A Phase-Dependent Hypothesis for Locomotor Functions of Human Foot Complex

The human foot is a very complex structure comprising numerous bones, muscles, ligaments and synovial joints. As the only component in contact with the ground, the foot complex delivers a variety of biomechanical functions during human locomotion, e.g. body support and propulsion, stability maintenance and impact absorption. These need the human foot to be rigid and damped to transmit ground reaction forces to the upper body and maintain body stability, and also to be compliant and resilient to moderate risky impacts and save energy. How does the human foot achieve these apparent conflicting functions？ In this study, we propose a phase-dependent hypothesis for the overall locomotor functions of the human foot complex based on in-vivo measurements of human natural gait and simulation results of a mathematical foot model. We propse that foot functions are highly dependent on gait phase, which is a major characteristics of human locomotion. In early stance just after heel strike, the foot mainly works as a shock absorber by moderating high impacts using the viscouselastic heel pad in both vertical and horizontal directions. In mid-stance phase （-80% of stance phase）, the foot complex can be considered as a springy rocker, reserving external mechanical work using the foot arch whilst moving ground contact point forward along a curved path to maintain body stability. In late stance after heel off, the foot complex mainly serves as a force modulator like a gear box, modulating effective mechanical advantages of ankle plantiflexor muscles using metatarsal-phalangeal joints. A sound under- standing of how diverse functions are implemented in a simple foot segment during human locomotion might be useful to gain insight into the overall foot locomotor functions and hence to facilitate clinical diagnosis, rehabilitation product design and humanoid robot development.     

Plantar soft tissue thickness during ground contact in walking.

A technique is introduced for the measurement of plantar soft tissue thickness during barefoot walking. Subjects stepped into an adjustable Plexiglas frame which ensured that the required bony landmarks were appropriately positioned relative to a linear ultrasound probe connected to a conventional 7.5 MHz ultrasound scanner. Clear images of the metatarsal condyles or other foot bones were obtained throughout ground contact. Subsequent analysis of the video taped images using a motion analysis system allowed the tissue displacement to be calculated as a function of time. The tissue underneath the second metatarsal head was shown to undergo an average maximum compression of 45.7% during the late stages of ground contact during first step gait in a group of five normal subjects with a mean unloaded tissue thickness of 15.2 mm. The technique has a number of applications, including use in the validation of deformation predicted by finite element models of the soft tissue of the foot, and the study of alterations in the cushioning properties of the heel by devices which constrain the displacement of the heel pad.     

Greater toe grip and gentler heel strike are the strategies to adapt to slippery surface

This study investigated the plantar pressure distribution during gait on wooden surface with different slipperiness in the presence of contaminants. Fifteen Chinese males performed 10 walking trials on a 5-m wooden walkway wearing cloth shoe in four contaminated conditions (dry, sand, water, oil). A pressure insole system was employed to record the plantar pressure data at 50Hz. Peak pressure and time-normalized pressure-time integral were evaluated in nine regions. In comparing walking on slippery to non-slippery surfaces, results showed a 30% increase of peak pressure beneath the hallux (from 195.6 to 254.1kPa), with a dramatic 79% increase in the pressure time integral beneath the hallux (from 63.8 to 114.3kPa) and a 34% increase beneath the lateral toes (from 35.1 to 47.2kPa). In addition, the peak pressure beneath the medial and lateral heel showed significant 20-24% reductions, respectively (from 233.6-253.5 to 204.0-219.0kPa). These findings suggested that greater toe grip and gentler heel strike are the strategies to adapt to slippery surface. Such strategies plantarflexed the ankle and the metatarsals to achieve a flat foot contact with the ground, especially at heel strike, in order to shift the ground reaction force to a more vertical direction. As the vertical ground reaction force component increased, the available ground friction increased and the floor became less slippery. Therefore, human could walk without slip on slippery surfaces with greater toe grip and gentler heel strike as adaptation strategies.     

