Skip to main content
SpringerLink
Log in

Analysis of the main soft tissue stress associated with flexible flatfoot deformity: a finite element study

  • Original Paper
  • Published:
Biomechanics and Modeling in Mechanobiology Aims and scope Submit manuscript

Abstract

A better understanding of soft tissue stress and its role in supporting the medial longitudinal arch in flexible flatfoot could help to guide the clinical treatment. In this study, a 3-Dimensional finite element (FE) foot model was reconstructed to measure the stress of the soft tissue, and its variation in different scenarios related to flexible flatfoot. All bones, cartilages, ligaments and related tendons around the ankle, and fat pad were included in the finite element model. The equivalent stress on the articular surface of the joints in the medial longitudinal arch and the maximum principal stress of the ligaments around the ankle were obtained. The results show that the plantar fascia (PF) is the main tissue in maintaining the medial longitudinal arch. The equivalent stress of all the joints in the medial longitudinal arch increases when the PF attenuation and the talonavicular joint increases, while other joints decreases when all the three tissue attenuation. Moreover, the maximum principal stress variation of calcaneofibular ligament is largest when the PF attenuation and the tibionavicular ligament and posterior tibiotalar ligament are largest when the posterior tibial tendon (PTT) attenuation. The maximum principal stress variation of tibionavicular ligament and posterior tibiotalar ligament are even larger when all the three tissue attenuation. These findings support that the PF is the main factor in maintaining the medial longitudinal arch. The medial longitudinal arch collapse mainly affects the talonavicular joint and the calcaneofibular ligament, the tibionavicular ligament and the posterior tibiotalar ligament. This approach could help to improve the understanding of adult-acquired flatfoot deformity (AAFD).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Arangio GA, Salathe EP (2009) A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flat foot. Clin Biomech (bristol, Avon) 24(4):385–390

    Article  Google Scholar 

  • Bluman EM, Title CI, Myerson MS (2007) Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin 12(2):233–249

    Article  Google Scholar 

  • Burkhart TA, Andrews DM, Dunning CE (2013) Finite element modeling mesh quality, energy balance and validation methods: a review with recommendations associated with the modeling of bone tissue. J Biomech 46:1477–1488

    Article  Google Scholar 

  • Cheung JT, Zhang M (2005) A 3-dimensional finite element model of the human foot and ankle for insole design. Arch Phys Med Rehabil 86:353–358

    Article  Google Scholar 

  • Cifuentes-De la Portilla C, Larrainzar-Garijo R, Bayod J (2019a) Analysis of the main passive soft tissues associated with adult acquired flatfoot deformity development: a computational modeling approach. J Biomech 84:183–190

    Article  Google Scholar 

  • Cifuentes-De la Portilla C, Larrainzar-Garijo R, Bayod J (2019b) Biomechanical stress analysis of the main soft tissues associated with the development of adult acquired flatfoot deformity. Clin Biomech (bristol, Avon) 61:163–171

    Article  Google Scholar 

  • Cifuentes-De la Portilla C, Larrainzar-Garijo R, Bayod J (2020) Analysis of biomechanical stresses caused by hindfoot joint arthrodesis in the treatment of adult acquired flatfoot deformity: a finite element study. Foot Ankle Surg 26(4):412–420

    Article  Google Scholar 

  • Deschamps K, Staes F, Roosen P, Nobels F, Desloovere K, Bruyninckx H, Matricali GA (2011) Body of evidence supporting the clinical use of 3D multisegment foot models: a systematic review. Gait Posture 33:338–349

    Article  Google Scholar 

  • Fowble VA, Sands AK (2004) Treatment of adult acquired pes planoabductovalgus (flatfoot deformity): procedures that preserve complex hindfoot motion. Operat Tech Orthopaed 14:13–20

    Article  Google Scholar 

  • García-Aznar JM, Bayod J, Rosas A, Larrainzar R, García-Bógalo R, Doblaré M, Llanos LF (2009) Load transfer mechanism for different metatarsal geometries: a finite element study. J Biomech Eng 131:021011

    Article  Google Scholar 

  • Gould N, Schneider W, Ashikaga T (1998) Epidemiological survey of foot problems in the continental United States: 1978–1979. Foot Ankle 1(1):8–10

    Article  Google Scholar 

  • Guha AR, Perera AM (2002) Calcaneal osteotomy in the treatment of adult acquired flatfoot deformity. Foot Ankle Clin 17:247–258

    Article  Google Scholar 

  • Hsu CC, Tsai WC, Chen CP, Shau YW, Wang CL, Chen MJ, Chang KJ (2005) Effects of aging on the plantar soft tissue properties under the metatarsal heads at different impact velocities. Ultrasound Med Biol 31:1423–1429

    Article  Google Scholar 

  • Huang CK, Kitaoka HB, An KN, Chao EY (1993) Biomechanical evaluation of longitudinal arch stability. Foot Ankle 14:353–357

    Article  Google Scholar 

  • Ledoux WR, Blevins JJ (2007) The compressive material properties of the plantar soft tissue. J Biomech 40:2975–2981

    Article  Google Scholar 

  • Lee MS, Vanore JV, Thomas JL, Catanzariti AR, Kogler G, Kravitz SR, Miller SJ, Gassen SC (2005) Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg 44:78–113

