1
|
Maemichi T, Matsumoto M, Okunuki T, Kumai T. Changes in functional characteristics of heel fat pad with age. Clin Biomech (Bristol, Avon) 2024; 118:106294. [PMID: 38996494 DOI: 10.1016/j.clinbiomech.2024.106294] [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: 03/15/2024] [Revised: 06/10/2024] [Accepted: 06/16/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND This study aimed to investigate age-related changes in the heel fat pad's microchamber and macrochamber layers, particularly focusing on load-induced alterations. Understanding these changes is crucial for elucidating age-related differences in foot mechanics and their potential implications for mobility and comfort. METHODS Fifty-five healthy individuals were divided into three age groups: young adults (≤29 years), middle-aged adults (30-44 years), and elderly individuals (≥45 years). Ultrasonic imaging was utilized to measure the thickness of the heel fat pad's microchamber and macrochamber layers under varying load conditions. Thickness, percentage changes, and ratios of load-induced thickness changes were calculated to assess age-related differences. FINDINGS Under no-load conditions, both microchamber and macrochamber layers of the heel fat pad were significantly thicker in middle-aged and elderly individuals than in young adults. When load was applied middle-aged and elderly participants exhibited smaller changes in the macrochamber layer and larger changes in the microchamber layer compared to young adults. INTERPRETATION Our findings suggest that age influences the structural characteristics and response of the heel fat pad to mechanical loading. Thicker heel fat pad layers in middle-aged and elderly individuals under no-load conditions may reflect age-related changes in fat distribution or composition. Moreover, differences in load-induced thickness changes indicate altered mechanical properties with age, potentially affecting shock absorption and overall foot function. Understanding these age-related variations can help develop interventions aimed at preserving foot health and mobility across the lifespan.
Collapse
Affiliation(s)
- Toshihiro Maemichi
- Faculty of Sport Sciences, Waseda University, Saitama, Japan; Institute of Life Innovation Studies, Toyo University, Saitama, Japan.
| | - Masatomo Matsumoto
- Department of Medical Rehabilitation, Kuwana City Medicine Center, Mie, Japan; Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Takumi Okunuki
- Institute of Life Innovation Studies, Toyo University, Saitama, Japan; Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Wu L, Huang R, Tang L, Ning X, Zhu J, Ma X. A novel in-situ dynamic mechanical analysis for human plantar soft tissue: The device design, definition of characteristics, test protocol, and preliminary results. Heliyon 2024; 10:e29986. [PMID: 38707476 PMCID: PMC11068617 DOI: 10.1016/j.heliyon.2024.e29986] [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] [Received: 12/11/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
The in-situ mechanical characterization of elastomers is not highly regarded due to the existence of a well-established set of sample-based standard tests for research and industry. However, there are certain situations or materials, like biological soft tissue, where an in-situ approach is necessary due to the impossibility of sampling from a living body. We have developed a dynamic mechanical analysis (DMA)-like device to approach in-vivo and in-situ multidimensional stress-strain properties of human plantar soft tissues. This work elucidates the operational mechanism of the novel measurement, with the definition of a new set of moduli, test standardization and protocol. Exploratory results of a volunteer's living plantar, silica rubber samples are presented with well preciseness and consistence as expected.
Collapse
Affiliation(s)
- Longyan Wu
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Ran Huang
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
- Yiwu Research Institute of Fudan University, Yiwu, Zhejiang, 322000, China
- Center for Innovation and Entrepreneurship, Taizhou Institute of Zhejiang University, Taizhou, Zhejiang, 318000, China
| | - Lisheng Tang
- Center for Innovation and Entrepreneurship, Taizhou Institute of Zhejiang University, Taizhou, Zhejiang, 318000, China
| | - Xinyi Ning
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
| | - Jun Zhu
- Yiwu Research Institute of Fudan University, Yiwu, Zhejiang, 322000, China
| | - Xin Ma
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| |
Collapse
|
4
|
Gauthier C, Guttman A, Bakaes Y, Jackson JB, Gonzalez T. Analysis of Nonweightbearing MRI Fat Pad Thickness Under Central Metatarsals in Patients With and Without Metatarsalgia. Foot Ankle Int 2024; 45:406-411. [PMID: 38327178 DOI: 10.1177/10711007241227174] [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: 02/09/2024]
Abstract
BACKGROUND Metatarsalgia is a common diagnosis for patients with forefoot pain. Many have proposed metatarsal fat pad atrophy is a cause of metatarsalgia and therefore have suggested fat grafting instead of distal metatarsal osteotomies to treat metatarsalgia. For fat grafting to be a viable treatment, fat pad atrophy should correlate with metatarsalgia. This study looked to determine the relationship between metatarsal fat pad thickness and metatarsalgia and the correlation between metatarsal fat pad thickness and patient-reported outcomes. METHODS We conducted a retrospective review of patients with metatarsalgia and those with foot or ankle osteoarthritis who had a nonweightbearing MRI performed between February 1, 2021, and March 1, 2023. Data collected included demographics, PROMIS scores, metatarsal fat pad thickness in the second and third rays of the affected foot, and thinnest area on coronal section, measured on MRI. Student t test was used to compare continuous variables, whereas the χ2 test was used to compare categorical variables. Multivariable linear regression models were used to control for potential confounding factors. RESULTS A total of 112 patients were included in this study. Patients with metatarsalgia were significantly more likely to have a lower body mass index (29.3 vs 32.0, P = .03) than patients with osteoarthritis, but this finding was not present when controlling for confounding variables. We found no significant difference in fat pad thickness between patients with metatarsalgia vs patients with foot or ankle osteoarthritis (P = .43). We found no correlation between metatarsal fat pad thickness and pain interference (P = .59), physical function (P = .64), or mobility (P = .94) PROMIS scores. CONCLUSION In this retrospective comparative study of a relatively small cohort we found no significant difference in metatarsal fat pad thickness for patients with metatarsalgia vs patients with foot and ankle osteoarthritis based on nonweightbearing MRI, and no association between metatarsal fat pad thickness and patient-reported outcomes. LEVEL OF EVIDENCE Level III, case control study.
Collapse
Affiliation(s)
- Chase Gauthier
- Prisma Health, Department of Orthopedic Surgery, Columbia, SC, USA
| | - Anne Guttman
- Prisma Health, Department of Orthopedic Surgery, Columbia, SC, USA
| | - Yianni Bakaes
- Prisma Health, Department of Orthopedic Surgery, Columbia, SC, USA
| | | | - Tyler Gonzalez
- Prisma Health, Department of Orthopedic Surgery, Columbia, SC, USA
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Marotta N, Moggio L, Calafiore D, Prestifilippo E, Spanó R, Tasselli A, Drago Ferrante V, Invernizzi M, de Sire A, Ammendolia A. Efficacy of Proprioceptive Training on Plantar Pressure and Jump Performance in Volleyball Players: A Proof-of-Principle Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:1906. [PMID: 36850501 PMCID: PMC9963449 DOI: 10.3390/s23041906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Volleyball players are often subject to micro-traumatisms of the heel fat pad and ankle injuries. Recently, mat-based proprioceptive training has assumed a key role in recovery from these disorders. Therefore, this proof-of-principle study aimed to assess the efficacy of proprioceptive mat training on plantar pressures and athletic performance in volleyball players. The participants included adult semi-professional volleyball players allocated into two groups: an experimental group, with mat-based proprioceptive and balance training, and a control group, with a sham protocol. For the outcome, we evaluated the barefoot plantar pressure, performing an analysis on a baropodometric resistive platform. The countermovement jump and squat jump were measured using an inertial measurement unit. Nineteen subjects were included in the two groups: the active proprioceptive group (n = 10) or the control group (n = 9). The results show a more uniform redistribution of loads with pressure hindfoot relief in the experimental group compared to the control group (p = 0.021, RBC = 0.67). Moreover, we observed a significant increase in peak landing force and high concentric power development in the experimental group compared to the controls. Focused proprioceptive management provided hindfoot load attenuation by stimulating higher peaks of concentric force in the experimental group compared to the sham group. Even though the study included a small sample, the results obtained in this proof-of-principle study suggest a positive role of proprioceptive stimulation in the inter-seasonal scenario for volleyball players to improve their jump performance and reduce the micro-traumatisms of the heel fat pad and the ankle injury rate. However, further studies performed on larger samples are needed to confirm these preliminary results.
