Accep ed Manusc ip
Ti le: Analysis o biomechanical s esses caused by hind oo
join a h odesis in he ea men o adul acqui ed la oo
de o mi y: A ini e elemen s udy
Au ho s: Ch is ian Ci uen es-De la Po illa, Rica do
La ainza -Ga ijo, Ja ie Bayod
PII: S1268-7731(19)30073-6
DOI: h ps://doi.o g/10.1016/j. as.2019.05.010
Re e ence: FAS 1311
To appea in: Foo and Ankle Su ge y
Recei ed da e: 15 Janua y 2019
Re ised da e: 9 May 2019
Accep ed da e: 13 May 2019
Please ci e his a icle as: Ci uen es-De la Po illa C, La ainza -Ga ijo R, Bayod J,
Analysiso biomechanicals essescausedbyhind oo join a h odesisin he ea men
o adul acqui ed la oo de o mi y: A ini e elemen s udy, Foo and Ankle Su ge y
(2019), h ps://doi.o g/10.1016/j. as.2019.05.010
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Analysis o biomechanical s esses caused by hind oo join
a h odesis in he ea men o adul acqui ed la oo
de o mi y: A ini e elemen s udy
Ch is ian Ci uen es-De la Po illa a,c, Rica do La ainza -Ga ijo b1, Ja ie Bayod a
a Applied Mechanics and Bioenginee ing G oup (AMB), A agón Ins i u e o Enginee ing Resea ch (I3A),
Uni e sidad de Za agoza, Spain. bO hopaedics and T auma Depa men , Medicine School. Uni e sidad
Complu ense- Hospi al Uni e si a io In an a Leono , Mad id, Spain. c Facul ad de Ciencias Médicas -
Depa amen o de Medicina, Uni e sidad Espí i u San o – Ecuado
1
Co esponding au o : c isj[email p o ec ed]om
Highligh s
Biomechanical s ess gene a ed by he hind oo join s a h odesis was calcula ed
Sub ala a h odesis is he p ocedu e ha con ibu es leas o s ess educ ion
Talona icula a h odesis gene a es a signi ican s ess educ ion in hind oo
Calcaneocuboid a h odesis educes bo h he so issue and me a a sals s esses
T iple a h odesis gene a es he leas issue s esses in all he e alua ed cases
Abs ac :
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Backg ound: T ea men s o adul acqui ed la oo de o mi y in ea ly s ages (I-IIa-IIb) a e
ocused on s eng hening endons, in isola ion o combined wi h os eo omies, bu in s age
III, igidi y o oo de o mi y equi es mo e es ic i e p ocedu es such as hind oo join
a h odesis. Few expe imen al s udies ha e assessed he biomechanical e ec s o hese
ea men s, because o he di icul y o measu ing hese pa ame e s in cada e s. Ou
objec i e was o quan i y he biomechanical s ess caused by bo h isola ed hind oo
a h odesis and iple a h odesis on he main issues ha suppo he plan a a ch.
Me hods: An inno a i e ini e elemen model was used o e alua e some la oo scena ios
ea ed wi h isola ed hind oo a h odesis and iple a h odesis.
Resul s and conclusions: When a h odeses a e done in si u, alona icula seems a good
op ion, possible supe io o sub ala and a leas equi alen o iple. Calcaneocuboid
a h odesis educes signi ican ly bo h ascia plan a and sp ing ligamen s esses bu
concen a es highe s esses a ound he used join .
Keywo ds: A h odesis, Biomechanics, FE Modeling, Fla oo , Tibialis endon
dys unc ion.
1. In oduc ion
Adul acqui ed la oo de o mi y (AAFD
1
) causes a p og essi e la ening o he oo a ch,
which has adi ionally been associa ed wi h ibialis pos e io endon (TPT) dys unc ion
[1,2,3]. Howe e , some clinical s udies ha e ound ha he ailu e o up u e o he plan a
1
AAFD: Adul acqui ed la oo de o mi y, TPT: Tibialis pos e io endon, PF: Plan a ascia, SL: Sp ing
ligamen , PBT: Pe oneus b e is endon, PLT: Pe oneus longus endon, LPL: Long plan a ligamen , SPL:
Sho plan a ligamen , FDL: Flexo digi o um ligamen , FHL: Flexo hallucis ligamen .
