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Zhuang Z, Qian Z, Wang X, Xu X, Chen B, Song G, Liu X, Ren L, Ren L. Bioinspired Structural Composite Flexible Material with High Cushion Performance. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2304947. [PMID: 38044306 PMCID: PMC10837376 DOI: 10.1002/advs.202304947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/11/2023] [Indexed: 12/05/2023]
Abstract
Impacts occur everywhere, and they pose a serious threat to human health and production safety. Flexible materials with efficient cushioning and energy absorption are ideal candidates to provide protection from impacts. Despite the high demand, the cushioning capacity of protective materials is still limited. In this study, an integrated bionic strategy is proposed, and a bioinspired structural composite material with highly cushioning performance is developed on the basis of this strategy. The results demonstrated that the integrated bionic material, an S-spider web-foam, has excellent energy storage and dissipation as well as cushioning performance. Under impact loading, S-spider web-foam can reduce peak impact forces by a factor of 3.5 times better than silicone foam, achieving unprecedented cushioning performance. The results of this study deepen the understanding of flexible cushioning materials and may provide new strategies and inspiration for the preparation of high-performance flexible cushioning materials.
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Affiliation(s)
- Zhiqiang Zhuang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, 130022, China
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, 130022, China
- Institute of Structured and Architected Materials, Liaoning Academy of Materials, Shenyang, 110167, China
| | - Xu Wang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, 130022, China
| | - Xiaolin Xu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, 130022, China
| | - Boya Chen
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, 130022, China
| | - Guangsheng Song
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, 130022, China
| | - Xiangyu Liu
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, 130022, China
| | - Lei Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, 130022, China
- Institute of Structured and Architected Materials, Liaoning Academy of Materials, Shenyang, 110167, China
- Department of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Luquan Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, 130022, China
- Institute of Structured and Architected Materials, Liaoning Academy of Materials, Shenyang, 110167, China
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Qian Z, Zhuang Z, Liu X, Bai H, Ren L, Ren L. Effects of extreme cyclic loading on the cushioning performance of human heel pads under engineering test condition. Front Bioeng Biotechnol 2023; 11:1229976. [PMID: 37929195 PMCID: PMC10623005 DOI: 10.3389/fbioe.2023.1229976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023] Open
Abstract
Human heel pads commonly undergo cyclic loading during daily activities. Low cyclic loadings such as daily human walking tend to have less effect on the mechanical properties of heel pads. However, the impact of cyclic loading on cushion performance, a vital biomechanical property of heel pads, under engineering test condition remains unexplored. Herein, dynamic mechanical measurements and finite element (FE) simulations were employed to explore this phenomenon. It was found that the wavy collagen fibers in the heel pad will be straightened under cycle compression loading, which resulted in increased stiffness of the heel pad. The stiffness of the heel pads demonstrated an inclination to escalate over a span of 50,000 loading cycles, consequently resulting in a corresponding increase in peak impact force over the same loading cycles. Sustained cyclic loading has the potential to result in the fracturing of the straightened collagen fibers, this collagen breakage may diminish the stiffness of the heel pad, leading to a reduction in peak impact force. This work enhances understanding of the biomechanical functions of human heel pad and may provide potential inspirations for the innovative development of healthcare devices for foot complex.
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Affiliation(s)
- Zhihui Qian
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, Jilin, China
| | - Zhiqiang Zhuang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, Jilin, China
| | - Xiangyu Liu
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, Jilin, China
| | - Haotian Bai
- Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Lei Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, Jilin, China
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, United Kingdom
| | - Luquan Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, Jilin, China
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Marotta N, Moggio L, Calafiore D, Prestifilippo E, Spanó R, Tasselli A, Drago Ferrante V, Invernizzi M, de Sire A, Ammendolia A. Efficacy of Proprioceptive Training on Plantar Pressure and Jump Performance in Volleyball Players: A Proof-of-Principle Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:1906. [PMID: 36850501 PMCID: PMC9963449 DOI: 10.3390/s23041906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Volleyball players are often subject to micro-traumatisms of the heel fat pad and ankle injuries. Recently, mat-based proprioceptive training has assumed a key role in recovery from these disorders. Therefore, this proof-of-principle study aimed to assess the efficacy of proprioceptive mat training on plantar pressures and athletic performance in volleyball players. The participants included adult semi-professional volleyball players allocated into two groups: an experimental group, with mat-based proprioceptive and balance training, and a control group, with a sham protocol. For the outcome, we evaluated the barefoot plantar pressure, performing an analysis on a baropodometric resistive platform. The countermovement jump and squat jump were measured using an inertial measurement unit. Nineteen subjects were included in the two groups: the active proprioceptive group (n = 10) or the control group (n = 9). The results show a more uniform redistribution of loads with pressure hindfoot relief in the experimental group compared to the control group (p = 0.021, RBC = 0.67). Moreover, we observed a significant increase in peak landing force and high concentric power development in the experimental group compared to the controls. Focused proprioceptive management provided hindfoot load attenuation by stimulating higher peaks of concentric force in the experimental group compared to the sham group. Even though the study included a small sample, the results obtained in this proof-of-principle study suggest a positive role of proprioceptive stimulation in the inter-seasonal scenario for volleyball players to improve their jump performance and reduce the micro-traumatisms of the heel fat pad and the ankle injury rate. However, further studies performed on larger samples are needed to confirm these preliminary results.
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Affiliation(s)
- Nicola Marotta
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Lucrezia Moggio
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Rehabilitation Unit, Ospedale degli Infermi, 13875 Biella, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy
| | - Emanuele Prestifilippo
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Riccardo Spanó
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Anna Tasselli
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Vera Drago Ferrante
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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Teng ZL, Yang XG, Geng X, Gu YJ, Huang R, Chen WM, Wang C, Chen L, Zhang C, Helili M, Huang JZ, Wang X, Ma X. Effect of loading history on material properties of human heel pad: an in-vivo pilot investigation during gait. BMC Musculoskelet Disord 2022; 23:254. [PMID: 35292004 PMCID: PMC8925218 DOI: 10.1186/s12891-022-05197-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was aimed to develop a novel dynamic measurement technique for testing the material properties and investigating the effect of continuous compression load on the structural and mechanical properties of human heel pad during actual gait. METHODS The dual fluoroscopic imaging system (DFIS) and dynamic foot-ground contact pressure-test plate were used for measuring the material properties, including primary thickness, peak strain, peak stress, elastic modulus, viscous modulus and energy dissipation rate (EDR), both at time zero and following continuous loading. Ten healthy pilot subjects, aged from 23 to 72 (average: 46.5 ± 17.6), were enrolled. A "three-step gait cycle" is performed for all subjects, with the second step striking at a marked position on the force plate with the heel to maintain the location of the tested foot to be in the view of fluoroscopes. The subjects were measured at both relaxed (time-zero group) and fatigue (continuous-loading group) statuses, and the left and right heels were measured using the identical procedures. RESULTS The peak strain, peak stress, elastic modulus, and EDR are similar before and after continuous load, while the viscous modulus was significantly decreased (median: 43.9 vs. 20.37 kPa•s; p < 0.001) as well as primary thicknesses (median: 15.99 vs. 15.72 mm; p < 0.001). Age is demonstrated to be moderately correlated with the primary thicknesses both at time zero (R = -0.507) and following continuous load (R = -0.607). The peak stress was significantly correlated with the elastic modulus before (R = 0.741) and after continuous load (R = 0.802). The peak strain was correlated with the elastic modulus before (R = -0.765) and after continuous load (R = -0.801). The correlations between the viscous modulus and peak stress/ peak strain are similar to above(R = 0.643, 0.577, - 0.586 and - 0.717 respectively). The viscous modulus is positively correlated with the elastic modulus before (R = 0.821) and after continuous load (R = 0.784). CONCLUSIONS By using dynamic fluoroscopy combined with the plantar pressure plate, the in vivo viscoelastic properties and other data of the heel pad in the actual gait can be obtained. Age was negatively correlated with the primary thickness of heel pad and peak strain, and was positively correlated with viscous modulus. Repetitive loading could decrease the primary thickness of heel pad and viscous modulus.
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Affiliation(s)
- Zhao-Lin Teng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xiong-Gang Yang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xiang Geng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Yan-Jie Gu
- Academy for Engineering & Technology, Fudan University, No.220 Handan Road, Shanghai, 200438, China
| | - Ran Huang
- Academy for Engineering & Technology, Fudan University, No.220 Handan Road, Shanghai, 200438, China
| | - Wen-Ming Chen
- Academy for Engineering & Technology, Fudan University, No.220 Handan Road, Shanghai, 200438, China
| | - Chen Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Li Chen
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Chao Zhang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Maimaitirexiati Helili
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jia-Zhang Huang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xu Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xin Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Middle Road, Shanghai, 200040, China.