Collapse
Affiliation(s)
- Nicola Marotta
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Lucrezia Moggio
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Rehabilitation Unit, Ospedale degli Infermi, 13875 Biella, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy
| | - Emanuele Prestifilippo
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Riccardo Spanó
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Anna Tasselli
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Vera Drago Ferrante
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| |
Collapse
|
7
|
Alabau-Dasi R, Nieto-Gil P, Ortega-Avila AB, Gijon-Nogueron G. Variations in the Thickness of the Plantar Fascia After Training Based in Training Race. A Pilot Study. J Foot Ankle Surg 2022; 61:1230-1234. [PMID: 35370051 DOI: 10.1053/j.jfas.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 08/11/2021] [Accepted: 02/14/2022] [Indexed: 02/03/2023]
Abstract
Plantar fascia (PF) is a connective tissue made up of mostly type 1 collagen that is subjected to constant loads. This study evaluated the effect of continuous running on tissue stress in the PF by measuring changes in the thickness of the PF using ultrasound scans. It was a cross-sectional study involving 24 runners from the University of Valencia, recruited as volunteers between December 2018 and February 2019. A variety of data was recorded: (age, body mass index, type of footwear, number of workouts per week, KM run per week, sports injuries in the last year, pre and postrace ultrasound PF measurements). There were significant differences in the 3 postrace measurements of the left foot (<0.001). PF thicknesses were measured before and after running, with a minimal average difference of 0.4 mm in the medial and central fascicles, and 0.3 mm in the lateral fascicle. We observed PF thicknesses above 4mm in asymptomatic patients with no signs of vascularisation, proving that increased PF thickness is not the only criterion for diagnosis of plantar fasciitis.
Collapse
Affiliation(s)
| | - Pilar Nieto-Gil
- Department of Nursing and Podiatry, University of Valencia, Valencia, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences. University of Malaga, Spain; Biomedical Research Institute (IBIMA), Malaga, Spain.
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences. University of Malaga, Spain; Biomedical Research Institute (IBIMA), Malaga, Spain
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
An Investigation of Regional Plantar Soft Tissue Hardness and Its Potential Correlation with Plantar Pressure Distribution in Healthy Adults. Appl Bionics Biomech 2021; 2021:5566036. [PMID: 34239603 PMCID: PMC8241530 DOI: 10.1155/2021/5566036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background The plantar soft tissue plays a critical role in absorbing shocks and attenuating excessive stresses during walking. Plantar soft tissue property and plantar pressure are critical information for footwear design and clinical assessment. The aim of this study was to investigate the relationship between plantar soft tissue hardness and plantar pressure during walking. Methods 59 healthy volunteers (27 males and 32 females, aged 20 to 82) participated in this study. The plantar surface was divided into five regions: lateral rearfoot, medial rearfoot, lateral midfoot, lateral forefoot, and medial forefoot, and the plantar tissue hardness was tested using Shore durometer in each region. Average dynamic pressures in each region were analyzed for the five regions corresponding to the hardness tests. The relationship between hardness and average dynamic pressure was analyzed in each region. Results The average hardness of the plantar soft tissue in the above five regions is as follows: lateral rearfoot (34.49 ± 6.77), medial rearfoot (34.47 ± 6.64), lateral midfoot (27.95 ± 6.13), lateral forefoot (29.72 ± 5.47), and medial forefoot (28.58 ± 4.41). Differences of hardness were observed between age groups, and hardness of plantar soft tissues in forefoot regions increased with age (P < 0.05). A negative relationship was found between plantar soft tissue hardness and pressure reduction at lateral rearfoot, medial rearfoot, and lateral midfoot (P < 0.05). Conclusion The hardness of plantar soft tissues changes with age in healthy individuals, and there is a trend of increasing hardness of the plantar soft tissue with age. The plantar soft tissue hardness increases with plantar pressure.
Collapse
|
10
|
Sussman WI, Park DJ, Rucci PM, Chen YH. Subluxing fractured plantar fat pad: a case series and description of novel sonographic findings. Skeletal Radiol 2021; 50:1241-1247. [PMID: 33135090 DOI: 10.1007/s00256-020-03639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
Plantar fat pad syndrome has received little attention in the literature. A variety of structural changes of the plantar fat pad have been described in the literature, including atrophy, contusion, and fractured fat pad. This case series presents 4 patients (5 heels) with subluxation of a fractured plantar fat pad on dynamic ultrasound. Patients with subluxing fractured fat pad typically present with heel pain and a "snapping" or "popping" sensation when weight-bearing. Other causes of heel pain were excluded, and all patients in this series had an MRI that initially did not report any findings in the fat pad. Retrospective review of the MRI showed evidence of diffuse low T1 and T2 infiltration. To the authors' knowledge, subluxation of the plantar fat pad and the respective correlation to MRI findings have not been described in the literature. Here we describe the sonographic findings of this novel condition.
Collapse
Affiliation(s)
- Walter I Sussman
- Department of Physical Medicine & Rehabilitation, Tufts University School of Medicine, 800 Washington St, Box 400, Boston, MA, 02111, USA. .,Private Practice N, Easton, MA, USA.
| | - David J Park
- Physical Medicine & Rehabilitation Resident, Tufts Medical Center, Boston, MA, USA
| | | | - Yung H Chen
- Department of Radiology, Tufts University, Boston, MA, USA
| |
Collapse
|
11
|
Krupenevich RL, Clark WH, Ray SF, Takahashi KZ, Kashefsky HE, Franz JR. Effects of age and locomotor demand on foot mechanics during walking. J Biomech 2021; 123:110499. [PMID: 34015739 DOI: 10.1016/j.jbiomech.2021.110499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 04/26/2021] [Accepted: 05/02/2021] [Indexed: 01/09/2023]
Abstract
Older adults exhibit reductions in push-off power that are often attributed to deficits in plantarflexor force-generating capacity. However, growing evidence suggests that the foot may also contribute to push-off power during walking. Thus, age-related changes in foot structure and function may contribute to altered foot mechanics and ultimately reduced push-off power. The purpose of this paper was to quantify age-related differences in foot mechanical work during walking across a range of speeds and at a single fixed speed with varied demands for push-off power. 9 young and 10 older adults walked at 1.0, 1.2, and 1.4 m/s, and at 1.2 m/s with an aiding or impeding horizontal pulling force equal to 5% BW. We calculated foot work in Visual3D using a unified deformable foot model, accounting for contributions of structures distal to the hindfoot's center-of-mass. Older adults walked while performing less positive foot work and more negative net foot work (p < 0.05). Further, we found that the effect of age on mechanical work performed by the foot and the ankle-foot complex increased with increased locomotor demand (p < 0.05). Our findings suggest that during walking, age-related differences in foot mechanics may contribute to reduced push-off intensity via greater energy loss from distal foot structures, particularly during walking tasks with a greater demand for foot power generation. These findings are the first step in understanding the role of the foot in push-off power deficits in older adults and may serve as a roadmap for developing future low-cost mobility interventions.
Collapse
Affiliation(s)
- Rebecca L Krupenevich
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA.
| | - William H Clark
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Samuel F Ray
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Kota Z Takahashi
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Howard E Kashefsky
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| |
Collapse
|
12
|
Ugbolue UC, Yates EL, Rowland KE, Wearing SC, Gu Y, Lam WK, Baker JS, Sculthorpe NF, Dutheil F. A novel simplified biomechanical assessment of the heel pad during foot plantarflexion. Proc Inst Mech Eng H 2020; 235:197-207. [PMID: 33148117 DOI: 10.1177/0954411920971069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The heel pad (HP) which is located below the calcaneus comprises a composition of morphometrical and morphological arrangements of soft tissues that are influenced by factors such as gender, age and obesity. It is well known that HP pain and Achilles tendonitis consist of discomfort, pain and swelling symptoms that usually develop from excessive physical activities such as walking, jumping and running. The purpose of this study was to develop biomechanical techniques to evaluate the function and characteristics of the HP. Ten healthy participants (five males and five females) participated in this laboratory-based study, each performing a two-footed heel raise to mimic the toe-off phase during human locomotion. Twenty-six (3 mm) retroreflective markers were attached to the left and right heels (thirteen markers on each heel). Kinematic data was captured using three-dimensional motion analysis cameras synchronised with force plates. Descriptive and multivariate statistical tests were used in this study. In addition, a biomechanical technique that utilises only six markers from 26 markers to assess HP deformation and function has been developed and used in this study. Overall HP displacement was significantly higher in males on the most lateral part of the right heel (p < 0.05). No significant differences were evident when comparing the non-dominant and dominant heels during the baseline, unloading and loading phases (p > 0.05). Findings from this study suggested that biomechanical outputs expressed as derivatives from tracked HP marker movements can morphologically and morphometrically characterise HP soft tissue deformation changes. The outcome of this study highlights the importance of 3D motion analysis being used as a potential prospective intervention to quantify the function / characteristics of the heel pad soft tissues.
