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Wang S, Gao J, Lai L, Zhang X, Gong X, Li H, Wu Y. A finite element model of human hindfoot and its application in supramalleolar osteotomy. Clin Biomech (Bristol, Avon) 2024; 115:106257. [PMID: 38714108 DOI: 10.1016/j.clinbiomech.2024.106257] [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: 12/24/2023] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND The majority of the ankle osteoarthritis cases are posttraumatic and affect younger patients with a longer projected life span. Hence, joint-preserving surgery, such as supramalleolar osteotomy becomes popular among young patients, especially those with asymmetric arthritis due to alignment deformities. However, there is a lack of biomechanical studies on postoperative evaluation of stress at ankle joints. We aimed to construct a verifiable finite element model of the human hindfoot, and to explore the effect of different osteotomy parameters on the treatment of varus ankle arthritis. METHODS The bones of the hindfoot are reconstructed using normal CT tomography data from healthy volunteers, while the cartilages and ligaments are determined from the literature. The finite element calculation results are compared with the weight-bearing CT (WBCT) data to validate the model. By setting different model parameters, such as the osteotomy height (L) and the osteotomy distraction distance (h), the effects of different surgical parameters on the contact stress of the ankle joint surface are compared. FINDINGS The alignment and the deformation of hindfoot bones as determined by the finite element analysis aligns closely with the data obtained from WBCT. The maximum contact stress of the ankle joint surface calculated by this model increases with the increase of the varus angle. The maximum contact stresses as a function of the L and h of the ankle joint surface are determined. INTERPRETATION The relationship between surgical parameters and stress at the ankle joint in our study could further help guiding the planning of the supramalleolar osteotomy according to the varus/valgus alignment of the patients.
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Affiliation(s)
- Shuai Wang
- School of Aeronautic Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing 100191, China.
| | - Junzhe Gao
- School of Aeronautic Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing 100191, China
| | - Liangpeng Lai
- Foot and Ankle Surgery Department, Beijiing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
| | - Xiaojing Zhang
- School of Aeronautic Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing 100191, China
| | - Xiaofeng Gong
- Foot and Ankle Surgery Department, Beijiing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Heng Li
- Foot and Ankle Surgery Department, Beijiing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Yong Wu
- Foot and Ankle Surgery Department, Beijiing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
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Wu Y, Wang H, Deng C, Guo Y, Zhu X. Cushioning mechanism of the metatarsals during landing for the skateboarding ollie maneuver. Front Bioeng Biotechnol 2024; 12:1382161. [PMID: 38712330 PMCID: PMC11070832 DOI: 10.3389/fbioe.2024.1382161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
Skateboarding is an Olympic event with frequent jumping and landing, where the cushioning effect by the foot structure (from the arch, metatarsals, etc.) and damping performance by sports equipment (shoes, insoles, etc.) can greatly affect an athlete's sports performance and lower the risk of limb injury. Skateboarding is characterized by the formation of a "man-shoe-skateboard system," which makes its foot cushioning mechanism different from those of other sports maneuvers, such as basketball vertical jump and gymnastics broad jump. Therefore, it is necessary to clarify the cushioning mechanism of the foot structure upon landing on a skateboard. To achieve this, a multibody finite element model of the right foot, shoe, and skateboard was created using Mimics, Geomagic, and ANSYS. Kinetic data from the ollie maneuver were used to determine the plantar pressure and Achilles tendon force at three characteristics (T1, T2, and T3). The stress and strain on the foot and metatarsals (MT1-5) were then simulated. The simulation results had an error of 6.98% compared to actual measurements. During landing, the force exerted on the internal soft tissues tends to increase. The stress and strain variations were highest on MT2, MT3, and MT4. Moreover, the torsion angle of MT1 was greater than those of the other metatarsals. Additionally, the displacements of MT2, MT3, and MT4 were higher than those of the other parts. This research shows that skateboarders need to absorb the ground reaction force through the movements of the MTs for ollie landing. The soft tissues, bones, and ligaments in the front foot may have high risks of injury. The developed model serves as a valuable tool for analyzing the foot mechanisms in skateboarding; furthermore, it is crucial to enhance cushioning for the front foot during the design of skateboard shoes to reduce potential injuries.