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Yang XG, Teng ZL, Zhang ZM, Wang K, Huang R, Chen WM, Wang C, Chen L, Zhang C, Huang JZ, Wang X, Ma X, Geng X. Comparison of material properties of heel pad between adults with and without type 2 diabetes history: An in-vivo investigation during gait. Front Endocrinol (Lausanne) 2022; 13:894383. [PMID: 36060939 PMCID: PMC9428762 DOI: 10.3389/fendo.2022.894383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was aimed to compare the material properties of heel pad between diabetes patients and healthy adults, and investigate the impact of compressive loading history and length of diabetes course on the material properties of heel pad. METHODS The dual fluoroscopic imaging system (DFIS) and dynamic foot-ground contact pressure-test plate were used for measuring the material properties, including primary thickness, peak strain, peak stress, stiffness, viscous modulus and energy dissipation ratio (EDR), both at time zero and following continuous loading. Material properties between healthy adults and DM patients were compared both at time zero and following continuous weight bearing. After then, comparison between time-zero material properties and properties following continuous loading was performed to identify the loading history-dependent biomechanical behaviour of heel pad. Subgroup-based sensitivity analysis was then conducted to investigate the diabetes course (<10 years vs. ≥10 years) on the material properties of heel pad. RESULTS Ten type II DM subjects (20 legs), aged from 59 to 73 (average: 67.8 ± 4.9), and 10 age-matched healthy adults (20 legs), aged from 59 to 72 (average: 64.4 ± 3.4), were enrolled. Diabetes history was demonstrated to be associated with significantly lower primary thickness (t=3.18, p=0.003**), higher peak strain (t=2.41, p=0.021*), lower stiffness (w=283, p=0.024*) and lower viscous modulus (w=331, p<0.001***) at time zero, and significantly lower primary thickness (t=3.30, p=0.002**), higher peak strain (w=120, p=0.031*) and lower viscous modulus (t=3.42, p=0.002**) following continuous loading. The continuous loading was found to be associated with significantly lower primary thickness (paired-w=204, p<0.001***) and viscous modulus (paired-t=5.45, p<0.001***) in healthy adults, and significantly lower primary thickness (paired-w=206, p<0.001***) and viscous modulus (paired-t=7.47, p<0.001***) in diabetes group. No any significant difference was found when conducting the subgroup analysis based on length of diabetes course (<10 years vs. ≥10 years), but the regression analysis showed that the length of diabetes history was positively associated with the peak strain, at time zero (r=0.506, p<0.050) and following continuous loading (r=0.584, p<0.010). CONCLUSIONS Diabetes patients were found to be associated with decreased primary thickness and viscous modulus, and increased peak strain, which may contribute to the vulnerability of heel pad to injury and ulceration. Pre-compression history-dependent behaviour is observable in soft tissue of heel pad, with lowered primary thickness and viscous modulus.
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Affiliation(s)
- Xiong-gang Yang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhao-lin Teng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhen-ming Zhang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Kan Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ran Huang
- Academy for Engineering & Technology, Fudan University, Shanghai, China
| | - Wen-ming Chen
- Academy for Engineering & Technology, Fudan University, Shanghai, China
| | - Chen Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Chen
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Zhang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia-zhang Huang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Ma
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiang Geng, ; Xin Ma,
| | - Xiang Geng
- Department of Orthopedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiang Geng, ; Xin Ma,
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Biomechanical Gain in Joint Excursion from the Curvature of the Achilles Tendon: Role of the Geometrical Arrangement of Inflection Point, Center of Rotation, and Calcaneus. Diagnostics (Basel) 2021; 11:diagnostics11112097. [PMID: 34829443 PMCID: PMC8618986 DOI: 10.3390/diagnostics11112097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
The dorsal movement of the Achilles tendon during ankle rotation is restricted by anatomical obstructions. Previously, we demonstrated that the anatomical obstruction provides a gain (gainAT) in the proximal displacement of the calcaneus compared to the change in the Achilles tendon length. Here, we empirically validate and extend our previous modeling study by investigating the effects of a broad range of obstruction locations on gainAT. The largest gainAT could be achieved when the obstruction was located on the most ventral and distal sides within the physiological range of the Achilles tendon, irrespective of the ankle position.
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Gales DJ, Winter SL, Challis JH. The influence of heel pad confinement on heel pad mechanical properties. FOOTWEAR SCIENCE 2021. [DOI: 10.1080/19424280.2021.1950215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dan J. Gales
- Department of Health Sciences, Lock Haven University, PA, USA
| | - Samantha L. Winter
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - John H. Challis
- Biomechanics Laboratory, Pennsylvania State University, University Park, PA, USA
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Sussman WI, Park DJ, Rucci PM, Chen YH. Subluxing fractured plantar fat pad: a case series and description of novel sonographic findings. Skeletal Radiol 2021; 50:1241-1247. [PMID: 33135090 DOI: 10.1007/s00256-020-03639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
Plantar fat pad syndrome has received little attention in the literature. A variety of structural changes of the plantar fat pad have been described in the literature, including atrophy, contusion, and fractured fat pad. This case series presents 4 patients (5 heels) with subluxation of a fractured plantar fat pad on dynamic ultrasound. Patients with subluxing fractured fat pad typically present with heel pain and a "snapping" or "popping" sensation when weight-bearing. Other causes of heel pain were excluded, and all patients in this series had an MRI that initially did not report any findings in the fat pad. Retrospective review of the MRI showed evidence of diffuse low T1 and T2 infiltration. To the authors' knowledge, subluxation of the plantar fat pad and the respective correlation to MRI findings have not been described in the literature. Here we describe the sonographic findings of this novel condition.
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Affiliation(s)
- Walter I Sussman
- Department of Physical Medicine & Rehabilitation, Tufts University School of Medicine, 800 Washington St, Box 400, Boston, MA, 02111, USA. .,Private Practice N, Easton, MA, USA.
| | - David J Park
- Physical Medicine & Rehabilitation Resident, Tufts Medical Center, Boston, MA, USA
| | | | - Yung H Chen
- Department of Radiology, Tufts University, Boston, MA, USA
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The relationship of heel fat pad thickness with age and physiques in Japanese. Clin Biomech (Bristol, Avon) 2020; 80:105110. [PMID: 32745706 DOI: 10.1016/j.clinbiomech.2020.105110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In understanding the onset factors associated with Plantar heel pain and the structure of heel fat pad, measuring its thickness is the most basic frequently reported evaluation. This study aimed to determine changes to heel fat pad thickness associated with age and gender and the relationship between heel fat pad thickness, age, and physique in Japanese. METHODS This study was carried out in 1126 healthy individuals between the ages of 1 and 96 years. Participants were categorized according to age. Heel fat pad thickness was measured with an ultrasonography device using a linear ultrasonography probe. FINDINGS Heel fat pad tends to become thicker from ages 1-5 to 30-44 years and thinner from ages 30-44 to 80-96 years. Heel fat pad thickness in males and females was similar within each group, and males had higher heel fat pad thickness than females of corresponding ages. Heel fat pad thickness of males had a good correlation with height and body mass. Moreover, male heel fat pad thickness had a fair correlation with age. Heel fat pad thickness of females had a moderate correlation with height and body mass and a fair correlation with age. INTERPRETATION Heel fat pad thickness became thicker from ages 1-5 to 30-44 years and thinner from ages 30-44 to 80-96 years. Females had a lower heel fat pad thickness than males of corresponding ages. This result suggests that higher heel fat pad thickness in males is related to body mass and height.
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Ugbolue UC, Yates EL, Rowland KE, Wearing SC, Gu Y, Lam WK, Baker JS, Sculthorpe NF, Dutheil F. A novel simplified biomechanical assessment of the heel pad during foot plantarflexion. Proc Inst Mech Eng H 2020; 235:197-207. [PMID: 33148117 DOI: 10.1177/0954411920971069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The heel pad (HP) which is located below the calcaneus comprises a composition of morphometrical and morphological arrangements of soft tissues that are influenced by factors such as gender, age and obesity. It is well known that HP pain and Achilles tendonitis consist of discomfort, pain and swelling symptoms that usually develop from excessive physical activities such as walking, jumping and running. The purpose of this study was to develop biomechanical techniques to evaluate the function and characteristics of the HP. Ten healthy participants (five males and five females) participated in this laboratory-based study, each performing a two-footed heel raise to mimic the toe-off phase during human locomotion. Twenty-six (3 mm) retroreflective markers were attached to the left and right heels (thirteen markers on each heel). Kinematic data was captured using three-dimensional motion analysis cameras synchronised with force plates. Descriptive and multivariate statistical tests were used in this study. In addition, a biomechanical technique that utilises only six markers from 26 markers to assess HP deformation and function has been developed and used in this study. Overall HP displacement was significantly higher in males on the most lateral part of the right heel (p < 0.05). No significant differences were evident when comparing the non-dominant and dominant heels during the baseline, unloading and loading phases (p > 0.05). Findings from this study suggested that biomechanical outputs expressed as derivatives from tracked HP marker movements can morphologically and morphometrically characterise HP soft tissue deformation changes. The outcome of this study highlights the importance of 3D motion analysis being used as a potential prospective intervention to quantify the function / characteristics of the heel pad soft tissues.
