The influence of soft tissue movement on ground reaction forces, joint torques and joint reaction forces in drop landings

The aim of this study was to determine the effects that soft tissue motion has on ground reaction forces, joint torques and joint reaction forces in drop landings. To this end a four body-segment wobbling mass model was developed to reproduce the vertical ground reaction force curve for the first 100 ms of landing. Particular attention was paid to the passive impact phase, while selecting most model parameters a priori, thus permitting examination of the rigid body assumption on system kinetics. A two-dimensional wobbling mass model was developed in DADS (version 9.00, CADSI) to simulate landing from a drop of 43 cm. Subject-specific inertia parameters were calculated for both the rigid links and the wobbling masses. The magnitude and frequency response of the soft tissue of the subject to impulsive loading was measured and used as a criterion for assessing the wobbling mass motion. The model successfully reproduced the vertical ground reaction force for the first 100 ms of the landing with a peak vertical ground reaction force error of 1.2% and root mean square errors of 5% for the first 15 ms and 12% for the first 40 ms. The resultant joint forces and torques were lower for the wobbling mass model compared with a rigid body model, up to nearly 50% lower, indicating the important contribution of the wobbling masses on reducing system loading.     

Simultaneous measurement of three-dimensional joint kinematics and ligament strains with optical methods

The objective of this study was to assess the precision and accuracy of a nonproprietary, optical three-dimensional (3D) motion analysis system for the simultaneous measurement of soft tissue strains and joint kinematics. The system consisted of two high-resolution digital cameras and software for calculating the 3D coordinates of contrast markers. System precision was assessed by examining the variation in the coordinates of static markers over time. Three-dimensional strain measurement accuracy was assessed by moving contrast markers fixed distances in the field of view and calculating the error in predicted strain. Three-dimensional accuracy for kinematic measurements was assessed by simulating the measurements that are required for recording knee kinematics. The field of view (190 mm) was chosen to allow simultaneous recording of markers for soft tissue strain measurement and knee joint kinematics. Average system precision was between +/-0.004 mm and +/-0.035 mm, depending on marker size and camera angle. Absolute error in strain measurement varied from a minimum of +/-0.025% to a maximum of +/-0.142%, depending on the angle between cameras and the direction of strain with respect to the camera axes. Kinematic accuracy for translations was between +/-0.008 mm and +/-0.034 mm, while rotational accuracy was +/-0.082 deg to +/-0.160 deg. These results demonstrate that simultaneous optical measurement of 3D soft tissue strain and 3D joint kinematics can be performed while achieving excellent accuracy for both sets of measurements.     

Ex vivo determination of bone tissue strains for an in vivo mouse tibial loading model

Previous studies introduced the digital image correlation (DIC) as a viable technique for measuring bone strain during loading. In this study, we investigated the sensitivity of a DIC system in determining surface strains in a mouse tibia while loaded in compression through the knee joint. Specifically, we examined the effect of speckle distribution, facet size and overlap, initial vertical alignment of the bone into the loading cups, rotation with respect to cameras, and ex vivo loading configurations on the strain contour maps measured with a DIC system.     

Accuracy of finite element predictions in sideways load configurations for the proximal human femur

Subject-specific finite element models have been used to predict stress-state and fracture risk in individual patients. While many studies analysed quasi-axial loading configurations, only few works simulated sideways load configurations, such as those arising in a fall. The majority among these latter directly predicted bone strength, without assessing elastic strain prediction accuracy. The aim of the present work was to evaluate if a subject-specific finite element modelling technique from CT data that accurately predicted strains in quasi-axial loading configurations is suitable to accurately predict strains also when applying low magnitude loads in sideways configurations. To this aim, a combined numerical-experimental study was performed to compare finite element predicted strains with strain-gauge measurements from three cadaver proximal femurs instrumented with sixteen strain rosettes and tested non-destructively under twelve loading configurations, spanning a wide cone (0-30° for both adduction and internal rotation angles) of sideways fall scenarios. The results of the present study evidenced a satisfactory agreement between experimentally measured and predicted strains (R(2) greater than 0.9, RMSE% lower than 10%) and displacements. The achieved strain prediction accuracy is comparable to those obtained in state of the art studies in quasi-axial loading configurations. Still, the presence of the highest strain prediction errors (around 30%) in the lateral neck aspect would deserve attention in future studies targeting bone failure.     

