Biomechanical analysis of foot with different foot arch heights: a finite element analysis

Clinically, different foot arch heights are associated with different tissue injuries to the foot. To investigate the possible factors contributing to the difference in foot arch heights, previous studies have mostly measured foot pressure in either low-arched or high-arched feet. However, little information exists on stress variation inside the foot with different arch heights. Therefore, this study aimed to implement the finite element (FE) method to analyse the influence of different foot arches. This study established a 3D foot FE model using software ANSYS 11.0. After validating the FE model, this study created low-arched, high-arched and normal-arched foot FE models. The FE analysis found that both the stress and strain on the plantar fascia and metatarsal were higher in the high-arched foot, whereas the stress and strain on the calcaneous, navicular and cuboid were higher in low-arched foot. Additionally, forefoot pressure was increased with an increase in arch height.     

Implication of obesity on motion,posture and internal stress of the foot: an experimental and finite element analysis

Obesity causes increased loading on the foot which can damage the soft tissue and bone ultimately leading to foot problems. Experimental and computational methods were used to analyse the chain of biomechanical changes in the lower limb due to obesity. The experimental study shows some changes in foot posture and gait where obese subjects were more likely to have pronated feet, smaller joint angles in the sagittal and frontal planes, smaller cadence, and smaller stride length. Anatomically correct finite element models generated on obese subjects showed increased and altered internal and plantar stress. Altered foot posture was identified as a key indicator of increased internal stress indicating the importance of foot posture correction.     

Muscle-driven finite element simulation of human foot movements

This paper describes a finite element scheme for realistic muscle-driven simulation of human foot movements. The scheme is used to simulate human ankle plantar flexion. A three-dimensional anatomically detailed finite element model of human foot and lower leg is developed and the idea of generating natural foot movement based entirely on the contraction of the plantar flexor muscles is used. The bones, ligaments, articular cartilage, muscles, tendons, as well as the rest soft tissues of human foot and lower leg are included in the model. A realistic three-dimensional continuum constitutive model that describes the biomechanical behaviour of muscles and tendons is used. Both the active and passive properties of muscle tissue are accounted for. The materials for bones and ligaments are considered as homogeneous, isotropic and linearly elastic, whereas the articular cartilage and the rest soft tissues (mainly fat) are defined as hyperelastic materials. The model is used to estimate muscle tissue deformations as well as stresses and strains that develop in the lower leg muscles during plantar flexion of the ankle. Stresses and strains that develop in Achilles tendon during such a movement are also investigated.     

Using 3D finite element models verified the importance of callus material and microstructure in biomechanics restoration during bone defect repair

Background: There is lack of further observations on the microstructure and material property of callus during bone defect healing and the relationships between callus properties and the mechanical strength. Methods: Femur bone defect model was created in rabbits and harvested CT data to reconstruct finite element models at 1 and 2 months. Three types of assumed finite element models were compared to study the callus properties, which assumed the material elastic property as heterogeneous (R-model), homogenous (H-model) or did not change from 1 to 2 months (U-model). Results: The apparent elastic moduli increased at 2 months (from 355.58 ± 132.67 to 1139.30 ± 967.43 MPa) in R-models. But there was no significant difference in apparent elastic moduli between R-models (355.58 ± 132.67 and 1139.30 ± 967.43 MPa) and H-models (344.79 ± 138.73 and 1001.52 ± 692.12 MPa) in 1 and 2 months. A significant difference of apparent elastic moduli was found between the R-model (1139.30 ± 967.43 MPa) and U-model group (207.15 ± 64.60 MPa) in 2 months. Conclusions: This study showed that the callus structure stability remodeled overtime to achieve a more effective structure, while the material quality of callus tissue is a very important factor for callus strength. At the meantime, this study showed an evidence that the material heterogeneity maybe not as important as it is in bone fracture model.     