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ascia (PF) o he calcaneona icula ligamen (known as he Sp ing ligamen (SL)) could
also gene a e bo h he collapse o he a ch and o e oo abduc ion, he main signs o AAFD
[1,4,5]. In he ea ly s ages o he disease (S ages I, IIa and IIb), many ea men op ions
ocus on s eng hening he TPT, in isola ion o combined wi h some os eo omies, o
ebalance he oo s uc u e. Howe e , when he la oo de o mi y is igid (s age III o IV),
su geons need o use mo e es ic i e ea men s such as a h odesis o he hind oo join s
(sub ala , alona icula and calcaneocuboid) in isola ion o combined ( iple a h odesis o
o he p ocedu es) [6,7,8]. Isola ed pos e io sub ala a h odesis is a well-known
p ocedu e used o ea AAFD when he oo a ch has a igid de o ma ion o signs o join
ins abili y, a h i is and pain [9]. A cada e model-based s udy ha compa es he capaci y
o main aining he oo a ches a e applying di e en hind oo join a h odeses ound ha
isola ed pos e io sub ala a h odesis was less e ec i e in suppo ing bo h medial and
longi udinal a ches compa ed o calcaneocuboid and alona icula a h odeses [10]. On
he o he hand, some s udies show ha isola ed alona icula a h odesis has no able
ad an ages, especially in pain con ol. Ha pe e al. [11] ca ied ou a ollow - up s udy (26
mon hs) o 29 pa ien s ea ed wi h a alona icula a h odesis, inding good esul s in
abou 86% o he cases. Howe e , his a h odesis has also been associa ed wi h an
inc eased isk o malunion, pseuda h osis and p og essi e os eoa h i is in adjacen join s
(in abou 3% o 10% o ea ed pa ien s) [12]. Calcaneocuboid a h odesis is a p ocedu e
commonly applied in conjunc ion wi h o he p ocedu es (including la e al column
leng hening) and is a ely pe o med in isola ion. Some s udies ha e ound ha he
isola ed a h odesis o he calcaneocuboid join causes degene a i e a h i is signs in he
su ounding join s [13], including also pseuda h osis, non-union and s ess ac u e o he
la e al column o he oo . Addi ionally, he e is also e idence ha i a ec s walking on
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ough su aces [13]. Ne e heless, some success cases ha e also been epo ed in
pa ien s wi h an isola ed usion o he calcaneocuboid join [14,15]. Finally, iple
a h odesis is pe haps one o he mos commonly used su gical p ocedu es in AAFD
co ec ion in bo h he in e media e and ad anced s ages [16]. Su geons may conside
iple a h odesis when endon ein o cemen p ocedu es o an isola ed hind oo
a h odesis ail [16,17]. O e ime, his p ocedu e has p o ed o be a eliable and
ep oducible al e na i e o he success ul co ec ion o he oo s uc u e de o mi y wi h
good clinical esul s. Howe e , long- e m ollow-up o pa ien s has shown ha many o
hem de elop a h i is a ound he ankle, and pain in he mid oo and oes [16,17,18].
All he a ailable in o ma ion is based on subjec i e e idence o he side-e ec s o hese
p ocedu es (especially ela ed wi h pain and a h osis), because i is ex emely di icul o
measu e issue s esses in isola ion in expe imen al es s wi h consis en esul s [19]. An
al e na i e app oach nowadays accep ed by clinicians and biomedical enginee s is ini e
elemen (FE) modeling. This compu a ional me hodology allows he design o complex
models ha adequa ely ep esen he biomechanics o he human oo [20,21]. Many
models ha e been epo ed o s udying oo biomechanics and he e ec s o some
su gical p ocedu es. Howe e , hese models a e ocused speci ically on oo s uc u e
de o ma ion and plan a p essu e measu emen [20], simpli ying he so issue ana omy.