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Affiliation(s)
| | | | | | | | - Xiaolan Zhu
- Sport Science School, Beijing Sport University, Beijing, China
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Isvilanonda V, Li EY, Williams ED, Cavanagh PR, Haynor DR, Chu B, Ledoux WR. Subject-specific material properties of the heel pad: An inverse finite element analysis. J Biomech 2024; 165:112016. [PMID: 38422775 DOI: 10.1016/j.jbiomech.2024.112016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/01/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Individuals with diabetes are at a higher risk of developing foot ulcers. To better understand internal soft tissue loading and potential treatment options, subject-specific finite element (FE) foot models have been used. However, existing models typically lack subject-specific soft tissue material properties and only utilize subject-specific anatomy. Therefore, this study determined subject-specific hindfoot soft tissue material properties from one non-diabetic and one diabetic subject using inverse FE analysis. Each subject underwent cyclic MRI experiments to simulate physiological gait and to obtain compressive force and three-dimensional soft tissue imaging data at 16 phases along the loading-unloading cycles. The FE models consisted of rigid bones and nearly-incompressible first-order Ogden hyperelastic skin, fat, and muscle (resulting in six independent material parameters). Then, calcaneus and loading platen kinematics were computed from imaging data and prescribed to the FE model. Two analyses were performed for each subject. First, the skin, fat, and muscle layers were lumped into a single generic soft tissue material and optimized to the platen force. Second, the skin, fat, and muscle material properties were individually determined by simultaneously optimizing for platen force, muscle vertical displacement, and skin mediolateral bulging. Our results indicated that compared to the individual without diabetes, the individual with diabetes had stiffer generic soft tissue behavior at high strain and that the only substantially stiffer multi-material layer was fat tissue. Thus, we suggest that this protocol serves as a guideline for exploring differences in non-diabetic and diabetic soft tissue material properties in a larger population.
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Affiliation(s)
- Vara Isvilanonda
- Center for Limb Loss and MoBility (CLiMB), Department of Veterans Affairs, Seattle, WA, USA; Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Ellen Y Li
- Center for Limb Loss and MoBility (CLiMB), Department of Veterans Affairs, Seattle, WA, USA; Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Evan D Williams
- Center for Limb Loss and MoBility (CLiMB), Department of Veterans Affairs, Seattle, WA, USA; Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Peter R Cavanagh
- Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA; Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Baocheng Chu
- Radiology, University of Washington, Seattle, WA, USA
| | - William R Ledoux
- Center for Limb Loss and MoBility (CLiMB), Department of Veterans Affairs, Seattle, WA, USA; Departments of Mechanical Engineering, University of Washington, Seattle, WA, USA; Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA.
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Behling AV, Rainbow MJ, Welte L, Kelly L. Chasing footprints in time - reframing our understanding of human foot function in the context of current evidence and emerging insights. Biol Rev Camb Philos Soc 2023; 98:2136-2151. [PMID: 37489055 DOI: 10.1111/brv.12999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
In this narrative review we evaluate foundational biomechanical theories of human foot function in light of new data acquired with technology that was not available to early researchers. The formulation and perpetuation of early theories about foot function largely involved scientists who were medically trained with an interest in palaeoanthropology, driven by a desire to understand human foot pathologies. Early observations of people with flat feet and foot pain were analogized to those of our primate ancestors, with the concept of flat feet being a primitive trait, which was a driving influence in early foot biomechanics research. We describe the early emergence of the mobile adaptor-rigid lever theory, which was central to most biomechanical theories of human foot function. Many of these theories attempt to explain how a presumed stiffening behaviour of the foot enables forward propulsion. Interestingly, none of the subsequent theories have been able to explain how the foot stiffens for propulsion. Within this review we highlight the key omission that the mobile adaptor-rigid lever paradigm was never experimentally tested. We show based on current evidence that foot (quasi-)stiffness does not actually increase prior to, nor during propulsion. Based on current evidence, it is clear that the mechanical function of the foot is highly versatile. This function is adaptively controlled by the central nervous system to allow the foot to meet the wide variety of demands necessary for human locomotion. Importantly, it seems that substantial joint mobility is essential for this function. We suggest refraining from using simple, mechanical analogies to explain holistic foot function. We urge the scientific community to abandon the long-held mobile adaptor-rigid lever paradigm, and instead to acknowledge the versatile and non-linear mechanical behaviour of a foot that is adapted to meet constantly varying locomotory demands.