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Affiliation(s)
- Ukadike C Ugbolue
- Faculty of Sports Science, Ningbo University, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK.,Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Emma L Yates
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK
| | - Keir E Rowland
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK
| | - Scott C Wearing
- Faculty of Health, School - Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, China
| | - Wing-Kai Lam
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd, Beijing, China.,Department of Kinesiology, Shenyang Sports University, Shenyang, China
| | - Julien S Baker
- Faculty of Sports Science, Ningbo University, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK.,Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Nicholas F Sculthorpe
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France.,Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia
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11
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Darling JD, O'Donnell TFX, Vu GH, Norman AV, St John E, Stangenberg L, Wyers MC, Hamdan AD, Schermerhorn ML. Wound location is independently associated with adverse outcomes following first-time revascularization for tissue loss. J Vasc Surg 2020; 73:1320-1331. [PMID: 32866559 DOI: 10.1016/j.jvs.2020.07.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Few studies adequately evaluate the impact of wound location on patient outcomes after lower extremity revascularization. Consequently, we evaluated the relationship between lower extremity wound location and long-term outcomes. METHODS We reviewed all patients at our institution undergoing any first-time open surgical bypass or percutaneous transluminal angioplasty with or without stenting for tissue loss between 2005 and 2014. We categorized wounds into three distinct groups: forefoot (ie, toes and metatarsal heads), midfoot (ie, dorsal, plantar, lateral, medial surfaces excluding toes, metatarsal heads, or heel), and heel. Limbs with multiple wounds were excluded from analyses. We compared rates of perioperative complications, wound healing, reintervention, limb salvage, amputation-free survival, and survival using χ2, Kaplan-Meier, and Cox regression analyses. RESULTS Of 2869 infrainguinal revascularizations from 2005 to 2014, 1126 underwent a first-time revascularization for tissue loss, of which 253 patients had multiple wounds, 197 had wounds proximal to the ankle, 100 had unreliable wound information, and 576 (forefoot, n = 397; midfoot, n = 61; heel, n = 118) fit our criteria and had a single foot wound with reliable information regarding wound specifics. Patients with forefoot, midfoot, and heel wounds had similar rates of coronary artery disease, hypertension, diabetes, and smoking history (all P > .05). Conversely, there were significant differences in patient age (71 vs 69 vs 70 years), prevalence of gangrene (41% vs 5% vs 21%), and dialysis dependence (18% vs 17% vs 30%) (all P < .05). There were no statistically significant differences in perioperative mortality (1.3% vs 4.9% vs 4.2%; P = .06) or postoperative complications among the three groups. Between forefoot, midfoot, and heel wounds, there were significant differences in unadjusted 6-month rates of complete wound healing (69% vs 64% vs 53%), 3-year rates of amputation-free survival (54% vs 57% vs 35%), and survival (61% vs 72% vs 41%) (all P < .05). After adjustment, compared with forefoot wounds, heel wounds were associated with higher rates of incomplete 6-month wound healing (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.1-2.]), major amputation or mortality (HR, 1.7; 95% CI, 1.1-2.7), and all-cause mortality (HR, 1.8; 95% CI, 1.1-3.0), but not major amputation alone (HR, 2.1; 95% CI, 0.9-4.5). In open surgical bypass-first patients, heel wounds were solely associated with an increased risk of all-cause mortality (HR, 1.7; 95% CI, 1.1-2.8), whereas heel wounds in percutaneous transluminal angioplasty-first patients were associated with an increased risk of incomplete wound healing (HR, 2.2; 95% CI, 1.3-3.7), major amputation or mortality (HR, 2.3; 95% CI, 1.1-5.4), and all-cause mortality (HR, 2.8; 95% CI, 1.1-7.2). CONCLUSIONS Heel wounds confer considerably higher short- and long-term morbidity and mortality compared with midfoot or forefoot wounds in patients undergoing any first-time lower extremity revascularization.
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Affiliation(s)
- Jeremy D Darling
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Tufts University School of Medicine, Boston, Mass
| | - Thomas F X O'Donnell
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Giap H Vu
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | | | - Lars Stangenberg
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Mark C Wyers
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Allen D Hamdan
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
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12
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Ugbolue UC, Yates EL, Wearing SC, Gu Y, Lam WK, Valentin S, Baker JS, Dutheil F, Sculthorpe NF. Sex differences in heel pad stiffness during in vivo loading and unloading. J Anat 2020; 237:520-528. [PMID: 33448360 PMCID: PMC7476210 DOI: 10.1111/joa.13207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022] Open
Abstract
Due to conflicting data from previous studies a new methodological approach to evaluate heel pad stiffness and soft tissue deformation has been developed. The purpose of this study was to compare heel pad (HP) stiffness in both limbs between males and females during a dynamic unloading and loading activity. Ten males and 10 females volunteered to perform three dynamic trials to unload and load the HP. The dynamic protocol consisted of three continuous phases: foot flat (baseline phase), bilateral heel raise (unloading phase) and foot flat (loading phase) with each phase lasting two seconds. Six retroreflective markers (3 mm) were attached to the skin of the left and right heels using a customised marker set. Three‐dimensional motion analysis cameras synchronised with force plates collected the kinematic and kinetic data throughout the trials. Three‐way repeated measures ANOVA together with a Bonferroni post hoc test were applied to the stiffness and marker displacement datasets. On average, HP stiffness was higher in males than females during the loading and unloading phases. ANOVA results revealed no significant differences for the stiffness and displacement outputs with respect to sex, sidedness or phase interactions (p > .05) in the X, Y and Z directions. Irrespective of direction, there were significant differences in stiffness between the baseline and unloading conditions (p < .001) but no significant differences between the baseline and loaded conditions (p = 1.000). Post hoc analyses for the marker displacement showed significant differences between phases for the X and Z directions (p < .032) but no significant differences in the Y direction (p > .116). Finally, females portrayed lower levels of mean HP stiffness whereas males had stiffer heels particularly in the vertical direction (Z) when the HP was both unloaded and loaded. High HP stiffness values and very small marker displacements could be valuable indicators for the risk of pathological foot conditions.
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Affiliation(s)
- Ukadike C Ugbolue
- Faculty of Sports Science, Ningbo University, Ningbo, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK.,Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Emma L Yates
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK
| | - Scott C Wearing
- Faculty of Health, School - Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Wing-Kai Lam
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd, Beijing, China.,Department of Kinesiology, Shenyang Sports Institute, Shenyang, China
| | - Stephanie Valentin
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK
| | - Julien S Baker
- Faculty of Sports Science, Ningbo University, Ningbo, China.,School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK.,Department of Sport, Physical Education and Health, Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France.,Faculty of Health, School of Exercise Science, Australian Catholic University, Melbourne, Vic., Australia
| | - Nicholas F Sculthorpe
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow, UK
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Bai WY, Wang L, Ying ZM, Hu B, Xu L, Zhang GQ, Cong PK, Zhu X, Zou W, Zheng HF. Identification of PIEZO1 polymorphisms for human bone mineral density. Bone 2020; 133:115247. [PMID: 31968281 DOI: 10.1016/j.bone.2020.115247] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/26/2022]
Abstract
Bone mineral density (BMD) is a key indicator for diagnosis and treatment for osteoporosis; the reduction of BMD could increase the risk of osteoporotic fracture. It was very recently found that Piezo1 mediated mechanically evoked responses in bone and further participated in bone formation in mice. Here, we performed cross phenotype meta-analysis for human BMD at lumbar spine (LS), femoral neck (FN), distal radius/forearm (FA) and heel and screened out 14 top SNPs for PIEZO1, these SNPs were overlapped with putative enhancers, DNase-I hypersensitive sites and active promoter flanking regions. We found that the signal of the best SNP rs62048221 was mainly from heel ultrasound estimated BMD (-0.02 SD per T allele, P = 8.50E-09), where calcaneus supported most of the mechanical force of body when standing, walking and doing physical exercises. Each copy of the effect allele T of SNP rs62048221 was associated with a decrease of 0.0035 g/cm2 BMD (P = 4.6E-27, SE = 0.0003) in UK Biobank data within 477,760 samples. SNP rs62048221 was located at the enhancer region (HEDD enhancer ID 2331049) of gene PIEZO1, site-directed ChIP assays in human mesenchymal stem cells (hMSCs) showed significant enrichment of H3K4me1 and H3K27ac in this region, luciferase assays showed that rs62048221 could significantly affect the activity of the enhancer where it resides. Our results first suggested that SNP rs62048221 might mediate the PIEZO1 expression level via modulating the activity of cis-regulatory elements and then further affect the BMD.