Comparison of ACL strain estimated via a data-driven model with in vitro measurements

Computer modeling and simulation techniques have been increasingly used to investigate anterior cruciate ligament (ACL) loading during dynamic activities in an attempt to improve our understanding of injury mechanisms and development of injury prevention programs. However, the accuracy of many of these models remains unknown and thus the purpose of this study was to compare estimates of ACL strain from a previously developed three-dimensional, data-driven model with those obtained via in vitro measurements. ACL strain was measured as the knee was cycled from approximately 10° to 120° of flexion at 20 deg s^?1 with static loads of 100, 50, and 50 N applied to the quadriceps, biceps femoris and medial hamstrings (semimembranosus and semitendinosus) tendons, respectively. A two segment, five-degree-of-freedom musculoskeletal knee model was then scaled to match the cadaver’s anthropometry and in silico ACL strains were then determined based on the knee joint kinematics and moments of force. Maximum and minimum ACL strains estimated in silico were within 0.2 and 0.42% of that measured in vitro, respectively. Additionally, the model estimated ACL strain with a bias (mean difference) of ?0.03% and dynamic accuracy (rms error) of 0.36% across the flexion-extension cycle. These preliminary results suggest that the proposed model was capable of estimating ACL strains during a simple flexion-extension cycle. Future studies should validate the model under more dynamic conditions with variable muscle loading. This model could then be used to estimate ACL strains during dynamic sporting activities where ACL injuries are more common.     

A nonlinear viscoelastic finite element model of polyethylene

A nonlinear viscoelastic finite element model of ultra-high molecular weight polyethylene (UHMWPE) was developed in this study. Eight cylindrical specimens were machined from ram extruded UHMWPE bar stock (GUR 1020) and tested under constant compression at 7% strain for 100 sec. The stress strain data during the initial ramp up to 7% strain was utilized to model the "instantaneous" stress-strain response using a Mooney-Rivlin material model. The viscoelastic behavior was modeled using the time-dependent relaxation in stress seen after the initial maximum stress was achieved using a stored energy formulation. A cylindrical model of similar dimensions was created using a finite element analysis software program. The cylinder was made up of hexahedral elements, which were given the material properties utilizing the "instantaneous" stress-strain curve and the energy-relaxation curve obtained from the experimental data. The cylinder was compressed between two flat rigid bodies that simulated the fixtures of the testing machine. Experimental stress-relaxation, creep and dynamic testing data were then used to validate the model. The mean error for predicted versus experimental data for stress relaxation at different strain levels was 4.2%. The mean error for the creep test was 7% and for dynamic test was 5.4%. Finally, dynamic loading in a hip arthroplasty was modeled and validated experimentally with an error of 8%. This study establishes a working finite element material model of UHMWPE that can be utilized to simulate a variety of postoperative arthroplasty conditions.     

Using digital image correlation to determine bone surface strains during loading and after adaptation of the mouse tibia

Previous models of cortical bone adaptation, in which loading is imposed on the bone, have estimated the strains in the tissue using strain gauges, analytical beam theory, or finite element analysis. We used digital image correlation (DIC), tracing a speckle pattern on the surface of the bone during loading, to determine surface strains in a murine tibia during compressive loading through the knee joint. We examined whether these surface strains in the mouse tibia are modified following two weeks of load-induced adaptation by comparison with contralateral controls. Results indicated non-uniform strain patterns with isolated areas of high strain (0.5%), particularly on the medial side. Strain measurements were reproducible (standard deviation of the error 0.03%), similar between specimens, and in agreement with strain gauge measurements (between 0.1 and 0.2% strain). After structural adaptation, strains were more uniform across the tibial surface, particularly on the medial side where peak strains were reduced from 0.5% to 0.3%. Because DIC determines local strains over the entire surface, it will provide a better understanding of how strain stimulus influences the bone response during adaptation.     