This s ong simpli ica ion does no allow he measu emen o ele an biomechanical
aspec s such as he issue ac ion s ess, limi ing he in o ma ion equi ed o unde s and
he mechanical consequences o al e ing he no mal oo s uc u e by using he hind oo
join s [22].
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The objec i e o his s udy was o use a ini e elemen oo model o quan i y he
biomechanical s ess caused by isola ed comple e sub ala , alona icula o
calcaneocuboid a h odeses and iple a h odesis on bo h oo bones and he main so
issues ha s abilize he longi udinal a ch. Ou hypo hesis is ha his analysis s a egy
could iden i y some hidden biomechanical e ec s o hese a h odeses, as well as inding
di e ences and simila i ies ha migh gi e su geons new in o ma ion o decide he bes
ea men op ion, depending on bo h he signs and se e i y o he la oo de o mi y. The
analysis was pe o med simula ing a TPT dys unc ion and a se e e case simula ed
combining TPT, PF and SL ailu es, applying in all cases he a h odeses men ioned.
2. Ma e ial and me hods
2.1. Fini e elemen model design
This model econs uc s a heal hy human unloaded oo , based on CT-images
( adiog aphs o 0.6 mm/slide) acqui ed om he igh oo o a 49-yea -old man (weigh =
75 Kg, heigh = 1.70 m). Tissue segmen a ion and 3-D econs uc ion (Bones, PF, TPT,
Achilles endon (AT) and pe oneus longus endon (PLT), pe oneus b e is endon (PBT),
lexo digi o um longus (FDL), lexo hallucis longus (FHL)) we e pe o med using MIMICS
V. 10 (Ma e ialize, Leu en, Belgium). The model main ains he ca ilage mo phology as
well as he di e en ia ion be ween co ical and abecula bone. This cha ac e is ic is
impo an when biomechanical s ess is e alua ed, e en hough some au ho s ha e
simpli ied he bone s uc u e by cha ac e izing he bone issue as comple ely co ical o
conside ing an a e age o he mechanical p ope ies o bo h co ical and abecula bone
[23,24,25]. Because o he di icul y o segmen ing he SL and bo h he sho plan a
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ligamen (SPL) and he long plan a ligamen (LPL) om images, hese issues we e
added o he model h ough he econs uc ion o hei ana omy ollowing bo h body a las
and su geons’ guidance. The comple e FE model is shown in ig. 1.
2.2. Meshing
The model’s meshing was pe o med using ICEM CFD V. 15 so wa e (Canonsbu g,
Pennsyl ania, Uni ed S a es), gene a ing 28 co ical bone pieces, 24 abecula bone
pieces, 26 ca ilage segmen s, 4 endons, 3 ligamen s and he plan a ascia. A ial-e o
app oach was employed o op imize he mesh size o each segmen , ollowing he
ecommenda ions o Bu kha e al. [26] who sugges ha in all he pa ame e s measu ed,
he numbe o inaccu a e elemen s mus be less han 5% (see able 1). All simula ions
and pos -p ocessing we e pe o med in Abaqus/CAE 6.14 (Dessaul Sys émes, Vélizy-
Villacoublay, F ance) using he Nonlinea geome y sol e a ailable.
2.3. Tissue biomechanical p ope ies and a h odeses simula ion
Tissue p ope ies (Young’s modulus and Poisson’s a io) o he co ical bone, abecula
bone, ligamen s and plan a ascia we e assigned in acco dance wi h published da a
[23,19]. The endons and ca ilages we e modeled as hype -elas ic ma e ials (Ogden
model), using he pa ame e s used in specialized a icles [27,28]. The issue ailu es o
weakness applied o simula e AAFD de elopmen we e pe o med applying he Iso opic
Ha dening heo y ha gene a es a p og essi e issue weakening.