Collapse
Affiliation(s)
- Ukadike C Ugbolue
- Faculty of Sports Science, Ningbo University, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK.,Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Emma L Yates
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK
| | - Keir E Rowland
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK
| | - Scott C Wearing
- Faculty of Health, School - Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, China
| | - Wing-Kai Lam
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd, Beijing, China.,Department of Kinesiology, Shenyang Sports University, Shenyang, China
| | - Julien S Baker
- Faculty of Sports Science, Ningbo University, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK.,Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Nicholas F Sculthorpe
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France.,Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|
13
|
Ugbolue UC, Yates EL, Wearing SC, Gu Y, Lam WK, Valentin S, Baker JS, Dutheil F, Sculthorpe NF. Sex differences in heel pad stiffness during in vivo loading and unloading. J Anat 2020; 237:520-528. [PMID: 33448360 PMCID: PMC7476210 DOI: 10.1111/joa.13207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022] Open
Abstract
Due to conflicting data from previous studies a new methodological approach to evaluate heel pad stiffness and soft tissue deformation has been developed. The purpose of this study was to compare heel pad (HP) stiffness in both limbs between males and females during a dynamic unloading and loading activity. Ten males and 10 females volunteered to perform three dynamic trials to unload and load the HP. The dynamic protocol consisted of three continuous phases: foot flat (baseline phase), bilateral heel raise (unloading phase) and foot flat (loading phase) with each phase lasting two seconds. Six retroreflective markers (3 mm) were attached to the skin of the left and right heels using a customised marker set. Three‐dimensional motion analysis cameras synchronised with force plates collected the kinematic and kinetic data throughout the trials. Three‐way repeated measures ANOVA together with a Bonferroni post hoc test were applied to the stiffness and marker displacement datasets. On average, HP stiffness was higher in males than females during the loading and unloading phases. ANOVA results revealed no significant differences for the stiffness and displacement outputs with respect to sex, sidedness or phase interactions (p > .05) in the X, Y and Z directions. Irrespective of direction, there were significant differences in stiffness between the baseline and unloading conditions (p < .001) but no significant differences between the baseline and loaded conditions (p = 1.000). Post hoc analyses for the marker displacement showed significant differences between phases for the X and Z directions (p < .032) but no significant differences in the Y direction (p > .116). Finally, females portrayed lower levels of mean HP stiffness whereas males had stiffer heels particularly in the vertical direction (Z) when the HP was both unloaded and loaded. High HP stiffness values and very small marker displacements could be valuable indicators for the risk of pathological foot conditions.
Collapse
Affiliation(s)
- Ukadike C Ugbolue
- Faculty of Sports Science, Ningbo University, Ningbo, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK.,Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Emma L Yates
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK
| | - Scott C Wearing
- Faculty of Health, School - Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Wing-Kai Lam
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd, Beijing, China.,Department of Kinesiology, Shenyang Sports Institute, Shenyang, China
| | - Stephanie Valentin
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK
| | - Julien S Baker
- Faculty of Sports Science, Ningbo University, Ningbo, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK.,Department of Sport, Physical Education and Health, Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France.,Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, Vic., Australia
| | - Nicholas F Sculthorpe
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK
| |
Collapse
|
14
|
Abstract
BACKGROUND Pedal fat grafting is a safe, minimally invasive approach to treat pedal fat pad atrophy. Prior randomized controlled trials demonstrate that the fat as measured directly under the metatarsal heads disappears between 2 and 6 months after fat grafting, despite patients having relief for 2 years. The authors aim to use magnetic resonance imaging to further assess three-dimensional volume of fat in the foot after autologous fat grafting to help explain the mechanism for improved pain. METHODS A prospective study was performed using magnetic resonance imaging before and at 6 months after pedal fat grafting to assess changes in the three-dimensional morphology of the fat. RESULTS Seventeen patients (six men and 11 women) underwent injections with a mean volume of 5.8 cc per foot. At 6 months, patients demonstrated increased tissue thickness (p = 0.008) and volume (p = 0.04). Improvements were seen in pain (p < 0.05) and activity (p < 0.05). Foot pressures and forces were significantly decreased and positively correlated with increased fat pad volume (p < 0.05). CONCLUSIONS Pedal fat grafting significantly increases metatarsal fat pad volume. The distribution of the fat may contribute to lasting clinical relief in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
15
|
Belhan O, Kaya M, Gurger M. The thickness of heel fat-pad in patients with plantar fasciitis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:463-467. [PMID: 31444011 PMCID: PMC6939011 DOI: 10.1016/j.aott.2019.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/10/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to investigate the thickness of heel fat pad (THP) and to detect the relationship between the plantar fasciitis (PF) and age, occupation, BMI, longitudinal arch, the thickness of heel fat-pad in the patients with PF. Methods A total of 50 patients (29 women and 21 men; mean age: 46.5 years (range: 22–70)) that were diagnosed with PF were included to this study. Patients' affected side were compared with the healthy opposite side with the angle of medial arch (AMA) and first metatarsophalangeal angle (FMTPA) on the foot radiograms, and THP and thickness of first metatarsal fat pad (TFMFP) using ultrasonography (USG) of both feet. Results The mean AMAs of feet with pain and without pain were 122.56° and 120.60°, respectively. The mean FMTPAs of feet with pain and without pain were 14.72° and 14.40°, respectively. The mean THPs of feet with pain at the point of the medial calcaneal tubercle and the mean TFMFPs of the feet with pain at the point of the first metatarsal head were 19.45 mm and 6.75 mm, respectively. The mean THPs of feet without pain at the point of the medial calcaneal tubercle and the mean TFMFPs of the feet without pain at the point of the first metatarsal head were 19.94 mm and 6.75 mm, respectively. It was observed that the mean AMA in the heels with pain was significantly higher than that of the heel without pain (p < 0.05) and the mean THP in the heels with pain was significantly thinner than that of the heel without pain (p < 0.05). Conclusion The results indicate that USG is an accurate and reliable imaging technique for the measurement of THP in the diagnosis of plantar fasciitis and the heel pad was thinner in the painful heels of patients with plantar fasciitis. Level of evidence Level III, Diagnostic Study.
Collapse
|
16
|
Wee J, Lee T. Heel pad becomes rapidly stiffer to dissipate the energy: finite element analysis. FOOTWEAR SCIENCE 2019. [DOI: 10.1080/19424280.2019.1606088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jaeyeon Wee
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, Republic of Korea
| | - Taeyong Lee
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, Republic of Korea
| |
Collapse
|
17
|
Foot and shoe responsible for majority of soft tissue work in early stance of walking. Hum Mov Sci 2019; 64:191-202. [DOI: 10.1016/j.humov.2019.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/23/2022]
|
18
|
Fat Grafting for Pedal Fat Pad Atrophy in a 2-Year, Prospective, Randomized, Crossover, Single-Center Clinical Trial. Plast Reconstr Surg 2019; 142:862e-871e. [PMID: 30204683 DOI: 10.1097/prs.0000000000005006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND By age 60, 30 percent of Americans suffer from fat pad atrophy of the foot. Forefoot fat pad atrophy results from long-term aggressive activity, genetically dictated foot type, multiple forefoot steroid injections, surgery, and foot trauma. METHODS The authors present data from a 2-year, prospective, randomized crossover study performed to assess pain and disability indexes, fat pad thickness, forces, and pressures of stance and gait. Group 1 underwent fat grafting with 2 years of follow-up, and group 2 underwent conservative management for 1 year, then underwent fat grafting with 1 year of follow-up. RESULTS Eighteen subjects (14 women and four men) constituted group 1. Thirteen subjects (nine women and four men) constituted group 2. Group 1 reported the worst pain at baseline and group 2 experienced the worst pain at 6- and 12-month standard-of-care visits; pain for both groups improved immediately following fat grafting and lasted through study follow-up (p < 0.05). Group 1 demonstrated functional improvements at 12, 18, and 24 months postoperatively (p < 0.05), whereas group 2 demonstrated the highest function at 12 months postoperatively (p < 0.05). Pedal fat pad thickness of subjects in group 1 increased postoperatively and returned to baseline thickness at 2 months postoperatively; subjects in group 2 experienced return to baseline thickness at 6 months postoperatively (p < 0.01). Forces and pressures of stance and gait increased over the 2 years of follow-up for group 1 (p < 0.05). CONCLUSION Pedal fat grafting provides long-lasting improvements in pain and function, and prevents against worsening from conservative management. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
Collapse
|
19
|
Farber SE, Minteer D, Gusenoff BR, Gusenoff JA. The Influence of Fat Grafting on Skin Quality in Cosmetic Foot Grafting: A Randomized, Cross-Over Clinical Trial. Aesthet Surg J 2019; 39:405-412. [PMID: 30007274 DOI: 10.1093/asj/sjy168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pedal fat grafting is a cosmetic procedure to treat the functional and aesthetic sequelae of pedal fat pad atrophy. Fat grafting has been found to mitigate these symptoms, but the exact mechanism is unknown. OBJECTIVES The authors hypothesized that pedal fat grafting may improve skin quality, accounting for prolonged symptomatic improvement despite loss of grafted fat. METHODS Patients with pedal atrophy were enrolled in a randomized crossover clinical trial. Group 1 underwent fat grafting upon enrollment with 2-year follow-up. Group 2 was managed conservatively for 1 year then placed into the fat grafting group with 1-year follow-up. Patients underwent pedal ultrasounds to determine thicknesses of the fat pad and dermis, and photographs were taken to assess skin quality. RESULTS Three men and 20 women with an average age of 63 ± 6 years and an average BMI of 26.0 ± 4.6 kg/m2 were enrolled in the study. Twenty-six feet were injected in Group 1 and 17 were injected in Group 2. Group 1 dermal thickness increased at 6 months post-injection (P < 0.05). This increase persisted through 24 months. Group 2 dermal thickness decreased prior to injection (P < 0.05) but returned to baseline after injection and through 12-month follow-up (P < 0.05). Fat pad thickness returned to baseline by study completion in both groups (P < 0.05). CONCLUSIONS Pedal fat grafting yielded a significant, sustained increase in dermal thickness, though grafted fat was not retained. Fat grafting may improve skin quality, which could contribute to improved clinical outcomes despite loss of grafted fat. LEVEL OF EVIDENCE: 2
Collapse
Affiliation(s)
- Stephanie E Farber
- Department of Plastic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Danielle Minteer
- Department of Plastic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Beth R Gusenoff
- Department of Plastic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jeffrey A Gusenoff
- Department of Plastic Surgery at the University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
20
|
A salvage strategy for heel pad degloving injury. OTA Int 2018; 1:e007. [PMID: 33937645 PMCID: PMC7953521 DOI: 10.1097/oi9.0000000000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/19/2018] [Accepted: 06/12/2018] [Indexed: 11/26/2022]
Abstract
Case: A 50-year-old female experienced a crush injury to the foot resulting in open degloving of her heel pad. This study details a surgical strategy to achieve healing and limb salvage. Conclusion: Heel pad injuries with degloving are difficult to salvage and have a poor prognosis. Amputation is often the only therapeutic option, unless part of the blood supply to the heel pad is intact, rendering limb salvage a possibility.
