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Yang XG, Peng Z, Liu X, Liu XL, Lu S. A narrative review of the measurement methods for biomechanical properties of plantar soft tissue in patients with diabetic foot. Front Endocrinol (Lausanne) 2024; 15:1332032. [PMID: 39135623 PMCID: PMC11317276 DOI: 10.3389/fendo.2024.1332032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/08/2024] [Indexed: 08/15/2024] Open
Abstract
This article provides an overview of the development history and advantages and disadvantages of measurement methods for soft tissue properties of the plantar foot. The measurement of soft tissue properties is essential for understanding the biomechanical characteristics and function of the foot, as well as for designing and evaluating orthotic devices and footwear. Various methods have been developed to measure the properties of plantar soft tissues, including ultrasound imaging, indentation testing, magnetic resonance elastography, and shear wave elastography. Each method has its own strengths and limitations, and choosing the most appropriate method depends on the specific research or clinical objectives. This review aims to assist researchers and clinicians in selecting the most suitable measurement method for their specific needs.
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Affiliation(s)
- Xiong-gang Yang
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, Kunming, Yunnan, China
| | - Zhi Peng
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xiang Liu
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xiao-liang Liu
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Sheng Lu
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, Kunming, Yunnan, China
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Pettenuzzo S, Belluzzi E, Pozzuoli A, Macchi V, Porzionato A, Boscolo-Berto R, Ruggieri P, Berardo A, Carniel EL, Fontanella CG. Mechanical Behaviour of Plantar Adipose Tissue: From Experimental Tests to Constitutive Analysis. Bioengineering (Basel) 2023; 11:42. [PMID: 38247919 PMCID: PMC10813593 DOI: 10.3390/bioengineering11010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Plantar adipose tissue is a connective tissue whose structural configuration changes according to the foot region (rare or forefoot) and is related to its mechanical role, providing a damping system able to adsorb foot impact and bear the body weight. Considering this, the present work aims at fully describing the plantar adipose tissue's behaviour and developing a proper constitutive formulation. Unconfined compression tests and indentation tests have been performed on samples harvested from human donors and cadavers. Experimental results provided the initial/final elastic modulus for each specimen and assessed the non-linear and time-dependent behaviour of the tissue. The different foot regions were investigated, and the main differences were observed when comparing the elastic moduli, especially the final elastic ones. It resulted in a higher level for the medial region (89 ± 77 MPa) compared to the others (from 51 ± 29 MPa for the heel pad to 11 ± 7 for the metatarsal). Finally, results have been used to define a visco-hyperelastic constitutive model, whose hyperelastic component, which describes tissue non-linear behaviour, was described using an Ogden formulation. The identified and validated tissue constitutive parameters could serve, in the early future, for the computational model of the healthy foot.
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Affiliation(s)
- Sofia Pettenuzzo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131 Padova, Italy; (S.P.); (A.B.)
| | - Elisa Belluzzi
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova (DiSCOG), Via Giustiniani 3, 35128 Padova, Italy; (E.B.); (A.P.)
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Via Giustiniani 3, 35128 Padova, Italy;
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
| | - Assunta Pozzuoli
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova (DiSCOG), Via Giustiniani 3, 35128 Padova, Italy; (E.B.); (A.P.)
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Via Giustiniani 3, 35128 Padova, Italy;
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
| | - Veronica Macchi
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
- Veneto Region Reference Center for the Preservation and Use of Gifted Bodies, Veneto Region, 35100 Padua, Italy
| | - Andrea Porzionato
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
- Veneto Region Reference Center for the Preservation and Use of Gifted Bodies, Veneto Region, 35100 Padua, Italy
| | - Rafael Boscolo-Berto
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
- Veneto Region Reference Center for the Preservation and Use of Gifted Bodies, Veneto Region, 35100 Padua, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, Via Giustiniani 3, 35128 Padova, Italy;
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
| | - Alice Berardo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131 Padova, Italy; (S.P.); (A.B.)
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Emanuele Luigi Carniel
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Industrial Engineering, University of Padova, 35131 Padova, Italy
| | - Chiara Giulia Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy; (V.M.); (A.P.); (R.B.-B.); (E.L.C.)