To simula e each case o a h odesis, he ca ilage issues o he used join we e eplaced
wi h co ical bone (Fig. 2) in o de o emula e a comple e join union. These changes we e
pe o med be o e s a ing he simula ions (unloaded oo ). No ex e nal ixa ion elemen s
we e included.
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2.4. Loading and Bounda y condi ions:
The model was econs uc ed om CT-images o an unloaded oo (In e nal Mo eau-
Cos a-Be ani angle (IMCB) o 106°). The i s s ep was o gene a e a no mal s anding
load posi ion (mids ance) o use as a e e ence case and o compa ison wi h all he
simula ed cases o bo h AAFD and su gical p ocedu es. All simula ions we e pe o med
applying he loading and bounda y condi ions shown in ig. 3. The load o 720N ep esen s
he ull weigh o an adul o abou 73Kg, leaning on one oo , which emula es a adi ional
scena io o an AAFD diagnosis assessmen .
The load was included in a descending e ical di ec ion and 10 deg ees o inclina ion,
dis ibu ed as ollows: Tibia – Talus join (90%) and Fibula – Talus (10%) [29]. The endon
ac ion o ce was included as epo ed by A angio e al. [30]. All simula ions we e
pe o med main aining ixed nodes a he lowe pa o he calcaneus and blocking he Z-
axis displacemen ( e ical) o he lowe nodes o he i s and i h me a a sals. In his
way, he g ound e ec in he mids ance phase was simula ed.
To ob ain he la oo de o ma ion, he model was i s simula ed emo ing he TPT ac ion
o ce [31]. Then a se e e case was simula ed, adding he weakening o bo h PF and SL
issues.
2.5. Model Valida ion
The model was alida ed ollowing he ecommenda ions o Tao e al. [32]. They
measu ed he e ical displacemen s o some ana omical poin s in wo di e en loading
condi ions: ligh loading and no mal s ance loading, using la e al Rx images (Sagi al
plane). The a ia ion o hese poin s in each case allowed us o compa e he e ical
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ela i e displacemen s obse ed in he adiog aphic images e sus hose gene a ed by
he model. The e ical dis ance om he g ound o he highes poin o he alus (TAL)
and he na icula (NAV), he midpoin o he i s cunei o m (CUN) and he highes poin
o he i s me a a sal head (1MT) was measu ed, as can be seen in ig. 4. These
measu emen s we e aken om images o 12 heal hy pa ien s, in o de o ob ain an
a e age o no mali y and a s anda d de ia ion (SD). The ee so wa e “ImageJ” was used
o measu e he image dis ances. Each adiological image was ob ained a he same
dis ance and was aligned using as e e ence poin s he highes poin o he alus head,
he pos e io ex eme o he i s dis al phalanx and he an e io ex eme o he calcaneus.
Addi ionally, some oo s uc u al measu emen s we e pe o med: The IMCB angle, he
alocalcaneal di e gence (TCD) angle and he Fo e oo Abduc ion (FA) angle.
2.6. Model analysis and e alua ion c i e ia.
The biomechanical s ess was quan i ied using he ield ou pu spec um a ailable in
Abaqus/CAE. The pa ame e used o he e alua ion was he maximum p incipal s ess
(S. Max). These eigen alues a e closely ela ed o he ensile s ess ha is gene a ed in
oo issues du ing no mal s ance phase. When a dys unc ional so issue was included
in he simula ion, i s biomechanical s ess was no measu ed.