Collapse
|
21
|
Suzuki R, Ito K, Lee T, Ogihara N. In-vivo viscous properties of the heel pad by stress-relaxation experiment based on a spherical indentation. Med Eng Phys 2017; 50:83-88. [PMID: 29079047 DOI: 10.1016/j.medengphy.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
Identifying the viscous properties of the plantar soft tissue is crucial not only for understanding the dynamic interaction of the foot with the ground during locomotion, but also for development of improved footwear products and therapeutic footwear interventions. In the present study, the viscous and hyperelastic material properties of the plantar soft tissue were experimentally identified using a spherical indentation test and an analytical contact model of the spherical indentation test. Force-relaxation curves of the heel pads were obtained from the indentation experiment. The curves were fit to the contact model incorporating a five-element Maxwell model to identify the viscous material parameters. The finite element method with the experimentally identified viscoelastic parameters could successfully reproduce the measured force-relaxation curves, indicating the material parameters were correctly estimated using the proposed method. Although there are some methodological limitations, the proposed framework to identify the viscous material properties may facilitate the development of subject-specific finite element modeling of the foot and other biological materials.
Collapse
Affiliation(s)
- Ryo Suzuki
- Department of Mechanical Engineering, Keio University, Yokohama, Japan
| | - Kohta Ito
- Department of Mechanical Engineering, Keio University, Yokohama, Japan
| | - Taeyong Lee
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, South Korea
| | - Naomichi Ogihara
- Department of Mechanical Engineering, Keio University, Yokohama, Japan.
| |
Collapse
|
22
|
Taş S, Bek N, Ruhi Onur M, Korkusuz F. Effects of Body Mass Index on Mechanical Properties of the Plantar Fascia and Heel Pad in Asymptomatic Participants. Foot Ankle Int 2017; 38:779-784. [PMID: 28535692 DOI: 10.1177/1071100717702463] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Musculoskeletal foot disorders have a high incidence among overweight and obese individuals. One of the important factors causing this high incidence may be plantar fascia and heel pad (HP)-related mechanical changes occurring in these individuals. The aim of the present study was to investigate the plantar fascia and HP stiffness and thickness parameters in overweight and obese individuals and compare these values with those of normal-weight individuals. METHODS This study was carried out in 87 (52 female, 35 male) healthy sedentary individuals between the ages of 19 and 58 years (34 ± 11 years). Participants were subsequently categorized according to body mass index (BMI) as normal weight (18.5 kg/m2 < BMI < 25 kg/m2) or overweight and obese (BMI ≥25 kg/m2). Plantar fascia and HP thickness and stiffness were measured with an ultrasonography device using a linear ultrasonography probe. RESULTS Overweight and obese individuals had higher HP thickness ( P < .001), plantar fascia thickness ( P = .001), heel pad microchamber layer (MIC) stiffness ( P < .001), and heel pad macrochamber layer (MAC) stiffness ( P < .001), whereas they had lower plantar fascia stiffness ( P < .001) compared with the individuals with normal weight. BMI had a moderate correlation with HP thickness ( P < .001, r = 0.500), plantar fascia thickness ( P = .001, r = 0.536), MIC stiffness ( P < .001, r = 0.496), and MAC stiffness ( P < .001, r = 0.425). A negative and moderate correlation was found between BMI and plantar fascia stiffness ( P < .001, r = -0.439). CONCLUSION Increased BMI causes a decrease in the stiffness of plantar fascia and an increase in the thickness of the plantar fascia as well as the thickness and stiffness of HP. Increased body mass could cause changes in the mechanical properties of HP and plantar fascia. LEVEL OF EVIDENCE Level 3, comparative study.
Collapse
Affiliation(s)
- Serkan Taş
- 1 Beytepe Hospital, Hacettepe University, Ankara, Turkey
| | - Nilgün Bek
- 2 Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Hacettepe University, Ankara, Turkey
| | - Mehmet Ruhi Onur
- 3 Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Feza Korkusuz
- 4 School of Medicine, Departments of Sports Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
23
|
Investigation of the optimum heel pad stiffness: a modeling study. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:585-593. [DOI: 10.1007/s13246-017-0565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
|
24
|
Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial. Plast Reconstr Surg 2017; 138:1099-1108. [PMID: 27391833 DOI: 10.1097/prs.0000000000002667] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pedal fat pad atrophy is associated with pain, decreased tissue thickness, and increased foot pressures. To date, no objective studies investigating the use of fat grafting to the forefoot have been performed. The authors hypothesize that pedal fat grafting can reduce pain, increase tissue thickness, and decrease pedal pressures. METHODS A prospective randomized study was performed to assess tissue thickness, pain, and foot pressures. Group 1 underwent fat grafting immediately with 1-year follow-up, and group 2 underwent conservative management for 1 year. RESULTS Thirteen patients (two men and 11 women) constituted group 1 and 12 patients (four men and eight women) constituted group 2. Ten patients in group 1 underwent bilateral injections with a mean volume of 4.8 cc per foot. Mean follow-up time was 11.1 ± 5.4 months for group 1 and 13.8 ± 4.2 months for group 2. At 1 year, group 1 demonstrated improved foot function (p = 0.022), pain (p = 0.022), and work/leisure activities (p = 0.021). Group 1 had no change in tissue thickness, whereas in group 2, the right third metatarsal tissue thickness decreased significantly (p = 0.036). Foot pressures in group 1 did not improve; however, group 2 had a significant increase in left foot pressure (p = 0.011). When comparing the groups at 1 year, group 2 had significantly higher foot pressures and forces than group 1 (p < 0.05). CONCLUSIONS Pedal fat grafting significantly improves pain and disability outcomes, and prevents against worsening foot pressures. Future analysis will reveal whether fat grafting has lasting efficacy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
Collapse
|
25
|
Kirkpatrick J, Yassaie O, Mirjalili SA. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations. J Anat 2017; 230:743-751. [PMID: 28369929 DOI: 10.1111/joa.12607] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
Abstract
The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain.
