Taeyong Lee

Effects of internal stress concentrations in plantar soft-tissue—A preliminary three-dimensional finite element analysis

It has been hypothesized that diabetic foot ulceration might be internally initiated. This study established a three-dimensional and nonlinear finite element model of a human foot complex with comprehensive skeletal and soft-tissue components. The model was validated by experimental data of subject-specific barefoot plantar pressure measurements. The feasibility of the model to predict the 3D, internal, plantar soft-tissue deformation and stress was evaluated. The preliminary results indicate that large von Mises stress occurs where plantar soft-tissue contacts with geometrically irregular bony structures, thus internal stress distribution within the plantar soft-tissue was dramatically influenced by bony prominences due to stress concentration. At the forefoot part, an average stress magnification factor of 3.01 was quantified. The lateral sesamoid bone associated to the 1st MTH showed the largest effect of stress concentration. The modeling approach presented provides a possible way to explore the complexity of the mechanical environment inside the plantar soft-tissue.

Role of gastrocnemius–soleus muscle in forefoot force transmission at heel rise — A 3D finite element analysis

The functions of the gastrocnemius-soleus (G-S) complex and other plantar flexor muscles are to stabilize and control major bony joints, as well as to provide primary coordination of the foot during the stance phase of gait. Geometric positioning of the foot and transferring of plantar loads can be adversely affected when muscular control is abnormal (e.g., equinus contracture). Although manipulation of the G-S muscle complex by surgical intervention (e.g., tendo-Achilles lengthening) is believed to be effective in restoring normal plantar load transfer in the foot, there is lack of quantitative data supporting that notion. Thus, the objective of this study is to formulate a three-dimensional musculoskeletal finite element model of the foot to quantify the precise role of the G-S complex in terms of biomechanical response of the foot. The model established corresponds to a muscle-demanding posture during heel rise, with simulated activation of major extrinsic plantar flexors. In the baseline (reference) case, required muscle forces were determined from what would be necessary to generate the targeted resultant ground reaction forces. The predicted plantar load transfer through the forefoot plantar surface, as indicated by plantar pressure distribution, was verified by comparison with experimental observations. This baseline model served as a reference for subsequent parametric analysis, where muscle forces applied by the G-S complex were decreased in a step-wise manner. Adaptive changes of the foot mechanism, in terms of internal joint configurations and plantar stress distributions, in response to altered muscular loads were analyzed. Movements of the ankle and metatarsophalangeal joints, as well as forefoot plantar pressure peaks and pressure distribution under the metatarsal heads (MTHs), were all found to be extremely sensitive to reduction in the muscle load in the G-S complex. A 40% reduction in G-S muscle stabilization can result in dorsal-directed rotations of 8.81° at the ankle, and a decreased metatarsophalangeal joint extension of 4.65°. The resulting peak pressure reductions at individual MTHs, however, may be site-specific and possibly dependent on foot structure, such as intrinsic alignment of the metatarsals. The relationships between muscular control, internal joint movements, and plantar load distributions are envisaged to have important clinical implications on tendo-Achilles lengthening procedures, and to provide surgeons with an understanding of the underlying mechanism for relieving forefoot pressure in diabetic patients suffering from ankle equinus contracture.

Predicting failure load of the femur with simulated osteolytic defects using noninvasive imaging technique in a simplified load case.

Currently, there is no proven sensitive or specific method for predicting pathological fracture of the femur. The clinical management of lytic femoral metastases is based on geometric measurement of the bone, of the defect, or both. However, the mechanical behavior of a structure depends on both its material and geometric properties. Our hypothesis is that a change in bone structural properties as the result of tumor induced osteolysis determines the fracture risk in bones with skeletal metastases. We developed a method of QCT (Quantitative Computed Tomography) combined with engineering beam analysis as a noninvasive tool for measuring the material and geometric properties of the femur with simulated lytic defects in the intertrochanteric region. In this ex-vivo study we prove that engineering beam structural analysis applied to serial transaxial QCT scans through human femora with simulated lytic defects at the proximal femur predicts the load at failure and location of fracture better than current clinical guidelines. Structural rigidity measured by QCT in this study may be used to predict the load carrying capacity of femurs with metastatic defects and, furthermore, may be used when the tumor has weakened the bone sufficiently such that pathological fracture is imminent and prophylactic stabilization is necessary.