3. Resul s
3.1. Abou he model alida ion
Resul s o he alida ion p ocess can be seen in able 2. The model gene a es a oo
s uc u e de o ma ion simila o a heal hy pa ien in a loading es , simula ing all he issues
in no mal and unc ional condi ions. The e alua ion was pe o med obse ing he oo
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o mechanical e ec . Each a h odesis was simula ed as a comple e join - usion be o e
s a ing he simula ion (unloaded oo in no mal posi ion), wi hou including any ex e nal
suppo elemen . Howe e , since ou objec i e was o quan i y s ess changes gene a ed
by he su gical p ocedu es and no he s uc u al co ec ion ha each p ocedu e is capable
o gene a ing, he ini ial posi ion o he oo s uc u e is no a de e minan . Addi ionally,
al hough he alues o biomechanical s ess gene a ed canno be assumed as ue s ess
alues o all people (because o in e -subjec a iabili y), we can analyze he ela i e
di e ences gene a ed in each case and he loca ion o he s ess concen a ion poin s.
Besides, ou model was designed om CT-images o an unloaded oo ( aken om a
adi ional adiological oo s udy), and he ini ial bone shapes come om a heal hy pe son.
Despi e hese limi a ions, mainly ela ed wi h he me hodology applied, ou s udy
quan i ied he s esses in oo issues ha canno be measu ed in cada e s no in i o.
This in o ma ion could imp o e he unde s anding o he so issue and bone s esses
ela ed wi h bo h AAFD de elopmen and he su gical ea men s applied.
5. Conclusions:
The esul s show ha in igid de o mi ies, when a h odeses a e done “in si u”,
Talona icula a h odesis is a good op ion. I gene a es signi ican s ess educ ion and
o e s an al e na i e o isola ed sub ala a h odesis and could be combined wi h o he
su gical p ocedu es in o de o co ec la oo de o mi y. In his heo e ically si ua ion,
sub ala a h odesis is he isola ed hind oo a h odesis ha con ibu es leas o s ess
educ ion on bo h he plan a ascia and he sp ing ligamen . In ac , his isola ed
a h odesis gene a es he highes s ess on bo h he o e oo and hind oo o all he
e alua ed isola ed p ocedu es. Addi ionally, al hough calcaneocuboid a h odesis
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signi ican ly educes he s ess in he plan a a ch s abilize issues, i gene a es a
signi ican s ess concen a ion ha could esul in a h i is p oblems a ound he used
zone. T iple a h odesis was he p ocedu e ha bes educes he s esses in bo h so
issues and oo bones.
Acknowledgmen s
The au ho s g a e ully acknowledge he suppo o he Minis y o Economy and
compe i i eness o he Go e nmen o Spain h ough he p ojec DPI2016-77016-R.
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Re e ences
[1] Mos a a M. Abousayed, Maxwell C. Alley, Rachel Shakked, and And ew J. Rosenbaum, "Adul -
Acqui ed Fla oo De o mi y: E iology, Diagnosis, and Managemen ," JBJS e iews, ol. 5, p. e7, 2017.
[2] S e en L. Haddad e al., "Adul acqui ed la oo de o mi y," Foo & ankle in e na ional, ol. 32,
pp. 95-101, 2011.
[3] Jona han T. Deland, "Adul -acqui ed Fla oo De o mi y," Jou nal o he Ame ican Academy o
O hopaedic Su geons, ol. 16, pp. 399-406, 2008.
[4] Jona han T. Deland, "The adul acqui ed la oo and sp ing ligamen complex: pa hology and
implica ions o ea men ," Foo and ankle clinics, ol. 6, pp. 129-135, 2001.
[5] L. He áiz Hidalgo e al., "Dis unción del endón ibial pos e io : ¿qué o as es uc u as es án
implicadas en el desa ollo del pie plano adqui ido del adul o?," Radiología, ol. 56, pp. 247-256, 2014.
[6] E ic M. Bluman, C aig I. Ti le, and Ma k S. Mye son, "Pos e io Tibial Tendon Rup u e: A Re ined
Classi ica ion Sys em," Foo and Ankle Clinics, ol. 12, no. 2, 2007.
[7] Richa d G. Al a ez, And ew Ma ini, Coleen Schmi , and Cha les L. Sal zman, "S age I and II
pos e io ibial endon dys unc ion ea ed by a s uc u ed nonope a i e managemen p o ocol: an
o hosis and exe cise p og am," Foo & ankle in e na ional, ol. 27, pp. 2-8, 2006.
