An MRI compatible loading device for the reconstruction of clinically relevant plantar pressure distributions and loading scenarios of the forefoot

This study aims to present a new MRI compatible loading device capable of reconstructing realistic loading scenarios of the human foot for research in the field of foot biomechanics. This device has two different configurations: one used to compress the forefoot and one to bend the metatarsophalangeal joints. Required plantar pressure distribution under the metatarsal heads can be achieved by modifying the distribution of the dorsally applied forces. To validate the device, subject-specific plantar pressures were measured and then reconstructed using the device. For quiet stance the peak pressure reconstruction error was 3% while for mid-stance phase of gait it was 8%. The device was also used to measure the passive bending stiffness of the metatarsophalangeal joints of one subject with low intra-subject variability. A series of preliminary MRI scans confirmed that the loading device can be used to produce static weight-bearing images of the foot (voxel size: 0.23mm×0.23mm×1.00mm). The results indicate that the device presented here can accurately reconstruct subject specific plantar pressure distributions and measure the foot’s metatarsophalangeal passive stiffness. Possible future applications include the validation of finite element models, the investigation of the relationship between plantar pressure and internal stresses/strains and the study of the foot’s inter-segmental passive stiffness

A method for subject-specific modelling and optimisation of the cushioning properties of insole materials used in diabetic footwear

This study aims to develop a numerical method that can be used to investigate the cushioning properties of different insole materials on a subject-specific basis. Diabetic footwear and orthotic insoles play an important role for the reduction of plantar pressure in people with diabetes (type-2). Despite that, little information exists about their optimum cushioning properties. A new in-vivo measurement based computational procedure was developed which entails the generation of 2D subject-specific finite element models of the heel pad based on ultrasound indentation. These models are used to inverse engineer the material properties of the heel pad and simulate the contact between plantar soft tissue and a flat insole. After its validation this modelling procedure was utilised to investigate the importance of plantar soft tissue stiffness, thickness and loading for the correct selection of insole material. The results indicated that heel pad stiffness and thickness influence plantar pressure but not the optimum insole properties. On the other hand loading appears to significantly influence the optimum insole material properties. These results indicate that parameters that affect the loading of the plantar soft tissues such as body mass or a person’s level of physical activity should be carefully considered during insole material selection

An MRI compatible loading device for the reconstruction of clinically relevant plantar pressure distributions and loading scenarios of the forefoot.

The purpose of this study is to demonstrate a new MRI compatible loading device capable of reconstructing realistic loading scenarios of the human foot for research in the field of foot biomechanics. This device has two different configurations: one used to compress the forefoot and one to bend the metatarsophalangeal joints. Required plantar pressure distribution under the metatarsal heads can be achieved by modifying the distribution of the dorsally applied forces. To validate the device, subject-specific plantar pressures were measured and then reconstructed using the device. For quiet stance the peak pressure reconstruction error was 3% while for mid-stance phase of gait it was 8%. The device was also used to measure the passive bending stiffness of the metatarsophalangeal joints of one subject with low intra-subject variability. A series of preliminary MRI scans confirmed that the loading device can be used to produce static weight-bearing images of the foot (voxel size: 0.23 mm × 0.23 mm × 1.00 mm). The results indicate that the device presented here can accurately reconstruct subject specific plantar pressure distributions and measure the foot's metatarsophalangeal passive stiffness. Possible future applications include the validation of finite element models, the investigation of the relationship between plantar pressure and internal stresses/strains and the study of the foot's inter-segmental passive stiffness

Numerical simulation of bone screw induced pretension: The cases of under-tapping and conical profile