The modified super-ellipsoid yield criterion for human trabecular bone

Despite the importance of multiaxial failure of trabecular bone in many biomechanical applications, to date no complete multiaxial failure criterion for human trabecular bone has been developed. By using experimentally validated nonlinear high-resolution, micromechanical finite-element models as a surrogate for multiaxial loading experiments, we determined the three-dimensional normal strain yield surface and all combinations of the two-dimensional normal-shear strain yield envelope. High-resolution finite-element models of three human femoral neck trabecular bone specimens obtained through microcomputed tomography were used. In total, 889 multiaxial-loading cases were analyzed, requiring over 41,000 CPU hours on parallel supercomputers. Our results indicated that the multiaxial yield behavior of trabecular bone in strain space was homogeneous across the specimens and nearly isotropic. Analysis of stress-strain curves along each axis in the 3-D normal strain space indicated uncoupled yield behavior whereas substantial coupling was seen for normal-shear loading. A modified super-ellipsoid surface with only four parameters fit the normal strain yield data very well with an arithmetic error +/-SD less than -0.04 +/- 5.1%. Furthermore, the principal strains associated with normal-shear loading showed excellent agreement with the yield surface obtained for normal strain loading (arithmetic error +/- SD < 2.5 +/- 6.5%). We conclude that the four-parameter "Modified Super-Ellipsoid" yield surface presented here describes the multiaxial failure behavior of human femoral neck trabecular bone very well.     

The influence of deceleration forces on ACL strain during single-leg landing: a simulation study

Anterior cruciate ligament (ACL) injury commonly occurs during single limb landing or stopping from a run, yet the conditions that influence ACL strain are not well understood. The purpose of this study was to develop, test and apply a 3D specimen-specific dynamic simulation model of the knee designed to evaluate the influence of deceleration forces during running to a stop (single-leg landing) on ACL strain. This work tested the conceptual development of the model by simulating a physical experiment that provided direct measurements of ACL strain during vertical impact loading (peak value 1294N) with the leg near full extension. The properties of the soft tissue structures were estimated by simulating previous experiments described in the literature. A key element of the model was obtaining precise anatomy from segmented MR images of the soft tissue structures and articular geometry for the tibiofemoral and patellofemoral joints of the knee used in the cadaver experiment. The model predictions were correlated (Pearson correlation coefficient 0.889) to the temporal and amplitude characteristic of the experimental strains. The simulation model was then used to test the balance between ACL strain produced by quadriceps contraction and the reductions in ACL strain associated with the posterior braking force. When posterior forces that replicated in vivo conditions were applied, the peak ACL strain was reduced. These results suggest that the typical deceleration force that occurs during running to a single limb landing can substantially reduce the strain in the ACL relative to conditions associated with an isolated single limb landing from a vertical jump.     

Surface structures, haemagglutination and cell surface hydrophobicity of Bacteroides fragilis strains.

Nineteen strains of Bacteroides fragilis were examined by negative staining for surface structures. One strain (ATCC 23745) possessed peritrichous fibrils, 16 strains carried peritrichous fimbriae and two strains carried no surface structures. The fimbriae had a diameter of 2.1 +/- 0.25 nm and appeared to be 'curly'. Only a small proportion (4 to 41%, depending on the strain) of cells in a population carried fimbriae or fibrils. Strain A312 Showed phase variation of fimbriae as expression of fimbriae was repressed at 20 degrees C and in early exponential phase at 37 degrees C. The fibrils on strain ATCC 23745 did not exhibit phase variation in response to changes in incubation temperature, growth phase or growth in two different media. Capsules were demonstrated by the Indian ink method on 18 of the 19 strains, varying in size from strain to strain and within the same population. Cultures often contained both capsulate and noncapsulate cells. All strains possessed an electron dense ruthenium red staining layer between 7.9 and 23.9 nm in width attached to the outer membrane. Cell surface hydrophobicity quantified by the hexadecane partition assay gave low values ranging from 6.6 to 52.1%. Only a few strains were able to haemagglutinate and these were only weakly active. There was no correlation between cell surface hydrophobicity, haemagglutinating activity and surface structures.     

The material properties of the native porcine mitral valve chordae tendineae: an in vitro investigation

The material properties of the mitral valve chordae tendineae are important for the understanding of leaflet coaptation configuration and chordal pathology. There is limited information about the mechanical properties of the chordae during physiologic loading. Dual camera stereo photogrammetry was used to measure strains of the chordae in vitro under physiologic loading conditions. Two high-speed, high-resolution cameras captured the movement of graphite markers attached to the central section of the chordae. A uniaxial test simulating the same loading conditions was conducted on the same chordae using the same markers. The maximum strain experienced during the cardiac cycle was 4.29% +/- 3.43%. The loading rate was higher at 75.3% +/- 48.6% strain per second than the unloading rate at -54.8% +/- -56.6% strain per second. The anterior lateral strut chordae had a higher maximum strain (5.7% +/- 3.8%) and loading rate (80.5% +/- 51.9% strain per second) than the posterior medial strut chordae (5.5% +/- 2.3% strain and 68.1% +/- 48.3% strain per second). The posterior medial strut chordae had a higher unloading rate (-68.5% +/- -59.1% strain per second) than the anterior lateral strut chordae (-44.9% +/- -57.2% strain per second). Although the anterior lateral and posterior medial strut chordae have a significantly different diameter and length, they experience a similar strain, strain rate, and tension. In conclusion, a non-destructive technique was developed to measure in vitro chordal strain in the mitral valve. This technique allows the investigation of the behavior of biological tissues under physiologic loading conditions.     