[8] Ana Ma chena, Ma a Co és, and Gab iel Gijón Nogue ón, "Re isión bibliog á ica de los
a amien os del pie plano lexible. Análisis e ospec i o (1977-2011)/Sys ema ic e iew o lexible
la oo ea men s. Re ospec i e analysis (1977-2011)," Re is a In e nacional de Ciencias Podológicas,
ol. 7, p. 9, 2013.
[9] G. A. A angio, K. L. Reine , and E. P. Sala he, "A biomechanical model o he e ec o sub ala
a h oe eisis on he adul lexible la oo ," Clinical Biomechanics, ol. 19, no. 8, pp. 847-852, 2004.
ACCEPTED MANUSCRIPT
[10] Y. Chen, K. Zhang, M. Qiang, and Y. & Hao, "Main enance o longi udinal oo a ch a e di e en
mid/hind- oo a h odesis p ocedu es in a cada e ic model.," Clinical Biomechanics, ol. 29, pp. 170-176,
2014.
[11] Ma ion C. Ha pe , "Talona icula a h odesis o he acqui ed la oo in he adul .," Clinical
o hopaedics and ela ed esea ch, pp. 65-68, 1999.
[12] G. M. Wein aub and M. A. Heilala, "Isola ed alona icula a h odesis o adul onse la oo
de o mi y/pos e io ibial endon dys unc ion," Clinics in podia ic medicine and su ge y, ol. 24, no. 4, pp.
745-752, 2007.
[13] M. Ba mada, H. S. Shapi o, and S. F. Boc, "Calcaneocuboid a h odesis," Clinics in podia ic
medicine and su ge y, ol. 29, no. 1, pp. 77-89, 2012.
[14] T.J. Chang and D.J. Soomekh, "La e al column usions," Clin Podia Med Su g, ol. 21, no. 1, pp.
29–39, 2004.
[15] J. Y. Chan e al., "Con ibu ion o la e al column leng hening o co ec ion o o e oo abduc ion in
s age IIb adul acqui ed la oo de o mi y econs uc ion," Foo & ankle in e na ional, ol. 36, pp. 1400-
1411, 2015.
[16] S. C. G a es, R. A. Mann, and K. O. & G a es, "T iple a h odesis in olde adul s. Resul s a e long-
e m ollow-up," JBJS, ol. 75, pp. 355-362, 1993.
[17] I. B. G oo , M. Reijman, H. A. Luning, and J. A. & Ve haa , "Long- e m esul s a e a iple
a h odesis o he hind oo : unc ion and sa is ac ion in 36 pa ien s," In e na ional o hopaedics, ol. 32,
pp. 237-241, 2008.
[18] M. Knupp, S. A. S u kens, and B Hin e mann, "T iple a h odesis," Foo and ankle clinics, ol. 16,
no. 1, pp. 61-67, 2011.
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[19] Kai Tao, Wen-Ting Ji, Dong-Mei Wang, Cheng-Tao Wang, and Xu Wang, "Rela i e con ibu ions o
plan a ascia and ligamen s on he a ch s a ic s abili y: a ini e elemen s udy," Biomedizinische
Technik/Biomedical Enginee ing, ol. 55, pp. 265-271, 2010.
[20] Yan Wang, Duo Wai-Chi Wong, and Ming Zhang, "Compu a ional models o he oo and ankle o
pa homechanics and clinical applica ions: a e iew," Annals o biomedical enginee ing, ol. 44, pp. 213-
221, 2016.
[21] Ma co Vicecon i, Sigbjo n Olsen, Lu z-P. Nol e, and Kim Bu on, "Ex ac ing clinically ele an da a
om ini e elemen simula ions," Clinical Biomechanics, ol. 20, pp. 451-454, 2005.
