A good knowledge of midfoot biomechanics is important in understanding the biomechanics of the entire foot,but it has never been investigated thoroughly in the literature.This study carried out in vitro experiments and finite element analysis to investigate the midfoot biomechanics.A foot-ankle finite element model simulating the mid-stance phase of the normal gait was developed and the model validated in in vitro experimental tests.Experiments used seven in vitro samples of fresh human cadavers.The simulation found that the first principal stress peaks of all midfoot bones occurred at the navicular bone and that the tensile force of the spring ligament was greater than that of any other ligament.The experiments showed that the longitudinal strain acting on the medial cuneiform bone was-26.2±10.8μ-strain,and the navicular strain was-240.0±169.1μ-strain along the longitudinal direction and 65.1±25.8μ-strain along the transverse direction.The anatomical position and the spring ligament both result in higher shear stress in the navicular bone.The load from the ankle joint to five branches of the forefoot is redistributed among the cuneiforms and cuboid bones.Further studies on the mechanism of loading redistribution will be helpful in understanding the biomechanics of the entire foot.
NIU Wen XinTANG Ting TingZHANG MingJIANG Cheng HuaFAN Yu Bo
The locking plate and percutaneous crossing metallic screws and crossing absorbable screws have been used clinically to treat intra-articular calcaneal fractures, but little is known about the biomechanical differences between them. This study compared the biomechanical stability of calcaneal fractures fixed using a locking plate and crossing screws. Three-dimensional finite-element models of intact and fractured calcanei were developed based on the CT images of a cadaveric sample. Surgeries were simulated on models of Sanders type III calcaneal fractures to produce accurate postoperative models fixed by the three implants. A vertical force was applied to the superior surface of the subtalar joint to simulate the stance phase of a walking gait. This model was validated by an in vitro experiment using the same calcaneal sample. The intact calcaneus showed greater stiffness than the fixation models. Of the three fixations, the locking plate produced the greatest stiffness and the highest von Mises stress peak. The micromotion of the fracture fixated with the locking plate was similar to that of the fracture fixated with the metallic screws but smaller than that fixated with the absorbable screws. Fixation with both plate and crossing screws can be used to treat intra-articular calcaneal fractures. In general, fixation with crossing metallic screws is preferable because it provides sufficient stability with less stress shielding.
Ming NiDuo Wai-Chi WongJiong MeiWenxin NiuMing Zhang