Collapse
Affiliation(s)
- Joshua Kirkpatrick
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Omid Yassaie
- Department of Orthopedic Surgery, Wellington Hospital, Wellington, New Zealand
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| |
Collapse
|
26
|
Ahanchian N, Nester CJ, Howard D, Ren L, Parker D. Estimating the material properties of heel pad sub-layers using inverse Finite Element Analysis. Med Eng Phys 2017; 40:11-19. [DOI: 10.1016/j.medengphy.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 10/26/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
|
27
|
Suzuki R, Ito K, Lee T, Ogihara N. Parameter identification of hyperelastic material properties of the heel pad based on an analytical contact mechanics model of a spherical indentation. J Mech Behav Biomed Mater 2017; 65:753-760. [DOI: 10.1016/j.jmbbm.2016.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 09/04/2016] [Accepted: 09/21/2016] [Indexed: 11/26/2022]
|
28
|
Molligan J, Mitchell R, Bhasin P, Lakhani A, Schon L, Zhang Z. Implantation of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells in Foot Fat Pad in Rats. Foot Ankle Int 2015; 36:1344-51. [PMID: 26085579 DOI: 10.1177/1071100715591092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The foot fat pad (FFP) bears body weight and may become a source of foot pain during aging. This study investigated the regenerative effects of autologous adipose tissue-derived mesenchymal stem cells (AT-MSCs) in the FFP of rats. METHODS Fat tissue was harvested from a total of 30 male Sprague-Dawley rats for isolation of AT-MSCs. The cells were cultured, adipogenic differentiation was induced for 1 week, and the AT-MSCs were labeled with fluorescent dye before injection. AT-MSCs (5 × 10(4) in 50 µL of saline) were injected into the second infradigital pad in the right hindfoot of the rat of origin. Saline only (50 µL) was injected into the corresponding fat pad in the left hind paw of each rat. Rats (n = 10) were euthanized at 1, 2, and 3 weeks, and the second infradigital fat pads were dissected for histologic examination. RESULTS The fluorescence-labeled AT-MSCs were present in the foot pads throughout the 3-week experimental period. On histologic testing, the area of fat pad units (FPUs) in the fat pads that received AT-MSC injections was greater than that in the control fat pads. Although the thickness of septae was not changed by AT-MSC injections, the density of elastic fibers in the septae was increased in the fat pads with implanted AT-MSCs. CONCLUSION In this short-term study, the implanted AT-MSCs largely survived and might have stimulated the expansion of individual FPUs and increased the density of elastic fibers in the FFP in this rat model. CLINICAL RELEVANCE These data support the development of stem cell therapies for age-associated degeneration in FFP in humans.
Collapse
Affiliation(s)
- Jeremy Molligan
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Reed Mitchell
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Priya Bhasin
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Aliya Lakhani
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lew Schon
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Zijun Zhang
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
29
|
Lin CY, Lin CC, Chou YC, Chen PY, Wang CL. Heel Pad Stiffness in Plantar Heel Pain by Shear Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2890-2898. [PMID: 26299685 DOI: 10.1016/j.ultrasmedbio.2015.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 05/20/2015] [Accepted: 07/07/2015] [Indexed: 06/04/2023]
Abstract
The goal of the study was to evaluate the reliability of supersonic shear wave elastography in measuring heel pad stiffness and the change in heel pad stiffness in patients with plantar heel pain. In the reliability test involving 12 normal participants, each heel pad was tested six times in succession, and adequate reliability was reflected in the intraclass correlation coefficients (0.95, 0.93 and 0.96 for the microchambers, macrochambers and bulk heel pad, respectively). In the clinical assessment involving 20 normal participants and 16 unilateral plantar heel pain patients, diseased heel pads (86.8 ± 22.9, 36.8 ± 7.7 and 46.6 ± 10.9 kPa for the microchambers, macrochambers and bulk heel pad, respectively) were significantly stiffer than unaffected heel pads (66.8 ± 14.1, 25.2 ± 5.7, 34.2 ± 6.6 kPa) and those of normal participants (60.9 ± 11.4, 26.3 ± 6.1, 31.8 ± 6.3 kPa), suggesting that the heel pad with plantar heel pain was associated with loss of elasticity.
Collapse
Affiliation(s)
- Che-Yu Lin
- Department of Orthopaedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Chiang Lin
- Department of Orthopaedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Orthopaedic Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Yunlin County, Taiwan
| | - Yang-Chen Chou
- Department of Orthopaedic Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Yunlin County, Taiwan
| | - Pei-Yu Chen
- Department of Orthopaedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Li Wang
- Department of Orthopaedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Orthopaedic Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Yunlin County, Taiwan; Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
30
|
Prediction of plantar soft tissue stiffness based on sex, age, bodyweight, height and body mass index. J Mech Behav Biomed Mater 2015; 54:219-22. [PMID: 26474035 DOI: 10.1016/j.jmbbm.2015.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/02/2015] [Accepted: 09/14/2015] [Indexed: 11/21/2022]
Abstract
15% of Diabetes Mellitus (DM) patients suffer high risk of ulceration and 85% of the amputation involving DM population is caused by non-healing ulcers. These findings elucidate the fact that foot ulcer can result in major amputation especially to the DM and elderly population. Therefore, early diagnosis of abnormally stiffened plantar soft tissue is needed to prevent the catastrophic tissue damage. In order to differentiate between normal and pathological tissues, a threshold reference value that defines healthy tissue is required. The objective of this study is to perform a multivariate analysis to estimate the healthy plantar tissue stiffness values based on the individuals physical attributes such as bodyweight (BW), height and body mass index (BMI) as well as their age and sex. 100 healthy subjects were recruited. Indentation was performed on 2nd metatarsal head pad at 3 different dorsiflexion angles of 0°, 20°, 40° and the hallux and heel at 0°. The results showed the important influences of BW, height and BMI in determining the plantar tissue stiffness. On the other hand, age and sex only play minimal roles. The study can be further extended to increase the reliability and accuracy of the proposed predictive model by evaluating several other related parameters such as body fat content, footwear usage, frequency of sports participation, etc.
Collapse
|
31
|
Hall MM, Finnoff JT, Sayeed YA, Smith J. Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1861-1871. [PMID: 26362149 DOI: 10.7863/ultra.14.12073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain. METHODS Thirty-nine asymptomatic runners without a history of plantar heel pain were recruited. The following sonographic measures were recorded: power Doppler sonography in the plantar heel pad and plantar fascia, echo texture of the plantar heel pad, uncompressed heel pad thickness, compressed heel pad thickness, heel pad compressibility index, plantar fascia thickness, and plantar fascia echo texture. RESULTS Doppler flow was shown in the plantar heel pads of 88% (68 of 77) of heels and 92% (36 of 39) of runners. Heel pad echo texture abnormalities were found in 86% (66 of 77) of heels and 97% (38 of 39) of runners. Mean values for right and left uncompressed heel pad thickness were 13.8 and 13.7 mm, respectively. The mean heel pad compressibility indices were 0.51 for the right heel and 0.53 for the left heel. Eight percent (6 of 77) of fat pads in 10% (4 of 39) of runners had abnormal compressibility indices. Doppler flow was present in the plantar fascia in 31% (24 of 77) of heels and 44% (17 of 39) of runners. The mean plantar fascia thicknesses were 3.78 mm for the right and 3.87 mm for the left. Forty-eight percent (37 of 77) of heels had an abnormal plantar fascia echo texture. CONCLUSIONS At least 1 potentially abnormal sonographic finding was present in each heel of all asymptomatic runners in this study. Consequently, sonographic abnormalities in the plantar heel should be interpreted within the clinical context when evaluating runners.
Collapse
Affiliation(s)
- Mederic M Hall
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa USA (M.M.H.); Departments of Physical Medicine and Rehabilitation (J.T.F., J.S.), Radiology (J.S.), and Anatomy (J.S.), Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota USA; and Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia USA (Y.A.S.).
| | - Jonathan T Finnoff
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa USA (M.M.H.); Departments of Physical Medicine and Rehabilitation (J.T.F., J.S.), Radiology (J.S.), and Anatomy (J.S.), Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota USA; and Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia USA (Y.A.S.)
| | - Yusef A Sayeed
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa USA (M.M.H.); Departments of Physical Medicine and Rehabilitation (J.T.F., J.S.), Radiology (J.S.), and Anatomy (J.S.), Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota USA; and Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia USA (Y.A.S.)
| | - Jay Smith
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa USA (M.M.H.); Departments of Physical Medicine and Rehabilitation (J.T.F., J.S.), Radiology (J.S.), and Anatomy (J.S.), Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota USA; and Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia USA (Y.A.S.)
| |
Collapse
|
32
|
Fontanella CG, Nalesso F, Carniel EL, Natali AN. Biomechanical behavior of plantar fat pad in healthy and degenerative foot conditions. Med Biol Eng Comput 2015; 54:653-61. [DOI: 10.1007/s11517-015-1356-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
|
33
|
Variability and repeatability analysis of plantar pressure during gait in older people. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:427-33. [PMID: 26236033 DOI: 10.1016/j.rbr.2015.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 02/27/2015] [Accepted: 03/17/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Repeatability and variability of the plantar pressure during walking are important components in the clinical assessment of the elderly. However, there is a lack of information on the uniformity of plantar pressure patterns in the elderly. OBJECTIVE To analyze the repeatability and variability in plantar pressure considering mean, peak and asymmetries during aged gait. METHODS Plantar pressure was monitored in four different days for ten elderly subjects (5 female), with mean±standard-deviation age of 73±6 years, walking barefoot at preferred speed. Data were compared between steps for each day and between different days. RESULTS Mean and peak plantar pressure values were similar between the different days of evaluation. Asymmetry indexes were similar between the different days evaluated. CONCLUSION Plantar pressure presented a consistent pattern in the elderly. However, the asymmetry indexes observed suggest that the elderly are exposed to repetitive asymmetric loading during locomotion. Such result requires further investigation, especially concerning the role of these asymmetries for development of articular injuries.