[22] Duo Wai-Chi Wong, Yan Wang, Tony Lin-Wei Chen, Ming Zhang, and A Leung, "Biomechanical
consequences o sub ala join a h oe eisis in ea ing pos e io ibial endon dys unc ion: a heo e ical
analysis using ini e elemen analysis," Compu e me hods in biomechanics and biomedical enginee ing,
ol. 20, no. 14, pp. 1525-1532, 2017.
[23] J. M. Ga cia-Azna e al., "Load ans e mechanism o di e en me a a sal geome ies: a ini e
elemen s udy," Jou nal o biomechanical enginee ing, ol. 131, p. 021011, 2009.
[24] Ch is ian. Ci uen es-De la Po illa, Rica do. La ainza -Ga ijo, and Ja ie . Bayod, "Biomechanical
s ess analysis o he main so issues associa ed wi h he de elopmen o adul acqui ed la oo
de o mi y," Clinical Biomechanics, ol. 61, no. c, pp. 163 - 171, dec 2018.
[25] Ch is ian Ci uen es-De la Po illa, Rica do La ainza -Ga ijo, and Ja ie Bayod, "Analysis o he main
passi e so issues associa ed wi h adul acqui ed la oo de o mi y de elopmen : A compu a ional
modeling app oach," Jou nal o Biomechanics, 2019.
[26] Timo hy A. Bu kha , Da id M. And ews, and Cyn hia E. Dunning, "Fini e elemen modeling mesh
quali y, ene gy balance and alida ion me hods: A e iew wi h ecommenda ions associa ed wi h he
modeling o bone issue," Jou nal o biomechanics, ol. 46, pp. 1477-1488, 2013.
ACCEPTED MANUSCRIPT
[27] Lijun Wu, "Nonlinea ini e elemen analysis o musculoskele al biomechanics o medial and
la e al plan a longi udinal a ch o Vi ual Chinese Human a e plan a ligamen ous s uc u e ailu es,"
Clinical Biomechanics, ol. 22, pp. 221-229, 2007.
[28] Joseph M. Mansou , "Biomechanics o ca ilage," Kinesiology: he mechanics and pa homechanics
o human mo emen , pp. 66-79, 2003.
[29] J. Bayod, R. Bece o-de-Bengoa-Vallejo, M. E. Losa-Iglesias, and M. Dobla é, "Mechanical s ess
edis ibu ion in he calcaneus a e au ologous bone ha es ing," Jou nal o biomechanics, ol. 45, pp.
1219-1226, 2012.
[30] G. A. A angio and E. P. Sala he, "A biomechanical analysis o pos e io ibial endon dys unc ion,
medial displacemen calcaneal os eo omy and lexo digi o um longus ans e in adul acqui ed la oo .,"
Clinical Biomechanics, ol. 24, no. 4, pp. 385-390, 2009.
[31] J. T. Deland e al., "Pos e io ibial endon insu iciency esul s a di e en s ages.," HSS jou nal,
ol. 2, pp. 157-160, 2006.
[32] Kai Tao e al., "An in i o expe imen al alida ion o a compu a ional model o human oo ,"
Jou nal o Bionic Enginee ing, ol. 6, pp. 387-397, 2009.
[33] R. La ainza -Ga ijo, C. Ci uen es-De la Po illa, B. Gu ié ez-Na a e, E. Díez-Nicolás, and J. &
Bayod, "E ec o de la os eo omía medializan e de calcáneo sob e ejidos blandos de sopo e del a co
plan a : un es udio compu acional," Re is a Española de Ci ugía O opédica y T auma ología., ol. 4, no.
3, 2018.
[34] Ami Ge en, Michal Megido-Ra id, Yaco I zchak, and Mi cea A can, "A 3-D nume ical model o
he human oo s uc u e du ing gai ," in [Enginee ing in Medicine and Biology, 1999. 21s Annual
Con e ence and he 1999 Annual Fall Mee ing o he Biomedical Enginee ing Socie y] BMES/EMBS
Con e ence, 1999. P oceedings o he Fi s Join , ol. 1, 1999, p. 559.
