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Zhang L, Zhang Q, Zhong Y, Hortobagyi T, Gu Y. Effect of forefoot transverse arch stiffness on foot biomechanical response--based on finite element method. Front Bioeng Biotechnol 2024; 12:1387768. [PMID: 39040495 PMCID: PMC11260739 DOI: 10.3389/fbioe.2024.1387768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Background The plantar vault, comprising the transverse and longitudinal arches of the human foot, is essential for impact absorption, elastic energy storage, and propulsion. Recent research underscores the importance of the transverse arch, contributing over 40% to midfoot stiffness. This study aimed to quantify biomechanical responses in the ankle-foot complex by varying the stiffness of the deep metatarsal transverse ligament (DTML). Methods Using CT image reconstruction, we constructed a complex three-dimensional finite element model of the foot and ankle joint complex, accounting for geometric complexity and nonlinear characteristics. The focus of our study was to evaluate the effect of different forefoot transverse arch stiffness, that is, different Young's modulus values of DTML (from 135 MPa to 405 MPa), on different biomechanical aspects of the foot and ankle complex. Notably, we analyzed their effects on plantar pressure distribution, metatarsal stress patterns, navicular subsidence, and plantar fascial strain. Results Increasing the stiffness of the DTML has significant effects on foot biomechanics. Specifically, higher DTML stiffness leads to elevate von Mises stress in the 1st, 2nd, and 3rd metatarsals, while concurrently reducing plantar pressure by 14.2% when the Young's modulus is doubled. This stiffening also impedes navicular bone subsidence and foot lengthening. Notably, a 100% increase in the Young's modulus of DTML results in a 54.1% decrease in scaphoid subsidence and a 2.5% decrease in foot lengthening, which collectively contribute to a 33.1% enhancement in foot longitudinal stiffness. Additionally, doubling the Young's modulus of DTML can reduce the strain stretch of the plantar fascia by 38.5%. Conclusion Preserving DTML integrity sustains the transverse arch, enhancing foot longitudinal stiffness and elastic responsiveness. These findings have implications for treating arch dysfunction and provide insights for shoe developers seeking to enhance propulsion.
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Affiliation(s)
- Linjie Zhang
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
| | - Qiaolin Zhang
- Doctoral School of Safety and Security Sciences, Obuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yilin Zhong
- Faculty of Sport Science, Ningbo University, Ningbo, China
| | - Tibor Hortobagyi
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
| | - Yaodong Gu
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
- Faculty of Sport Science, Ningbo University, Ningbo, China
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Yoon YS, An DH, Lee YJ, Lee DY, Kyung MG. Comparison of in-shoe plantar pressure between Korean combat boots and running shoes. BMJ Mil Health 2024:e002592. [PMID: 38772623 DOI: 10.1136/military-2023-002592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/05/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Combat boots are special shoes designed for soldiers to wear during activities in rough terrain, such as long marches or military training. Combat boots have been known to cause high plantar pressure and increase the injury rate of the lower extremities. Therefore, this study aimed to compare the difference in in-shoe plantar pressure between Korean combat boots and running shoes. We hypothesised that the newest Korean combat boots would have comparable plantar pressure distribution with running shoes. METHODS We prospectively recruited 30 asymptomatic male participants, who are candidates for military services, from the local area. Two types of shoes (the newly developed Korean combat boots and running shoes) were examined. Pedobarographic measurements were collected using the pedar-X in-shoe pressure measurement system. Peak pressure (PP), pressure time integral (PTI), contact area and contact time were analysed. RESULTS Both PP and PTI at the region of central and lateral forefeet (FF) were significantly higher in combat boots. The contact area of combat boots was significantly lower at the region of the hallux, second-fifth toes, medial FF, central FF and midfoot. Contact time at the region of central FF and medial heel was significantly higher in combat boots. CONCLUSIONS Understanding the plantar pressure distribution of combat boots can be helpful for developing combat boots and preventing injury. Based on the results of our study, the next-generation Korean combat boots should be developed to increase contact area and distribute impulse under the head of the metatarsal bone.