Material properties of the human calcaneal fat pad in compression: experiment and theory

The structural behaviour of the human heel pad has been studied extensively due to its ability to absorb shock, protect against excessive local stress, and reduce plantar pressures. However, the material properties of the tissue have not been adequately measured. These must be known in order to perform a finite element analysis of the effect of factors such as foot geometry and shoe/surface construction on heel pad function. Therefore, the purposes of this study were to (a) measure the viscoelastic behaviour of the fat pad in compression, and (b) to determine an appropriate constitutive equation to model the tissue. A series of unconfined compression tests were performed on 8 mm diameter cylinders of fat pad tissue, consisting of quasi-static, 175, 350 mm/s and stress-relaxation tests to 50% deformation. The tissue exhibited nonlinear, viscoelastic behaviour. No significant difference was found in the quasi-static behaviour between samples from different locations and orientations in the heel. The stress-relaxation tests were used to determine the time constant (τ₁=0.5 s), the 175 mm/s test to determine the relaxation coefficient (g₁=28), and the 350 mm/s compression test to determine the material constants (C₁₀₀=C₀₁₀=0.01, C₂₀₀=C₀₂₀=0.1 Pa) of a single-phase, hyperelastic, linear viscoelastic strain energy function (r²=0.98).     

The role of the heel pad and shank soft tissue during impacts: a further resolution of a paradox

The aim of this study was to test the hypothesis that the motion of the soft tissue of the lower leg contributes significantly to the attenuation of the forces during heel impacts. To examine this, a two-dimensional model of the shank and heel pad was developed using DADS. The model contained a heel pad element and a rigid skeleton to which was connected soft tissue which could move relative to the bone. Simulations permitted estimation of heel pad properties directly from heel pad deformations, and from the kinematics of an impacting pendulum. These two approaches paralleled those used in vitro and in vivo, respectively. Measurements from the pendulum indicated that heel pad properties changed from those found in vitro to those found in vivo as relative motion of the bone and soft tissue was allowed. This would indicate that pendulum measures of the in vivo heel pad properties are also measuring the properties of the whole lower leg. The ability of the wobbling mass of the shank to dissipate energy during an impact was found to be significant. These results demonstrate the important role of both the heel pad and soft tissue of the shank to the dissipation of mechanical energy during impacts. These results provide a further clarification of the paradox between the measurements of heel pad properties made in vivo and in vitro.     

A Coupling Analysis of the Biomechanical Functions of Human Foot Complex during Locomotion

This study represents a functional analysis of the human foot complex based on in-vivo gait measurements, finite element (FE) modeling and biological coupling theory, with the objective of achieving a comprehensive understanding of the impact attenuation and energy absorption functions of the human foot complex. A simplified heel pad FE model comprising reticular fiber structure and fat cells was constructed based on the foot pad Magnetic Resonance (MR) images. The model was then used to investigate the foot pad behaviors under impact during locomotion. Three-dimensional (3D) gait measurement and a 3D FE foot model comprising 29 bones, 85 ligaments and the plantar soft tissues were used to investigate the foot arch and plantar fascia deformations in mid-stance phase. The heel pad simulation results show that the pad model with fat cells (coupling model) has much stronger capacity in impact attenuation and energy storage than the model without fat cells (structure model). Furthermore, the FE simulation reproduced the deformations of the foot arch structure and the plantar fascia extension observed in the gait measurements, which reinforces the postulation that the foot arch structure also plays an important role in energy absorption during locomotion. Finally, the coupling mechanism of the human foot functions in impact attenuation and energy absorption was proposed.     

The effects of gastrocnemius–soleus muscle forces on ankle biomechanics during triple arthrodesis

This paper presents a finite element model of the ankle, taking into account the effects of muscle forces, determined by a musculoskeletal analysis, to investigate the contact stress distribution in the tibio-talar joint in patients with triple arthrodesis and in normal subjects. Forces of major ankle muscles were simulated and corresponded well with the trend of their EMG signals. These forces were applied to the finite element model to obtain stress distributions for patients with triple arthrodesis and normal subjects in three stages of the gait cycle, i.e. heel strike, midstance, and heel rise. The results demonstrated that the stress distribution patterns of the tibio-talar joint in patients with triple arthrodesis differ from those of normal subjects in investigated gait cycle stages. The mean and standard deviations for maximum stresses in the tibo-talar joint in the stance phase for patients and normal subjects were 9.398e7 ± 1.75e7 and 7.372e7 ± 4.43e6 Pa, respectively. The maximum von Mises stresses of the tibio-talar joint for all subjects in the stance phase found to be on the lateral side of the inferior surface of the joint. The results also indicate that, in patients with triple arthrodesis, increasing gastrocnemius–soleus muscle force reduces the stress on the medial malleolus compared with normal subjects. Most of stresses in this area are between 45 and 109 kPa, and will decrease to almost 32 kPa in patients after increasing of 40% in gastrocnemius–soleus muscle force.     