ACCEPTED MANUSCRIPT
[35] Jason Tak-Man Cheung, Ming Zhang, Aa on Kam-Lun Leung, and Yu-Bo Fan, "Th ee-dimensional
ini e elemen analysis o he oo du ing s anding—a ma e ial sensi i i y s udy," Jou nal o biomechanics,
ol. 38, pp. 1045-1054, 2005.
[36] Zhongkui Wang, Kan Imai, Masami su Kido, Kazuya Ikoma, and Shinichi Hi ai, "S udy o Su gical
Simula ion o Fla oo Using a Fini e Elemen Model," in Inno a ion in Medicine and Heal hca e 2015.:
Sp inge , 2016, pp. 353-363.
[37] Z. Wang, M. Kido, K. Imai, K. Ikoma, and S & Hi ai, "Towa ds pa ien -speci ic medializing calcaneal
os eo omy o adul la oo : a ini e elemen s udy," Compu e me hods in biomechanics and biomedical
enginee ing, ol. 21, no. 4, pp. 332-343, 2018.
[38] D. H. Zanolli, R. R. Glisson, J. A. Nunley, and M. E. & Easley, "Biomechanical assessmen o lexible
la oo co ec ion: compa ison o echniques in a cada e model," JBJS, ol. 96, p. 45, 2014.
[39] I. D. Hu chinson e al., "How do hind oo usions a ec ankle biomechanics: a cada e model,"
Clinical O hopaedics and Rela ed Resea ch, ol. 474, no. 4, pp. 1008-1016, 2016.
[40] KJ Logel, BG Pa ks, and LC Schon, "Calcaneocuboid dis ac ion a h odesis and i s
me a a socunei o m a h odesis o co ec ion o acqui ed la oo de o mi y in a cada e model," Foo
Ankle In , ol. 28, no. 4, pp. 435 - 440, 2007.
[41] En ique Mo ales O cajo, Es e am Ba bosa de las Casas, and Ja ie Bayod López, "Compu a ional
oo modeling o clinical assessmen ," Uni e sidad de Za agoza, Ph.D. disse a ion 2015.
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Lis o Figu e legends:
Figu e 1: Comple e FE model. All he oo issues included in he model and he
di e en ia ion be ween co ical and abecula bone a e shown.
Figu e 2: Explana ion o how he a h odesis was simula ed. The ca ilage ma e ial
was changed o a co ical ma e ial in each o he used join s.
Figu e 3: Bounda y and loading se ings applied o he oo model. The oo a ch
o he econs uc ed model (unloaded) was measu ed using he in e nal Mou ean-
Cos a-Be ani angle.
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Figu e 4: Model alida ion schema. Sagi al plane adiog aphs we e used o
compa e he oo de o ma ion in wo loading condi ions (ligh loading and no mal
s anding load).
Figu e 5: S uc u al de o ma ion ob ained a e simula ing bo h he heal hy oo and
he Adul acqui ed la oo de o mi y case.
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Figu e 6: Plan a ascia biomechanical s ess (N/mm2) gene a ed a e simula ing a ibialis
pos e io endon dys unc ion.
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Table 4: Maximum s ess (N/mm2) gene a ed a e simula ing a plan a ascia, sp ing
ligamen and ibialis pos e io endon dys unc ion.
Heal hy
Fla oo
Sub ala
a h odesis
Talona icula
a h odesis
Calcaneocuboid
a h odesis
T iple
a h odesis
SPL
24,88
42,34
39,50
34,98
4,61
3,38
LPL
24,42
60,67
64,62
41,53
82,33
72,2
PBT
210,77
210,41
178,91
213,9
219,73
221,58
PLT
183,76
247,34
241,9
213,75
382,56
354,93
FHL
242,7
267,2
243,3
247,36
248,09
252,27
FDL
184,3
182,27
166,12
183,97
183,67
179,16
AT
104,1
136
121
114
114
112
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