    Article  Google Scholar 

  • Mansour JM (2003) Biomechanics of cartilage. Kinesiology: the mechanics and pathomechanics of human movement, p 66–79

  • Miller-Young JE, Duncan NA, Baroud G (2002) Material properties of the human calcaneal fat pad in compression: experiment and theory. J Biomech 35:1523–1531

    Article  Google Scholar 

  • Morales Orcajo E, de las Casas EB, López JB (2015) Computational foot modeling for clinical assessment, Universidad de Zaragoza. PhD. Thesis

  • Rabbito M, Pohl MB, Humble N, Ferber R (2011) Biomechanical and clinical factors related to stage I posterior tibial tendon dysfunction. J Orthop Sports Phys Ther 41:776–784

    Article  Google Scholar 

  • Richie DH (2007) Biomechanics and clinical analysis of the adult acquired flatfoot. Clin Podiatr Med Surg 24:617–644

    Article  Google Scholar 

  • Shibuya N, Jupiter DC, Ciliberti LJ, VanBuren V, Fontaine JL (2010) Characteristics of adult flatfoot in the United States. J Foot Ankle Surg 49:363–368

    Article  Google Scholar 

  • Smith BA, Adelaar RS, Wayne JS (2017) Patient specific computational models to optimize surgical correction for flatfoot deformity. J Orthop Res 35(7):1523–1531

    Article  Google Scholar 

  • Smyth NA, Aiyer AA, Kaplan JR, Carmody CA, Kadakia AR (2017) Adult- acquired flatfoot deformity. Eur J Orthop Surg Traumatol 27:433–439

    Article  Google Scholar 

  • Tao K, Wang D, Wang C, Wang X, Liu A, Nester C, Howard D (2009) An in vivo experimental validation of a computational model of human foot. J Bionic Eng 6:387–397

    Article  Google Scholar 

  • Tao K, Ji WT, Wang DM, Wang CT, Wang X (2010) Relative contributions of plantar fascia and ligaments on the arch static stability: a finite element study. Biomed Tech Eng 55:265–271

    Article  Google Scholar 

  • Toullec E (2015) Adult flatfoot. Orthopaed Traumatol Surg Res 101:11–17

    Article  Google Scholar 

  • Viceconti M, Olsen S, Nolte LP, Burton K (2005) Extracting clinically relevant data from finite element simulations. Clin Biomech 20:451–454

    Article  Google Scholar 

  • Vulcano E, Deland JT, Ellis SJ (2013) Approach and treatment of the adult acquired flatfoot deformity. Curr Rev Musculoskelet Med 6:294–303

    Article  Google Scholar 

  • Wang Y, Wong DWC, Zhang M (2016a) Computational models of the foot and ankle for pathomechanics and clinical applications: a review. Ann Biomed Eng 44:213–221

    Article  Google Scholar 

  • Wang Z, Imai K, Kido M, Ikoma K, Hirai S (2016b) Study of surgical simulation of flatfoot using a finite element model. Innov Med Healthc 2015:353–363

    Google Scholar 

  • Wang Z, Imai K, Kido M, Ikoma K, Hirai S (2014) A finite element model of flatfoot (Pes Planus) for improving surgical plan. In: Conf Proc IEEE Eng Med Biol Soc, pp 844–847

  • Wong DW, Wang Y, Leung AK, Yang M, Zhang M (2018) Finite element simulation on posterior tibial tendinopathy: load transfer alteration and implications to the onset of pes planus. Clin Biomech (bristol, Avon) 51:10–16

    Article  Google Scholar 

  • Wu L (2007) Nonlinear finite element analysis for musculoskeletal biomechanics of medial and lateral plantar longitudinal arch of Virtual Chinese Human after plantar ligamentous structure failures. Clin Biomech (bristol, Avon) 22:221–229

    Article  Google Scholar 

  • Zheng YP, Choi YKC, Wong K, Chan S, Mak AFT (2000) Biomechanical assessment of plantar foot tissue in diabetic patients using an ultrasound indentation system. Ultrasound Med Biol 26:451–456

    Article  Google Scholar 

Download references

Acknowledgements

We thank Mechanical Engineer Wei Wang for help with finite element model construction.

Funding

This study was supported by Zhejiang Provincial Basic Research for Public Welfare Funds (LGF21H060007).

Author information

Author notes

  1. Yi-jun Zhang, Yan Guo and Xiao Long have contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China

    Yi-jun Zhang, Xiao Long, Jing-yu Du & Xiang-jin Lin

  2. State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University School of Mechanical Engineering, Hangzhou, 310027, People’s Republic of China

    Yan Guo & Tao Liu

Authors
  1. Yi-jun Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yan Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiao Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing-yu Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiang-jin Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yi-jun Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Medical Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine. All the participants recruited in the study provided written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, Yj., Guo, Y., Long, X. et al. Analysis of the main soft tissue stress associated with flexible flatfoot deformity: a finite element study. Biomech Model Mechanobiol 20, 2169–2177 (2021). https://doi.org/10.1007/s10237-021-01500-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10237-021-01500-1

Keywords

Search

Navigation