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Published in: BMC Musculoskeletal Disorders 1/2022

Open Access 01-12-2022 | Arthritis | Research

Biomechanical application of finite elements in the orthopedics of stiff clubfoot

Authors: Wei Liu, Fei Li, Haiyang He, Aihelamu Teraili, Xue Wang, Paerhati Wahapu, Chengwei Wang

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

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Abstract

Background

The purpose of this study was to evaluate the effect of varying the different correction angles of hindfoot osteotomy orthosis on the biomechanical changes of the adjacent joints after triple arthrodesis in adult patients with stiff clubfoot to determine the optimal hindfoot correction angle and provide a biomechanical basis for the correction of hindfoot deformity in patients with stiff clubfoot.

Methods

A 26-year-old male patient with a stiff left clubfoot was selected for the study, and his ankle and foot were scanned using dual-source computed tomography. A three-dimensional finite element model of the ankle was established, and after the validity of the model was verified by plantar pressure experiments, triple arthrodesis was simulated to analyze the biomechanical changes of the adjacent joints under the same load with “3°” of posterior varus, “0°” of a neutral position and “3°, 6°, 9°” of valgus as the correction angles.

Results

The peak plantar pressure calculated by the finite element model of the clubfoot was in good agreement with the actual plantar pressure measurements, with an error of less than 1%. In triple arthrodesis, the peak von Mises stress in the adjacent articular cartilage was significantly different and less than the preoperative stress when the corrected angle of the hindfoot was valgus “6°”. In comparison, the peak von Mises stress in the adjacent articular cartilage was not significantly different in varus “3°”, neutral “0°”, valgus “3°” and valgus “9°” compared with the preoperative stress.