Collapse
|
34
|
Minimum indentation depth for characterization of 2nd sub-metatarsal head and heel pad tissue properties. J Biomech 2015; 48:2096-101. [PMID: 25890816 DOI: 10.1016/j.jbiomech.2015.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/14/2014] [Accepted: 03/07/2015] [Indexed: 11/23/2022]
Abstract
Most in-vivo indentation techniques are limited by the lack of adequate indentation into the plantar soft tissue. The purpose of this study is therefore to assess the effect of deformation depth on plantar soft tissue behavior and to establish a guideline for the minimum indentation depth that is sufficient to quantify critical plantar soft tissue behavior. Twenty young subjects (20-25 years) participated in this study. The test was conducted with equal weight borne on each of the participants׳ feet to mimic the static stance of the gait cycle. During the experiment, the indenter probed the 2nd sub-metatarsal head (MTH) and heel pad tissue at a constant rate of 12.3 mm/s. The maximum tissue deformation induced was varied from 1.2 mm to 6.0 mm, in steps of 1.2 mm. The tissue stiffness obtained from the tissue response curves was compared and fitted to the proposed viscoelastic model. As the probe tip indents deeper into the plantar soft tissue beyond a threshold depth, Xs, the force gradient increases notably. The absolute value of Xs was approximately 2.23 mm and 2.14 mm at the heel and 2nd sub-MTH respectively. Indentation depths which were less than this threshold depth might not be representative of the nature of plantar soft tissue nor reflect the critical deformation it experiences during physical activities that expose the tissue to risk of ulceration. Our study indicated the necessity to induce a minimum tissue indentation depth in order to describe its actual characteristics. By doing so, additional useful parameters can be obtained to identify potentially abnormal soft tissue.
Collapse
|
35
|
Menz HB. Biomechanics of the Ageing Foot and Ankle: A Mini-Review. Gerontology 2014; 61:381-8. [DOI: 10.1159/000368357] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/15/2014] [Indexed: 11/19/2022] Open
|
36
|
WEARING SCOTTC, HOOPER SUEL, DUBOIS PHILIP, SMEATHERS JAMESE, DIETZE ALBRECHT. Force–Deformation Properties of the Human Heel Pad during Barefoot Walking. Med Sci Sports Exerc 2014; 46:1588-94. [DOI: 10.1249/mss.0000000000000281] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
37
|
Fukuchi RK, Stefanyshyn DJ, Stirling L, Duarte M, Ferber R. Flexibility, muscle strength and running biomechanical adaptations in older runners. Clin Biomech (Bristol, Avon) 2014; 29:304-10. [PMID: 24380685 DOI: 10.1016/j.clinbiomech.2013.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increased injury risk in older runners has been associated with alterations in muscle strength, flexibility, and gait biomechanics. This study investigated whether older runners exhibit changes in muscle strength, flexibility and running biomechanics compared to younger runners, and possible relationships between these changes. METHODS Thirty-five young (20-36yrs) and 35 older (55-71yrs) recreational runners participated in the study. Measures of three-dimensional biomechanical data during treadmill running at 2.7m/s and measures of muscle strength and flexibility were compared between groups. A correlation analysis between biomechanical and clinical variables was also performed. FINDINGS Older runners demonstrated an overall reduction in muscle strength and flexibility, and altered running patterns compared to young runners but correlations between clinical and biomechanical variables were scarce. Reduced hip, ankle and trunk excursions along with reduced knee and ankle positive work were found in older runners. Older runners also exhibited increased knee abduction impulse, ankle abduction impulse and vertical loading rates. In contrast, older runners did not present a distal-to-proximal lower extremity joint moment redistribution. INTERPRETATION We observed age-related reduced strength and flexibility concomitant with alterations in running biomechanics, but a lack of correlation between these variables. This finding hampers the use of single, or even a subset of characteristics to better understand age-related changes in runners. The observed changes are complex and multivariate in nature. Clinicians will most likely have to monitor both clinical and biomechanical characteristics to optimize care. However, future studies need to prospectively address what are biomechanical age-related risk factors in runners.
Collapse
Affiliation(s)
- Reginaldo K Fukuchi
- Running Injury Clinic, Faculty of Kinesiology, University of Calgary, Canada; Biomedical Engineering, Federal University of ABC, Santo André, Brazil.
| | - Darren J Stefanyshyn
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - Lisa Stirling
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - Marcos Duarte
- Biomedical Engineering, Federal University of ABC, Santo André, Brazil
| | - Reed Ferber
- Running Injury Clinic, Faculty of Kinesiology, University of Calgary, Canada
| |
Collapse
|
38
|
Measurement of functional heel pad behaviour in-shoe during gait using orthotic embedded ultrasonography. Gait Posture 2013; 39:328-32. [PMID: 23962596 DOI: 10.1016/j.gaitpost.2013.07.118] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/24/2013] [Accepted: 07/28/2013] [Indexed: 02/02/2023]
Abstract
The ability to measure the functional behaviour of the plantar heel pad is clinically relevant in dystrophic or pathological heel conditions and may help to inform the design and development of interventions that attempt to restore normal function. In this study we present a novel technique which utilises orthotic heel inserts with an embedded ultrasound (US) transducer to allow the functional, dynamic behaviour of the heel pad to be measured in-shoe during gait. The aim of this study was to demonstrate feasibility of the technique, determine the reproducibility of measurements, and to compare the effects of two orthotic inserts: (i) a flat orthotic heel raise and (ii) a contoured heel cup insert on the behaviour of the heel pad during gait. Dynamic compression of the heel pads of 16 healthy participants was recorded during treadmill walking and combined with plantar pressure measurements to allow stiffness and energy disappation ratio (EDR) to be estimated. Inter-session reliability of the US measurements was found to be excellent (ICC2,1=0.94-0.95), as was inter-rater reliability (ICC2,1=0.89). Use of the heel cup insert significantly reduced the maximum compression of the heel pad (p<0.0001) as well as the overall stiffness of the pad (p<0.001). There was no change in EDR (p=0.949). In-shoe embedded US is a reliable method to establish person-specific functional geometry of plantar soft tissues. Use of a contoured heel cup reduces the compression of the mid portion of the heel pad.
Collapse
|
39
|
Fritz B, Schmeltzpfenning T, Plank C, Hein T, Grau S. Anthropometric influences on dynamic foot shape: Measurements of plantar three-dimensional foot deformation. FOOTWEAR SCIENCE 2013. [DOI: 10.1080/19424280.2013.789559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
40
|
Cheing GLY, Chau RMW, Kwan RLC, Choi CH, Zheng YP. Do the biomechanical properties of the ankle-foot complex influence postural control for people with Type 2 diabetes? Clin Biomech (Bristol, Avon) 2013; 28:88-92. [PMID: 23021727 DOI: 10.1016/j.clinbiomech.2012.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ankle-foot complex plays an important role in the mechanics of postural control. The objectives of this study were to compare the biomechanical properties of the ankle-foot complex of people with diabetes who had or did not have peripheral neuropathy with those healthy individuals; and to examine its correlation with postural control. METHODS A total of 64 individuals participated in this study: 9 people with diabetic peripheral neuropathy, 23 diabetes without neuropathy, and 32 healthy controls. A hand-held ultrasound indentation system was used to assess the soft tissue biomechanical properties of the ankle-foot complex. The Sensory Organization test was performed using The Smart EquiTest system to assess postural control. FINDINGS The soft tissue of the Achilles tendon was significantly thickened in all individuals with diabetes (P<0.001), and was associated with the vestibular ratio (r=0.40; P<0.05). The Young's modulus of the plantar soft tissue was significantly increased in the diabetic neuropathy group (all P<0.05). Also, the Young's modulus of the plantar soft tissue at the first metatarsal head was positively correlated with the somatosensory ratio (r=0.46; P<0.05) and visual ratio (r=0.39; P<0.05). INTERPRETATION Diabetic patients with or without neuropathy had a thicker Achilles tendon and stiffer plantar soft tissue than the healthy control. Changes in the biomechanical properties of the ankle-foot complex were correlated with the use of vestibular, somatosensory or visual inputs to maintain balance in individuals with diabetes.
