Deformation and stress distribution of the human foot after plantar ligaments release: A cadaveric study and finite element analysis |
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Authors: | Jun Liang YunFeng Yang GuangRong Yu WenXin Niu YuBin Wang |
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Institution: | (1) Department of Orthopaedic Surgery, Second Affiliated Hospital, Shantou University Medical College, Dongxia Road N, Shantou, Guangdong, 515041, China;(2) Institute of Digitized Medicine, Wenzhou Medical College, Wenzhou, 325035, China;(3) Institute of Clinical Anatomy, First Military Medical University, Guangzhou, 510515, China;(4) Department of Orthopaedic Surgery, Second Affiliated Hospital, Wenzhou Medical College, Wenzhou, 325027, China |
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Abstract: | The majority of foot deformities are related to arch collapse or instability, especially the longitudinal arch. Although the
relationship between the plantar fascia and arch height has been previously investigated, the stress distribution remains
unclear. The aim of this study was to explore the role of the plantar ligaments in foot arch biomechanics. We constructed
a geometrical detailed three-dimensional (3-D) finite element (FE) model of the human foot and ankle from computer tomography
images. The model comprised the majority of joints in the foot as well as bone segments, major ligaments, and plantar soft
tissue. Release of the plantar fascia and other ligaments was simulated to evaluate the corresponding biomechanical effects
on load distribution of the bony and ligamentous structures. These intrinsic ligaments of the foot arch were sectioned to
simulate different pathologic situations of injury to the plantar ligaments, and to explore bone segment displacement and
stress distribution. The validity of the 3-D FE model was verified by comparing results with experimentally measured data
via the displacement and von Mise stress of each bone segment. Plantar fascia release decreased arch height, but did not cause
total collapse of the foot arch. The longitudinal foot arch was lost when all the four major plantar ligaments were sectioned
simultaneously. Plantar fascia release was compromised by increased strain applied to the plantar ligaments and intensified
stress in the midfoot and metatarsal bones. Load redistribution among the centralized metatarsal bones and focal stress relief
at the calcaneal insertion were predicted. The 3-D FE model indicated that plantar fascia release may provide relief of focal
stress and associated heel pain. However, these operative procedures may pose a risk to arch stability and clinically may
produce dorsolateral midfoot pain. The initial strategy for treating plantar fasciitis should be non-operative. |
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