A Mathematical Formulation for 3D Quasi-Static Multibody Models of Diarthrodial Joints

This study describes a general set of equations for quasi-static analysis of three-dimensional multibody systems, with a particular emphasis on modeling of diarthrodial joints. The model includes articular contact, muscle forces, tendons and tendon pulleys, ligaments, and the wrapping of soft tissue structures around bone and cartilage surfaces. The general set of equations governing this problem are derived using a consistent notation for all types of links, which can be converted conveniently into efficient computer codes. The computational efficiency of the model is enhanced by the use of analytical Jacobians, particularly in the analysis of articular surface contact and wrapping of soft tissue structures around bone and cartilage surfaces. The usefulness of the multibody model is demonstrated by modeling the patellofemoral joint of six cadaver knees, using cadaver-specific data for the articular surface and bone geometries, as well as tendon and ligament insertions and muscle lines of actions. Good accuracy was observed when comparing the model patellar kinematic predictions to experimental data (mean +/- stand. dev. error in translation: 0.63 +/- 1.19 mm, 0.10 +/- 0.71 mm, -0.29 +/- 0.84 mm along medial, proximal, and anterior directions, respectively; in rotation: -1.41 +/- 1.71 degrees, 0.27 +/- 2.38 degrees, -1.13 +/- 1.83 degrees in flexion, tilt and rotation, respectively). The accuracy which can be achieved with this type of model, and the computational efficiency of the algorithm employed in this study may serve in many applications such as computer-aided surgical planning, and real-time computer-assisted surgery in the operating room.     

Constrained tibial vibration in mice: a method for studying the effects of vibrational loading of bone

Vibrational loading can stimulate the formation of new trabecular bone or maintain bone mass. Studies investigating vibrational loading have often used whole-body vibration (WBV) as their loading method. However, WBV has limitations in small animal studies because transmissibility of vibration is dependent on posture. In this study, we propose constrained tibial vibration (CTV) as an experimental method for vibrational loading of mice under controlled conditions. In CTV, the lower leg of an anesthetized mouse is subjected to vertical vibrational loading while supporting a mass. The setup approximates a one degree-of-freedom vibrational system. Accelerometers were used to measure transmissibility of vibration through the lower leg in CTV at frequencies from 20 Hz to 150 Hz. First, the frequency response of transmissibility was quantified in vivo, and dissections were performed to remove one component of the mouse leg (the knee joint, foot, or soft tissue) to investigate the contribution of each component to the frequency response of the intact leg. Next, a finite element (FE) model of a mouse tibia-fibula was used to estimate the deformation of the bone during CTV. Finally, strain gages were used to determine the dependence of bone strain on loading frequency. The in vivo mouse leg in the CTV system had a resonant frequency of 60 Hz for +/-0.5 G vibration (1.0 G peak to peak). Removing the foot caused the natural frequency of the system to shift from 60 Hz to 70 Hz, removing the soft tissue caused no change in natural frequency, and removing the knee changed the natural frequency from 60 Hz to 90 Hz. By using the FE model, maximum tensile and compressive strains during CTV were estimated to be on the cranial-medial and caudolateral surfaces of the tibia, respectively, and the peak transmissibility and peak cortical strain occurred at the same frequency. Strain gage data confirmed the relationship between peak transmissibility and peak bone strain indicated by the FE model, and showed that the maximum cyclic tibial strain during CTV of the intact leg was 330+/-82microepsilon and occurred at 60-70 Hz. This study presents a comprehensive mechanical analysis of CTV, a loading method for studying vibrational loading under controlled conditions. This model will be used in future in vivo studies and will potentially become an important tool for understanding the response of bone to vibrational loading.     