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Affiliation(s)
- Young Sik Yoon
- Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Gangwon-do, Korea (the Republic of)
| | - D H An
- Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Y J Lee
- Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Gangwon-do, Korea (the Republic of)
| | - D Y Lee
- Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - M G Kyung
- Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea (the Republic of)
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Tenforde AS, Ackerman KE, Bouxsein ML, Gaudette L, McCall L, Rudolph SE, Gehman S, Garrahan M, Hughes JM, Outerleys J, Davis IS, Popp KL. Factors Associated With High-Risk and Low-Risk Bone Stress Injury in Female Runners: Implications for Risk Factor Stratification and Management. Orthop J Sports Med 2024; 12:23259671241246227. [PMID: 38779133 PMCID: PMC11110515 DOI: 10.1177/23259671241246227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/24/2023] [Indexed: 05/25/2024] Open
Abstract
Background Bone stress injury (BSI) is a common overuse injury in active women. BSIs can be classified as high-risk (pelvis, sacrum, and femoral neck) or low-risk (tibia, fibula, and metatarsals). Risk factors for BSI include low energy availability, menstrual dysfunction, and poor bone health. Higher vertical load rates during running have been observed in women with a history of BSI. Purpose/Hypothesis The purpose of this study was to characterize factors associated with BSI in a population of premenopausal women, comparing those with a history of high-risk or low-risk BSI with those with no history of BSI. It was hypothesized that women with a history of high-risk BSI would be more likely to exhibit lower bone mineral density (BMD) and related factors and less favorable bone microarchitecture compared with women with a history of low-risk BSI. In contrast, women with a history of low-risk BSI would have higher load rates. Study Design Cross-sectional study; Level of evidence, 3. Methods Enrolled were 15 women with a history of high-risk BSI, 15 with a history of low-risk BSI, and 15 with no history of BSI. BMD for the whole body, hip, and spine was standardized using z scores on dual-energy x-ray absorptiometry. High-resolution peripheral quantitative computed tomography was used to quantify bone microarchitecture at the radius and distal tibia. Participants completed surveys characterizing factors that influence bone health-including sleep, menstrual history, and eating behaviors-utilizing the Eating Disorder Examination Questionnaire (EDE-Q). Each participant completed a biomechanical assessment using an instrumented treadmill to measure load rates before and after a run to exertion. Results Women with a history of high-risk BSI had lower spine z scores than those with low-risk BSI (-1.04 ± 0.76 vs -0.01 ± 1.15; P < .05). Women with a history of high-risk BSI, compared with low-risk BSI and no BSI, had the highest EDE-Q subscores for Shape Concern (1.46 ± 1.28 vs 0.76 ± 0.78 and 0.43 ± 0.43) and Eating Concern (0.55 ± 0.75 vs 0.16 ± 0.38 and 0.11 ± 0.21), as well as the greatest difference between minimum and maximum weight at current height (11.3 ± 5.4 vs 7.7 ± 2.9 and 7.6 ± 3.3 kg) (P < .05 for all). Women with a history of high-risk BSI were more likely than those with no history of BSI to sleep <7 hours on average per night during the week (80% vs 33.3%; P < .05). The mean and instantaneous vertical load rates were not different between groups. Conclusion Women with a history of high-risk BSI were more likely to exhibit risk factors for poor bone health, including lower BMD, while load rates did not distinguish women with a history of BSI.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Logan Gaudette
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Lauren McCall
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara E Rudolph
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Gehman
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Garrahan
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Jereme Outerleys
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Irene S Davis
- School of Physical Therapy Tampa, University of South Florida, Florida, USA
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA. A.S.T., K.E.A., and M.L.B. contributed equally to this study. I.S.D. and K.L.P. contributed equally to this study
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Song Y, Cen X, Chen H, Sun D, Munivrana G, Bálint K, Bíró I, Gu Y. The influence of running shoe with different carbon-fiber plate designs on internal foot mechanics: A pilot computational analysis. J Biomech 2023; 153:111597. [PMID: 37126883 DOI: 10.1016/j.jbiomech.2023.111597] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