Explicit finite element modelling of heel pad mechanics in running: inclusion of body dynamics and application of physiological impact loads

Many heel pathologies including plantar heel pain may result from micro tears/trauma in the subcutaneous tissues, in which internal tissue deformation/stresses within the heel pad play an important role. Previously, many finite element models have been proposed to evaluate stresses inside the heel pad, but the majority of these models only focus on static loading boundary conditions. This study explored a dynamics modelling approach to the heel pad subjected to realistic impact loads during running. In this model, the inertial property and action of the body are described by a lumped parameter model, while the heel/shoe interactions are modelled using a viscoelastic heel pad model with contact properties. The impact force pattern, dynamic heel pad deformation and stress states predicted by the model were compared with published experimental data. Further parametrical studies revealed the model responses, in terms of internal stresses in the skin and fatty tissue, change nonlinearly when body dynamics changes. A reduction in foot's touchdown velocity resulted in a less severe impact landing and stress relief inside the heel pad, for example peak von-Mises stress in fatty tissue, was reduced by 11.3%. Applications of the model may be extendable to perform iterative analyses to further understand the complex relationships between body dynamics and stress distributions in the soft tissue of heel pad during running. This may open new opportunities to study the mechanical aetiology of plantar heel pain in runners.     

Real-time subject-specific monitoring of internal deformations and stresses in the soft tissues of the foot: a new approach in gait analysis

No technology is presently available to provide real-time information on internal deformations and stresses in plantar soft tissues of individuals during evaluation of the gait pattern. Because internal deformations and stresses in the plantar pad are critical factors in foot injuries such as diabetic foot ulceration, this severely limits evaluation of patients. To allow such real-time subject-specific analysis, we developed a hierarchal modeling system which integrates a two-dimensional gross structural model of the foot (high-order model) with local finite element (FE) models of the plantar tissue padding the calcaneus and medial metatarsal heads (low-order models). The high-order whole-foot model provides real-time analytical evaluations of the time-dependent plantar fascia tensile forces during the stance phase. These force evaluations are transferred, together with foot-shoe local reaction forces, also measured in real time (under the calcaneus, medial metatarsals and hallux), to the low-order FE models of the plantar pad, where they serve as boundary conditions for analyses of local deformations and stresses in the plantar pad. After careful verification of our custom-made FE solver and of our foot model system with respect to previous literature and against experimental results from a synthetic foot phantom, we conducted human studies in which plantar tissue loading was evaluated in real time during treadmill gait in healthy individuals (N = 4). We concluded that internal deformations and stresses in the plantar pad during gait cannot be predicted from merely measuring the foot-shoe force reactions. Internal loading of the plantar pad is constituted by a complex interaction between the anatomical structure and mechanical behavior of the foot skeleton and soft tissues, the body characteristics, the gait pattern and footwear. Real-time FE monitoring of internal deformations and stresses in the plantar pad is therefore required to identify elevated deformation/stress exposures toward utilizing it in gait laboratories to protect feet that are susceptible to injury.     

Peak dynamic force in human gait

Studies were made of the forces generated at heel stroke in human gait using both force plates having a high resonant frequencies (capable of picking up high frequency components in the contact force) as well as a force transducer inserted into the heel of the shoe of the subjects. The output traces were analyzed for the existence of high frequency impulsive loads during a normal walking cycle. The effect of the complicance of the foot and floor was studied with the force transducers. The results showed that during normal human gait the lower limb is subjected to a high frequency impulsive load at heel strike. The severity of this impulse varied with the individual, the velocity and angle with which the limb aproached the ground and the compliance of the two materials coming in contact at heel strike. The magnitude of this peak force varied from 0.5 to 1.25 times body weight and its frequency components from 10 to 75 Hz.     