Conclusion

The results of this study showed that different angles of hindfoot correction in triple arthrodesis did not increase the peak von Mises stress in the adjacent joints, which may not lead to the development of arthritis in the adjacent joint, and a hindfoot correction angle of “6°” of valgus significantly reduced the peak von Mises stress in the adjacent joints after triple arthrodesis.
Literature
1.
go back to reference Akinci O, Akalin Y. Medium-term results of single-stage posteromedial release and triple arthrodesis in treatment of neglected clubfoot deformity in adults. Acta Orthop Traumatol Turc. 2015;49(2):175–83. Akinci O, Akalin Y. Medium-term results of single-stage posteromedial release and triple arthrodesis in treatment of neglected clubfoot deformity in adults. Acta Orthop Traumatol Turc. 2015;49(2):175–83.
2.
go back to reference Zhuang T, El-Banna G, Frick S. Arthrodesis of the foot or ankle in adult patients with congenital clubfoot. Cureus. 2019;11(12):e6505. Zhuang T, El-Banna G, Frick S. Arthrodesis of the foot or ankle in adult patients with congenital clubfoot. Cureus. 2019;11(12):e6505.
3.
go back to reference Brodsky JW. The adult sequelae of treated congenital clubfoot. Foot Ankle Clin. 2010;15(2):287–96.CrossRef Brodsky JW. The adult sequelae of treated congenital clubfoot. Foot Ankle Clin. 2010;15(2):287–96.CrossRef
4.
go back to reference Klerken T, Kosse NM, Aarts CAM, Louwerens JWK. Long-term results after triple arthrodesis: influence of alignment on ankle osteoarthritis and clinical outcome. Foot Ankle Surg. 2019;25(2):247–50.CrossRef Klerken T, Kosse NM, Aarts CAM, Louwerens JWK. Long-term results after triple arthrodesis: influence of alignment on ankle osteoarthritis and clinical outcome. Foot Ankle Surg. 2019;25(2):247–50.CrossRef
5.
go back to reference Aarts CA, Heesterbeek PJ, Jaspers PE, Stegeman M, Louwerens JW. Does osteoarthritis of the ankle joint progress after triple arthrodesis? A midterm prospective outcome study. Foot Ankle Surg. 2016;22(4):265–9.CrossRef Aarts CA, Heesterbeek PJ, Jaspers PE, Stegeman M, Louwerens JW. Does osteoarthritis of the ankle joint progress after triple arthrodesis? A midterm prospective outcome study. Foot Ankle Surg. 2016;22(4):265–9.CrossRef
6.
go back to reference Hentges MJ, Gesheff MG, Lamm BM. Realignment Subtalar Joint Arthrodesis. J Foot Ankle Surg. 2016;55(1):16–21.CrossRef Hentges MJ, Gesheff MG, Lamm BM. Realignment Subtalar Joint Arthrodesis. J Foot Ankle Surg. 2016;55(1):16–21.CrossRef
7.
go back to reference Buck FM, Hoffmann A, Mamisch-Saupe N, Farshad M, Resnick D, Espinosa N, Hodler J. Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques. Eur Radiol. 2013;23(9):2594–601.CrossRef Buck FM, Hoffmann A, Mamisch-Saupe N, Farshad M, Resnick D, Espinosa N, Hodler J. Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques. Eur Radiol. 2013;23(9):2594–601.CrossRef
8.
go back to reference Haight HJ, Dahm DL, Smith J, Krause DA. Measuring standing hindfoot alignment: reliability of goniometric and visual measurements. Arch Phys Med Rehabil. 2005;86(3):571–5.CrossRef Haight HJ, Dahm DL, Smith J, Krause DA. Measuring standing hindfoot alignment: reliability of goniometric and visual measurements. Arch Phys Med Rehabil. 2005;86(3):571–5.CrossRef
9.
go back to reference Saltzman CL, el-Khoury GY. The hindfoot alignment view. Foot Ankle Int. 1995;16(9):572–6.CrossRef Saltzman CL, el-Khoury GY. The hindfoot alignment view. Foot Ankle Int. 1995;16(9):572–6.CrossRef
10.
go back to reference Akrami M, Qian Z, Zou Z, Howard D, Nester CJ, Ren L. Subject-specific finite element modelling of the human foot complex during walking: sensitivity analysis of material properties, boundary and loading conditions. Biomech Model Mechanobiol. 2018;17(2):559–76.CrossRef Akrami M, Qian Z, Zou Z, Howard D, Nester CJ, Ren L. Subject-specific finite element modelling of the human foot complex during walking: sensitivity analysis of material properties, boundary and loading conditions. Biomech Model Mechanobiol. 2018;17(2):559–76.CrossRef