Even though screw induced pretension impacts the holding strength of bone screws, its implementation into the numerical simulation of the pullout phenomenon remains a problem with no apparent solution. The present study aims at developing a new methodology to simulate screw induced pretension for the cases of: a) cylindrical screws inserted with under-tapping and b) conical screws. For this purpose pullout was studied experimentally using synthetic bone and then simulated numerically. Synthetic bone failure was simulated using a bilinear cohesive zone material model. Pretension generation was simulated by allowing the screw to expand inside a hole with smaller dimensions or different shape than the screw itself. The finite element models developed here were validated against experimental results and then utilized to investigate the impact of under-tapping and conical angle. The results indicated that pretension can indeed increase a screw's pullout force but only up to a certain degree. Under-tapping increased cylindrical screws' pullout force up to 12%, 15% and 17% for synthetic bones of density equal to 0.08 g/cc, 0.16 g/cc and 0.28 g/cc respectively. Inserting a conical screw into a cylindrical hole increased pullout force up to 11%. In any case an optimum level of screw induced pretension exists

Finite element modelling of the foot for clinical application: A systematic review

Over the last two decades finite element modelling has been widely used to give new insight on foot and footwear biomechanics. However its actual contribution for the improvement of the therapeutic outcome of different pathological conditions of the foot, such as the diabetic foot, remains relatively limited. This is mainly because finite element modelling is only been used within the research domain. Clinically applicable finite element modelling can open the way for novel diagnostic techniques and novel methods for treatment planning/optimisation which would significantly enhance clinical practice. In this context this review aims to provide an overview of modelling techniques in the field of foot and footwear biomechanics and to investigate their applicability in a clinical setting. Even though no integrated modelling system exists that could be directly used in the clinic and considerable progress is still required, current literature includes a comprehensive toolbox for future work towards clinically applicable finite element modelling. The key challenges include collecting the information that is needed for geometry design, the assignment of material properties and loading on a patient-specific basis and in a cost-effective and non-invasive way. The ultimate challenge for the implementation of any computational system into clinical practice is to ensure that it can produce reliable results for any person that belongs in the population for which it was developed. Consequently this highlights the need for thorough and extensive validation of each individual step of the modelling process as well as for the overall validation of the final integrated system

Viscoelasticity in Foot-Ground Interaction

Mechanical properties of the plantar soft tissue, which acts as the interface between the skeleton and the ground, play an important role in distributing the force underneath the foot and in influencing the load transfer to the entire body during weight-bearing activities. Hence, understanding the mechanical behaviour of the plantar soft tissue and the mathematical equations that govern such behaviour can have important applications in investigating the effect of disease and injuries on soft tissue function. The plantar soft tissue of the foot shows a viscoelastic behaviour, where the reaction force is not only dependent on the amount of deformation but also influenced by the deformation rate. This chapter provides an insight into the mechanical behaviour of plantar soft tissue during loading with specific emphasis on heel pad, which is the first point of contact during normal gait. Furthermore, the methods of assessing the mechanical behaviour including the in vitro/in situ and in vivo are discussed, and examples of creep, stress relaxation, rate dependency and hysteresis behaviour of the heel pad are shown. In addition, the viscoelastic models that represent the mechanical behaviour of the plantar soft tissue under load along with the equations that govern this behaviour are elaborated and discussed

Chapter Viscoelasticity in Foot-Ground Interaction

Dynamical models of robots performing tasks in contact with objects or the environment are difficult to obtain. Therefore, different methods of learning the dynamics of tasks have been proposed. In this chapter, we present a method that provides the joint torques needed to execute a task in a compliant and at the same time accurate manner. The presented method of compliant movement primitives (CMPs), which consists of the task kinematical and dynamical trajectories, goes beyond mere reproduction of previously learned motions. Using statistical generalization, the method allows to generate new, previously untrained trajectories. Furthermore, the use of transition graphs allows us to combine parts of previously learned motions and thus generate new ones. In the chapter, we provide a brief overview of this research topic in the literature, followed by an in-depth explanation of the compliant movement primitives framework, with details on both statistical generalization and transition graphs. An extensive experimental evaluation demonstrates the applicability and the usefulness of the approach