Virtually optimized insoles for offloading the diabetic foot: A randomized crossover study

Integration of objective biomechanical measures of foot function into the design process for insoles has been shown to provide enhanced plantar tissue protection for individuals at-risk of plantar ulceration. The use of virtual simulations utilizing numerical modeling techniques offers a potential approach to further optimize these devices. In a patient population at-risk of foot ulceration, we aimed to compare the pressure offloading performance of insoles that were optimized via numerical simulation techniques against shape-based devices. Twenty participants with diabetes and at-risk feet were enrolled in this study. Three pairs of personalized insoles: one based on shape data and subsequently manufactured via direct milling; and two were based on a design derived from shape, pressure, and ultrasound data which underwent a finite element analysis-based virtual optimization procedure. For the latter set of insole designs, one pair was manufactured via direct milling, and a second pair was manufactured through 3D printing. The offloading performance of the insoles was analyzed for forefoot regions identified as having elevated plantar pressures. In 88% of the regions of interest, the use of virtually optimized insoles resulted in lower peak plantar pressures compared to the shape-based devices. Overall, the virtually optimized insoles significantly reduced peak pressures by a mean of 41.3 kPa (p < 0.001, 95% CI [31.1, 51.5]) for milled and 40.5 kPa (p < 0.001, 95% CI [26.4, 54.5]) for printed devices compared to shape-based insoles. The integration of virtual optimization into the insole design process resulted in improved offloading performance compared to standard, shape-based devices.Clinical trial registration: ISRCTN19805071, www.ISRCTN.org.     

Validation of plantar pressure simulations using finite and discrete element modelling in healthy and diabetic subjects

Plantar pressure simulation driven by integrated 3D motion capture data, using both a finite element and a discrete element model, is compared for ten healthy and ten diabetic neuropathic subjects. The simulated peak pressure deviated on average between 16.7 and 34.2% from the measured peak pressure. The error in the position of the peak pressure was on average smaller than 4.2 cm. No method was more accurate than the other although statistical differences were found between them. Both techniques are thus complementary and useful tools to better understand the alteration of diabetic foot biomechanics during gait.     

Motor strategy patterns study of diabetic neuropathic individuals while walking. A wavelet approach

The aim of this study was to investigate muscle?s energy patterns and spectral properties of diabetic neuropathic individuals during gait cycle using wavelet approach. Twenty-one diabetic patients diagnosed with peripheral neuropathy, and 21 non-diabetic individuals were assessed during the whole gait cycle. Activation patterns of vastus lateralis, medial gastrocnemius and tibialis anterior were studied by means of bipolar surface EMG. The signal?s energy and frequency were compared between groups using t-test. The energy was compared in each frequency band (7–542 Hz) using ANOVAs for repeated measures for each group and each muscle. The diabetic individuals displayed lower energies in lower frequency bands for all muscles and higher energies in higher frequency bands for the extensors? muscles. They also showed lower total energy of gastrocnemius and a higher total energy of vastus, considering the whole gait cycle. The overall results suggest a change in the neuromuscular strategy of the main extensor muscles of the lower limb of diabetic patients to compensate the ankle extensor deficit to propel the body forward and accomplish the walking task.     

Influence of bicortical techniques in internal connection placed in premaxillary area by 3D finite element analysis

The aim of study was to evaluate the stress distribution in implant-supported prostheses and peri-implant bone using internal hexagon (IH) implants in the premaxillary area, varying surgical techniques (conventional, bicortical and bicortical in association with nasal floor elevation), and loading directions (0°, 30° and 60°) by three-dimensional (3D) finite element analysis. Three models were designed with Invesalius, Rhinoceros 3D and Solidworks software. Each model contained a bone block of the premaxillary area including an implant (IH, Ø4 × 10 mm) supporting a metal-ceramic crown. 178 N was applied in different inclinations (0°, 30°, 60°). The results were analyzed by von Mises, maximum principal stress, microstrain and displacement maps including ANOVA statistical test for some situations. Von Mises maps of implant, screws and abutment showed increase of stress concentration as increased loading inclination. Bicortical techniques showed reduction in implant apical area and in the head of fixation screws. Bicortical techniques showed slight increase stress in cortical bone in the maximum principal stress and microstrain maps under 60° loading. No differences in bone tissue regarding surgical techniques were observed. As conclusion, non-axial loads increased stress concentration in all maps. Bicortical techniques showed lower stress for implant and screw; however, there was slightly higher stress on cortical bone only under loads of higher inclinations (60°).     