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Affiliation(s)
- Wei-Yang Bai
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou 310024, China; Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou 310024, China
| | - Lijun Wang
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Sciences, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Zhi-Min Ying
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Bin Hu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Lin Xu
- Department of Orthopedics, The Affiliated Yantai Hospital of Binzhou Medical University, Yantai 264000, China
| | - Guo-Qing Zhang
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou 310024, China; Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou 310024, China
| | - Pei-Kuan Cong
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou 310024, China; Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou 310024, China
| | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Weiguo Zou
- State Key Laboratory of Cell Biology, CAS Center for Excellence in Molecular Cell Sciences, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China.
| | - Hou-Feng Zheng
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou 310024, China; Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou 310024, China.
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Hajizadeh M, Desmyttere G, Carmona JP, Bleau J, Begon M. Can foot orthoses impose different gait features based on geometrical design in healthy subjects? A systematic review and meta-analysis. Foot (Edinb) 2020; 42:101646. [PMID: 32045719 DOI: 10.1016/j.foot.2019.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Foot orthoses (FOs) are popular treatment to alleviate several abnormalities of lower extremity. FO designs might alter lower extremity biomechanics differently, but the association is not yet known. This review aimed to evaluate how different FO designs, namely FO with medial posting, lateral posting, arch support, or arch & heel support, change lower limb kinematics and kinetics during walking. LITERATURE SURVEY Electronic database search were conducted from inception to March 2019, and 25 papers passed the inclusion criteria. Two independent reviewers checked the quality using a modified Downs and Black checklist (73.7±5.5%) and a biomechanical quality checklist (71.4±17.1%). Effect sizes for differences between with- and without- FO walking were calculated, and meta-analysis was performed whenever at least two studies reported the same variable. RESULTS Medial posting reduced peak ankle eversion moment. Lateral posting brought about higher peak ankle dorsiflexion and peak ankle eversion for kinematics, as well as higher peak ankle abduction moment, lower peak knee adduction moment, and higher peak mediolateral ground reaction force (GRF) for kinetics. FOs with either arch support or arch & heel support tended to decrease vertical ground reaction force, but it was not significant. CONCLUSION The findings of this review reveal that medial or lateral posting work efficiently to change foot and knee kinematics and kinetics. However, the impact force is just slightly decreased by arch-supported and heel supported FOs. Due to the small number of available studies, and heterogeneity in meta-analysis findings, further research with more standardized biomechanical approach are required.
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Affiliation(s)
- Maryam Hajizadeh
- Laboratoire de Simulation et Modélisation du Mouvement, Institut Génie Biomédical, Faculté de médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada.
| | - Gauthier Desmyttere
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada
| | | | - Jacinte Bleau
- Laboratoire Orthopédique Médicus, 5135 10(e) avenue, Montréal, QC H1Y 2G5, Canada
| | - Mickael Begon
- Laboratoire de Simulation et Modélisation du Mouvement, Institut Génie Biomédical, Faculté de médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada; Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada
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15
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Wu CH, Lin CY, Hsiao MY, Cheng YH, Chen WS, Wang TG. Altered stiffness of microchamber and macrochamber layers in the aged heel pad: Shear wave ultrasound elastography evaluation. J Formos Med Assoc 2018; 117:434-439. [DOI: 10.1016/j.jfma.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/28/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022] Open
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Suzuki R, Ito K, Lee T, Ogihara N. In-vivo viscous properties of the heel pad by stress-relaxation experiment based on a spherical indentation. Med Eng Phys 2017; 50:83-88. [PMID: 29079047 DOI: 10.1016/j.medengphy.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
Identifying the viscous properties of the plantar soft tissue is crucial not only for understanding the dynamic interaction of the foot with the ground during locomotion, but also for development of improved footwear products and therapeutic footwear interventions. In the present study, the viscous and hyperelastic material properties of the plantar soft tissue were experimentally identified using a spherical indentation test and an analytical contact model of the spherical indentation test. Force-relaxation curves of the heel pads were obtained from the indentation experiment. The curves were fit to the contact model incorporating a five-element Maxwell model to identify the viscous material parameters. The finite element method with the experimentally identified viscoelastic parameters could successfully reproduce the measured force-relaxation curves, indicating the material parameters were correctly estimated using the proposed method. Although there are some methodological limitations, the proposed framework to identify the viscous material properties may facilitate the development of subject-specific finite element modeling of the foot and other biological materials.
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Affiliation(s)
- Ryo Suzuki
- Department of Mechanical Engineering, Keio University, Yokohama, Japan
| | - Kohta Ito
- Department of Mechanical Engineering, Keio University, Yokohama, Japan
| | - Taeyong Lee
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, South Korea
| | - Naomichi Ogihara
- Department of Mechanical Engineering, Keio University, Yokohama, Japan.
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17
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Investigation of the optimum heel pad stiffness: a modeling study. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:585-593. [DOI: 10.1007/s13246-017-0565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
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18
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Material properties of the heel fat pad across strain rates. J Mech Behav Biomed Mater 2016; 65:398-407. [PMID: 27643676 PMCID: PMC5161234 DOI: 10.1016/j.jmbbm.2016.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/24/2016] [Accepted: 09/01/2016] [Indexed: 11/21/2022]
Abstract
The complex structural and material behaviour of the human heel fat pad determines the transmission of plantar loading to the lower limb across a wide range of loading scenarios; from locomotion to injurious incidents. The aim of this study was to quantify the hyper-viscoelastic material properties of the human heel fat pad across strains and strain rates. An inverse finite element (FE) optimisation algorithm was developed and used, in conjunction with quasi-static and dynamic tests performed to five cadaveric heel specimens, to derive specimen-specific and mean hyper-viscoelastic material models able to predict accurately the response of the tissue at compressive loading of strain rates up to 150 s−1. The mean behaviour was expressed by the quasi-linear viscoelastic (QLV) material formulation, combining the Yeoh material model (C10=0.1MPa, C30=7MPa, K=2GPa) and Prony׳s terms (A1=0.06, A2=0.77, A3=0.02 for τ1=1ms, τ2=10ms, τ3=10s). These new data help to understand better the functional anatomy and pathophysiology of the foot and ankle, develop biomimetic materials for tissue reconstruction, design of shoe, insole, and foot and ankle orthoses, and improve the predictive ability of computational models of the foot and ankle used to simulate daily activities or predict injuries at high rate injurious incidents such as road traffic accidents and underbody blast.
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19
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Molligan J, Mitchell R, Bhasin P, Lakhani A, Schon L, Zhang Z. Implantation of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells in Foot Fat Pad in Rats. Foot Ankle Int 2015; 36:1344-51. [PMID: 26085579 DOI: 10.1177/1071100715591092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The foot fat pad (FFP) bears body weight and may become a source of foot pain during aging. This study investigated the regenerative effects of autologous adipose tissue-derived mesenchymal stem cells (AT-MSCs) in the FFP of rats. METHODS Fat tissue was harvested from a total of 30 male Sprague-Dawley rats for isolation of AT-MSCs. The cells were cultured, adipogenic differentiation was induced for 1 week, and the AT-MSCs were labeled with fluorescent dye before injection. AT-MSCs (5 × 10(4) in 50 µL of saline) were injected into the second infradigital pad in the right hindfoot of the rat of origin. Saline only (50 µL) was injected into the corresponding fat pad in the left hind paw of each rat. Rats (n = 10) were euthanized at 1, 2, and 3 weeks, and the second infradigital fat pads were dissected for histologic examination. RESULTS The fluorescence-labeled AT-MSCs were present in the foot pads throughout the 3-week experimental period. On histologic testing, the area of fat pad units (FPUs) in the fat pads that received AT-MSC injections was greater than that in the control fat pads. Although the thickness of septae was not changed by AT-MSC injections, the density of elastic fibers in the septae was increased in the fat pads with implanted AT-MSCs. CONCLUSION In this short-term study, the implanted AT-MSCs largely survived and might have stimulated the expansion of individual FPUs and increased the density of elastic fibers in the FFP in this rat model. CLINICAL RELEVANCE These data support the development of stem cell therapies for age-associated degeneration in FFP in humans.