Collapse
Affiliation(s)
- Gladys L Y Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.
| | | | | | | | | |
Collapse
|
41
|
Matteoli S, Fontanella CG, Carniel EL, Wilhjelm JE, Virga A, Corbin N, Corvi A, Natali AN. Investigations on the viscoelastic behaviour of a human healthy heel pad: In vivo compression tests and numerical analysis. Proc Inst Mech Eng H 2012; 227:334-42. [DOI: 10.1177/0954411912465061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the viscoelastic behaviour of the human heel pad by comparing the stress–relaxation curves obtained from a compression device used on an in vivo heel pad with those obtained from a three-dimensional computer-based subject-specific heel pad model subjected to external compression. The three-dimensional model was based on the anatomy revealed by magnetic resonance imaging of a 31-year-old healthy female. The calcaneal fat pad tissue was described with a viscohyperelastic model, while a fibre-reinforced hyperelastic model was formulated for the skin. All numerical analyses were performed to interpret the mechanical response of heel tissues, with loading conditions and displacement rate in agreement with experimental tests. The heel tissues showed a non-linear, viscoelastic behaviour described by characteristic hysteretic curves, stress–relaxation and viscous recovery phenomena. The reliability of the investigations was validated by the interpretation of the mechanical response of heel tissues under the application of three pistons with diameter of 15, 20 and 40 mm, at the same displacement rate of about 1.7 mm/s. The maximum and minimum relative errors were found to be less than 0.95 and 0.064, respectively.
Collapse
Affiliation(s)
- Sara Matteoli
- Department of Mechanics and Industrial Technologies, University of Florence, Florence, Italy
- Biomedical Engineering Group, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Chiara G Fontanella
- Centre of Mechanics of Biological Materials, Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Emanuele L Carniel
- Centre of Mechanics of Biological Materials, Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Jens E Wilhjelm
- Biomedical Engineering Group, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Antonio Virga
- Department of Mechanics and Industrial Technologies, University of Florence, Florence, Italy
| | - Nadège Corbin
- Biomedical Engineering Group, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Andrea Corvi
- Department of Mechanics and Industrial Technologies, University of Florence, Florence, Italy
- Fondation “In cammino…”, Fucecchio, Florence, Italy
| | - Arturo N Natali
- Centre of Mechanics of Biological Materials, Department of Industrial Engineering, University of Padua, Padua, Italy
| |
Collapse
|
42
|
Fontanella C, Matteoli S, Carniel E, Wilhjelm J, Virga A, Corvi A, Natali A. Investigation on the load-displacement curves of a human healthy heel pad: In vivo compression data compared to numerical results. Med Eng Phys 2012; 34:1253-9. [DOI: 10.1016/j.medengphy.2011.12.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 12/12/2011] [Accepted: 12/14/2011] [Indexed: 10/14/2022]
|
43
|
Periyasamy R, Anand S, Ammini AC. The effect of aging on the hardness of foot sole skin: a preliminary study. Foot (Edinb) 2012; 22:95-9. [PMID: 22386216 DOI: 10.1016/j.foot.2012.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Foot problems are common in older people and altered biomechanical parameters under the foot sole has been proposed as a key risk factor for foot lesions. Therefore the aim of this study was to investigate the age-related differences in the hardness of foot sole skin. METHODS Twenty-six healthy volunteers without foot problems, aged from 26 to 65 years, were examined using shore meter. The hardness of the foot sole under the big toe (area 8), 1st metatarsal head (area 5), 3rd metatarsal head (area 6), 5th metatarsal head (area 7), mid foot (area 3, 4) and hind foot (area 1, 2) were measured. The correlation between age and hardness of foot sole was examined and comparisons were made between two age groups. RESULTS From the result we observe statistical significant (p<0.05; p<0.01; p<0.005) differences in hardness between age groups in hind foot, metatarsal heads (1st, 3rd & 5th) and big toe. Strong positive correlations between age and hardness of the foot sole were found at the big toe (r=0.57; p<0.005), 1st metatarsal head (r=0.567; p<0.00001), 3rd metatarsal head (r=0.565; p<0.00001), 5th metatarsal head (r=0.55; p<0.00001), and heel (r=0.59; p<0.0001). CONCLUSION The loss of compliance in the foot sole may be one of the factors responsible for the higher incidence of foot problems in aged people. Routine foot examination and appropriate therapeutic intervention including the use of foot orthoses and optimal hardness of foot wear insole may help to prevent the serious foot injuries.
Collapse
Affiliation(s)
- R Periyasamy
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.
| | | | | |
Collapse
|
44
|
Mechanical work as an indirect measure of subjective costs influencing human movement. PLoS One 2012; 7:e31143. [PMID: 22383998 PMCID: PMC3286468 DOI: 10.1371/journal.pone.0031143] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 01/03/2012] [Indexed: 11/19/2022] Open
Abstract
To descend a flight of stairs, would you rather walk or fall? Falling seems to have some obvious disadvantages such as the risk of pain or injury. But the preferred strategy of walking also entails a cost for the use of active muscles to perform negative work. The amount and distribution of work a person chooses to perform may, therefore, reflect a subjective valuation of the trade-offs between active muscle effort and other costs, such as pain. Here we use a simple jump landing experiment to quantify the work humans prefer to perform to dissipate the energy of landing. We found that healthy normal subjects (N = 8) preferred a strategy that involved performing 37% more negative work than minimally necessary (P<0.001) across a range of landing heights. This then required additional positive work to return to standing rest posture, highlighting the cost of this preference. Subjects were also able to modulate the amount of landing work, and its distribution between active and passive tissues. When instructed to land softly, they performed 76% more work than necessary (P<0.001), with a higher proportion from active muscles (89% vs. 84%, P<0.001). Stiff-legged landings, performed by one subject for demonstration, exhibited close to the minimum of work, with more of it performed passively through soft tissue deformations (at least 30% in stiff landings vs. 16% preferred). During jump landings, humans appear not to minimize muscle work, but instead choose to perform a consistent amount of extra work, presumably to avoid other subjective costs. The degree to which work is not minimized may indirectly quantify the relative valuation of costs that are otherwise difficult to measure.
Collapse
|
45
|
Campanelli V, Fantini M, Faccioli N, Cangemi A, Pozzo A, Sbarbati A. Three-dimensional morphology of heel fat pad: an in vivo computed tomography study. J Anat 2011; 219:622-31. [PMID: 21848602 DOI: 10.1111/j.1469-7580.2011.01420.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Heel fat pad cushioning efficiency is the result of its structure, shape and thickness. However, while a number of studies have investigated heel fat pad (HFP) anatomy, structural behavior and material properties, no previous study has described its three-dimensional morphology in situ. The assessment of the healthy, unloaded, three-dimensional morphology of heel pad may contribute to deepen the understanding of its role and behavior during locomotion. It is the basis for the assessment of possible HFP morphological modifications due to changes in the amount or distribution of the loads normally sustained by the foot. It may also help in guiding the surgical reconstruction of the pad and in improving footwear design, as well as in developing a correct heel pad geometry for finite element models of the foot. Therefore the purpose of this study was to obtain a complete analysis of HFP three-dimensional morphology in situ. The right foot of nine healthy volunteers was scanned with computed tomography. A methodological approach that maximizes reliability and repeatability of the data was developed by building a device to lock the foot in a neutral position with respect to the scan planes during image acquisition. Scan data were used to reconstruct virtual three-dimensional models for both the calcaneus and HFP. A set of virtual coronal and axial sections were extracted from the three-dimensional model of each HFP and processed to extract a set of one- and two-dimensional morphometrical measurements for a detailed description of heel pad morphology. The tissue exhibited a consistent and sophisticated morphology that may reflect the biomechanics of the foot support. HFP was found to be have a crest on its anterior dorsal surface, flanges on the sides and posteriorly, and a thick portion that reached and covered the posterior surface of the calcaneus and the achilles tendon insertion. Its anterior internal portion was thinner and a lump of fat was consistently present in this region. Finally, HFP was found to be thicker in males than in females.
Collapse
Affiliation(s)
- Valentina Campanelli
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Anatomy and Histology Section, University of Verona, Verona, Italy.
| | | | | | | | | | | |
Collapse
|
46
|
Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. Soft tissue thickness under the metatarsal heads is reduced in older people with toe deformities. J Orthop Res 2011; 29:1042-6. [PMID: 21567451 DOI: 10.1002/jor.21328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 11/15/2010] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine whether thickness of the plantar soft tissue (ST) under the metatarsal heads (MTH) differed between older individuals with and without toe deformities. Non-weightbearing total ST and fat pad (FP) thickness at the heel, 1st metatarsal head (1MTH) and 5th metatarsal head (5MTH) were measured using ultrasound in 312 men and women aged over 60 years. Each participant had their feet assessed for the presence of hallux valgus or lesser toe deformities. Total ST and FP thicknesses in those with hallux valgus (n=36) or lesser toe deformities (n=72) were compared to gender-, age- and BMI-matched controls using independent t-tests. Individuals with hallux valgus had significantly reduced total ST thickness under 1MTH compared to controls (7.4 ± 1.6 mm vs. 8.5 ± 1.5 mm; p = 0.002). Similarly, individuals with lesser toe deformities displayed significantly reduced total ST thickness under 5MTH compared to controls (5.1 ± 1.0 mm vs. 5.5 ± 1.3 mm; p = 0.01). As FP thickness did not differ between cases and controls, we speculate that the musculotendinous complex is compromised, and may result in reduced toe function in those with toe deformities.