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Affiliation(s)
- Anja-Verena Behling
- School of Human Movement and Nutrition Science, The University of Queensland, Union Rd, St Lucia, Queensland, 4067, Australia
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Lauren Welte
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Luke Kelly
- School of Human Movement and Nutrition Science, The University of Queensland, Union Rd, St Lucia, Queensland, 4067, Australia
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Wagner P, Wagner E. Republication of "Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term Prospective Case Series With a Novel Technique and Topic Review". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195049. [PMID: 37590285 PMCID: PMC10426300 DOI: 10.1177/24730114231195049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence IV, prospective case series.
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Affiliation(s)
- Pablo Wagner
- Orthopedic Department, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Hospital Militar de Santiago, Universidad de los Andes, Santiago, Chile
| | - Emilio Wagner
- Orthopedic Department, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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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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Ikuta Y, Nakasa T, Sumii J, Nekomoto A, Adachi N. Distributional patterns of subchondral bone density and histopathological features of the first tarsometatarsal joint in hallux valgus feet. BMC Musculoskelet Disord 2022; 23:569. [PMID: 35701770 PMCID: PMC9195286 DOI: 10.1186/s12891-022-05523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hypermobility of the first tarsometatarsal (TMT) joint is frequently identified in patients with hallux valgus (HV); however, its association with the development of osteoarthritis in the first TMT joint in such patients remains unknown. The purpose of this study was to clarify the distribution of subchondral bone density of the first TMT joint via computed tomography (CT) using Hounsfield units (HU). Methods Patients were divided into three groups: the osteotomy (20 feet; 20 women, mean age: 61.8 years), arthrodesis (23 feet; two men, 21 women, 71.2 years), and control group (patients without HV deformity who had undergone CT scans of the foot; 13 feet; seven men, six women, 29.7 years). The HU ratios were calculated, which were defined as the HU value of each subdivision of the subarticular spongiosa of the first TMT joint [dorsomedial (DM), dorsolateral (DL), plantomedial (PM), and plantolateral (PL)] divided by the HU values of the entire joint surface. The ratios for the osteotomy, arthrodesis, and control groups were compared. The degradation of the articular cartilage in the first TMT joint was histologically graded in the arthrodesis group. Tukey–Kramer multiple comparison analysis was conducted to compare the HU ratios among the three groups, and the histological grade in each subdivision. Results The arthrodesis group demonstrated high HU ratios in the DM area of the medial cuneiform, and significantly lower HU ratios in the PL area of the first metatarsal. Lower HU ratios in the DL area were observed in both the osteotomy and the arthrodesis group when compared to that in the medial cuneiform of the control group. The histological evaluation indicated nearly normal articular cartilage for all subdivided areas in both the medial cuneiform and the first metatarsal in patients with severe HV. Conclusions Although high subchondral bone density was identified in the DM area of the medial cuneiform in severe HV, only mild degradation was histologically observed in the articular cartilage of the first TMT joint. Our findings suggest that the indications for arthrodesis of the first TMT should be reconsidered based on the severity of the degenerative changes in the first TMT joint.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan. .,Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan.,Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
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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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Najefi AA, Malhotra K, Patel S, Cullen N, Welck M. Assessing the Rotation of the First Metatarsal on Computed Tomography Scans: A Systematic Literature Review. Foot Ankle Int 2022; 43:66-76. [PMID: 34167335 DOI: 10.1177/10711007211020676] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus is a multiplanar deformity that is often treated on the basis of 2-dimensional (2D) parameters and radiographs. Recurrence rates after surgical correction remain high, and failure to correct pronation of the metatarsal is increasingly stipulated as being part of the problem. Multiple methods of assessing metatarsal pronation have been proposed. METHODS We performed a systematic literature review identifying studies that measured metatarsal pronation and torsion on computed tomography (CT) scans. Specific methodology, patient groups, results, and reliability assessments were all reported. RESULTS We identified 14 studies that fulfilled the inclusion criteria. Eleven studies measured 2D values on CT scan, and 3 studies used computer-based 3-dimensional (3D) modeling and artificial intelligence systems to help calculate pronation. Metatarsal pronation angle, α angle, sesamoid rotation