A novel gait platform to measure isolated plantar metatarsal forces during walking

A new gait platform described in this report allows an isolated measurement of the vertical and shear forces under an individual metatarsal head during barefoot walking. The apparatus incorporated a customized tactile force sensor and a high-speed camera system, which enabled easy identification of a single anatomical landmark at the forefoots plantar surface that is in contact with the sensor throughout stance. After calibration, the measured peak forces under the 2nd MTH showed variability of 3.7%, 9.2%, and 8.9% in vertical, anterior-posterior, and medial-lateral directions, respectively. The device therefore provides information about the magnitude and timing of such local metatarsal forces, and has been shown to be of significant research and clinical interest. Its ability to achieve this with a high degree of accuracy ensures its potential as a valuable research tool.

Ibandronate does not reduce the anabolic effects of PTH in ovariectomized rat tibiae: a microarchitectural and mechanical study.

Osteoporosis remains a challenging problem. Understanding the regulation on osteoclast and osteoblast by drugs has been of great interest. Both anabolic and anti-resorptive drugs yield positive results in the treatment of osteoporosis. However, whether the concurrent administration of parathyroid hormone (1-34) and ibandronate may offer an advantage over monotherapy is still unknown. This study, therefore, attempts to compare the efficacy of two therapeutical approaches and to investigate the beneficial effects in concurrent therapy in a rat model using three-point bending, pQCT and μCT analysis. A total of 60 female Sprague-Dawley rats of age 10 to 12 weeks were divided into 5 groups (SHAM, OVX+VEH, OVX+PTH, OVX+IBAN, OVX+PTH+IBAN) and subjected to ovariectomy or sham surgery accordingly. Low-dose parathyroid hormone (PTH) and/or ibandronate or its vehicle were administered subcutaneously to the respective groups starting from 4th week post-surgery at weekly intervals. Three rats from each group were euthanized every 2 weeks and their tibiae were harvested. The tibiae were subjected to metaphyseal three-point bending, pQCT and μCT analysis. Serum biomarkers for both bone formation (P1NP) and resorption (CTX) were studied. A total of 11 indices showed a significant difference between SHAM and OVX+VEH groups, suggesting the successful establishment of osteoporosis in the rat model. Compared to the previous studies which showed impedance from bisphosphonates in combination therapy with PTH, our study revealed that ibandronate does not block the anabolic effects of PTH in ovariectomized rat tibiae. Maximum load, strength-strain indices and serum bone formation markers of OVX+PTH+IBAN group are significantly higher than both monotherapy groups. With the proper ratio of anabolic and anti-resorptive drugs, the effect could be more pronounced.

An instrumented tissue tester for measuring soft tissue property under the metatarsal heads in relation to metatarsophalangeal joint angle

Identification of the localized mechanical response of the plantar soft tissue pads underneath the metatarsal heads (i.e., sub-MTH pad) to external loading is key to understand and predict how it functions in a gait cycle. The mechanical response depends on various parameters, such as the external load (direction and rate), the sub-MTH tissue properties (anisotropy and viscoelasticity), and the configuration of the metatarsophalangeal (MTP) joint overlying the tissue. In this study, an instrument-driven tissue tester that incorporates a portable motorized indentor within a special foot positioning apparatus was developed for realistic in vivo mechanical characterization (i.e. tissue stiffness and force relaxation behavior) of the local sub-MTH pad with the MTP joint configured at various dorsiflexion angles associated with gait. The tester yields consistent results for tests on the 2nd sub-MTH pad. Measurement errors for the initial stiffness (for indentation depths ≤ 1 mm), end-point stiffness, and percentage force relaxation were less than 0.084 N/mm, 0.133 N/mm, and 0.127%, respectively, across all test configurations. The end-point tissue stiffness, which increased by 104.2% due to a 50° MTP joint dorsiflexion, also agreed with a previous investigation. In vivo tissues force relaxation was shown to be pronounced (avg. = 8.1%), even for a short holding-time interval. The proposed technique to facilitate study of the dependence of the local sub-MTH pad and tissue response on the MTP joint angle might be preferable to methods that focus solely on measurement of tissue property because under physiologic conditions the sub-MTH pad elasticity may vary in gait, to adapt to drastically changing mechanical demands in the sub-MTH region of the terminal stance-phase, where MTP joint dorsiflexion occurs.

Positive alterations of viscoelastic and geometric properties in ovariectomized rat femurs with concurrent administration of ibandronate and PTH.