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Affiliation(s)
- Jeremy Molligan
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Reed Mitchell
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Priya Bhasin
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Aliya Lakhani
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lew Schon
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Zijun Zhang
- Orthobiologic Laboratory, MedStar Union Memorial Hospital, Baltimore, MD, USA
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20
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Bosanquet DC, Wright AM, White RD, Williams IM. A review of the surgical management of heel pressure ulcers in the 21st century. Int Wound J 2015; 13:9-16. [PMID: 25683573 DOI: 10.1111/iwj.12416] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/09/2014] [Indexed: 12/11/2022] Open
Abstract
Heel ulceration, most frequently the result of prolonged pressure because of patient immobility, can range from the trivial to the life threatening. Whilst the vast majority of heel pressure ulcers (PUs) are superficial and involve the skin (stages I and II) or underlying fat (stage III), between 10% and 20% will involve deeper tissues, either muscle, tendon or bone (stage IV). These stage IV heel PUs represent a major health and economic burden and can be difficult to treat. The worst outcomes are seen in those with large ulcers, compromised peripheral arterial supply, osteomyelitis and associated comorbidities. Whilst the mainstay of management of stage I-III heel pressure ulceration centres on offloading and appropriate wound care, successful healing in stage IV PUs is often only possible with surgical intervention. Such intervention includes simple debridement, partial or total calcanectomy, arterial revascularisation in the context of coexisting peripheral vascular disease or using free tissue flaps. Amputation may be required for failed surgical intervention, or as a definitive first-line procedure in certain high-risk or poor prognosis patient groups. This review provides an overview of heel PUs, alongside a comprehensive literature review detailing the surgical interventions available when managing such patients.
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Affiliation(s)
| | - Ann M Wright
- Department of Surgery, Royal Gwent Hospital, Newport, UK
| | - Richard D White
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
| | - Ian M Williams
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
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WEARING SCOTTC, HOOPER SUEL, DUBOIS PHILIP, SMEATHERS JAMESE, DIETZE ALBRECHT. Force–Deformation Properties of the Human Heel Pad during Barefoot Walking. Med Sci Sports Exerc 2014; 46:1588-94. [DOI: 10.1249/mss.0000000000000281] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Molligan J, Schon L, Zhang Z. A stereologic study of the plantar fat pad in young and aged rats. J Anat 2013; 223:537-45. [PMID: 24033117 DOI: 10.1111/joa.12104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2013] [Indexed: 01/16/2023] Open
Abstract
Plantar fat pad (PFP) is a tissue structure that absorbs the initial impact of walking and running and ultimately bears body weight at standing. This study was designed to quantify the histomorphological changes of the PFP in aged rats. The most medial PFP was dissected from the hind feet of young rats (4 months old, n = 6) and aged rats (24 months old, n = 6). Histological structure and cellular senescence of PFP were analyzed stereologically and histomorphometrically. Immunohistochemistry of matrix metalloproteinase 9 (MMP9) was also performed on PFP tissue sections. Compared with young rats, the thickness of epidermis, dermis and septa of the PFP were significantly reduced in the aged rats. The total volume of adipose tissue in the PFP of aged rats was only about 65% of that in the young rats. The microvascular density and the number of fat pad units (FPU), a cluster of adipocytes enclosed by elastin septa, in the PFP were unchanged in the aged rats. In the aged rats, the number of adipocytes per FPU was reduced but the number of simple adipocyte clusters, without surrounding septa, was increased. The shift of the types of adipocyte clusters in the aged PFP was accompanied by degradation of elastin fibers and increased expression of MMP9. In conclusion, the PFP, particularly the elastic septa, degenerates significantly in aged rats and this may contribute to the pathology of PFP-related diseases.
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Affiliation(s)
- Jeremy Molligan
- Orthobiologic Laboratory, Medstar Union Memorial Hospital, Baltimore, MD, USA
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Age-related increase in electromyography burst activity in males and females. J Aging Res 2013; 2013:720246. [PMID: 23984069 PMCID: PMC3747463 DOI: 10.1155/2013/720246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 07/10/2013] [Indexed: 12/03/2022] Open
Abstract
The rapid advancement of electromyography (EMG) technology facilitates measurement of muscle activity outside the laboratory during daily life. The purpose of this study was to determine whether bursts in EMG recorded over a typical 8-hour day differed between young and old males and females. Muscle activity was recorded from biceps brachii, triceps brachii, vastus lateralis, and biceps femoris of 16 young and 15 old adults using portable surface EMG. Old muscles were active 16–27% of the time compared to 5–9% in young muscles. The number of bursts was greater in old than young adults and in females compared to males. Burst percentage and mean amplitude were greater in the flexor muscles compared with the extensor muscles. The greater burst activity in old adults coupled with the unique activity patterns across muscles in males and females provides further understanding of how changes in neuromuscular activity effects age-related functional decline between the sexes.
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Matteoli S, Fontanella CG, Carniel EL, Wilhjelm JE, Virga A, Corbin N, Corvi A, Natali AN. Investigations on the viscoelastic behaviour of a human healthy heel pad: In vivo compression tests and numerical analysis. Proc Inst Mech Eng H 2012; 227:334-42. [DOI: 10.1177/0954411912465061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the viscoelastic behaviour of the human heel pad by comparing the stress–relaxation curves obtained from a compression device used on an in vivo heel pad with those obtained from a three-dimensional computer-based subject-specific heel pad model subjected to external compression. The three-dimensional model was based on the anatomy revealed by magnetic resonance imaging of a 31-year-old healthy female. The calcaneal fat pad tissue was described with a viscohyperelastic model, while a fibre-reinforced hyperelastic model was formulated for the skin. All numerical analyses were performed to interpret the mechanical response of heel tissues, with loading conditions and displacement rate in agreement with experimental tests. The heel tissues showed a non-linear, viscoelastic behaviour described by characteristic hysteretic curves, stress–relaxation and viscous recovery phenomena. The reliability of the investigations was validated by the interpretation of the mechanical response of heel tissues under the application of three pistons with diameter of 15, 20 and 40 mm, at the same displacement rate of about 1.7 mm/s. The maximum and minimum relative errors were found to be less than 0.95 and 0.064, respectively.
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Affiliation(s)
- Sara Matteoli
- Department of Mechanics and Industrial Technologies, University of Florence, Florence, Italy
- Biomedical Engineering Group, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Chiara G Fontanella
- Centre of Mechanics of Biological Materials, Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Emanuele L Carniel
- Centre of Mechanics of Biological Materials, Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Jens E Wilhjelm
- Biomedical Engineering Group, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Antonio Virga
- Department of Mechanics and Industrial Technologies, University of Florence, Florence, Italy
| | - Nadège Corbin
- Biomedical Engineering Group, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Andrea Corvi
- Department of Mechanics and Industrial Technologies, University of Florence, Florence, Italy
- Fondation “In cammino…”, Fucecchio, Florence, Italy
| | - Arturo N Natali
- Centre of Mechanics of Biological Materials, Department of Industrial Engineering, University of Padua, Padua, Italy
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Chokhandre S, Halloran JP, van den Bogert AJ, Erdemir A. A three-dimensional inverse finite element analysis of the heel pad. J Biomech Eng 2012; 134:031002. [PMID: 22482682 DOI: 10.1115/1.4005692] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quantification of plantar tissue behavior of the heel pad is essential in developing computational models for predictive analysis of preventive treatment options such as footwear for patients with diabetes. Simulation based studies in the past have generally adopted heel pad properties from the literature, in return using heel-specific geometry with material properties of a different heel. In exceptional cases, patient-specific material characterization was performed with simplified two-dimensional models, without further evaluation of a heel-specific response under different loading conditions. The aim of this study was to conduct an inverse finite element analysis of the heel in order to calculate heel-specific material properties in situ. Multidimensional experimental data available from a previous cadaver study by Erdemir et al. ("An Elaborate Data Set Characterizing the Mechanical Response of the Foot," ASME J. Biomech. Eng., 131(9), pp. 094502) was used for model development, optimization, and evaluation of material properties. A specimen-specific three-dimensional finite element representation was developed. Heel pad material properties were determined using inverse finite element analysis by fitting the model behavior to the experimental data. Compression dominant loading, applied using a spherical indenter, was used for optimization of the material properties. The optimized material properties were evaluated through simulations representative of a combined loading scenario (compression and anterior-posterior shear) with a spherical indenter and also of a compression dominant loading applied using an elevated platform. Optimized heel pad material coefficients were 0.001084 MPa (μ), 9.780 (α) (with an effective Poisson's ratio (ν) of 0.475), for a first-order nearly incompressible Ogden material model. The model predicted structural response of the heel pad was in good agreement for both the optimization (<1.05% maximum tool force, 0.9% maximum tool displacement) and validation cases (6.5% maximum tool force, 15% maximum tool displacement). The inverse analysis successfully predicted the material properties for the given specimen-specific heel pad using the experimental data for the specimen. The modeling framework and results can be used for accurate predictions of the three-dimensional interaction of the heel pad with its surroundings.