angle, and measurements for torsion were the most commonly used methods. All angles and measurements were performed as 2D measurements, but the metatarsal pronation angle was also performed with 3D modeling. Reliability and reproducibility of the α angle and metatarsal pronation angle were excellent, despite being performed on studies with small numbers. CONCLUSION Multiple methods have been reported to demonstrate first metatarsal pronation on CT, of which the α angle and the metatarsal pronation angle are the most pragmatic and useful in a clinical setting. Further work is needed to further validate the reliability of these measurements in larger series and to identify normal pronation and metatarsal torsion on weightbearing imaging. Further work is required to determine whether addressing pronation reduces recurrence rates and improves outcomes in surgery for hallux valgus. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Ali-Asgar Najefi
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Karan Malhotra
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Shelain Patel
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Nicholas Cullen
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Matthew Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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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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Graef J, Tsitsilonis S, Niemann M, Gehlen T, Nadler P, Graef F. Retrospective analysis of treatment decisions and clinical outcome of Lisfranc injuries: operative vs. conservative treatment. INTERNATIONAL ORTHOPAEDICS 2021; 45:3213-3219. [PMID: 34357433 PMCID: PMC8626366 DOI: 10.1007/s00264-021-05135-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022]
Abstract
Purpose Lisfranc injuries are rare and often pose a challenge for surgeons, particularly in initially missed or neglected cases. The evidence on which subtypes of Lisfranc injuries are suitable for conservative treatment or should undergo surgery is low. The aim of this study was to retrospectively analyze treatment decisions of Lisfranc injuries and the clinical outcome of these patients within the last ten years. Methods All patients treated due to a Lisfranc injury in a German level I trauma centre from January 2011 until December 2020 were included in this study. Radiologic images and medical data from the patient files were analyzed concerning the classification of injury, specific radiologic variables, such as the Buehren criteria, patient baseline characteristics, and patient outcome reported with the Foot Function Index (FFI). Results Ninety-nine patients were included in this study (conservative = 20, operative = 79). The overall clinical outcome assessed by the FFI was good (FFI sum 23.93, SD 24.93); patients that were identified as suitable for conservative treatment did not show inferior functional results. Qualitative radiological factors like the grade of displacement and the trauma mechanism were more strongly associated with the decision for surgical treatment than quantitative radiologic factors such as the distance from the first to the second metatarsal bone. Conclusion If the indication for conservative or operative treatment of Lisfranc injuries is determined correctly, the clinical outcome can be comparable. These decisions should be based on several factors including quantitative and qualitative radiologic criteria, as well as the trauma mechanism.
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Affiliation(s)
- Josefine Graef
- Charité - Universitätsmedizin Berlin, Diagnostic and Interventional Radiology and Nuclear Medicine, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Serafeim Tsitsilonis
- Charité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marcel Niemann
- Charité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tobias Gehlen
- Charité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Pascal Nadler
- Charité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Frank Graef
- Charité - Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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Wagner E, Wagner P. Metatarsal Pronation in Hallux Valgus Deformity: A Review. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e20.00091. [PMID: 32656482 PMCID: PMC7322783 DOI: 10.5435/jaaosglobal-d-20-00091] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 01/23/2023]
Abstract
Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance. Years ago, a rounded shape of the lateral edge of the first metatarsal head was identified as an important factor to detect after surgery because a less rounded metatarsal head was associated to less recurrence. More recently, pronation of the metatarsal bone was identified as the cause for the rounded appearance of the metatarsal head, and therefore, supination stress was found to be useful to achieve a better correction of the deformity. Using CT scans, up to 87% of hallux valgus cases have been shown to present with a pronated metatarsal bone, which highlights the multiplanar nature of the deformity. This pronation explained the perceived shape of the metatarsal bone and the malposition of the medial sesamoid bone in radiological studies, which has been associated as one of the most important factors for recurrence after treatment. Treatment options are discussed briefly, including metatarsal osteotomies and tarsometatarsal arthrodesis.