Energetics of actively powered locomotion using the simplest walking model

We modified an irreducibly simple model of passive dynamic walking to walk on level ground, and used it to study the energetics of walking and the preferred relationship between speed and step length in humans. Powered walking was explored using an impulse applied at toe-off immediately before heel strike, and a torque applied on the stance leg. Although both methods can supply energy through mechanical work on the center of mass, the toe-off impulse is four times less costly because it decreases the collision loss at heel strike. We also studied the use of a hip torque on the swing leg that tunes its frequency but adds no propulsive energy to gait. This spring-like actuation can further reduce the collision loss at heel strike, improving walking energetics. An idealized model yields a set of simple power laws relating the toe-off impulses and effective spring constant to the speed and step length of the corresponding gait. Simulations incorporating nonlinear equations of motion and more realistic inertial parameters show that these power laws apply to more complex models as well.     

Spatial-dependent mechanical properties of the heel pad by shear wave elastography

The heel pad plays an important role in gait, and its biomechanical behavior and functionality are determined by its specialized architecture and mechanical properties. The purpose of this study was to apply supersonic shear wave elastography, an ultrasound-based noninvasive modality that can quantitatively estimate the shear stiffness of the tissue, to investigate the spatial-dependent mechanical properties of the heel pad. Measurements were conducted in 40 heel pads of 20 normal participants aged between 20 and 30 years by shear wave elastography. The continuous change in local shear stiffness of the heel pad along the depth direction of the heel pad was measured. The result showed that the mechanical properties of the heel pad were highly heterogeneous but followed a simple and specific pattern that local heel pad shear stiffness was highest beneath the plantar skin and decreased continuously with increasing depth. This finding provides a better understanding of the heel pad biomechanics and basis for further investigation of the heterogeneous properties of the heel pad.     

An MRI-compatible foot-loading device for assessment of internal tissue deformation

It is well known that mechanical forces acting within the soft tissues of the foot can contribute to the formation of neuropathic ulcers in people with diabetes. Presently, only surface measurements of plantar pressure are used clinically to estimate risk status due to mechanical loading. It is currently not known how surface measurements relate to the three-dimensional (3-D) internal stress/strain state of the foot. This article describes the development of a foot-loading device that allows for the direct observation of the internal deformation of foot tissues under known forces. Ground reaction forces and plantar pressure distributions during normal walking were measured in ten healthy young adults. One instant in the gait cycle, when pressure under the metatarsal heads reached a peak, was extracted for simulation in an MR imager. T1-weighted 3-D gradient echo MRI sets were collected as the simulated walking ground reaction force was incrementally applied to the foot by the novel foot-loading device. The sub-metatarsal head soft-tissue thickness decreased rapidly at first and then reached a plateau. Peak plantar pressure measurements collected within the loading device (161+/-75kPa) were lower in magnitude and less focal than pressures measured during walking (492+/-91kPa). This finding implies that although the device successfully applied full peak walking ground reaction forces to the foot, they were not distributed in the same manner as during walking. Although not representative of gait, the data collected from this in vivo mechanical test are suitable for determination of foot tissue material properties or, when combined with finite element modeling, to examine the relationship between surface loading and internal stress.     

Footprint analysis of gait using a pressure sensor system.

The purpose of this study was to investigate if the detailed pressure data of the footprints of normal gait add essential information to the spatio-temporal variables of gait. The gait of 62 healthy adult subjects was investigated using GAITRite pressure sensor system. Each footprint was divided into 12 equal trapezoids and after that the hindfoot, midfoot and forefoot analysis was developed. A typical activation pattern of the sensors with two peaks of active area and peak pressure distribution during normal walking was obtained. The first peak reflected the heel strike, and the second peak reflected push-off at the end of the stance phase. The lowest pressure values were in the midfoot, where the lateral part of the foot activated sensors more than the medial part. The footprint patterns of right and left legs were symmetrical and corresponded with the symmetry found in the spatio-temporal variables of gait. The variability for the active area and the peak pressure were more pronounced for the lateral part of the midfoot and a smaller variation was seen in areas with concentrated observations (e.g. 1st, 2nd and 5th lateral trapezoids). Increasing active area in the forefoot was associated with decreasing pressure sensor activity in the midfoot. The footprint patterns identified the symmetry between the legs and at the same time revealed the velocity performance.     