Modeling of time-dependent force response of fingertip to dynamic loading

An extended exposure to repeated loading on fingertip has been associated to many vascular, sensorineural, and musculoskeletal disorders in the fingers, such as carpal tunnel syndrome, hand-arm vibration syndrome, and flexor tenosynovitis. A better understanding of the pathomechanics of these sensorineural and vascular diseases in fingers requires a formulation of a biomechanical model of the fingertips and analyses to predict the mechanical responses of the soft tissues to dynamic loading. In the present study, a model based on finite element techniques has been developed to simulate the mechanical responses of the fingertips to dynamic loading. The proposed model is two-dimensional and incorporates the essential anatomical structures of a finger: skin, subcutaneous tissue, bone, and nail. The skin tissue is assumed to be hyperelastic and viscoelastic. The subcutaneous tissue was considered to be a nonlinear, biphasic material composed of a hyperelastic solid and an invicid fluid, while its hydraulic permeability was considered to be deformation dependent. Two series of numerical tests were performed using the proposed finger tip model to: (a) simulate the responses of the fingertip to repeated loading, where the contact plate was assumed to be fixed, and the bone within the fingertip was subjected to a prescribed sinusoidal displacement in vertical direction; (b) simulate the force response of the fingertip in a single keystroke, where the keyboard was composed of a hard plastic keycap, a rigid support block, and a nonlinear spring. The time-dependent behavior of the fingertip under dynamic loading was derived. The model predictions of the time-histories of force response of the fingertip and the phenomenon of fingertip separation from the contacting plate during cyclic loading agree well with the reported experimental observations.     

Characterization of in vivo strain in the rat tibia during external application of a four-point bending load.

This paper describes a technique for characterizing strains and stresses induced in vivo in the rat tibia during application of an external four-point bending load. An external load was applied through the muscle and soft tissue with a four-point bending device, to induce strain in a 11 mm section of the right tibiae of ten adult female Sprague-Dawley rats. Induced strains were measured in vivo on the lateral surface of the tibia. Inter-rat difference, leg positioning and strain gage placement were evaluated as sources of variability of applied strains. Beam bending theory was used to predict externally induced in vivo strains. Finite element analysis was used to quantify the magnitude of shear stresses induced by this type of loading. There was a linear relationship between applied load and induced in vivo strains. In vivo strains induced by external loading were linearly correlated (R2 = 0.87) with the strains calculated using beam bending theory. The finite element analysis predicted shear stresses at less than 10% of the longitudinal stresses resulting from four-point bending. Strains predicted along the tibia by finite element analysis and beam bending theory were well-correlated. Inter-rat variability due to tibia size and shape difference was the most important source of variation in induced strain (CV = 21.6%). Leg positioning was less important (CV = 9.5%).     

Effect of ACL deficiency on MCL strains and joint kinematics

The knee joint is partially stabilized by the interaction of multiple ligament structures. This study tested the interdependent functions of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) by evaluating the effects of ACL deficiency on local MCL strain while simultaneously measuring joint kinematics under specific loading scenarios. A structural testing machine applied anterior translation and valgus rotation (limits 100 N and 10 N m, respectively) to the tibia of ten human cadaveric knees with the ACL intact or severed. A three-dimensional motion analysis system measured joint kinematics and MCL tissue strain in 18 regions of the superficial MCL. ACL deficiency significantly increased MCL strains by 1.8% (p<0.05) during anterior translation, bringing ligament fibers to strain levels characteristic of microtrauma. In contrast, ACL transection had no effect on MCL strains during valgus rotation (increase of only 0.1%). Therefore, isolated valgus rotation in the ACL-deficient knee was nondetrimental to the MCL. The ACL was also found to promote internal tibial rotation during anterior translation, which in turn decreased strains near the femoral insertion of the MCL. These data advance the basic structure-function understanding of the MCL, and may benefit the treatment of ACL injuries by improving the knowledge of ACL function and clarifying motions that are potentially harmful to secondary stabilizers.     

Modelling the Brain for Rotational Loading: Shear Effects and Other Complications

This study considers modelling the brain due to rotation of the skull where, at lower frequencies, the shear property of the material is important. Investigations reported here cover the effect of elastic and viscoelastic (lossy) cerebral material, the effect of the Falx protruding into the brain, the gap around the Falx and the brain filled with non viscous fluid in addition to different models of the Falx with bending or membrane stiffness. Analytical benchmark formulations are also described for the simple 2D plane strain in a cylinder produced by a half-sine rotation on the outer periphery which allows numerical (Finite Element) models to be validated. The results show the importance of the material properties, duration of loading and amplitude of loading as well as the influence of the partition. The results are shown for predicted maximum Principal strains in the models, as this may well be indicative of whether damage of the brain tissue occurs.     

