The Design and Validation of a Novel Computational Simulation of the Leg for the Investigation of Injury, Disease, and Surgical Treatment

Computational modeling of joints and their function, a developing field, is becoming a significant health and wellness tool of our modern age. Due to familiarity of prior research focused on the lower extremity, a foot and ankle 3D computational model was created to explore the potential for these computational methods. The method of isolating CT scanned tissue and rendering a patient specific anatomy in the digital domain was accomplished by the use of MIMICS™ , SolidWorks™, and COSMOSMotion™ – all available in the commercial domain. The kinematics of the joints are driven solely by anatomically modeled soft tissue applied to articulating joint geometry. Soft tissues are based on highly realistic measurements of anatomical dimension and behavior. By restricting all model constraints to true to life anatomical approximations and recreating their behavior, this model uses inverse kinematics to predict the motion of the foot under various loading conditions. Extensive validation of the function of the model was performed. This includes stability of the arch (due to ligament deficiency) and joint behavior (due to disease and repair). These simulations were compared to a multitude of studies, which confirmed the accuracy of soft tissue strain, joint alignment, joint contact force and plantar load distribution. This demonstrated the capability of the simulation technique to both qualitatively recreate trends seen experimentally and clinically, as well as quantitatively predict a variety of tissue and joint measures. The modeling technique has further strength by combining measurements that are typically done separate (experimental vs. clinical) to build a more holistic model of foot behavior. This has the potential to allow additional conclusions to be drawn about complications associated with repair techniques. This model was built with the intent to provide an example of how patient specific bony geometry can be used as either a research or surgical tool when considering a disease state or repair technique. The technique also allows for the repeated use of anatomy, which is not possible experimentally or clinically. These qualities, along with the accuracy demonstrated in validation, prove the integrity of the technique along with demonstrating its strengths.