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Affiliation(s)
- Emilio Wagner
- Departamento de Traumatologia, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Pablo Wagner
- Departamento de Traumatologia, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
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Abstract
Coronal malalignment is an important deformity parameter in hallux valgus feet. Approximately 90% of patients with hallux valgus have some degree of metatarsal pronation. In operated hallux valgus, persistent metatarsal pronation is an independent deformity relapse factor. Coronal malalignment can be identified through an anteroposterior (AP) weight-bearing foot radiograph and a weight-bearing forefoot scan. The AP foot view can identify 3 levels of rotation: mild, moderate and severe metatarsal pronation. Regarding the treatment options, some techniques are capable of rotational correction, such as the proximal rotational metatarsal osteotomy, Lapidus, dome osteotomy, and proximal oblique sliding closing wedge.
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Affiliation(s)
- Pablo Wagner
- Universidad de Desarrollo - Clinica Alemana de Santiago, Universidad de los Andes - Hospital Militar de Santiago, Vitacura 5951, Vitacura, Santiago, Chile.
| | - Emilio Wagner
- Universidad de Desarrollo - Clinica Alemana de Santiago, Vitacura 5951, Vitacura, Santiago, Chile
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Claaßen L, Venjakob E, Yao D, Lerch M, Plaass C, Colsman CS, Ettinger S. The computed tomographybased anatomy of the ossa cuneiformia. Orthop Rev (Pavia) 2019; 11:7876. [PMID: 31210911 PMCID: PMC6551459 DOI: 10.4081/or.2019.7876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/22/2019] [Indexed: 11/04/2022] Open
Abstract
There is a lack of basic anatomic information regarding the ossa cuneiformia. The aim of the present descriptive study was the detailed evaluation of the anatomy of the ossa cuneiformia. We analyzed 100 computer tomography scans of feet without deformities or previous trauma. The length, height and width of each cuneiforme and their articular surfaces were assessed. We itemized the data to gender differences and to foot length. The medial cuneiforme os had a length of 24.0 mm ± 2.4 (mean ± standard deviation), a width of 17.3 mm ± 2.8 and a height of 28.0 mm ± 3.4. The respective values for the intermediate cuneiforme were 18.2 mm ± 2.1, 15.8 mm ± 2.1 and 22.5 ± 2.2 and for the lateral cuneiforme 26.4 mm ± 2.7, 17.2 mm ± 2.9 and 22.8 mm ± 2.9. We found statistical relevant differences regarding gender and foot length subgroups whereas not for all parameters. The present study illustrates basic anatomic data regarding the ossa cuneiformia. This information might be helpful for implant design and placement during midfoot surgery.
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Affiliation(s)
- Leif Claaßen
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Elina Venjakob
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Daiwei Yao
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Matthias Lerch
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Christian Plaass
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Christina Stukenborg- Colsman
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Sarah Ettinger
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
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Wagner P, Wagner E. Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO). FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418790071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.
