DOI QR코드

DOI QR Code

Plantar Soft-tissue Stress states in standing: a Three-Dimensional Finite Element Foot Modeling Study

  • Chen, Wen-Ming (Division of Bioengineering. National University of Singapore) ;
  • Lee, Peter Vee-Sin (Division of Bioengineering. National University of Singapore) ;
  • Lee, Tae-Yong (Division of Bioengineering. National University of Singapore)
  • Published : 2009.06.30

Abstract

It bas been hypothesized that foot ulceration might be internally initiated. Current instruments which merely allow superficial estimate of plantar loading acting on the foot, severely limit the scope of many biomechanical/clinical studies on this issue. Recent studies have suggested that peak plantar pressure may be only 65% specific for the development of ulceration. These limitations are at least partially due to surface pressures not being representative of the complex mechanical stress developed inside the subcutaneous plantar soft-tissue, which are potentially more relevant for tissue breakdown. This study established a three-dimensional and nonlinear finite element model of a human foot complex with comprehensive skeletal and soft-tissue components capable of predicting both the external and internal stresses and deformations of the foot. The model was validated by experimental data of subject-specific plantar foot pressure measures. The stress analysis indicated the internal stresses doses were site-dependent and the observation found a change between 1.5 to 4.5 times the external stresses on the foot plantar surface. The results yielded insights into the internal loading conditions of the plantar soft-tissue, which is important in enhancing our knowledge on the causes of foot ulceration and related stress-induced tissue breakdown in diabetic foot.