- Department of Industrial Engineering, University of Padova, 35131 Padova, Italy
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Teng ZL, Yang XG, Geng X, Gu YJ, Huang R, Chen WM, Wang C, Chen L, Zhang C, Helili M, Huang JZ, Wang X, Ma X. Effect of loading history on material properties of human heel pad: an in-vivo pilot investigation during gait. BMC Musculoskelet Disord 2022; 23:254. [PMID: 35292004 PMCID: PMC8925218 DOI: 10.1186/s12891-022-05197-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was aimed to develop a novel dynamic measurement technique for testing the material properties and investigating the effect of continuous compression load on the structural and mechanical properties of human heel pad during actual gait. METHODS The dual fluoroscopic imaging system (DFIS) and dynamic foot-ground contact pressure-test plate were used for measuring the material properties, including primary thickness, peak strain, peak stress, elastic modulus, viscous modulus and energy dissipation rate (EDR), both at time zero and following continuous loading. Ten healthy pilot subjects, aged from 23 to 72 (average: 46.5 ± 17.6), were enrolled. A "three-step gait cycle" is performed for all subjects, with the second step striking at a marked position on the force plate with the heel to maintain the location of the tested foot to be in the view of fluoroscopes. The subjects were measured at both relaxed (time-zero group) and fatigue (continuous-loading group) statuses, and the left and right heels were measured using the identical procedures. RESULTS The peak strain, peak stress, elastic modulus, and EDR are similar before and after continuous load, while the viscous modulus was significantly decreased (median: 43.9 vs. 20.37 kPa•s; p < 0.001) as well as primary thicknesses (median: 15.99 vs. 15.72 mm; p < 0.001). Age is demonstrated to be moderately correlated with the primary thicknesses both at time zero (R = -0.507) and following continuous load (R = -0.607). The peak stress was significantly correlated with the elastic modulus before (R = 0.741) and after continuous load (R = 0.802). The peak strain was correlated with the elastic modulus before (R = -0.765) and after continuous load (R = -0.801). The correlations between the viscous modulus and peak stress/ peak strain are similar to above(R = 0.643, 0.577, - 0.586 and - 0.717 respectively). The viscous modulus is positively correlated with the elastic modulus before (R = 0.821) and after continuous load (R = 0.784). CONCLUSIONS By using dynamic fluoroscopy combined with the plantar pressure plate, the in vivo viscoelastic properties and other data of the heel pad in the actual gait can be obtained. Age was negatively correlated with the primary thickness of heel pad and peak strain, and was positively correlated with viscous modulus. Repetitive loading could decrease the primary thickness of heel pad and viscous modulus.
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Affiliation(s)
- Zhao-Lin Teng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xiong-Gang Yang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xiang Geng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Yan-Jie Gu
- Academy for Engineering & Technology, Fudan University, No.220 Handan Road, Shanghai, 200438, China
| | - Ran Huang
- Academy for Engineering & Technology, Fudan University, No.220 Handan Road, Shanghai, 200438, China
| | - Wen-Ming Chen
- Academy for Engineering & Technology, Fudan University, No.220 Handan Road, Shanghai, 200438, China
| | - Chen Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Li Chen
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Chao Zhang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Maimaitirexiati Helili
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jia-Zhang Huang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xu Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xin Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China.
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Yang XG, Teng ZL, Zhang ZM, Wang K, Huang R, Chen WM, Wang C, Chen L, Zhang C, Huang JZ, Wang X, Ma X, Geng X. Comparison of material properties of heel pad between adults with and without type 2 diabetes history: An in-vivo investigation during gait. Front Endocrinol (Lausanne) 2022; 13:894383. [PMID: 36060939 PMCID: PMC9428762 DOI: 10.3389/fendo.2022.894383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was aimed to compare the material properties of heel pad between diabetes patients and healthy adults, and investigate the impact of compressive loading history and length of diabetes course on the material properties of heel pad. METHODS The dual fluoroscopic imaging system (DFIS) and dynamic foot-ground contact pressure-test plate were used for measuring the material properties, including primary thickness, peak strain, peak stress, stiffness, viscous modulus and energy dissipation ratio (EDR), both at time zero and following continuous loading. Material properties between healthy adults and DM patients were compared both at time zero and following continuous weight bearing. After then, comparison between time-zero material properties and properties following continuous loading was performed to identify the loading history-dependent biomechanical behaviour of heel pad. Subgroup-based sensitivity analysis was then conducted to investigate the diabetes course (<10 years vs. ≥10 years) on the material properties of heel pad. RESULTS Ten type II DM subjects (20 legs), aged from 59 to 73 (average: 67.8 ± 4.9), and 10 age-matched healthy adults (20 legs), aged from 59 to 72 (average: 64.4 ± 3.4), were enrolled. Diabetes history was demonstrated to be associated with significantly lower primary thickness (t=3.18, p=0.003**), higher peak strain (t=2.41, p=0.021*), lower stiffness (w=283, p=0.024*) and lower viscous modulus (w=331, p<0.001***) at time zero, and significantly lower primary thickness (t=3.30, p=0.002**), higher peak strain (w=120, p=0.031*) and lower viscous modulus (t=3.42, p=0.002**) following continuous loading. The continuous loading was found to be associated with significantly lower primary thickness (paired-w=204, p<0.001***) and viscous modulus (paired-t=5.45, p<0.001***) in healthy adults, and significantly lower primary thickness (paired-w=206, p<0.001***) and viscous modulus (paired-t=7.47, p<0.001***) in diabetes group. No any significant difference was found when conducting the subgroup analysis based on length of diabetes course (<10 years vs. ≥10 years), but the regression analysis showed that the length of diabetes history was positively associated with the peak strain, at time zero (r=0.506, p<0.050) and following continuous loading (r=0.584, p<0.010). CONCLUSIONS Diabetes patients were found to be associated with decreased primary thickness and viscous modulus, and increased peak strain, which may contribute to the vulnerability of heel pad to injury and ulceration. Pre-compression history-dependent behaviour is observable in soft tissue of heel pad, with lowered primary thickness and viscous modulus.
