Finite element analysis of the foot:​ model validation and comparison between two common treatments of the clawed hallux deformity

Isvilanonda, Vara; Dengler, Evan; Iaquinto, Joseph M.; Sangeorzan, Bruce J.; Ledoux, William R.

Affiliations

¹RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Department of Veterans Affairs, Seattle, WA, USA

²Department of Mechanical Engineering, University of Washington, Seattle, WA, USA

³Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA

Abstract and keywords

Background: Clawed hallux is defined by first metatarsophalangeal joint extension and first interphalangeal joint flexion; it can increase plantar pressures and ulceration risk. We investigated two corrective surgical techniques, the modified Jones and flexor hallucis longus tendon transfer.

Methods: A finite element foot model was modified to generate muscle overpulls, including extensor hallucis longus, flexor hallucis longus and peroneus longus. Both corrective procedures were simulated, predicting joint angle and plantar pressure changes.

Findings: The clawed hallux deformity was generated by overpulling: 1) extensor hallucis longus, 2) peroneus longus + extensor hallucis longus, 3) extensor hallucis longus + flexor hallucis longus and 4) all three together. The modified Jones reduced metatarsophalangeal joint angles, but acceptable hallux pressure was found only when there was no flexor hallucis longus overpull. The flexor hallucis longus tendon transfer reduced deformity at the metatarsophalangeal and interphalangeal joints but may extended the hallux due to the unopposed extensor hallucis longus. Additionally, metatarsal head pressure increased with overpulling of the extensor hallucis longus + flexor hallucis longus, and all three muscles together.

Interpretation: The modified Jones was effective in correcting clawed hallux deformity involving extensor hallucis longus overpull without flexor hallucis longus overpull. The flexor hallucis longus tendon transfer was effective in correcting clawed hallux deformity resulting from the combined overpull of both extensor and flexor hallucis longus, but not with isolated extensor hallucis longus overpull. An additional procedure to reduce the metatarsal head pressure may be required concomitant to the flexor hallucis longus tendon transfer. However this procedure avoids interphalangeal joint fusion.

Keywords: Modified Jones; FHL tendon transfer; Foot; Finite element analysis; Clawed hallux deformity

Links

DOI: 10.1016/j.clinbiomech.2012.05.005

PubMed: 22694884

WoS: 000308850800016

History

Received: 2012-01-13

Accepted: 2012-05-14

Online: 2012-06-11

Cited Works (22)

Year	Entry
1992	Perry J. Gait Analysis: Normal and Pathological Function. Thorofare, NJ: SLACK Incorporated; 1992.
1982	Pierrynowski MR. A Physiological Model for the Solution of Individual Muscle Forces During Normal Human Walking [PhD thesis]. Simon Fraser University; January 1982.
1999	Zysset PK, Guo XE, Hoffler CE, Moore KE, Goldstein SA. Elastic modulus and hardness of cortical and trabecular bone lamellae measured by nanoindentation in the human femur. J Biomech. October 1999;32(10):1005-1012.
1993	Sarrafian SK. Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 2nd ed. Philadelphia: J. B. Lippincott Company; 1993.
2009	García-Aznar JM, Bayod J, Rosas A, Larrainzar R, García-Bógalo R, Doblaré M, Llanos LF. Load transfer mechanism for different metatarsal geometries: a finite element study. J Biomech Eng. February 2009;131(2):021011.
2011	Qiu T-X, Teo E-C, Yan Y-B, Lei W. Finite element modeling of a 3D coupled foot–boot model. Med Eng Phys. December 2011;33(10):1228-1233.
2010	Iaquinto JM, Wayne JS. Computational model of the lower leg and foot/ankle complex: application to arch stability. J Biomech Eng. February 2010;132(2):021009.
2010	Pai S, Ledoux WR. The compressive mechanical properties of diabetic and non-diabetic plantar soft tissue. J Biomech. June 18, 2010;43(9):1754-1760.
1997	Cavanagh PR, Morag E, Boulton AJM, Young MJ, Deffner KT, Pammer SE. The relationship of static foot structure to dynamic foot function. J Biomech. March 1997;30(3):243-250.
1997	Lemmon D, Shiang TY, Hashmi A, Ulbrecht JS, Cavanagh PR. The effect of insoles in therapeutic footwear: a finite element approach. J Biomech. June 1997;30(6):615-620.
2005	Ishikawa M, Komi PV, Grey MJ, Lepola V, Bruggemann G-P. Muscle-tendon interaction and elastic energy usage in human walking. J Appl Physiol. 2005;99(2):603-608.
1986	Brand RA, Pedersen DR, Friederich JA. The sensitivity of muscle force predictions to changes in physiologic cross-sectional area. J Biomech. 1986;19(8):589-596.
2007	Wu L. Nonlinear finite element analysis for musculoskeletal biomechanics of medial and lateral plantar longitudinal arch of Virtual Chinese Human after plantar ligamentous structure failures. Clin Biomech (Bristol, Avon). 2007;22(2):221-229.
2005	Mkandawire C, Ledoux WR, Sangeorzan BJ, Ching RP. Foot and ankle ligament morphometry. J Rehab Res Dev. November–December 2005;42(6):809-819.
1987	Cavanagh PR, Rodgers MM, Iiboshi A. Pressure distribution under symptom-free feet during barefoot standing. Foot Ankle Int. April 1987;7(5):262-278.
2008	Cheng H-YK, Lin C-L, Wang H-W, Chou S-W. Finite element analysis of plantar fascia under stretch: the relative contribution of windlass mechanism and Achilles tendon force. J Biomech. 2008;41(9):1937-1944.
2011	Hu Y, Ledoux WR, Fassbind M, Rohr ES, Sangeorzan BJ, Haynor D. Multi-rigid image segmentation and registration for the analysis of joint motion from three-dimensional magnetic resonance imaging. J Biomech Eng. October 2011;133(10):101005.
1994	Kitaoka HB, Luo ZP, Growney ES, Berglund LJ, An K-N. Material properties of the plantar aponeurosis. Foot Ankle Int. 1994;15(10):557-560.
1983	Wickiewicz TL, Roy RR, Powell PL, Edgerton VR. Muscle architecture of the human lower limb. Clin Orthop Relat Res. October 1983;179:275-283.
1998	Athanasiou KA, Liu GT, Lavery LA, Lanctot DR, Schenck RC Jr. Biomechanical topography of human articular cartilage in the first metatarsophalangeal joint. Clin Orthop Relat Res. 1998;348:269-281.
1999	Maganaris CN, Paul JP. In vivo human tendon mechanical properties. J Physiol. November 15, 1999;521(1):307-313.
1954	Hicks JH. The mechanics of the foot, II: the plantar aponeurosis and the arch. J Anat. 1954;88(pt 1):25-30.

Cited By (3)

Year	Entry
2016	Morales-Orcajo E, Bayod J, Barbosa de Las Casas E. Computational foot modeling: scope and applications. Arch Comput Methods Eng. September 2016;23(3):389-416.
2020	Ellison MA. Beam Theory and Finite Element Approaches to Modelling the Stresses in the Second Metatarsal During Running [PhD thesis]. Exeter, UK: University of Exeter; March 2020.
2013	Spratley EM. Patient-Specific Modeling of Adult Acquired Flatfoot Deformity Before and After Surgery [PhD thesis]. Richmond, VA: Virginia Commonwealth University; 2013.