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Year	Entry
2008	Yu J, Cheung JT-M, Fan Y, Zhang Y, Leung AK-L, Zhang M. Development of a finite element model of female foot for high-heeled shoe design. Clin Biomech (Bristol, Avon). 2008;23(suppl 1):S31-S38.
1993	Sarrafian SK. Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 2nd ed. Philadelphia: J. B. Lippincott Company; 1993.
2005	Halloran JP, Petrella AJ, Rullkoetter PJ. Explicit finite element modeling of total knee replacement mechanics. J Biomech. February 2005;38(2):323-331.
2006	Cheung JT-M, An K-N, Zhang M. Consequences of partial and total plantar fascia release: a finite element study. Foot Ankle Int. 2006;27(2):125-132.
1994	Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. July 1994;15(7):349-353.
2004	Cheung JT-M, Zhang M, An K-N. Effects of plantar fascia stiffness on the biomechanical responses of the ankle–foot complex. Clin Biomech (Bristol, Avon). October 2004;19(8):839-846.
2005	Cheung JT-M, Zhang M, Leung AK-L, Fan Y-B. Three-dimensional finite element analysis of the foot during standing: a material sensitivity study. J Biomech. May 2005;38(5):1045-1054.
2008	Edwards WB, Gillette JC, Thomas JM, Derrick TR. Internal femoral forces and moments during running: implications for stress fracture development. Clin Biomech (Bristol, Avon). December 2008;23(10):1269-1278.
1991	Blankevoort L, Kuiper JH, Huiskes R, Grootenboer HJ. Articular contact in a three-dimensional model of the knee. J Biomech. 1991;24(11):1019-1031.
1999	Li G, Gil J, Kanamori A, Woo SL-Y. A validated three-dimensional computational model of a human knee joint. J Biomech Eng. December 1999;121(6):657-662.
2005	Cheung JT-M, Zhang M. A 3-dimensional finite element model of the human foot and ankle for insole design. Arch Phys Med Rehabil. 2005;86(2):353-358.
1998	Murphy GA, Pneumaticos SG, Kamaric E, Noble PC, Trevino SG, Baxter DE. Biomechanical consequences of sequential plantar fascia release. Foot Ankle Int. 1998;19(3):149-152.
1986	Butler DL, Kay MD, Stouffer DC. Comparison of material properties in fascicle-bone units from human patellar tendon and knee ligaments. J Biomech. 1986;19(6):425-432.
2006	Netter FH. Atlas of Human Anatomy. 4th ed. Philadelphia, PA: Saunders; 2006.
2003	Taniguchi A, Tanaka Y, Takakura Y, Kadono K, Maeda M, Yamamoto H. Anatomy of the spring ligament. J Bone Joint Surg. 2003;85A(11):2174-2178.
2009	Lenaerts G, Bartels W, Gelaude F, Mulier M, Spaepen A, Van der Perre G, Jonkers I. Subject-specific hip geometry and hip joint centre location affects calculated contact forces at the hip during gait. J Biomech. June 19, 2009;42(9):1246-1251.
2006	Liacouras PC. Computational Modeling to Predict Mechanical Function of Joints: Validations and Applications of Lower Leg Simulations [PhD thesis]. Richmond, VA: Virginia Commonwealth University; August 2006.
2007	Liacouras PC, Wayne JS. Computational modeling to predict mechanical function of joints: application to the lower leg with simulation of two cadaver studies. J Biomech Eng. 2007;129(6):811-817.
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.
1990	Nigg BM, Skarvan G, Frank CB, Yeadon MR. Elongation and forces of ankle ligaments in a physiological range of motion. Foot Ankle. August 1990;11(1):30-40.
2004	Song Y, Debski RE, Musahl V, Thomas M, Woo SL-Y. A three-dimensional finite element model of the human anterior cruciate ligament: a computational analysis with experimental validation. J Biomech. March 2004;37(3):383-390.
2006	Bey MJ, Zauel R, Brock SK, Tashman S. Validation of a new model-based tracking technique for measuring three-dimensional, in vivo glenohumeral joint kinematics. J Biomech Eng. August 2006;128(4):604-609.
1988	Blankevoort L, Huiskes R, de Lange A. The envelope of passive knee joint motion. J Biomech. 1988;21(9):705-720.
2003	Crary JL, Hollis JM, Manoli A II. The effect of plantar fasci release on strain in the spring and long plantar ligaments. Foot Ankle Int. March 2003;24(3):245-250.
2010	Liu F, Kozanek M, Hosseini A, Van de Velde SK, Gill TJ, Rubash HE, Li G. In vivo tibiofemoral cartilage deformation during the stance phase of gait. J Biomech. March 3, 2010;43(4):658-665.
1995	Kim W, Voloshin AS. Role of plantar fascia in the load bearing capacity of the human foot. J Biomech. September 1995;28(9):1025-1033.
1988	Siegler S, Block J, Schenck CD. The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot Ankle. April 1988;8(5):234-242.
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.
1954	Hicks JH. The mechanics of the foot, II: the plantar aponeurosis and the arch. J Anat. 1954;88(pt 1):25-30.
1964	Wright DG, Rennels DC. A study of the elastic properties of plantar fascia. J Bone Joint Surg. 1964;46A(3):482-492.

Year

Entry

2008

Yu J, Cheung JT-M, Fan Y, Zhang Y, Leung AK-L, Zhang M. Development of a finite element model of female foot for high-heeled shoe design. Clin Biomech (Bristol, Avon). 2008;23(suppl 1):S31-S38.

1993

Sarrafian SK. Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 2nd ed. Philadelphia: J. B. Lippincott Company; 1993.

2005

Halloran JP, Petrella AJ, Rullkoetter PJ. Explicit finite element modeling of total knee replacement mechanics. J Biomech. February 2005;38(2):323-331.

2006

Cheung JT-M, An K-N, Zhang M. Consequences of partial and total plantar fascia release: a finite element study. Foot Ankle Int. 2006;27(2):125-132.

1994

Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. July 1994;15(7):349-353.

2004

Cheung JT-M, Zhang M, An K-N. Effects of plantar fascia stiffness on the biomechanical responses of the ankle–foot complex. Clin Biomech (Bristol, Avon). October 2004;19(8):839-846.

2005

Cheung JT-M, Zhang M, Leung AK-L, Fan Y-B. Three-dimensional finite element analysis of the foot during standing: a material sensitivity study. J Biomech. May 2005;38(5):1045-1054.

2008

Edwards WB, Gillette JC, Thomas JM, Derrick TR. Internal femoral forces and moments during running: implications for stress fracture development. Clin Biomech (Bristol, Avon). December 2008;23(10):1269-1278.