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Affiliation(s)
- Snehal Chokhandre
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
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Abstract
Impact loading during walking has been associated with overuse related musculoskeletal disorders, such as osteoarthritis. This study was designed to determine the effect of two shoe insole designs on impact-related loading during walking. In total, 22 healthy adults walked along a 10-m walkway in three different insole conditions: (i) no insole; (ii) flat material insole; (iii) heel-cup insole. Impact forces at the ground were determined and estimated at the knee in a subset of participants (n = 14). Repeated measures ANOVA revealed a significant reduction in peak vertical ground reaction force (vGRF) with the flat material insole compared with the no insole and heel-cup conditions (p = 0.001). No differences between conditions were observed in vGRF loading rate (p > 0.05). Peak impact force at the knee was reduced with flat material insoles and heel-cup insoles (p < 0.05). These data indicate that reductions in impact forces during walking are dependent upon insole design. STATEMENT OF RELEVANCE: This study provides new evidence that impact loads are reduced with shoe insoles during walking. High impact loads are implicated in the development and progression of knee pathologies, including osteoarthritis. Thus, these findings indicate that insole use may be beneficial for various musculoskeletal disorders, including key public health problems such as osteoarthritis.
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Affiliation(s)
- Mark W Creaby
- Centre for Health, Exercise and Sports Medicine, Melbourne Physiotherapy School, University of Melbourne, Victoria, Australia.
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Bonanno DR, Landorf KB, Menz HB. Pressure-relieving properties of various shoe inserts in older people with plantar heel pain. Gait Posture 2011; 33:385-9. [PMID: 21256025 DOI: 10.1016/j.gaitpost.2010.12.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 12/02/2010] [Accepted: 12/09/2010] [Indexed: 02/02/2023]
Abstract
Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain. Thirty-six adults aged over 65 years with plantar heel pain participated in the study. Using the in-shoe Pedar(®) system, plantar pressure data were recorded while participants walked along an 8 m walkway wearing a standardised shoe and 4 different shoe inserts. The shoe inserts consisted of a silicon heel cup, a soft foam heel pad, a heel lift and a prefabricated foot orthosis. Data were collected for the heel, midfoot and forefoot. Statistically significant attenuation of heel peak plantar pressure was provided by 3 of the 4 shoe inserts. The greatest reduction was achieved by the prefabricated foot orthosis, which provided a fivefold reduction compared to the next most effective insert. The contoured nature of the prefabricated foot orthosis allowed for an increase in midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure. The findings from this study indicate that of the shoe inserts tested, the contoured prefabricated foot orthosis is the most effective at reducing pressure under the heel in older people with heel pain.
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Affiliation(s)
- Daniel R Bonanno
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, Vic 3086, Australia.
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Natali A, Fontanella C, Carniel E. Constitutive formulation and analysis of heel pad tissues mechanics. Med Eng Phys 2010; 32:516-22. [DOI: 10.1016/j.medengphy.2010.02.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 02/11/2010] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
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Abstract
There remains much confusion regarding the pathophysiology of pressure ulcers. Data indicate that the prevalence of pressure ulcers is increasing. The heel is unique in structure and well adapted to the task of shock absorption. However, it is often subject to prolonged pressure, which predisposes it to tissue breakdown, with attempts at reconstruction prone to failure. Four dissections were carried out of the heel region, which included removing each heel pad en bloc for histology. Seventeen arterial injection studies, 12 venous studies, and a combined arterial and venous study of the foot were performed. The results were correlated with clinical cases and previous research. The heel was found to be richly vascularized by a subdermal plexus and periosteal plexus with vessels traveling between the 2 within fibrous septa that connect the reticular dermis and periosteum of the calcaneus. These septa effectively create isolated compartments containing relatively avascular fat. A layer of panniculus carnosus muscle was observed in the subcutaneous tissue. It is likely that the metabolically active panniculus carnosus muscle is involved early in the course of pressure ulcers. Extensive pressure damage can be concealed by intact skin. Friction and shear are additional factors important in skin breakdown.
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Liikavainio T, Bragge T, Hakkarainen M, Jurvelin JS, Karjalainen PA, Arokoski JP. Reproducibility of Loading Measurements With Skin-Mounted Accelerometers During Walking. Arch Phys Med Rehabil 2007; 88:907-15. [PMID: 17601473 DOI: 10.1016/j.apmr.2007.03.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine reproducibility of load measurements with skin-mounted accelerometers (SMAs) during walking. DESIGN Reliability study. SETTING A motion analysis laboratory. PARTICIPANTS Ten healthy young men. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Two triaxial accelerometers were fixed to the subjects' skin above and below the knee joint. The subjects walked barefoot at their preferred speed and at a constant speed (1.3m/s, +/-5%) in a gait laboratory and along a corridor. The same protocol was repeated over 2 days. Initial peak acceleration (IPA), peak-to-peak (PP) acceleration, and maximal and average acceleration transient rates (ATRs) were calculated. The coefficient of variation (CV) and Pearson linear correlation coefficient were calculated to measure reproducibility of SMA load measurements. RESULTS IPA and PP acceleration had good interday repeatability (CV <15%). The repeatability of average ATR and maximal ATR parameters was generally not acceptable. The loading variables obtained from ground reaction forces and SMA measurements during gait revealed high linear correlations, indicating that with SMA measurements it is possible to predict certain ground reaction force loading parameters. CONCLUSIONS SMAs are practical for use in clinical environments to collect acceleration data that may be used to estimate joint loads.
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Affiliation(s)
- Tuomas Liikavainio
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland.
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Sizer PS, Phelps V, James R, Matthijs O. Diagnosis and management of the painful ankle/foot part 1: clinical anatomy and pathomechanics. Pain Pract 2007; 3:238-62. [PMID: 17147674 DOI: 10.1046/j.1533-2500.2003.03029.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Distinctive anatomical features can be witnessed in the ankle/foot complex, affording specific pathological conditions. Disorders of the ankle/foot complex are multifactoral and features in both the clinical anatomy and biomechanics contribute to the development of ankle/foot pain. The superior tibiofibular, distal tibiofibular, talocrural, subtalar, and midtarsal joint systems must all participate in function of the ankle/foot complex, as each biomechanically contributes to functional movements and clinical disorders witnessed in the lower extremity. A clinician's ability to effectively evaluate, diagnose, and treat the distal lower extremity is largely reliant upon a foundational understanding of the clinical anatomy and biomechanics of this complex complex. Thus, clinicians are encouraged to consider these distinctions when examining and diagnosing disorders of the ankle/foot.
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Affiliation(s)
- Phillip S Sizer
- Texas Tech University Health Science Center, School of Allied Health, Doctorate of Science Program in Physical Therapy, Lubbock TX 79430, USA
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Hsu CC, Tsai WC, Wang CL, Pao SH, Shau YW, Chuan YS. Microchambers and macrochambers in heel pads: are they functionally different? J Appl Physiol (1985) 2007; 102:2227-31. [PMID: 17272407 DOI: 10.1152/japplphysiol.01137.2006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The heel pad consists of a superficial microchamber layer and a deep macrochamber layer. This study highlights the different biomechanical behaviors between the microchamber and macrochamber layers using ultrasonography. The heel pad in each left foot of six healthy volunteers aged ∼25 yr old was measured with a device consisting of a 10-MHz linear-array ultrasound transducer and a load cell. The testing heels were loaded on the ultrasound transducer with a loading velocity of ∼0.5 cm/s and were withdrawn when the specified maximum stress (158 kPa) was reached. Unloaded tissue thickness, end-loaded thickness, deformation proportion, average deformation, and rebound rates and elastic modulus of the microchamber and macrochamber layers were assessed. The unloaded thickness of the microchamber layer was ∼30% of the macrochamber layer. The microchamber layer also had significantly less unloaded thickness, end-loaded thickness, mean deformation rate, mean rebound rate, and deformation proportion than the macrochamber layer. A significant difference between the unloaded and end-loaded thickness in the macrochamber layer was observed. The average soft tissue deformation rate was significantly different from the rebound rate in the microchamber layer. A similar trend was detected in the macrochamber layer. The elastic modulus of the microchamber layer was 450 kPa (SD 240), which was nearly 10 times of that in the macrochamber layer. In conclusion, ultrasound can identify the heterogeneous tissue properties of the heel pad. The macrochamber layer responds to loading with large deformation, and the microchamber layer has a high degree of tissue stiffness.