11.
go back to reference Moayedi M, Arshi AR, Salehi M, Akrami M, Naemi R. Associations between changes in loading pattern, deformity, and internal stresses at the foot with hammer toe during walking; a finite element approach. Comput Biol Med. 2021;135:104598.CrossRef Moayedi M, Arshi AR, Salehi M, Akrami M, Naemi R. Associations between changes in loading pattern, deformity, and internal stresses at the foot with hammer toe during walking; a finite element approach. Comput Biol Med. 2021;135:104598.CrossRef
12.
go back to reference Bocanegra MAM, López JB, Vidal-Lesso A, Tobar AM, Vallejo RBdB. Numerical assessment of the structural effects of relative sliding between tissues in a finite element model of the foot. Mathematics. 2021;9(15):1719. Bocanegra MAM, López JB, Vidal-Lesso A, Tobar AM, Vallejo RBdB. Numerical assessment of the structural effects of relative sliding between tissues in a finite element model of the foot. Mathematics. 2021;9(15):1719.
13.
go back to reference Wang C, He X, Zhang Z, Lai C, Li X, Zhou Z, Ruan K. Three-dimensional finite element analysis and biomechanical analysis of midfoot von mises stress levels in Flatfoot, Clubfoot, and Lisfranc Joint Injury. Med Sci Monit. 2021;27:e931969.CrossRef Wang C, He X, Zhang Z, Lai C, Li X, Zhou Z, Ruan K. Three-dimensional finite element analysis and biomechanical analysis of midfoot von mises stress levels in Flatfoot, Clubfoot, and Lisfranc Joint Injury. Med Sci Monit. 2021;27:e931969.CrossRef
14.
go back to reference Lian Z, Guan H, Ivanovski S, Loo YC, Johnson NW, Zhang H. Effect of bone to implant contact percentage on bone remodelling surrounding a dental implant. Int J Oral Maxillofac Surg. 2010;39(7):690–8.CrossRef Lian Z, Guan H, Ivanovski S, Loo YC, Johnson NW, Zhang H. Effect of bone to implant contact percentage on bone remodelling surrounding a dental implant. Int J Oral Maxillofac Surg. 2010;39(7):690–8.CrossRef
15.
go back to reference Keyak JH, Kaneko TS, Tehranzadeh J, Skinner HB. Predicting proximal femoral strength using structural engineering models. Clin Orthop Relat Res. 2005;437:219–28.CrossRef Keyak JH, Kaneko TS, Tehranzadeh J, Skinner HB. Predicting proximal femoral strength using structural engineering models. Clin Orthop Relat Res. 2005;437:219–28.CrossRef
16.
go back to reference Peng L, Bai J, Zeng X, Zhou Y. Comparison of isotropic and orthotropic material property assignments on femoral finite element models under two loading conditions. Med Eng Phys. 2006;28(3):227–33.CrossRef Peng L, Bai J, Zeng X, Zhou Y. Comparison of isotropic and orthotropic material property assignments on femoral finite element models under two loading conditions. Med Eng Phys. 2006;28(3):227–33.CrossRef
17.
go back to reference Pendergast M, Rusovici R. A finite element parametric study of clavicle fixation plates. Int J Numer Method Biomed Eng. 2015;31(6):e02710. Pendergast M, Rusovici R. A finite element parametric study of clavicle fixation plates. Int J Numer Method Biomed Eng. 2015;31(6):e02710.
18.
go back to reference Lv ML, Zhang H, Chen L, Liu Y, Wang F, Wong DW, Sun L, Ni M. Finite element method based parametric study of gastrocnemius-soleus recession: implications to the treatment of midfoot-forefoot overload syndrome. Comput Methods Biomech Biomed Engin. 2021;24(8):913–21.CrossRef Lv ML, Zhang H, Chen L, Liu Y, Wang F, Wong DW, Sun L, Ni M. Finite element method based parametric study of gastrocnemius-soleus recession: implications to the treatment of midfoot-forefoot overload syndrome. Comput Methods Biomech Biomed Engin. 2021;24(8):913–21.CrossRef
19.
go back to reference Darwich A, Nazha H, Sliman A, Abbas W. Ankle-foot orthosis design between the tradition and the computerized perspectives. Int J Artif Organs. 2020;43(5):354–61.CrossRef Darwich A, Nazha H, Sliman A, Abbas W. Ankle-foot orthosis design between the tradition and the computerized perspectives. Int J Artif Organs. 2020;43(5):354–61.CrossRef