Besides bone mineral density (BMD), structural and nano-level viscoelastic properties of bone are also crucial determinants of bone strength. However, treatment induced viscosity changes in osteoporotic bone have seldom been characterized. In this study, the effects of anabolic, antiresorptive and concurrent treatments on ovariectomized rat bones were thoroughly analyzed using multiple bone strength parameters. A total of 52 female Sprague-Dawley rats of 3 months age were divided into 5 groups and subjected to sham (SHM group) or ovariectomy surgery (OVX, PTH, IBN and COM groups). Weekly low-dose parathyroid hormone (PTH) and/or ibandronate or its vehicle was administered subcutaneously to the respective groups starting from 4th week post-surgery. Four rats per group were euthanized every 4 weeks and their femurs were harvested. The BMD, micro-architectural parameters, cortical bone geometry and viscoelastic parameters were measured at the distal femoral metaphysis. Our results showed that PTH, ibandronate or its concurrent treatment can effectively reverse ovariectomy induced deteriorations in both trabecular and cortical bone. Different drugs had selective effects especially in preserving geometric and viscoelastic properties of the bone. The concurrent administration of PTH and ibandronate was shown to offer an added advantage in preserving mean BMD and had a positive effect on cortical bone geometry, resulting from an increased periosteal formation and a decreased endocortical resorption. Viscosity (η) was prominently restored in combined treatment group. It is in accordance with an observed denser alignment of collagen fibers and hydroxyapatite crystal matrix with fewer pores, which may play an important role in hindering fracture propagation.

Localized sclerotic bone response demonstrated reduced nanomechanical creep properties

Sclerosis (tissue hardening) development is a common occurrence in slow growing or benign osteolytic lesions. However, there is lack of knowledge on the mechanical and material property changes associated with sclerotic bone response. The immune system is postulated to play a relevant role in evoking sclerotic bone responses. In this study, localized sclerotic response in an immunocompetent model of Walker 256 breast carcinoma in SD rats showed an apparent increase in new reactive bone formation. Sclerotic rat femurs had significant increases in bone mineral density (BMD), bone mineral content (BMC), bone volume fraction (BV/TV), bone surface density (BS/TV), trabecular number (Tb.N) and a significant decrease in trabecular separation (Tb.Sp) and structural model index (SMI) as compared to control rat femurs. Significantly reduced creep responses (increased η) were observed for both trabecular and cortical bone in sclerotic bones while no significant difference was observed in elastic modulus (E) and hardness (H) values. Therefore, we conclude that viscoelastic creep property using nanoindentation would serve as a more sensitive indicator of localized bone modeling than elastic properties. Moreover, reduced viscoelasticity can contribute towards increased microcrack propagation and therefore reduced toughness. Since significant positive correlations between elastic properties (E) and (H) with viscosity (η) were also observed, our results indicate that sclerotic response of bone metastasis would cause reduced toughness (increased η) with stiffening of material (increased E and H).

Biomechanical Analysis of Trail Running Shoes Applied to Korean Shoe-Lasts

【The purpose of this study was to analyze biomechanical factors of trail running shoes applied to korean shoe-lasts. 10 healthy male subjects with an average age of 37.2 years(SD=8.28), weight of 69.6 kg(SD=10.56) and a height of 171 cm(SD=4.93) were recruited for this study. Ten males walked on a treadmill wearing four different shoes. Foot pressure data was collected using a Pedar-X mobile system(Novel Gmbh., Germany) operating at the 1000 Hz. Surface EMG signals for tibialis anterior, gastrocnemius, vastus lateralis and biceps femoris were acquired at 1000 Hz using Noraxon TeleMyo DTS system(Noraxon Inc., USA). Foot pressure and leg muscle fatigue were measured and calculated during walking. The results are as follows: After walking 60 minutes, Type A showed a lower MPF. MPF values were significantly different from each muscle(p】

Investigation of the biomechanical effect of variable stiffness shoe on external knee adduction moment in various dynamic exercises

BackgroundThe growing ageing population and high prevalence of knee osteoarthritis (OA) in athletes across nations have created a strong demand for improved non-invasive therapeutic alternatives for knee OA. The aim of this study is to investigate the effect of the variable stiffness shoe (VSS), a new non-invasive therapeutic approach, on external knee adduction moment (EKAM) in various dynamic exercises. EKAM is believed to have positive correlation with the progression and development of knee OA.MethodsThirty young participants (16 male and 14 female; age 22.6 ± 1.9 years) from National University of Singapore were enrolled in this study. The tested activities were walking, running, drop-landing, and lateral hopping. All the dynamic exercises were recorded simultaneously by the 8-camera VICON Motion Systems (Oxford Metric, UK) with a sampling rate of 100 Hz.ResultsThe results showed that the EKAM was reduced in all the dynamic exercises with the use of VSS. The VSS produced significant reductions in the peak EKAM during walking (4.97%, p = 0.039), running (11.15%, p = 0.011), drop-landing (11.18%, p = 0.038) and lateral hopping (17.34%, p = 0.023) as compared to the control shoe.ConclusionsThe reduction of EKAM with the use of VSS in various dynamic exercises demonstrates its potential in delaying the onset and the progression of knee OA in early stage of knee OA patients.