Biomechanical study on surgical fixation methods for minimally invasive treatment of hallux valgus

Mao, Rui; Guo, Junchao; Luo, Chenyu; Fan, Yubo; Wen, Jie; Wang, Lizhen

doi:10.1016/j.medengphy.2017.04.010

Cited by 14 publications

(7 citation statements)

References 53 publications

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“…Wong et al (2015) attempted to explain the complication of the Lapidus procedure (the 1st MCJ fusion) and found that there was high tensile stress located at the bone graft inferiorly that could lead to non-union of the fusion. Guo et al (2018) found that distal metatarsal osteotomy could reduce the sesamoid displacement and redistributed the plantar pressure whereas the team also compared bandaging, Kirschner fixation, and fiberglass fixation in their later study (Mao et al, 2017). Besides, Brilakis et al (2019) compared the procedure variation of Mitchell's procedure with and without pins and quantified the additional stability contributed by the use of pins.…”

Section: Discussionmentioning

confidence: 99%

Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion)

Wong

Yan

Chen

et al. 2020

Front. Bioeng. Biotechnol.

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Hallux valgus is a common foot problem affecting nearly one in every four adults. Generalized ligament laxity was proposed as the intrinsic cause or risk factor toward the development of the deformity which was difficult to be investigated by cohort clinical trials. Herein, we aimed to evaluate the isolated influence of generalized ligament laxity on the deterioration using computer simulation (finite element analysis). We reconstructed a computational foot model from a mild hallux valgus participant and conducted a gait analysis to drive the simulation of walking. Through parametric analysis, the stiffness of the ligaments was impoverished at different degrees to resemble different levels of generalized ligament laxity. Our simulation study reported that generalized ligament laxity deteriorated hallux valgus by impairing the loadbearing capacity of the first metatarsal, inducing higher deforming force, moment and malalignment at the first metatarsophalangeal joint. Besides, the deforming moment formed a deteriorating vicious cycle between hallux valgus and forefoot abduction and may result in secondary foot problems, such as flatfoot. However, the metatarsocuneiform joint did not show a worsening trend possibly due to the overriding forefoot abduction. Controlling the deforming load shall be prioritized over the correction of angles to mitigate deterioration or recurrence after surgery.

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Section: Discussionmentioning

confidence: 99%

Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion)

Wong

Yan

Chen

et al. 2020

Front. Bioeng. Biotechnol.

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“…Wong et al [13] assumed HV deformity to be a normal foot with hypermobility and manifested that the arthrodesis of the first metatarsocuneiform is a useful treatment for functional restoration of HV based on the increased compressive stress in the first metatarsal. Furthermore, a subject-specific FE model of HV foot was developed recently to compare the effects of different surgical fixation methods on HV treatment by predicting the peak von Mises stress and compression stress of the distal fragment of the first metatarsal [14].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: A finite element analysis

Zhang

Awrejcewicz

Szymanowska

et al. 2018

Computers in Biology and Medicine

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The internal stress of the human foot enables efficient parametric evaluation of structural and functional impairments associated with foot deformities, such as hallux valgus (HV). However, the status of the internal stress of such a deformed foot remains insufficiently addressed due to the difficulties and limitations of experimental approaches. This study, using finite element (FE) methodology, investigated the influence of severe HV deformity on the metatarsal stress and the metatarsophalangeal (MTP) joint loading during balanced standing. FE models of a normal foot and a severe HV were constructed and validated. Each FE model involves 28 bones and various cartilaginous structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. All the materials except for the encapsulated soft tissue were considered isotropic and linearly elastic, while the encapsulated soft tissue was set as nonlinear hyperelastic. Hexahedral elements were assigned to the solid parts of bones, cartilage, and the encapsulated soft tissue. Link elements were assigned to ligaments and plantar fascia. A plate was created for simulating ground support. A vertical force of a half-body weight was applied on the bottom of the plate for simulating balanced standing loading. The superior surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. Stress distribution in the metatarsals, contact pressure, and force at the MTP joints were comparatively analysed. Compared to the normal foot, the HV foot showed higher stress concentration in the metatarsals but lower magnitude of MTP joint loading. In addition, the region with high contact pressure at the first MTP joint shifted medially in the HV foot. Knowledge of this study indicates that patients with severe HV deformity are at higher risk of metatarsal injuries and functional impairment of the MTP joints while weight bearing.

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“…The contact pressure analysis of the models showed that the hyperelastic behavior assigned to muscles of the models corresponding to Figure 5b,c, compared to the model shown in Figure 5a with an isotropic behavior of most of its tissues, improved the qualitative distribution of the plantar pressure on the sole, resulting in a more homogeneous pressure. According to the mean of the experimental data taken from the literature [8,9,17,19,[21][22][23][24], mesh separation in the model in Figure 5c improved plantar pressure under the heel and metatarsal head by 1.6% and 18.6%, respectively, compared to the model in Figure 5a. However, the mesh separation between the tissues in the model in Figure 5c, compared to the shared mesh in the model in Figure 5b, did not make a con-siderable difference either quantitatively or qualitatively in the variation of the maximum plantar pressure on the sole.…”

Section: Discussionmentioning

confidence: 94%

“…ABAQUS software (ABAQUS Inc., Pawtucket, RI, USA) was used to solve our FEFM. The distribution and magnitude of the contact pressure (plantar pressure) on the sole, specifically under the calcaneus (heel) and the metatarsals heads, reported in previous experimental and numerical analysis were used to compare and validate the numerical foot model developed in this work [8,9,17,[21][22][23][24]. In addition, a study was used of the plantar pressure (footprint) of the patient from which the model was obtained [19].…”

Section: Foot Model Validationmentioning

confidence: 99%

“…The creation of simplified models is a good option in these cases. Some of these simplified foot models simulate ligaments, tendons, the aponeurosis plantar and muscles with one-dimensional elements [6][7][8][9], while other models simulate these soft tissues with three-dimensional solid elements with scanned human geometry [10][11][12]. We also see that some of the simplified finite element foot models mentioned above lack some muscles, tendons, or skin (fat pad).…”

Section: Introductionmentioning

confidence: 99%

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Numerical Assessment of the Structural Effects of Relative Sliding between Tissues in a Finite Element Model of the Foot

et al. 2021

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Penetration and shared nodes between muscles, tendons and the plantar aponeurosis mesh elements in finite element models of the foot may cause inappropriate structural behavior of the tissues. Penetration between tissues caused using separate mesh without motion constraints or contacts can change the loading direction because of an inadequate mesh displacement. Shared nodes between mesh elements create bonded areas in the model, causing progressive or complete loss of load transmitted by tissue. This paper compares by the finite element method the structural behavior of the foot model in cases where a shared mesh has been used versus a separated mesh with sliding contacts between some important tissues. A very detailed finite element model of the foot and ankle that simulates the muscles, tendons and plantar aponeurosis with real geometry has been used for the research. The analysis showed that the use of a separate mesh with sliding contacts and a better characterization of the mechanical behavior of the soft tissues increased the mean of the absolute values of stress by 83.3% and displacement by 17.4% compared with a shared mesh. These increases mean an improvement of muscle and tendon behavior in the foot model. Additionally, a better quantitative and qualitative distribution of plantar pressure was also observed.

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Biomechanical study on surgical fixation methods for minimally invasive treatment of hallux valgus

Cited by 14 publications

References 53 publications

Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion)

Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion)

Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: A finite element analysis

Numerical Assessment of the Structural Effects of Relative Sliding between Tissues in a Finite Element Model of the Foot

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