20.
go back to reference Zhang XB, Wu H, Zhang LG, Zhao JT, Zhang YZ. Calcaneal varus angle change in normal calcaneus: a three-dimensional finite element analysis. Med Biol Eng Comput. 2017;55(3):429–37.CrossRef Zhang XB, Wu H, Zhang LG, Zhao JT, Zhang YZ. Calcaneal varus angle change in normal calcaneus: a three-dimensional finite element analysis. Med Biol Eng Comput. 2017;55(3):429–37.CrossRef
21.
go back to reference Zhang H, Lv ML, Liu Y, Sun W, Niu W, Wong DW, Ni M, Zhang M. Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: implications to early weight-bearing rehabilitation. Clin Biomech (Bristol Avon). 2020;80:105143.CrossRef Zhang H, Lv ML, Liu Y, Sun W, Niu W, Wong DW, Ni M, Zhang M. Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: implications to early weight-bearing rehabilitation. Clin Biomech (Bristol Avon). 2020;80:105143.CrossRef
22.
go back to reference Hejazi S, Rouhi G, Rasmussen J. The effects of gastrocnemius-soleus muscle forces on ankle biomechanics during triple arthrodesis. Comput Methods Biomech Biomed Engin. 2017;20(2):130–41.CrossRef Hejazi S, Rouhi G, Rasmussen J. The effects of gastrocnemius-soleus muscle forces on ankle biomechanics during triple arthrodesis. Comput Methods Biomech Biomed Engin. 2017;20(2):130–41.CrossRef
23.
go back to reference Hsu YC, Gung YW, Shih SL, Feng CK, Wei SH, Yu CH, Chen CS. Using an optimization approach to design an insole for lowering plantar fascia stress–a finite element study. Ann Biomed Eng. 2008;36(8):1345–52.CrossRef Hsu YC, Gung YW, Shih SL, Feng CK, Wei SH, Yu CH, Chen CS. Using an optimization approach to design an insole for lowering plantar fascia stress–a finite element study. Ann Biomed Eng. 2008;36(8):1345–52.CrossRef
24.
go back to reference Dai XQ, Li Y, Zhang M, Cheung JT. Effect of sock on biomechanical responses of foot during walking. Clin Biomech (Bristol Avon). 2006;21(3):314–21.CrossRef Dai XQ, Li Y, Zhang M, Cheung JT. Effect of sock on biomechanical responses of foot during walking. Clin Biomech (Bristol Avon). 2006;21(3):314–21.CrossRef
25.
go back to reference Wang Y, Qi E, Zhang X, Xue L, Wang L, Tian J. A finite element analysis of relationship between fracture, implant and tibial tunnel. Sci Rep. 2021;11(1):1781.CrossRef Wang Y, Qi E, Zhang X, Xue L, Wang L, Tian J. A finite element analysis of relationship between fracture, implant and tibial tunnel. Sci Rep. 2021;11(1):1781.CrossRef
26.
go back to reference Mo F, Li Y, Li J, Zhou S, Yang Z. A three-dimensional finite element foot-ankle model and its personalisation methods analysis. Int J Mech Sci. 2022;219:107108. Mo F, Li Y, Li J, Zhou S, Yang Z. A three-dimensional finite element foot-ankle model and its personalisation methods analysis. Int J Mech Sci. 2022;219:107108.
27.
go back to reference Darwich A, Nazha H, Nazha A, Daoud M, Alhussein A. Bio-numerical analysis of the human ankle-foot model corresponding to Neutral Standing Condition. J Biomed Phys Eng. 2020;10(5):645–50.CrossRef Darwich A, Nazha H, Nazha A, Daoud M, Alhussein A. Bio-numerical analysis of the human ankle-foot model corresponding to Neutral Standing Condition. J Biomed Phys Eng. 2020;10(5):645–50.CrossRef
28.
go back to reference Mercan N, Yıldırım A, Dere Y. Biomechanical analysis of tibiofibular syndesmosis injury fixation methods: a finite element analysis. J Foot Ankle Surg. 2022;00(0):1–8. Mercan N, Yıldırım A, Dere Y. Biomechanical analysis of tibiofibular syndesmosis injury fixation methods: a finite element analysis. J Foot Ankle Surg. 2022;00(0):1–8.
29.
go back to reference Li J, Wang Y, Wei Y, Kong D, Lin Y, Wang D, Cheng S, Yin P, Wei M. The effect of talus osteochondral defects of different area size on ankle joint stability: a finite element analysis. BMC Musculoskelet Disord. 2022;23(1):500.CrossRef Li J, Wang Y, Wei Y, Kong D, Lin Y, Wang D, Cheng S, Yin P, Wei M. The effect of talus osteochondral defects of different area size on ankle joint stability: a finite element analysis. BMC Musculoskelet Disord. 2022;23(1):500.CrossRef