1991

Blankevoort L, Kuiper JH, Huiskes R, Grootenboer HJ. Articular contact in a three-dimensional model of the knee. J Biomech. 1991;24(11):1019-1031.

1999

Li G, Gil J, Kanamori A, Woo SL-Y. A validated three-dimensional computational model of a human knee joint. J Biomech Eng. December 1999;121(6):657-662.

2005

Cheung JT-M, Zhang M. A 3-dimensional finite element model of the human foot and ankle for insole design. Arch Phys Med Rehabil. 2005;86(2):353-358.

1998

Murphy GA, Pneumaticos SG, Kamaric E, Noble PC, Trevino SG, Baxter DE. Biomechanical consequences of sequential plantar fascia release. Foot Ankle Int. 1998;19(3):149-152.

1986

Butler DL, Kay MD, Stouffer DC. Comparison of material properties in fascicle-bone units from human patellar tendon and knee ligaments. J Biomech. 1986;19(6):425-432.

2006

Netter FH. Atlas of Human Anatomy. 4th ed. Philadelphia, PA: Saunders; 2006.

2003

Taniguchi A, Tanaka Y, Takakura Y, Kadono K, Maeda M, Yamamoto H. Anatomy of the spring ligament. J Bone Joint Surg. 2003;85A(11):2174-2178.

2009

Lenaerts G, Bartels W, Gelaude F, Mulier M, Spaepen A, Van der Perre G, Jonkers I. Subject-specific hip geometry and hip joint centre location affects calculated contact forces at the hip during gait. J Biomech. June 19, 2009;42(9):1246-1251.

2006

Liacouras PC. Computational Modeling to Predict Mechanical Function of Joints: Validations and Applications of Lower Leg Simulations [PhD thesis]. Richmond, VA: Virginia Commonwealth University; August 2006.

2007

Liacouras PC, Wayne JS. Computational modeling to predict mechanical function of joints: application to the lower leg with simulation of two cadaver studies. J Biomech Eng. 2007;129(6):811-817.

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.

1990

Nigg BM, Skarvan G, Frank CB, Yeadon MR. Elongation and forces of ankle ligaments in a physiological range of motion. Foot Ankle. August 1990;11(1):30-40.

2004

Song Y, Debski RE, Musahl V, Thomas M, Woo SL-Y. A three-dimensional finite element model of the human anterior cruciate ligament: a computational analysis with experimental validation. J Biomech. March 2004;37(3):383-390.

2006

Bey MJ, Zauel R, Brock SK, Tashman S. Validation of a new model-based tracking technique for measuring three-dimensional, in vivo glenohumeral joint kinematics. J Biomech Eng. August 2006;128(4):604-609.

1988

Blankevoort L, Huiskes R, de Lange A. The envelope of passive knee joint motion. J Biomech. 1988;21(9):705-720.

2003

Crary JL, Hollis JM, Manoli A II. The effect of plantar fasci release on strain in the spring and long plantar ligaments. Foot Ankle Int. March 2003;24(3):245-250.

2010

Liu F, Kozanek M, Hosseini A, Van de Velde SK, Gill TJ, Rubash HE, Li G. In vivo tibiofemoral cartilage deformation during the stance phase of gait. J Biomech. March 3, 2010;43(4):658-665.

1995

Kim W, Voloshin AS. Role of plantar fascia in the load bearing capacity of the human foot. J Biomech. September 1995;28(9):1025-1033.

1988

Siegler S, Block J, Schenck CD. The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot Ankle. April 1988;8(5):234-242.

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.

1954

Hicks JH. The mechanics of the foot, II: the plantar aponeurosis and the arch. J Anat. 1954;88(pt 1):25-30.

1964

Wright DG, Rennels DC. A study of the elastic properties of plantar fascia. J Bone Joint Surg. 1964;46A(3):482-492.

Year	Entry
2013	Spratley EM. Patient-Specific Modeling of Adult Acquired Flatfoot Deformity Before and After Surgery [PhD thesis]. Richmond, VA: Virginia Commonwealth University; 2013.

Year

Entry

2013

Spratley EM. Patient-Specific Modeling of Adult Acquired Flatfoot Deformity Before and After Surgery [PhD thesis]. Richmond, VA: Virginia Commonwealth University; 2013.