Keywords

References

  1. Alexander, I. J., Chao, E. Y., & Johnson, K. A.(1990). The assessment of dynamic foot-to-ground contact forces and plantar pressure distribution: a review of the evolution of current techniques and clinical applications. Foot & Ankle International, 11, 152-67. https://doi.org/10.1177/107110079001100306
  2. Armstrong, D. G., Peters, E. J., Athanasiou, K. A., & Lavery, L. A.(1998). Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration? Journal Foot Ankle Surgery, 37, 303-7. https://doi.org/10.1016/S1067-2516(98)80066-5
  3. Athanasiou, K. A., Liu, G. T., Lavery, L. A., Lanctot, D. R., & Schenck, R. C., Jr.(1998.) Biomechanical topography of human articular cartilage in the first metatarsophalangeal joint. Clinical Orthopaedic Related Research, 269-81.
  4. Boulton, A. J., Vileikyte, L., Ragnarson-Tennvall, G., & Apelqvist, J.(2005). The global burden of diabetic foot disease. Lancet, 366, 1719-24. https://doi.org/10.1016/S0140-6736(05)67698-2
  5. Brash, P. D., Foster, J. E, Vennart, W., Daw, J., & Tooke, J. E.(1996). Magnetic resonance imaging reveals micro-haemorrhage in the feet of diabetic patients with a history of ulceration. Diabetic Medicine, 13, 973-8. https://doi.org/10.1002/(SICI)1096-9136(199611)13:11<973::AID-DIA272>3.0.CO;2-5
  6. Bus, S. A., Maas, M., Cavanagh, P. R., Michels, R. P., & Levi, M.(2004). Plantar fat-pad displacement in neuropathic diabetic patients with toe deformity: a magnetic resonance imaging study. Diabetes Care, 27, 2376-81. https://doi.org/10.2337/diacare.27.10.2376
  7. Bygrave, C. J., & Betts, R. P.(1992). The plantar tissue thickness in the foot: a new ultrasound technique for loadbearing measurements and a metatarsal head depth study. The Foot, 3, 71-8. https://doi.org/10.1016/0958-2592(93)90065-B
  8. Cavanagh, P. R., Ulbrecht, J. S., & Caputo, G. M.(2000). New developments in the biomechanics of the diabetic foot. Diabetes Metabolism Research Reviews, 16 Suppl 1, S6-S10. https://doi.org/10.1002/1520-7560(200009/10)16:1+<::AID-DMRR130>3.0.CO;2-Z
  9. Delbridge, L., Perry, P., Marr, S., Arnold, N., Yue, D. K., Turtle, J. R., & Reeve, T. S.(1988). Limited joint mobility in the diabetic foot: relationship to neuropathic ulceration. Diabetic Medicine, 5, 333-7. https://doi.org/10.1111/j.1464-5491.1988.tb01000.x
  10. Duckworth, T., Boulton, A. J., Betts, R. P., Franks, C. I., & Ward, J. D.(1985). Plantar pressure measurements and the prevention of ulceration in the diabetic foot. Journal Bone Joint Surgery British, 67, 79-85.
  11. Gefen, A.(2003). Plantar soft tissue loading under the medial metatarsals in the standing diabetic foot. Medicine Engineer Physical, 25, 491-9. https://doi.org/10.1016/S1350-4533(03)00029-8
  12. Gefen, A., Megido-Ravid, M., Azariah, M., Itzchak, Y., & Arcan, M.(2001). Integration of plantar soft tissue stiffness measurements in routine MRI of the diabetic foot. Clinical Biomechanics, (Bristol, Avon) 16, 921-5. https://doi.org/10.1016/S0268-0033(01)00074-2
  13. Keyak, J. H., Rossi, S. A., Jones, K. A., & Skinner, H. B.(1998). Prediction of femoral fracture load using automated finite element modeling. Journal of Biomechanics, 31, 125-33.
  14. Lemmon, D., Shiang, T. Y., Hashmi, A., Ulbrecht, J. S., & Cavanagh, P. R.(1997). The effect of insoles in therapeutic footwear a finite element approach. Journal of Biomechanics, 30, 615-20. https://doi.org/10.1016/S0021-9290(97)00006-7
  15. Masson, E. A., Hay, E. M., Stockley, I., Veves, A., Betts, R. P., & Boulton, A. J.(1989). Abnormal foot pressures alone may not cause ulceration. Diabetic Medicine, 6, 426-8. https://doi.org/10.1111/j.1464-5491.1989.tb01198.x
  16. Morag, E., & Cavanagh, P. R.(1999). Structural and functional predictors of regional peak pressures under the foot during walking. Journal of Biomechanics, 32, 359-70. https://doi.org/10.1016/S0021-9290(98)00188-2
  17. Mueller, M. J., Hastings, M., Commean, P. K., Smith, K. E., Pilgram, T. K., Robertson, D., & Johnson, J.(2003). Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy. Journal of Biomechanics, 36, 1009-17. https://doi.org/10.1016/S0021-9290(03)00078-2
  18. Nakamura, S., Crowninshield, R. D., & Cooper, R. R.(1981). An analysis of soft tissue loading in the foot a preliminary report. Bulletin of Prosthetics Research, 18(1), 27-34.
  19. Pham, H., Armstrong, D. G., Harvey, C., Harkless, L. B., Giurini, J. M., & Veves, A.(2000). Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care, 23, 606-11. https://doi.org/10.2337/diacare.23.5.606
  20. Siegler, S., Block, J., & Schneck, C. D.(1988). The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot & Ankle International, 8, 234-42. https://doi.org/10.1177/107110078800800502
  21. Singh, N., Armstrong, D. G., & Lipsky, B. A.(2005). Preventing foot ulcers in patients with diabetes. Journal of American Medical Association, 293, 217-28. https://doi.org/10.1001/jama.293.2.217
  22. Stess, R. M., Jensen, S. R., & Mirmiran, R.(1997). The role of dynamic plantar pressures in diabetic foot ulcers. Diabetes Care, 20, 855-8. https://doi.org/10.2337/diacare.20.5.855
  23. Wright, D. G., & Rennels, D. C.(1964). A Study of the Elastic Properties of Plantar Fascia. Journal of Bone Joint Surgery American, 46, 482-92.