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Affiliation(s)
- Chih-Chin Hsu
- Institute of Applied Mechanics, National Taiwan University, Industrial Technology Research Institute, No. 1, Roosevelt Rd., Sec. 4, Taipei 106, and Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taoyuan, Taiwan
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Ledoux WR, Blevins JJ. The compressive material properties of the plantar soft tissue. J Biomech 2007; 40:2975-81. [PMID: 17433335 DOI: 10.1016/j.jbiomech.2007.02.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 02/07/2007] [Indexed: 11/18/2022]
Abstract
The plantar soft tissue is the primary means of physical interaction between a person and the ground during locomotion. Dynamic loads greater than body weight are borne across the entire plantar surface during each step. However, most testing of these tissues has concentrated on the structural properties of the heel pad. The purpose of this study was to determine the material properties of the plantar soft tissue from six locations beneath: the great toe (subhallucal), the 1st, 3rd and 5th metatarsal heads (submetatarsal), the lateral midfoot (lateral submidfoot) and the heel (subcalcaneal). We obtained specimens from these locations from 11 young, non-diabetic donors; the tissue was cut into 2 cm x 2 cm blocks and the skin was removed. Stress relaxation experiments were conducted and the data were fit using the quasi-linear viscoelastic (QLV) theory. To determine tissue modulus, energy loss and the effect of test frequency, we also conducted displacement controlled triangle waves at five frequencies ranging from 0.005 to 10 Hz. The subcalcaneal tissue was found to have an increased relaxation time compared to the other areas. The subcalcaneal tissue was also found to have an increased modulus and decreased energy loss compared to the other areas. Across all areas, the modulus and energy loss increased for the 1 and 10 Hz tests compared to the other testing frequencies. This study is the first to generate material properties for all areas of the plantar soft tissue, demonstrating that the subcalcaneal tissue is different than the other plantar soft tissue areas. These data will have implications for foot computational modeling efforts and potentially for orthotic pressure reduction devices.
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Affiliation(s)
- William R Ledoux
- RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Heath Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA.
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Hsu CC, Tsai WC, Chen CPC, Shau YW, Wang CL, Chen MJL, Chang KJ. Effects of aging on the plantar soft tissue properties under the metatarsal heads at different impact velocities. ULTRASOUND IN MEDICINE & BIOLOGY 2005; 31:1423-9. [PMID: 16223646 DOI: 10.1016/j.ultrasmedbio.2005.05.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Revised: 05/16/2005] [Accepted: 05/26/2005] [Indexed: 05/04/2023]
Abstract
The plantar soft tissue properties under the metatarsal heads at different impact velocities in different age groups were measured. Each metatarsus of the left foot in healthy young adults (n = 9, 19 to 35 years old) and in healthy older persons (n = 10, 42 to 72 years old) was examined in vivo using a self-constructed loading-unloading device at low, medium and high impact status; the impact velocities of the device were about 2.5, 5 and 10 cm/s, respectively. The device comprised a 5- to 12-MHz linear-array ultrasound transducer, a miniature load cell and a fixation frame. From low to high impact status, the elastic modulus (E) in young adults significantly increased from about 300 kPa to about 500 kPa. However, the E in the older group did not show this trend. From low to high impact status, the energy dissipation ratio (EDR) of the metatarsus significantly increased from about 30% to about 60% in the young group and significantly increased from about 40% to about 70% in the older group. Most of the metatarsus in the older subjects had significantly greater E and EDR than those in the younger persons.
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Affiliation(s)
- Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taipei, Taiwan
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Ledoux WR, Meaney DF, Hillstrom HJ. A quasi-linear, viscoelastic, structural model of the plantar soft tissue with frequency-sensitive damping properties. J Biomech Eng 2005; 126:831-7. [PMID: 15796342 DOI: 10.1115/1.1824133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Little is known about the structural properties of plantar soft-tissue areas other than the heel; nor is it known whether the structural properties vary depending on location. Furthermore, although the quasi-linear viscoelastic (QLV) theory has been used to model many soft-tissue types, it has not been employed to model the plantar soft tissue. The structural properties of the plantar soft tissue were quantified via stress relaxation experiments at seven regions (subcalcaneal, five submetatarsal, and subhallucal) across eight cadaveric feet. The cadaveric feet were 36.9 +/- 17.4 (mean +/- S.D.) years of age, all free from vascular diseases and orthopedics disorders. All tests were performed at a constant environmental temperature of 35 degrees C. Stress relaxation experiments were performed; different loads were employed for different areas based on normative gait data. A modification of the relaxation spectrum employed within the QLV theory allowed for the inclusion of frequency-sensitive relaxation properties in addition to nonlinear elastic behavior. The tissue demonstrated frequency-dependent damping properties that made the QLV theory ill suited to model the relaxation. There was a significant difference between the elastic structural properties (A) of the subcalcaneal tissue and all other areas (p = 0.004), and a trend (p = 0.067) for the fifth submetatarsal to have less viscous damping (c1) than the subhallucal, or first, second, or third submetatarsal areas. Thus, the data demonstrate that the structural properties of the foot can vary across regions, but careful consideration must be given to the applied loads and the manner in which the loads were applied.
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Affiliation(s)
- William R Ledoux
- Department of Veterans Affairs, RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, Seattle WA, 98108, USA.
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Klaesner JW, Hastings MK, Zou D, Lewis C, Mueller MJ. Plantar tissue stiffness in patients with diabetes mellitus and peripheral neuropathy. Arch Phys Med Rehabil 2002; 83:1796-801. [PMID: 12474190 DOI: 10.1053/apmr.2002.35661] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine if a difference exists in the plantar soft tissue of patients with diabetes mellitus (DM) and peripheral neuropathy (PN) compared with age-matched controls. DESIGN Case-control study with a parallel 3-element 1-dimensional viscoelastic model developed to characterize indentation data. SETTING Data collection performed in an academic physical therapy laboratory. PARTICIPANTS Forty subjects were recruited into 2 groups (20 subjects with DM, PN, and history of plantar ulcers; 20 control subjects), matched for age (DM: 55.22+/-9.39 y; control: 55.91+/-10.97 y), gender (DM: 14 men, 6 women; control: 14 men, 6 women), and body mass index (DM: 32.96+/-8.39 kg/m(2); control: 32.58+/-7.69 kg/m(2)). INTERVENTIONS The plantar soft tissue stiffness was measured over the first, third, and fifth metatarsals, and heel of each subject using an indentor system that accurately measures force/displacement (F/D) data. A parallel 3-element viscoelastic mechanical model was then used to transform the F/D data into values that were used to make stiffness assessments. MAIN OUTCOME MEASURE The element coefficients of our model indicated the stiffness of the plantar tissue. RESULTS The plantar tissue of the subjects with DM over the metatarsal heads was stiffer than the control population as indicated by one of the spring constants in the parallel 3-element model (first: 1.13+/-0.55 N/mm vs.72+/-.32 N/mm; third:.96+/-.32 N/mm vs.79+/-.17 N/mm; fifth:.90+/-.31 N/mm vs.69+/-.28 N/mm; P<.05). CONCLUSIONS The plantar tissue of subjects with DM, PN, and a history of ulcers was stiffer than control subjects. However, additional research is needed to determine the relationship among increased soft tissue stiffness, plantar pressures, and skin breakdown.
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Affiliation(s)
- Joseph W Klaesner
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA.
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Influence of Age, Gender, and Obesity on the Mechanical Properties of the Heel Pad under Walking Impact Conditions. J Appl Biomech 2002. [DOI: 10.1123/jab.18.4.345] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Impact mechanics of the human heel pad were studied using a ballistic pendulum. Young and elderly men and women took part in the experiment. Twelve parameters were used to describe heel pad properties. Analysis of variance was conducted to assess the influence of age, gender, and obesity. Heel pad properties were correlated with impact force and time to peak force in order to study impact mechanics. Maximal stiffness, peak displacement, and energy absorption were established so as to sufficiently describe impact properties of the heel pad. Age, gender, and obesity introduced significant differences in heel pad properties. Peak displacement and time to peak force increased in the elderly. Women presented a shorter time to peak force together with lower peak displacement, energy absorption, and lower maximal stiffness than men. Obese elderly showed lower impact forces, longer time to peak, and greater peak displacement than non-obese and younger participants. In addition, energy absorption was greater and maximal stiffness was lower for obese than for non-obese participants.