Rotational stiffness of football shoes influences talus motion during external rotation of the foot

Shoe-surface interface characteristics have been implicated in the high incidence of ankle injuries suffered by athletes. Yet, the differences in rotational stiffness among shoes may also influence injury risk. It was hypothesized that shoes with different rotational stiffness will generate different patterns of ankle ligament strain. Four football shoe designs were tested and compared in terms of rotational stiffness. Twelve (six pairs) male cadaveric lower extremity limbs were externally rotated 30 deg using two selected football shoe designs, i.e., a flexible shoe and a rigid shoe. Motion capture was performed to track the movement of the talus with a reflective marker array screwed into the bone. A computational ankle model was utilized to input talus motions for the estimation of ankle ligament strains. At 30 deg of rotation, the rigid shoe generated higher ankle joint torque at 46.2?±?9.3 Nm than the flexible shoe at 35.4?±?5.7 Nm. While talus rotation was greater in the rigid shoe (15.9?±?1.6 deg versus 12.1?±?1.0 deg), the flexible shoe generated more talus eversion (5.6?±?1.5 deg versus 1.2± 0.8 deg). While these talus motions resulted in the same level of anterior deltoid ligament strain (approxiamtely 5%) between shoes, there was a significant increase of anterior tibiofibular ligament strain (4.5± 0.4% versus 2.3?±?0.3%) for the flexible versus more rigid shoe design. The flexible shoe may provide less restraint to the subtalar and transverse tarsal joints, resulting in more eversion but less axial rotation of the talus during foot∕shoe rotation. The increase of strain in the anterior tibiofibular ligament may have been largely due to the increased level of talus eversion documented for the flexible shoe. There may be a direct correlation of ankle joint torque with axial talus rotation, and an inverse relationship between torque and talus eversion. The study may provide some insight into relationships between shoe design and ankle ligament strain patterns. In future studies, these data may be useful in characterizing shoe design parameters and balancing potential ankle injury risks with player performance.     

Validating a voxel-based finite element model of a human mandible using digital speckle pattern interferometry

Finite element analysis is a powerful tool for predicting the mechanical behaviour of complex biological structures like bones, but to be confident in the results of an analysis, the model should be validated against experimental data. In such validation experiments, the strains in the loaded bones are usually measured with strain gauges glued to the bone surface, but the use of strain gauges on bone can be difficult and provides only very limited data regarding surface strain distributions. This study applies the full-field strain measurement technique of digital speckle pattern interferometry to measure strains in a loaded human mandible and compares the results with the predictions of voxel-based finite element models of the same specimen. It is found that this novel strain measurement technique yields consistent, reliable measurements. Further, strains predicted by the finite element analysis correspond well with the experimental data. These results not only confirm the usefulness of this technique for future validation studies in the field of bone mechanics, but also show that the modelling approach used in this study is able to predict the experimental results very accurately.     

Three-dimensional finite element analysis of the foot during standing--a material sensitivity study

Information on the internal stresses/strains in the human foot and the pressure distribution at the plantar support interface under loading is useful in enhancing knowledge on the biomechanics of the ankle-foot complex. While techniques for plantar pressure measurements are well established, direct measurement of the internal stresses/strains is difficult. A three-dimensional (3D) finite element model of the human foot and ankle was developed using the actual geometry of the foot skeleton and soft tissues, which were obtained from 3D reconstruction of MR images. Except the phalanges that were fused, the interaction among the metatarsals, cuneiforms, cuboid, navicular, talus, calcaneus, tibia and fibula were defined as contact surfaces, which allow relative articulating movement. The plantar fascia and 72 major ligaments were simulated using tension-only truss elements by connecting the corresponding attachment points on the bone surfaces. The bony and ligamentous structures were embedded in a volume of soft tissues. The encapsulated soft tissue was defined as hyperelastic, while the bony and ligamentous structures were assumed to be linearly elastic. The effects of soft tissue stiffening on the stress distribution of the plantar surface and bony structures during balanced standing were investigated. Increases of soft tissue stiffness from 2 and up to 5 times the normal values were used to approximate the pathologically stiffened tissue behaviour with increasing stages of diabetic neuropathy. The results showed that a five-fold increase in soft tissue stiffness led to about 35% and 33% increase in the peak plantar pressure at the forefoot and rearfoot regions, respectively. This corresponded to about 47% decrease in the total contact area between the plantar foot and the horizontal support surface. Peak bone stress was found at the third metatarsal in all calculated cases with a minimal increase of about 7% with soft tissue stiffening.