Collapse
Affiliation(s)
- Karen J Mickle
- Biomechanics Research Laboratory, University of Wollongong, Northfields Avenue, Wollongong, New South Wales 2522, Australia.
| | | | | | | | | |
Collapse
|
47
|
Zelik KE, Kuo AD. Human walking isn't all hard work: evidence of soft tissue contributions to energy dissipation and return. ACTA ACUST UNITED AC 2011; 213:4257-64. [PMID: 21113007 DOI: 10.1242/jeb.044297] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The muscles and tendons of the lower extremity are generally considered the dominant producers of positive and negative work during gait. However, soft-tissue deformations not captured by joint rotations might also dissipate, store and even return substantial energy to the body. A key locomotion event is the collision of the leg with the ground, which deforms soft tissues appreciably in running. Significant deformation might also result from the impulsive ground collision in walking. In a study of normal human walking (N=10; 0.7-2.0 m s(-1) speeds), we show indirect evidence for both negative and positive work performed by soft tissue, consistent with a damped elastic collision and rebound. We used the difference between measured joint work and another quantity - the work performed on the body center of mass - to indicate possible work performed by soft tissue. At 1.25 m s(-1), we estimated that soft tissue performs approximately 7.5 J of negative work per collision. This constitutes approximately 60% of the total negative collision work and 31% of the total negative work per stride. The amount of soft tissue work during collision increases sharply with speed. Each collision is followed by 4 J of soft tissue rebound that is also not captured by joint work measures. Soft tissue deformation may save muscles the effort of actively dissipating energy, and soft tissue elastic rebound could save up to 14% of the total positive work per stride. Soft tissues not only cushion impacts but also appear to perform substantial work.
Collapse
Affiliation(s)
- Karl E Zelik
- Department of Mechanical, University of Michigan, Ann Arbor, MI 48109, USA.
| | | |
Collapse
|
48
|
Bonanno DR, Landorf KB, Menz HB. Pressure-relieving properties of various shoe inserts in older people with plantar heel pain. Gait Posture 2011; 33:385-9. [PMID: 21256025 DOI: 10.1016/j.gaitpost.2010.12.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 12/02/2010] [Accepted: 12/09/2010] [Indexed: 02/02/2023]
Abstract
Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain. Thirty-six adults aged over 65 years with plantar heel pain participated in the study. Using the in-shoe Pedar(®) system, plantar pressure data were recorded while participants walked along an 8 m walkway wearing a standardised shoe and 4 different shoe inserts. The shoe inserts consisted of a silicon heel cup, a soft foam heel pad, a heel lift and a prefabricated foot orthosis. Data were collected for the heel, midfoot and forefoot. Statistically significant attenuation of heel peak plantar pressure was provided by 3 of the 4 shoe inserts. The greatest reduction was achieved by the prefabricated foot orthosis, which provided a fivefold reduction compared to the next most effective insert. The contoured nature of the prefabricated foot orthosis allowed for an increase in midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure. The findings from this study indicate that of the shoe inserts tested, the contoured prefabricated foot orthosis is the most effective at reducing pressure under the heel in older people with heel pain.
Collapse
Affiliation(s)
- Daniel R Bonanno
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, Vic 3086, Australia.
| | | | | |
Collapse
|
49
|
Wearing SC, Smeathers JE, Urry SR, Sullivan PM, Yates B, Dubois P. Plantar enthesopathy: thickening of the enthesis is correlated with energy dissipation of the plantar fat pad during walking. Am J Sports Med 2010; 38:2522-7. [PMID: 20935245 DOI: 10.1177/0363546510377405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The enthesis of the plantar fascia is thought to play an important role in stress dissipation. However, the potential link between entheseal thickening characteristic of enthesopathy and the stress-dissipating properties of the intervening plantar fat pad have not been investigated. PURPOSE This study was conducted to identify whether plantar fat pad mechanics explain variance in the thickness of the fascial enthesis in individuals with and without plantar enthesopathy. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The study population consisted of 9 patients with unilateral plantar enthesopathy and 9 asymptomatic, individually matched controls. The thickness of the enthesis of the symptomatic, asymptomatic, and a matched control limb was acquired using high-resolution ultrasound. The compressive strain of the plantar fat pad during walking was estimated from dynamic lateral radiographs acquired with a multifunction fluoroscopy unit. Peak compressive stress was simultaneously acquired via a pressure platform. Principal viscoelastic parameters were estimated from subsequent stress-strain curves. RESULTS The symptomatic fascial enthesis (6.7 ± 2.0 mm) was significantly thicker than the asymptomatic enthesis (4.2 ± 0.4 mm), which in turn was thicker than the enthesis (3.3 ± 0.4 mm) of control limbs (P < .05). There was no significant difference in the mean thickness, peak stress, peak strain, or secant modulus of the plantar fat pad between limbs. However, the energy dissipated by the fat pad during loading and unloading was significantly lower in the symptomatic limb (0.55 ± 0.17) when compared with asymptomatic (0.69 ± 0.13) and control (0.70 ± 0.09) limbs (P < .05). The sonographic thickness of the enthesis was correlated with the energy dissipation ratio of the plantar fat pad (r = .72, P < .05), but only in the symptomatic limb. CONCLUSION The energy-dissipating properties of the plantar fat pad are associated with the sonograpic appearance of the enthesis in symptomatic limbs, providing a previously unidentified link between the mechanical behavior of the plantar fat pad and enthesopathy.
Collapse
|
50
|
Gu Y, Li J, Ren X, Lake MJ, Zeng Y. Heel skin stiffness effect on the hind foot biomechanics during heel strike. Skin Res Technol 2010; 16:291-6. [PMID: 20636997 DOI: 10.1111/j.1600-0846.2010.00425.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The human heel pad is a complex biological structure consisting of the fat pad and the skin. The mechanical properties of the skin layer are of significant importance to the load-bearing function of the heel pad and human locomotion. The condition of the heel skin is also directly associated with some medical conditions such as heel ulcers that may become a site for the skin breakdown, which is the most common precursor to lower extremity amputation among persons with diabetes. It is essential to develop a detailed understanding of the properties of the heel skin layer and its effect on hind foot biomechanics during heel strike. OBJECTIVES This work aims to gain a better insight into the biomechanical behaviour of the heel skin layer through a combined experimental and numerical study. The main objective is to characterise the biomechanical responses of the hind foot system during heel strike with potential variation of the skin stiffness based on a subject-specific finite element (FE) model and biomechanical testing. METHODS A three-dimensional (3D) FE model of the human hind foot incorporating a separate heel skin layer was developed based on subject-specific medical images. An inverse FE analysis of the in vivo indentation test was carried out to study the nonlinear material property of the heel skin. The FE model was then used to study the deformation of the hind foot during heel strike in comparison with the plantar pressure measurement results and to establish the effects of stiffness of the heel skin on the stress and pressure distributions. RESULTS The FE foot model with subject-specific heel skin properties was successfully used to predict the deformation of the hind foot during heel strike, and the results showed good agreements with biomechanical pressure measurements. The results showed that the high pressure and stress in the heel skin appeared in the centre region during a heel strike. Heel skin stiffness sensitivity studies showed that an increase in the skin stiffness had a limited effect on the stress and contact pressure of the hind foot bones, but caused a slight increase in the skin stresses, while skin softening caused a decrease in the peak plantar pressure and its distribution pattern changed. In addition, the results also suggest that skin softening may cause a higher stress level in the bones and ligaments. CONCLUSION The nonlinear parameter of the heel skin has been successfully predicted from in vivo indentation tests based on a subject-specific FE model. Skin properties' sensitivity tests clearly showed that the stiffness of the heel skin could have a direct effect on the biomechanics of the hind foot. The results suggest that individuals with a pathologically stiffened heel skin could exert an increase in the heel pressure, which may potentially lead to skin breakdown or ulcer.
Collapse
Affiliation(s)
- Yaodong Gu
- Human Movement Research Center, Zhejiang College of Sports, Zhejiang, China
| | | | | | | | | |
Collapse
|