A novel methodology for generating 3D finite element models of the hip from 2D radiographs

Finite element (FE) modelling has been proposed as a tool for estimating fracture risk and patient-specific FE models are commonly based on computed tomography (CT). Here, we present a novel method to automatically create personalised 3D models from standard 2D hip radiographs. A set of geometrical parameters of the femur were determined from seven a–p hip radiographs and compared to the 3D femoral shape obtained from CT as training material; the error in reconstructing the 3D model from the 2D radiographs was assessed. Using the geometry parameters as the input, the 3D shape of another 21 femora was built and meshed, separating a cortical and trabecular compartment. The material properties were derived from the homogeneity index assessed by texture analysis of the radiographs, with focus on the principal tensile and compressive trabecular systems. The ability of these FE models to predict failure load as determined by experimental biomechanical testing was evaluated and compared to the predictive ability of DXA. The average reconstruction error of the 3D models was 1.77 mm (±1.17 mm), with the error being smallest in the femoral head and neck, and greatest in the trochanter. The correlation of the FE predicted failure load with the experimental failure load was r²=64% for the reconstruction FE model, which was significantly better (p<0.05) than that for DXA (r²=24%). This novel method for automatically constructing a patient-specific 3D finite element model from standard 2D radiographs shows encouraging results in estimating patient-specific failure loads.     

A lower extremity model for muscle-driven simulation of activity using explicit finite element modeling

A key strength of computational modeling is that it can provide estimates of muscle, ligament, and joint loads, stresses, and strains through non-invasive means. However, simulations that can predict the forces in the muscles during activity while maintaining sufficient complexity to realistically represent the muscles and joint structures can be computationally challenging. For this reason, the current state of the art is to apply separate rigid-body dynamic and finite-element (FE) analyses in series. However, the use of two or more disconnected models often fails to capture key interactions between the joint-level and whole-body scales. Single framework MSFE models have the potential to overcome the limitations associated with disconnected models in series. The objectives of the current study were to create a multi-scale FE model of the human lower extremity that combines optimization, dynamic muscle modeling, and structural FE analysis in a single framework and to apply this framework to evaluate the mechanics of healthy knee specimens during two activities. Two subject-specific FE models (Model 1, Model 2) of the lower extremity were developed in ABAQUS/Explicit including detailed representations of the muscles. Muscle forces, knee joint loading, and articular contact were calculated for two activities using an inverse dynamics approach and static optimization. Quadriceps muscle forces peaked at the onset of chair rise (2174 N, 1962 N) and in early stance phase (510 N, 525 N), while gait saw peak forces in the hamstrings (851 N, 868 N) in midstance. Joint forces were similar in magnitude to available telemetric patient data. This study demonstrates the feasibility of detailed quasi-static, muscle-driven simulations in an FE framework.     

Implementation of reflex loops in a biomechanical finite element model

In the field of biomechanics, the offer of models which are more and more realistic requires to integrate a physiological response, in particular, the controlled muscle bracing and the reflexes. The following work aims to suggest a unique methodology which couples together a sensory and motor loop with a finite element model. Our method is applied to the study of the oscillation of the elbow in the case of a biceps brachial stretch reflex. The results obtained are promising in the purpose of the development of reactive human body models.     

Reliable simulations of the human proximal femur by high-order finite element analysis validated by experimental observations

Background: The mechanical response of patient-specific bone to various load conditions is of major clinical importance in orthopedics. Herein we enhance the methods presented in Yosibash et al. [2007. A CT-based high-order finite element analysis of the human proximal femur compared to in-vitro experiments. ASME Journal of Biomechanical Engineering 129(3), 297–309.] for the reliable simulations of the human proximal femur by high-order finite elements (FEs) and validate the simulations by experimental observations.