Biomechanical characteristics of elderly individuals walking on land and in water

In this study, we examined Spatial–temporal gait stride parameters, lower extremity joint angles, ground reaction forces (GRF) components, and electromyographic activation patterns of 10 healthy elderly individuals (70 ± 6 years) walking in water and on land and compared them to a reference group of 10 younger adults (29 ± 6 years). They all walked at self-selected comfortable speeds both on land and while immersed in water at the Xiphoid process level. Concerning the elderly individuals, the main significant differences observed were that they presented shorter stride length, slower speed, lower GRF values, higher horizontal impulses, smaller knee range of motion, lower ankle dorsiflexion, and more knee flexion at the stride’s initial contact in water than on land. Concerning the comparison between elderly individuals and adults, elderly individuals walked significantly slower on land than adults but both groups presented the same speed walking in water. In water, elderly individuals presented significantly shorter stride length, lower stride duration, and higher stance period duration than younger adults. That is, elderly individuals’ adaptations to walking in water differ from those in the younger age group. This fact should be considered when prescribing rehabilitation or fitness programs for these populations.     

Determination of toe-off event time during treadmill locomotion using kinematic data

Researchers collecting gait kinematic data during treadmill locomotion are often interested in determining the times of toe off and heel strike for each stride. In the absence of additional hardware, only position data collected with motion-capture equipment may be available. Others have published methods for using kinematic data for detecting overground gait events. However, during treadmill locomotion, especially running, overground methods may not possess sufficient accuracy. The purpose of this paper is to describe a method for using kinematic data to determine the time of toe off during treadmill locomotion. Ten subjects walked and ran on a treadmill while a motion-capture system collected positional data from heel and toe markers. The treadmill was equipped with force platforms that allowed an accurate determination of foot-ground contact. The time of toe off was determined using the vertical component of the toe marker, and this method was found to have greater accuracy for event detection than other published methods. Researchers can use the described method to determine times of heel strike and toe off during treadmill locomotion using only kinematic data.     

The compressive mechanical properties of diabetic and non-diabetic plantar soft tissue

Diabetic subjects are at an increased risk of developing plantar ulcers. Knowledge of the physiologic compressive properties of the plantar soft tissue is critical to understanding the possible mechanisms of ulcer formation and improving treatment options. The purpose of this study was to determine the compressive mechanical properties of the plantar soft tissue in both diabetic and non-diabetic specimens from six relevant locations beneath the foot, namely the hallux (big toe), first, third, and fifth metatarsal heads, lateral midfoot, and calcaneus (heel). Cylindrical specimens (1.905 cm diameter) from these locations were excised and separated from the skin and bone from 4 diabetic and 4 non-diabetic age-matched, elderly, fresh-frozen cadaveric feet. Specimens were then subjected to biomechanically realistic strains of ～50% in compression using triangle wave tests conducted at five frequencies ranging from 1 to 10 Hz to determine tissue modulus, energy loss, and strain rate dependence. Diabetic vs. non-diabetic results across all specimens, locations, and testing frequencies demonstrated altered mechanical properties with significantly increased modulus (1146.7 vs. 593.0 kPa) but no change in energy loss (68.5 vs. 67.9%). All tissue demonstrated strain rate dependence and tissue beneath the calcaneus was found to have decreased modulus and energy loss compared to other areas. The results of this study could be used to generate material properties for all areas of the plantar soft tissue in diabetic or non-diabetic feet, with implications for foot computational modeling efforts and potentially for pressure alleviating footwear that could reduce plantar ulcer incidence.     

