiliated to Fujian Medical University, Ningde, Fujian, China (mainland)
| | - Zhiping Zhou
- Department of Orthopedics, Mingdong Hospital affiliated to Fujian Medical University, Ningde, Fujian, China (mainland)
| | - Kangming Ruan
- Department of Orthopedics, Mingdong Hospital affiliated to Fujian Medical University, Ningde, Fujian, China (mainland)
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Tisano A, Alito A, Milardi D, Fazio R, Virelli L, Zanella C, Ruggeri C, Filardi V, Bruschetta D. Statistical investigation about spinal clinical asymmetry in a school population. J Orthop 2020; 22:336-340. [PMID: 32904173 DOI: 10.1016/j.jor.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
Background Spinal disorders and obesity are increasing and are an important cause for concern among healthcare and educational bodies. There is a wide variability in the literature of clinical positivity for scoliosis in the examination of the spine. Aim Our study aims to investigate a relationship between scoliosis hump in schoolchildren and obesity, evaluating different kind of variables. Methods The sample was comprised by 478 schoolchildren from Italy, with a mean age of 12.6 years (SD: 1.861). They were classified by using ATR test, body mass index (BMI), the Edinburgh Inventory, the deep flexion test. Results Results of ATR test evidence 26 subjects (5,4%) positive for ATR ≥ 7; 102 subjects (21,3%) positive for ATR ≥ 6; and finally 191 subjects (40,0%) positive for ATR ≥ 5. There were 191 (40%) subjects with scoliosis; obesity was present in 62 (13%) cases and, after the regression, associations were found between scoliotic posture and gender, presence of obesity, and flexibility. Conclusions Our study confirms a relationship between obesity and scoliosis, which increases with the age. Female subjects have higher risks to develop humps and spinal disorders. It is advisable to use a combination of several parameters to achieve a more sensitive evaluation.
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Affiliation(s)
- A Tisano
- Dep of Clinical and Experimental Medicine University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - A Alito
- U.O.C. Physical and Rehabilitation Medicine, Policlinico G. Martino, Via Consolare Valeria 1, 98100, Messina, Italy
| | - D Milardi
- Dep. of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Via C. Valeria 1, 98100, Messina, Italy
| | - R Fazio
- Rehabilitation Center E. Spalenza, Don Gnocchi Foundation, Via Camillo Golgi 1, 25038, Rovato (BS), Italy
| | - L Virelli
- Section of Orthopedic Rehabilitation, Department of Rehabilitation and Functional Recovery, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (MI), Italy
| | - C Zanella
- Division of Physical Medicine and Rehabilitation Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti, 14, 10126 Torino, Italy
| | - C Ruggeri
- Dep of Clinical and Experimental Medicine University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - V Filardi
- D.A. Research and Internationalization, University of Messina, V. C. Del Mare 41, 98100, Messina, Italy
| | - D Bruschetta
- Dep. of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Via C. Valeria 1, 98100, Messina, Italy
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Filardi V. Stress distribution in the humerus during elevation of the arm and external abduction. J Orthop 2020; 19:218-222. [PMID: 32071517 DOI: 10.1016/j.jor.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022] Open
Abstract
Objective The purpose of this study is to estimate stress distribution occurring in the humerus during elevation and external rotation of the arm.Methods: contact forces and moments were estimated using telemeterized shoulder implants. An accurate three-dimensional (3D) finite element (FE) model of the natural scapula was developed, and loaded by data obtained by instrumented prosthesis. Results Stresses of about 40 MPa were found on the homerus during the elevation phase acting at 30° and 80°, while a peak of 60 MPa was found during the external rotation phase at 20°. The stress aging on scapula was of about 45 MPa, while the acromion was subjected at about 30 MPa. Stresses aging on ligaments were of about 15 MPa. Conclusion These results indicated that the transfer of major muscle and joint reaction take place predominantly through the thick bony ridges, and stresses induced can be dangerous especially for patients with shoulder problems or during the first post-operative weeks after shoulder fractures or joint replacements.
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Affiliation(s)
- V Filardi
- D.A. Research and Internationalization, University of Messina, Via Consolato del mare 41, 98121, Messina, Italy
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21
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Filardi V. Hallux valgus (HV): A multi-approach investigation analysis. J Orthop 2020; 18:166-170. [PMID: 32021025 DOI: 10.1016/j.jor.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022] Open
Abstract
Objective this study aims to develop a 3D FE model of the foot suffering from valgus hallux in order to investigate the plantar pressure distributions between bony structures. Methods in a first phase a baropodometric analysis was performed, successively a FE analysis was performed comparing results and obtaining information on the stress shielding. Results the valgus hallux deforms the correct spreading of the stress inside the bony structures causing an overloading of pressure located on the hallux and downloading the other toes. Conclusion This comparative study can furnish important indications about the distribution of the stress patterns on the foot.