A clinically applicable non-invasive method to quantitatively assess the visco-hyperelastic properties of human heel pad, implications for assessing the risk of mechanical trauma

Pathological conditions such as diabetic foot and plantar heel pain are associated with changes in the mechanical properties of plantar soft tissue. However, the causes and implications of these changes are not yet fully understood. This is mainly because accurate assessment of the mechanical properties of plantar soft tissue in the clinic remains extremely challenging.To develop a clinically viable non-invasive method of assessing the mechanical properties of the heel pad. Furthermore the effect of non-linear mechanical behaviour of the heel pad on its ability to uniformly distribute foot-ground contact loads in light of the effect of overloading is also investigated.An automated custom device for ultrasound indentation was developed along with custom algorithms for the automated subject-specific modeling of heel pad. Non-time-dependent and time-dependent material properties were inverse engineered from results from quasi-static indentation and stress relaxation test respectively. The validity of the calculated coefficients was assessed for five healthy participants. The implications of altered mechanical properties on the heel pad's ability to uniformly distribute plantar loading were also investigated in a parametric analysis.The subject-specific heel pad models with coefficients calculated based on quasi-static indentation and stress relaxation were able to accurately simulate dynamic indentation. Average error in the predicted forces for maximum deformation was only 6.6±4.0%. When the inverse engineered coefficients were used to simulate the first instance of heel strike the error in terms of peak plantar pressure was 27%. The parametric analysis indicated that the heel pad's ability to uniformly distribute plantar loads is influenced both by its overall deformability and by its stress-strain behaviour. When overall deformability stays constant, changes in stress/strain behaviour leading to a more "linear" mechanical behaviour appear to improve the heel pad's ability to uniformly distribute plantar loading.The developed technique can accurately assess the visco-hyperelastic behaviour of heel pad. It was observed that specific change in stress-strain behaviour can enhance/weaken the heel pad's ability to uniformly distribute plantar loading that will increase/decrease the risk for overloading and trauma

A novel concept for low-cost non-electronic detection of overloading in the foot during activities of daily living

Identifying areas in the sole of the foot which are routinely overloaded during daily living is extremely important for the management of the diabetic foot. This work showcases the feasibility of reliably detecting overloading using a low-cost non-electronic technique. This technique uses thin-wall structures that change their properties differently when they are repeatedly loaded above or below a tuneable threshold. Flexible hexagonal thin-wall structures were produced using three-dimensional printing, and their mechanical behaviour was assessed before and after repetitive loading at different magnitudes. These structures had an elastic mechanical behaviour until a critical pressure (Pcrit = 252 kPa ± 17 kPa) beyond which they buckled. Assessing changes in stiffness after simulated use enabled the accurate detection of whether a sample was loaded above or below Pcrit (sensitivity = 100%, specificity = 100%), with the overloaded samples becoming significantly softer. No specific Pcrit value was targeted in this study. However, finite-element modelling showed that Pcrit can be easily raised or lowered, through simple geometrical modifications, to become aligned with established thresholds for overloading (e.g. 200 kPa) or to assess overloading thresholds on a patient-specific basis. Although further research is needed, the results of this study indicate that clinically relevant overloading could indeed be reliably detected without the use of complex electronic in-shoe sensors

Diabetic ulcer alert: Time to rethink our approach to patient adherence

Efforts to prevent diabetic foot ulceration (DFU) are undermined by a disconcerting paradox; people with diabetes and diabetic foot complications are advised to avoid wearing inappropriate footwear which can severely injure their feet, but they still keep wearing them anyway.1 The current consensus is that this paradox can be resolved through effective education.2 Even though the importance of patient education is undisputed, in this opinion piece, we argue that this is not enough and that clinical research and interventions beyond patient education are urgently needed. Drawing insights from the domain of obesity prevention,3 we propose that adjustments to the environment in which individuals with diabetes select their footwear should be also considered. A possible method to achieve this, is by empowering the people who sell footwear to become part of the solution