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Affiliation(s)
- Xiong-gang Yang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhao-lin Teng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhen-ming Zhang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Kan Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ran Huang
- Academy for Engineering & Technology, Fudan University, Shanghai, China
| | - Wen-ming Chen
- Academy for Engineering & Technology, Fudan University, Shanghai, China
| | - Chen Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Chen
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Zhang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-zhang Huang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiang Geng, ; Xin Ma,
| | - Xiang Geng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiang Geng, ; Xin Ma,
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Spartacus V, Shojaeizadeh M, Raffault V, Shoults J, Van Wieren K, Sparrey CJ. In vivo soft tissue compressive properties of the human hand. PLoS One 2021; 16:e0261008. [PMID: 34898632 PMCID: PMC8668133 DOI: 10.1371/journal.pone.0261008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 11/22/2021] [Indexed: 12/25/2022] Open
Abstract
Background/Purpose Falls onto outstretched hands are the second most common sports injury and one of the leading causes of upper extremity injury. Injury risk and severity depends on forces being transmitted through the palmar surface to the upper extremity. Although the magnitude and distribution of forces depend on the soft tissue response of the palm, the in vivo properties of palmar tissue have not been characterized. The purpose of this study was to characterize the large deformation palmar soft tissue properties. Methods In vivo dynamic indentations were conducted on 15 young adults (21–29 years) to quantify the soft tissue characteristics of over the trapezium. The effects of loading rate, joint position, tissue thickness and sex on soft tissue responses were assessed. Results Energy absorbed by the soft tissue and peak force were affected by loading rate and joint angle. Energy absorbed was 1.7–2.8 times higher and the peak force was 2–2.75 times higher at high rate loading than quasistatic rates. Males had greater energy absorbed than females but not at all wrist positions. Damping characteristics were the highest in the group with the thickest soft tissue while damping characteristics were the lowest in group with the thinnest soft tissues. Conclusion Palmar tissue response changes with joint position, loading rate, sex, and tissue thickness. Accurately capturing these tissue responses is important for developing effective simulations of fall and injury biomechanics and assessing the effectiveness of injury prevention strategies.
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Affiliation(s)
- Victoria Spartacus
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- * E-mail:
| | - Maedeh Shojaeizadeh
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Vincent Raffault
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - James Shoults
- Science Technical Center, Simon Fraser University, Burnaby, BC, Canada
| | - Ken Van Wieren
- Science Technical Center, Simon Fraser University, Burnaby, BC, Canada
| | - Carolyn J. Sparrey
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
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Negishi T, Ito K, Kamono A, Lee T, Ogihara N. Strain-rate dependence of viscous properties of the plantar soft tissue identified by a spherical indentation test. J Mech Behav Biomed Mater 2019; 102:103470. [PMID: 31605932 DOI: 10.1016/j.jmbbm.2019.103470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/19/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
Abstract
The mechanical properties of the plantar soft tissue are known to vary in diabetic patients, indicating that parameter identification of the mechanical properties of the foot tissue using an indentation test is clinically important for possible early diagnosis and interventions of diabetic foot. However, accurate mechanical characterization of the viscous properties of the plantar soft tissue has been difficult, as measured force-relaxation curves of the same soft tissue differ depending on how the material is loaded. In the present study, we attempted to clarify how the indentation rate of the plantar soft tissue affects the measured force-relaxation curves, which is necessary in order to identify the viscoelastic properties. The force-relaxation curves of the heel pads were obtained from the indentation experiment in vivo at indentation rates of 15, 25, 50, 75, and 100 mm/s. The curves were fit to an analytical contact model of spherical indentation incorporating a five-element Maxwell model. The results of the present study demonstrated that, although experimentally obtained force-relaxation curves were actually variable depending on the indentation rate, similar viscous parameters could be identified for the same heel if the effects of (1) the underestimation of the peak force due to the energy dissipation occurring during indentation and (2) the deceleration of the indenter at the target position were incorporated in the parameter identification process. The indentation-rate-independent viscous properties could therefore be estimated using the proposed method.
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Affiliation(s)
- Takuo Negishi
- Department of Mechanical Engineering, Keio University, Yokohama, Japan
| | - Kohta Ito
- Department of Mechanical Engineering, Keio University, Yokohama, Japan
| | - Arinori Kamono
- Department of Mechanical Engineering, Keio University, Yokohama, Japan; School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Japan
| | - Taeyong Lee
- Department of Biomedical Engineering, Ewha Womans University, Seoul, South Korea
| | - Naomichi Ogihara
- Department of Mechanical Engineering, Keio University, Yokohama, Japan; Department of Biological Science, Graduate School of Science, The University of Tokyo, Tokyo, Japan.
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