A carbon-fiber plate (CFP) embedded into running shoes is a commonly applied method to improve running economy, but little is known in regard the effects of CFP design features on internal foot mechanics. This study aimed to explore how systematic changes in CFP geometrical variations (i.e., thickness and location) can alter plantar pressure and strain under the forefoot as well as metatarsal stress state through computational simulations. A foot-shoe finite element (FE) model was built and different CFP features including three thicknesses (1 mm, 2 mm, and 3 mm) and three placements (high-loaded (just below the insole), mid-loaded (in between the midsole), and low-loaded (just above the outsole)) were further modulated within the shoe sole. Simulations were conducted at the impact peak instant during forefoot strike running. Compared with the no-CFP shoe, peak plantar pressure and compressive strain under the forefoot consistently decreased when the CFP thickness increased, and the low-loaded conditions were found more effective (peak pressure decreased up to 31.91% and compressive strain decreased up to 18.61%). In terms of metatarsal stress, CFP designs resulted in varied effects and were dependent on their locations. Specifically, high-loaded CFP led to relatively higher peak metatarsal stress without the reduction trend as thickness increased (peak stress increased up to 12.91%), while low-loaded conditions showed a gradual reduction in peak stress, decreasing by 0.74%. Therefore, a low-loaded thicker CFP should be considered to achieve the pressure-relief effects of running shoes without the expense of increased metatarsal stress.
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Affiliation(s)
- Yang Song
- Faculty of Sports Science, Ningbo University, Ningbo, China; Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary; Faculty of Kinesiology, University of Split, Split, Croatia
| | - Xuanzhen Cen
- Faculty of Sports Science, Ningbo University, Ningbo, China; Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary; Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Hairong Chen
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Dong Sun
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | | | - Kovács Bálint
- Faculty of Sports Science, Ningbo University, Ningbo, China; Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
| | - István Bíró
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary; Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China.
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Nuyts L, De Brabandere A, Van Rossom S, Davis J, Vanwanseele B. Machine-learned-based prediction of lower extremity overuse injuries using pressure plates. Front Bioeng Biotechnol 2022; 10:987118. [PMID: 36118590 PMCID: PMC9481267 DOI: 10.3389/fbioe.2022.987118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Although running has many benefits for both the physical and mental health, it also involves the risk of injuries which results in negative physical, psychological and economical consequences. Those injuries are often linked to specific running biomechanical parameters such as the pressure pattern of the foot while running, and they could potentially be indicative for future injuries. Previous studies focus solely on some specific type of running injury and are often only applicable to a gender or running-experience specific population. The purpose of this study is, for both male and female, first-year students, (i) to predict the development of a lower extremity overuse injury in the next 6 months based on foot pressure measurements from a pressure plate and (ii) to identify the predictive loading features. For the first objective, we developed a machine learning pipeline that analyzes foot pressure measurements and predicts whether a lower extremity overuse injury is likely to occur with an AUC of 0.639 and a Brier score of 0.201. For the second objective, we found that the higher pressures exerted on the forefoot are the most predictive for lower extremity overuse injuries and that foot areas from both the lateral and the medial side are needed. Furthermore, there are two kinds of predictive features: the angle of the FFT coefficients and the coefficients of the autoregressive AR process. However, these features are not interpretable in terms of the running biomechanics, limiting its practical use for injury prevention.
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Affiliation(s)
- Loren Nuyts
- DTAI, Department of Computer Science, KU Leuven, Leuven, Belgium
- *Correspondence: Loren Nuyts,
| | | | - Sam Van Rossom
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jesse Davis
- DTAI, Department of Computer Science, KU Leuven, Leuven, Belgium
| | - Benedicte Vanwanseele
- Human Movements Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
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