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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Sarrafian S K. Functional characteristics of the foot and plantar aponeurosis under tibiotalar loading. Foot Ankle, 1987, 8: 4–18, 3623360, 1:STN:280:DyaL2szgs1SqtQ%3D%3D
Murphy G A, Pneumaticos S G, Kamaric E, et al. Biomechanical consequences of sequential plantar fascia release. Foot Ankle Int, 1998, 19: 149–152, 9542985, 1:STN:280:DyaK1c3gtF2rtg%3D%3D
Riddle D L, Pulisic M, Sparrow K. Impact of demographic and impairment-related variables on disability associated with plantar fasciitis. Foot Ankle Int, 2004, 25: 311–317, 15134611
Snider M P, Clancy W G, McBeath A A. Plantar fascia release for chronic plantar fasciitis in runners. Am J Sports Med, 1983, 11: 215–219, 6614290, 10.1177/036354658301100406, 1:STN:280:DyaL3szgs1alsg%3D%3D
Taniguchi A, Tanaka Y, Takakura Y, et al. Anatomy of the spring ligament. J Bone Joint Surg Am, 2003, 85: 2174–2178, 14630849
Huang C K, Kitaoka H B, An K N, et al. Biomechanical evaluation of longitudinal arch stability. Foot Ankle, 1993, 14: 353–357, 8406252, 1:STN:280:DyaK2c%2FhtVKjug%3D%3D
Kitaoka H B, Luo Z P, An K N. Analysis of longitudinal arch supports in stabilizing the arch of the foot. Clin Orthop Relat Res, 1997, 341: 250–256, 9269181, 10.1097/00003086-199708000-00036
Kitaoka H B, Luo Z P, An K N. Reconstruction operations for acquired flatfoot: Biomechanical evaluation. Foot Ankle Int, 1998, 19: 203–207, 9578097, 1:STN:280:DyaK1c3jslajug%3D%3D
Daly P J, Kitaoka H B, Chao E Y. Plantar fasciotomy for intractable plantar fasciitis: Clinical results and biomechanical evaluation. Foot Ankle, 1992, 13: 188–195, 1634150, 1:STN:280:DyaK38zjvF2mtQ%3D%3D
Berkelmans W A M, Poort H W, Slooff T J J H. A new method to analyse the mechanical behavior of skeletal parts. Acta Orth Scand, 1972, 34: 301–317, 10.3109/17453677208998949
Cheng H Y, Lin C L, Chou S W, et al. Nonlinear finite element analysis of the plantar fascia due to the windlass mechanism. Foot Ankle Int, 2008, 29: 845–851, 18752786, 10.3113/FAI.2008.0845, 1:CAS:528:DC%2BD1cXhtVWlur7L
Arangio G A, Reinert K L, Salathe E P. A biomechanical model of the effect of subtalar arthroereisis on the adult flexible flat foot. Clin Biomech (Bristol, Avon), 2004, 19: 847–852, 10.1016/j.clinbiomech.2003.11.002
Gefen A. Stress analysis of the standing foot following surgical plantar fascia release. J Biomech, 2002, 35: 629–637, 11955502, 10.1016/S0021-9290(01)00242-1
Camacho D L, Ledoux W R, Rohr E S, et al. A three-dimensional, anatomically detailed foot model: A foundation for a finite element simulation and means of quantifying foot-bone position. J Rehabil Res Dev, 2002, 39: 401–410, 12173760
Jacob S, Patil M K. Three-dimensional foot modeling and analysis of stresses in normal and early stage Hansen’s disease with muscle paralysis. J Rehabil Res Dev, 1999, 36: 252–263, 10659808, 1:STN:280:DC%2BD3c7itlajtg%3D%3D
Gefen A, Megido-Ravid M, Itzchak Y, et al. Biomechanical analysis of the three-dimensional foot structure during gait: A basic tool for clinical applications. J Biomech Eng, 2000, 122: 630–639, 11192385, 10.1115/1.1318904, 1:STN:280:DC%2BD3M7ns12isA%3D%3D
Chu T M, Reddy N P, Padovan J. Three-dimensional finite element stress analysis of the polypropylene, ankle-foot orthosis: Static analysis. Med Eng Phys, 1995, 17: 372–379, 7670697, 10.1016/1350-4533(95)97317-I, 1:STN:280:DyaK2MvgtVGmtw%3D%3D
Patil K M, Braak L H, Huson A. Analysis of stresses in two-dimensional models of normal and neuropathic feet. Med Biol Eng Comput, 1996, 34: 280–284, 8935493, 10.1007/BF02511238, 1:STN:280:DyaK2s%2FovFGrtw%3D%3D
Cheung J T, An K N, Zhang M. Consequences of partial and total plantar fascia release: A finite element study. Foot Ankle Int, 2006, 27: 125–132, 16487466
Tweed J L, Barnes M R, Allen M J, et al. Biomechanical consequences of total plantar fasciotomy: A review of the literature. J Am Podiatr Med Assoc, 2009, 99: 422–430, 19767549
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Liang, J., Yang, Y., Yu, G. et al. Deformation and stress distribution of the human foot after plantar ligaments release: A cadaveric study and finite element analysis. Sci. China Life Sci. 54, 267–271 (2011). https://doi.org/10.1007/s11427-011-4139-0
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DOI: https://doi.org/10.1007/s11427-011-4139-0