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Affiliation(s)
- V Filardi
- D.A. Research and Internationalization, University of Messina, Via Consolato del mare 41, 98121, Messina, Italy
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22
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Filardi V. Tibio talar contact stress: An experimental and numerical study. J Orthop 2019; 17:44-48. [PMID: 31879472 DOI: 10.1016/j.jor.2019.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/13/2019] [Indexed: 11/18/2022] Open
Abstract
Aims Tibio-talar contact stress has been evaluated and successively compared by performing an ankle contact finite element (FE) analysis and an experimental test carried on an assembled simple synthetic model of ankle equipped with a high-resolution (Tekscan) pressure sensor. Methods A numerical FEM analysis was carried out by simulating the ankle joint (foot, and tibia) in order to investigating the stress shielding on the contact surfaces. The foot was constrained at the base while a load of 980 N was applied on the top of the tibia. The same setup was experimentally reproduced by introducing a high-resolution (Tekscan) pressure sensor between tibia and foot. Results Results evidenced a good agreement between numerical and experimental data, a percentage difference of 15% was evaluated on the equivalent Von Mises contact stress. Conclusion The obtained results reveal interesting consequences deriving by taking into account how the stress shielding can influence the integrity and resistance of bones. The methods used for this validation enable formal comparison of computational and experimental results, and open the way for objective statistical measures of regional correlation between FE-computed contact stress distributions from comparison articular joint surfaces.
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Affiliation(s)
- V Filardi
- D.A. Research and Internationalization - University of Messina, Via Consolato del mare 41, 98121, Messina, Italy
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Filardi V. Stress shielding analysis on easy step staple prosthesis for calcaneus fractures. J Orthop 2019; 18:132-137. [PMID: 32021019 DOI: 10.1016/j.jor.2019.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022] Open
Abstract
Objective The calcaneus is the most frequently injured tarsal bone, with calcaneal fractures meaning that 60% of the fractures affect the foot and about 1%-2% of all fractures. Methods Two 3D FE model of the foot were realized in order to compare the stress shielding occurring in a health foot and in a fractured one implanted with an easy step prosthesis by Stryker. This dispositive is indicated for calcaneus fractures. Results Results evidence the efficacy of this kind of prosthesis as the Eq. Von mises stresses are comparable in the two model. Higher concentration of stress are concentered on the Easy step. Conclusion In conclusion, the easy step staple prosthesis allows obtaining excellent results in terms of calcaneus fracture treatments. The correct implant size for a given patient can be determined by evaluating the patient's height, weight, functional demands and anatomy.
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Affiliation(s)
- V Filardi
- D.A. Research and Internationalization, University of Messina, Via Consolato del mare 41, 98121, Messina, Italy
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Filardi V. Stress shielding FE analysis on the temporomandibular joint. J Orthop 2019; 18:63-68. [PMID: 32189886 DOI: 10.1016/j.jor.2019.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/11/2019] [Indexed: 10/26/2022] Open
Abstract
Aims The purpose of this study is to develop a FE model of the temporomandibular joint (TMJ) to investigate a musculoskeletal System of forces able to taking into account the effect of all the muscles on the TMJ in terms of stress evaluated on the bone. Methods A 3-dimensional finite element model of the mandible was constructed from the images generated by cone-beam computed tomography of a patient undergoing fixed orthodontic treatment. In order to define the loading force system an exustive study was developed to investigated the entity of the Lateral pterygoid, Masseter, medial pterygoid, Temporalis, and Geniohoid digastric, muscles. Results Stresses in the TMJ components (disc, mandible condyle and the fossa eminence on the skull) were obtained. The results have shown stress distribution during normal occlusion. Conclusion An appreciation of the anatomical and mechanical features associated with the TMJ can serve as a foundation for understanding a patient's clinical presentation. Performance of a thorough patient history and clinical examination can guide the clinician toward an improved diagnostic process.
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Affiliation(s)
- V Filardi
- D.A. Research and Internationalization, University of Messina, Via Consolato del mare 41, 98121, Messina, Italy
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Filardi V. Healing of tibial comminuted fractures by the meaning of an innovative intramedullary nail. J Orthop 2019; 16:145-150. [PMID: 30886462 DOI: 10.1016/j.jor.2019.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/17/2019] [Indexed: 11/29/2022] Open
Abstract
In this paper, an innovative design of prosthesis, conceived to heal the comminuted fractures of long bones has been investigated. The proposed prosthesis consists of two shell valves hinged to each other by a central pin and bearing slits along the surface in such a way as to guarantee the exchange of body fluids and at the same time ensure the structural stability of the bone. Two screws then hold the two valves together. The operative technique for the introduction of this type of prosthesis for the decomposed fracture of long bones consists in the incision of the fracture site, introduction of the open shell prosthesis with reduction of the fracture and composition of the bone fragments, closure by means of fixing screws of the prosthesis shell, stitching open wound flaps. A complete numerical FE model of an implanted femur was analyzed, by considering a vertical load of 980 N. Analyses confirmed results, in terms of mechanical performances, comparable with the others traditional systems of prosthesis.
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Affiliation(s)
- V Filardi
- CARECI, University of Messina, Via consolato del mare 41, 98121, Messina, Italy
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