30.
go back to reference Myller KAH, Korhonen RK, Toyras J, Salo J, Jurvelin JS, Venalainen MS. Computational evaluation of altered biomechanics related to articular cartilage lesions observed in vivo. J Orthop Res. 2019;37(5):1042–51.CrossRef Myller KAH, Korhonen RK, Toyras J, Salo J, Jurvelin JS, Venalainen MS. Computational evaluation of altered biomechanics related to articular cartilage lesions observed in vivo. J Orthop Res. 2019;37(5):1042–51.CrossRef
31.
go back to reference Zhang Y, Awrejcewicz J, Szymanowska O, Shen S, Zhao X, Baker JS, Gu Y. Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: a finite element analysis. Comput Biol Med. 2018;97:1–7.CrossRef Zhang Y, Awrejcewicz J, Szymanowska O, Shen S, Zhao X, Baker JS, Gu Y. Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: a finite element analysis. Comput Biol Med. 2018;97:1–7.CrossRef
32.
go back to reference Yu J, Zhao D, Chen WM, Chu P, Wang S, Zhang C, Huang J, Wang X, Ma X. Finite element stress analysis of the bearing component and bone resected surfaces for total ankle replacement with different implant material combinations. BMC Musculoskelet Disord. 2022;23(1):70.CrossRef Yu J, Zhao D, Chen WM, Chu P, Wang S, Zhang C, Huang J, Wang X, Ma X. Finite element stress analysis of the bearing component and bone resected surfaces for total ankle replacement with different implant material combinations. BMC Musculoskelet Disord. 2022;23(1):70.CrossRef
33.
go back to reference Mazzoli D, Giannotti E, Rambelli C, Zerbinati P, Galletti M, Mascioli F, Prati P, Merlo A. Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study. Top Stroke Rehabil. 2019;26(7):518–22.CrossRef Mazzoli D, Giannotti E, Rambelli C, Zerbinati P, Galletti M, Mascioli F, Prati P, Merlo A. Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study. Top Stroke Rehabil. 2019;26(7):518–22.CrossRef
34.
go back to reference Graf AN, Kuo KN, Kurapati NT, Krzak JJ, Hassani S, Caudill AK, Flanagan A, Harris GF, Smith PA. A long-term follow-up of young adults with idiopathic clubfoot: does foot morphology relate to Pain? J Pediatr Orthop. 2019;39(10):527–33.CrossRef Graf AN, Kuo KN, Kurapati NT, Krzak JJ, Hassani S, Caudill AK, Flanagan A, Harris GF, Smith PA. A long-term follow-up of young adults with idiopathic clubfoot: does foot morphology relate to Pain? J Pediatr Orthop. 2019;39(10):527–33.CrossRef
35.
go back to reference Wang Y, Li Z, Wong DW, Cheng CK, Zhang M. Finite element analysis of biomechanical effects of total ankle arthroplasty on the foot. J Orthop Translat. 2018;12:55–65.CrossRef Wang Y, Li Z, Wong DW, Cheng CK, Zhang M. Finite element analysis of biomechanical effects of total ankle arthroplasty on the foot. J Orthop Translat. 2018;12:55–65.CrossRef
36.
go back to reference Yang Z, Liu F, Cui L, Liu H, Zuo J, Liu L, Li S. Adult rigid flatfoot: triple arthrodesis and osteotomy. Med (Baltim). 2020;99(7):e18826.CrossRef Yang Z, Liu F, Cui L, Liu H, Zuo J, Liu L, Li S. Adult rigid flatfoot: triple arthrodesis and osteotomy. Med (Baltim). 2020;99(7):e18826.CrossRef
37.
go back to reference Trad Z, Barkaoui A, Chafra M, Tavares JMR. Finite element analysis of the effect of high tibial osteotomy correction angle on articular cartilage loading. Proc Inst Mech Eng H. 2018;232(6):553–64.CrossRef Trad Z, Barkaoui A, Chafra M, Tavares JMR. Finite element analysis of the effect of high tibial osteotomy correction angle on articular cartilage loading. Proc Inst Mech Eng H. 2018;232(6):553–64.CrossRef
Metadata
Title
Biomechanical application of finite elements in the orthopedics of stiff clubfoot
Authors
Wei Liu
Fei Li
Haiyang He
Aihelamu Teraili
Xue Wang
Paerhati Wahapu
Chengwei Wang
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Arthritis
Published in
BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-022-06092-0

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