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Abstract
OBJECTIVES To quantify the dynamic behavior of the heel pad in type 2 diabetic patients and age-matched healthy individuals using mathematical modeling. BACKGROUND No single parameter can fully describe the heel-pad biomechanical properties during the loading-unloading process. DESIGN A descriptive study using pseudoelastic modeling was conducted to simulate the heel-pad stress-strain relationship in the loaded and unloaded states. Transmission electron microscope was used to examine six heel specimens taken from amputated legs in diabetic and non-diabetic patients. METHODS Energy dissipation ratio, loading curvature, and unloading curvature were calculated from the stress-strain curve-fits. Differences in ultrastructure between the heel pad of healthy subjects and those with diabetes were described. RESULTS The diabetic patients had a significantly higher mean energy dissipation ratio (mean 36.1% (SD, 8.7%) vs mean 27.9% (SD, 6.1%); P<0.001) and mean unloaded curvatures (mean 11.8 (SD, 5.1) vs mean 8.46 (SD, 2.6); P<0.001) than those of the control group. The collagen fibrils in diabetic heel samples were ruptured with unclear striation and uneven distribution. CONCLUSIONS The curvature parameters may explain the poor rebound phenomenon resulting in the high impact energy in diabetic heel pads. Breakdown in collagen fibrils may be responsible for this observation. RELEVANCE These findings can be integrated into the fabrication of orthotics that dissipate excessive heel impact energy and protect against injury.
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Affiliation(s)
- Tsz-Ching Hsu
- Department of Rehabilitation Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
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Hsu TC, Wang CL, Shau YW, Tang FT, Li KL, Chen CY. Altered heel-pad mechanical properties in patients with Type 2 diabetes mellitus. Diabet Med 2000; 17:854-9. [PMID: 11168328 DOI: 10.1046/j.1464-5491.2000.00394.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To compare the heel-pad mechanical properties in patients with Type 2 diabetes mellitus with forefoot ulceration, without forefoot ulceration and age-matched healthy subjects. METHODS Heel-pad mechanical properties in 40 heels of 20 healthy subjects (group I) age-matched with the other groups, 42 heels of 21 diabetic patients without forefoot ulceration (group II), and 14 heels of 12 diabetic patients with active forefoot ulceration (group III) were assessed using a self-constructed loading-unloading device and a 10-MHz linear-array ultrasound transducer. RESULTS There were no differences in the unloaded heel-pad thickness, compressibility index and elastic modulus between the three groups. When compared with group I subjects (mean +/- SD, 27.9 +/- 6.1%), a significant increase (P < 0.001) was found in both group II (36.1 +/- 8.7%) and group III patients (43.2 +/- 6.6%) for the energy dissipation ratio. This ratio was also significantly different (P = 0.003) between groups II and III. CONCLUSIONS The higher impact energy dissipated in the heel-pad may put patients with Type 2 diabetes at higher risk for developing foot ulceration.
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Affiliation(s)
- T C Hsu
- Department of Rehabilitation Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
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Treiman GS, Oderich GS, Ashrafi A, Schneider PA. Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing. J Vasc Surg 2000; 31:1110-8. [PMID: 10842147 DOI: 10.1067/mva.2000.106493] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to determine the effectiveness of treatment of nonhealing heel ulcers and gangrene and to define those variables that are associated with success. METHODS A multi-institutional review was undertaken at four university or university-affiliated hospitals of all patients with wounds of the heel and arterial insufficiency, which was defined as absent pedal pulses and a decreased ankle/brachial index (ABI). Risk factors, hemodynamic parameters, and arteriographic findings were statistically analyzed to determine their effect on wound healing. Life-table analysis was used to assess graft patency and wound healing. RESULTS Ninety-one patients (57 men, 34 women) were treated for heel wounds that did not heal for 1 to 12 months (62% of nonhealing wounds, 3 months or longer). The mean preoperative ABI was 0.51, and 31% of wounds were infected. Of the patients, 55% had impaired renal function (Cr > 1.5), with 24% undergoing dialysis, 70% had diabetes, and 64% smoked cigarettes. Treatment was topical wound care for all patients and operative wound débridement in 50%. Infrainguinal bypass was performed for 81 patients, 4 had inflow procedures, 3 had superficial femoral artery percutaneous transluminal angioplasty, and 3 had primary below-knee amputation. Postoperatively, 85% of patients had in-line flow to the foot with at least a single patent vessel, 66% had a pedal pulse, and the mean ABI improved by 0.40, to 0.91. Follow-up ranged from 1 to 60 months (mean, 21 months), and 77 patients (85%) are currently alive. In 66 patients (73%), the wounds healed-all within 6 months (mean, 3 months). For 14 (16%) the wounds had not healed, and 11 patients (11%) underwent below-knee amputation. By life-table analysis, limb salvage was 86% at 3 years. During follow-up, 75 infrainguinal bypasses (91%) remained patent (3 secondarily) and 6 occluded, with primary assisted patency of 87% at 3 years. All wounds in patients with occluded grafts failed to heal. Variables found to be statistically significant in predicting healing included normal renal function (95% healed vs 55% nonhealed, P <.002), a palpable pedal pulse (85% healed vs 42%, P <.0015), a patent posterior tibial artery past the ankle (86% healed vs 57%, P <.02), and the number of patent tibial arteries after bypass to the ankle (P <.0001). Neither the ABI nor the presence of infection (defined as positive tissue cultures or the presence of osteomyelitis), diabetes, or other cardiovascular risk factors influenced the outcome. CONCLUSIONS Complete wound healing of ischemic heel ulcers or gangrene may require up to 6 months, and short-term graft patency is of minimal benefit. Successful arterial reconstruction, especially a patent posterior tibial artery after bypass, is effective in treating most heel ulcers or gangrene. Patients with impaired renal function are at increased risk for failure of treatment, but their wounds may successfully heal and they should not be denied revascularization procedures.
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Affiliation(s)
- G S Treiman
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City 84132, Utah
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Hsu TC, Wang CL, Tsai WC, Kuo JK, Tang FT. Comparison of the mechanical properties of the heel pad between young and elderly adults. Arch Phys Med Rehabil 1998; 79:1101-4. [PMID: 9749691 DOI: 10.1016/s0003-9993(98)90178-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the mechanical properties of the human heel pad between young and aged adults. DESIGN A 7.5-MHz linear-array ultrasound transducer was incorporated into a specially designed device to measure the thickness of the heel pad under different loads. The heel pad was compressed with serial increments of 0.5kg to a maximum of 3kg and then relaxed sequentially. Then the load-displacement curve of the heel pad during a loading-unloading cycle was plotted. PARTICIPANTS Convenience sample of 33 volunteers without heel problems, aged 18 to 78 years, were divided into young (less than 40 years) and elderly (older than 60 years) groups. MAIN OUTCOME MEASURES Unloaded heel-pad thickness, compressibility index, stiffness, and energy dissipation ratio were calculated from the load-displacement curves. Student's t-test was used to compare the mechanical properties of the heel between these two groups. RESULTS The average unloaded heel-pad thickness was 1.76+/-.20cm in the young group and 2.01+/-.24cm in the elderly group (p < .001). The average compressibility index was 53.3%+/-7.7% in the young group and 61.3%+/-5.5% in the elderly group (p < .001). Energy dissipation ratio representing shock absorbency of the heel pad, was 23.7%+/-6.9% in the young group and 35.3%+/-10% in the elderly group (p < .001). CONCLUSION Unloaded heel-pad thickness, compressibility index, and energy dissipation ratio of the heel pad were significantly increased in the elderly group, indicating loss of the elasticity of the heel pad. The loss of elasticity may be responsible for the higher incidence of heel injury in elderly individuals.
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Affiliation(s)
- T C Hsu
- Department of Rehabilitation Medicine, Chang Gung Memorial Hospital, Chang Gung University, Gueishan, Taoyuan Hsien, Taiwan
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Gentile AT, Berman SS, Reinke KR, Demas CP, Ihnat DH, Hughes JD, Mills JL. A regional pedal ischemia scoring system for decision analysis in patients with heel ulceration. Am J Surg 1998; 176:109-14. [PMID: 9737612 DOI: 10.1016/s0002-9610(98)00168-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The objective of this study was to evaluate patients undergoing operative debridement for heel ulceration and to categorize pedal perfusion and its influence on therapeutic alternatives. METHODS Patients with heel ulceration were stratified by arteriography and graded I (patent posterior tibial, PT), II (occluded PT/reconstituted from peroneal), III (PT reconstituted from dorsal pedal), IV (no PT reconstitution but visible heel tributaries), and V (avascular heel). RESULTS From May 1992 through January 1997, 23 patients underwent operative treatment for 25 heel ulcers. The heel ischemia score stratified patients into two groups: 1, revascularization/debridement (71% grades I to III, 29% grade IV, 0% grade V); and 2, free tissue transfer with or without revascularization (100% grades IV, V). Cumulative functional limb salvage was 91% (BP), 60% (BP + TT), and 81% (TT) at 24 months (P = 0.15 log rank). CONCLUSION The heel ischemia score may direct treatment of heel ulceration by identifying patients who will need vascularized tissue transfer early in their treatment regimen.
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Affiliation(s)
- A T Gentile
- Section of Vascular Surgery, University of Arizona Health Sciences Center, Southern Arizona Vascular Institute, Tucson 85754-5727, USA
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