Trunk's Natural Inclination Influences Stance Limb Kinetics,but Not Body Kinematics,during Gait Initiation in Able Men

The imposing mass of the trunk in relation to the whole body has an important impact on human motion. The objective of this study is to determine the influence of trunk''s natural inclination - forward (FW) or backward (BW) with respect to the vertical - on body kinematics and stance limb kinetics during gait initiation.Twenty-five healthy males were divided based on their natural trunk inclination (FW or BW) during gait initiation. Instantaneous speed was calculated at the center of mass at the first heel strike. The antero-posterior impulse was calculated by integrating the antero-posterior ground reaction force in time. Ankle, knee, hip and thoraco-lumbar (L5) moments were calculated using inverse dynamics and only peaks of the joint moments were analyzed. Among all the investigated parameters, only joint moments present significant differences between the two groups. The knee extensor moment is 1.4 times higher (P<0.001) for the BW group, before the heel contact. At the hip, although the BW group displays a flexor moment 2.4 times higher (P<0.001) before the swing limb''s heel-off, the FW group displays an extensor moment 3.1 times higher (P<0.01) during the swing phase. The three L5 extensor peaks after the toe-off are respectively 1.7 (P<0.001), 1.4 (P<0.001) and 1.7 (P<0.01) times higher for the FW group. The main results support the idea that the patterns described during steady-state gait are already observable during gait initiation. This study also provides reference data to further investigate stance limb kinetics in specific or pathologic populations during gait initiation. It will be of particular interest for elderly people, knowing that this population displays atypical trunk postures and present a high risk of falling during this forward stepping.     

Biomechanical analysis of the three-dimensional foot structure during gait: a basic tool for clinical applications

A novel three-dimensional numerical model of the foot, incorporating, for the first time in the literature, realistic geometric and material properties of both skeletal and soft tissue components of the foot, was developed for biomechanical analysis of its structural behavior during gait. A system of experimental methods, integrating the optical Contact Pressure Display (CPD) method for plantar pressure measurements and a Digital Radiographic Fluoroscopy (DRF) instrument for acquisition of skeletal motion during gait, was also developed in this study and subsequently used to build the foot model and validate its predictions. Using a Finite Element solver, the stress distribution within the foot structure was obtained and regions of elevated stresses for six subphases of the stance (initial-contact, heel-strike, midstance, forefoot-contact, push-off, and toe-off) were located. For each of these subphases, the model was adapted according to the corresponding fluoroscopic data, skeletal dynamics, and active muscle force loading. Validation of the stress state was achieved by comparing model predictions of contact stress distribution with respective CPD measurements. The presently developed measurement and numerical analysis tools open new approaches for clinical applications, from simulation of the development mechanisms of common foot disorders to pre- and post-interventional evaluation of their treatment.     

The compressive material properties of the plantar soft tissue

The plantar soft tissue is the primary means of physical interaction between a person and the ground during locomotion. Dynamic loads greater than body weight are borne across the entire plantar surface during each step. However, most testing of these tissues has concentrated on the structural properties of the heel pad. The purpose of this study was to determine the material properties of the plantar soft tissue from six locations beneath: the great toe (subhallucal), the 1st, 3rd and 5th metatarsal heads (submetatarsal), the lateral midfoot (lateral submidfoot) and the heel (subcalcaneal). We obtained specimens from these locations from 11 young, non-diabetic donors; the tissue was cut into 2 cm x 2 cm blocks and the skin was removed. Stress relaxation experiments were conducted and the data were fit using the quasi-linear viscoelastic (QLV) theory. To determine tissue modulus, energy loss and the effect of test frequency, we also conducted displacement controlled triangle waves at five frequencies ranging from 0.005 to 10 Hz. The subcalcaneal tissue was found to have an increased relaxation time compared to the other areas. The subcalcaneal tissue was also found to have an increased modulus and decreased energy loss compared to the other areas. Across all areas, the modulus and energy loss increased for the 1 and 10 Hz tests compared to the other testing frequencies. This study is the first to generate material properties for all areas of the plantar soft tissue, demonstrating that the subcalcaneal tissue is different than the other plantar soft tissue areas. These data will have implications for foot computational modeling efforts and potentially for orthotic pressure reduction devices.