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Affiliation(s)
- Pablo Wagner
- Orthopedic Department, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Hospital Militar de Santiago, Universidad de los Andes, Santiago, Chile
| | - Emilio Wagner
- Orthopedic Department, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Biomechanical evaluation of reconstruction plates with locking, nonlocking, and hybrid screws configurations in calcaneal fracture: a finite element model study. Med Biol Eng Comput 2017; 55:1799-1807. [DOI: 10.1007/s11517-017-1623-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/25/2017] [Indexed: 12/12/2022]
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Finite element modelling of the foot for clinical application: A systematic review. Med Eng Phys 2017; 39:1-11. [DOI: 10.1016/j.medengphy.2016.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 10/13/2016] [Accepted: 10/23/2016] [Indexed: 11/20/2022]
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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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Abstract
Background/Methodology Ankle arthrodesis is one popular surgical treatment for ankle arthritis, chronic instability, and degenerative deformity. However, complications such as foot pain, joint arthritis, and bone fracture may cause patients to suffer other problems. Understanding the internal biomechanics of the foot is critical for assessing the effectiveness of ankle arthrodesis and provides a baseline for the surgical plan. This study aimed to understand the biomechanical effects of ankle arthrodesis on the entire foot and ankle using finite element analyses. A three-dimensional finite element model of the foot and ankle, involving 28 bones, 103 ligaments, the plantar fascia, major muscle groups, and encapsulated soft tissue, was developed and validated. The biomechanical performances of a normal foot and a foot with ankle arthrodesis were compared at three gait instants, first-peak, mid-stance, and second-peak. Principal Findings/Conclusions Changes in plantar pressure distribution, joint contact pressure and forces, von Mises stress on bone and foot deformation were predicted. Compared with those in the normal foot, the peak plantar pressure was increased and the center of pressure moved anteriorly in the foot with ankle arthrodesis. The talonavicular joint and joints of the first to third rays in the hind- and mid-foot bore the majority of the loading and sustained substantially increased loading after ankle arthrodesis. An average contact pressure of 2.14 MPa was predicted at the talonavicular joint after surgery and the maximum variation was shown to be 80% in joints of the first ray. The contact force and pressure of the subtalar joint decreased after surgery, indicating that arthritis at this joint was not necessarily a consequence of ankle arthrodesis but rather a progression of pre-existing degenerative changes. Von Mises stress in the second and third metatarsal bones at the second-peak instant increased to 52 MPa and 34 MPa, respectively, after surgery. These variations can provide indications for outcome assessment of ankle arthrodesis surgery.
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Affiliation(s)
- 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
| | - Zengyong Li
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture, School of Mechanical Engineering, Shandong University, Jinan, China
| | - 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
| | - 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
- * E-mail:
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Wai-Chi Wong D, Wang Y, Zhang M, Kam-Lun Leung A. Functional restoration and risk of non-union of the first metatarsocuneiform arthrodesis for hallux valgus: A finite element approach. J Biomech 2015; 48:3142-8. [PMID: 26243661 DOI: 10.1016/j.jbiomech.2015.07.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 07/11/2015] [Indexed: 11/29/2022]
Abstract
First metatarsocuneiform arthrodesis is one of the surgical interventions to correct hallux valgus, especially those with hypermobile first ray. There is lacking of biomechanical investigations to assess this operation. The objective of this study was to explore the functional restoration and the risk of non-union after the surgery via finite element analysis. A three-dimensional foot model was constructed from a female aged 28 via magnetic resonance imaging. Thirty bones and encapsulated bulk tissue were modeled. Walking stance was simulated by the gait analysis data of the same participant. Parts of the first metatarsal and cuneiform were resected and the bone graft was assigned with the same stiffness as adjacent bones to resemble the surgery of first metatarsocuneiform arthrodesis. The third principal stress of the first metatarsal at midstance (25% stance) and push off (60% stance) was increased by 76% and 139% respectively after the operation, while that of the second metatarsal was decreased by 14% and 66%. The operation reduced the medial deviation of the first metatarsal head by about 3.5mm during initial push off (60% stance). Besides, the bone graft could experience tensile stress inferiorly (26.51MPa). In conclusion, the increase of stress on the first metatarsal and the reduced medial excursion of the first metatarsal head after the simulated operation reflected that metatarsocuneiform arthrodesis could restore the load-bearing function of the first ray. However, inter-fragmentary compression could not be guaranteed. The appropriate course of hardware and non-weight-bearing protocol should be noted and further investigated.
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Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Aaron Kam-Lun Leung
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
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Wang Y, Wong DWC, Zhang M. Computational Models of the Foot and Ankle for Pathomechanics and Clinical Applications: A Review. Ann Biomed Eng 2015; 44:213-21. [DOI: 10.1007/s10439-015-1359-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/09/2015] [Indexed: 01/01/2023]
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