Method of approach: A fresh-frozen human femur was scanned by quantitative computed tomography (QCT) and thereafter loaded (in vitro experiments) by a quasi-static force of up to 1250 N. QCT scans were manipulated to generate a high-order FE bone model with distinct cortical and trabecular regions having inhomogeneous isotropic elastic properties with Young's modulus represented by continuous spatial functions. Sensitivity analyses were performed to quantify parameters that mostly influence the mechanical response. FE results were compared to displacements and strains measured in the experiments.

Results: Young moduli correlated to QCT Hounsfield Units by relations in Keyak and Falkinstein [2003. Comparison of in situ and in vitro CT scan-based finite element model predictions of proximal femoral fracture load. Medical Engineering and Physics 25, 781–787.] were found to provide predictions that match the experimental results closely. Excellent agreement was found for both the displacements and strains. The presented study demonstrates that reliable and validated high-order patient-specific FE simulations of human femurs based on QCT data are achievable for clinical computer-aided decision making.     

An in vitro and finite element study of load redistribution in the midfoot

A good knowledge of midfoot biomechanics is important in understanding the biomechanics of the entire foot,but it has never been investigated thoroughly in the literature.This study carried out in vitro experiments and finite element analysis to investigate the midfoot biomechanics.A foot-ankle finite element model simulating the mid-stance phase of the normal gait was developed and the model validated in in vitro experimental tests.Experiments used seven in vitro samples of fresh human cadavers.The simulation found that the first principal stress peaks of all midfoot bones occurred at the navicular bone and that the tensile force of the spring ligament was greater than that of any other ligament.The experiments showed that the longitudinal strain acting on the medial cuneiform bone was-26.2±10.8μ-strain,and the navicular strain was-240.0±169.1μ-strain along the longitudinal direction and 65.1±25.8μ-strain along the transverse direction.The anatomical position and the spring ligament both result in higher shear stress in the navicular bone.The load from the ankle joint to five branches of the forefoot is redistributed among the cuneiforms and cuboid bones.Further studies on the mechanism of loading redistribution will be helpful in understanding the biomechanics of the entire foot.     

A validated computational framework to evaluate the stiffness of 3D printed ankle foot orthoses

The purpose of this study was to create and validate a standardized framework for the evaluation of the ankle stiffness of two designs of 3D printed ankle foot orthoses (AFOs). The creation of four finite element (FE) models allowed patient-specific quantification of the stiffness and stress distribution over their specific range of motion during the second rocker of the gait. Validation was performed by comparing the model outputs with the results obtained from a dedicated experimental setup, which showed an overall good agreement with a maximum relative error of 10.38% in plantarflexion and 10.66% in dorsiflexion. The combination of advanced computer modelling algorithms and 3D printing techniques clearly shows potential to further improve the manufacturing process of AFOs.     

Comparison of stress distribution in dental crown with different cusp angles: 3D finite element analysis

The purpose of this study is to measure the failure risk of a crown depending on the cusp angle. Three all-ceramic crown models consisting of C_H (high incline), C_M (middle incline), and C_L (low incline) are designed. Stress is applied to the crown with Loading case-1 (top of cusp tip) and Loading case-2 (middle of cusp ridge) with the use of FEA software. In Loading case-1 and case-2, the C_H showed the highest Maximum Principal Stress (MPS) while the CL showed the lowest MPS. The cusp angle is an influential factor affecting stress distribution in dental crowns.     

Mechanical performance of endodontic restorations with prefabricated posts: sensitivity analysis of parameters with a 3D finite element model

Many studies have investigated the effect of different parameters of the endodontically restored tooth on its final strength, using in vitro tests and model simulations. However, the differences in the experimental set-up or modelling conditions and the limited number of parameters studied in each case prevent us from obtaining clear conclusions about the relative importance of each parameter. In this study, a validated 3D biomechanical model of the restored tooth was used for an exhaustive sensitivity analysis. The individual influence of 20 different parameters on the mechanical performance of an endodontic restoration with prefabricated posts was studied. The results bring up the remarkable importance of the loading angle on the final restoration strength. Flexural loads are more critical than compressive or tensile loads. Young's modulus of the post and its length and diameter are the most influential parameters for strength, whereas other parameters such as ferrule geometry or core and crown characteristics are less significant.