Effect of lyophilization on the bacterial cellulose produced by different Komagataeibacter strains to adsorb epicatechin.

Bacterial cellulose (BC) has been widely used as a model system to investigate the interaction of polyphenols with the polysaccharides of cell walls. In this study, the water absorption ability and the adsorption ability of epicatechin of the never-dried and freeze-dried BC produced by a high-yield Komagataeibacter hansenii strain ATCC 53582 was compared with two normal-yield strains. The structural characteristics of BC were investigated via microscopy observation and mechanical/rheological tests. The 1-butyl-3-methylimidazolium acetate/dimethyl sulfoxide ([BMIM]Ac/DMSO) co-solvent was used to dissolve BC to calculate the degree of polymerization (DP). Results showed that compared with the other two strain, the BC synthesised by ATCC 53582 had a higher cellulose concentration (1.2 wt%) but lower epicatechin adsorption (29 µg/mg under 4 mM, pH 7). Its fibril network collapsed and led to a reduced recovery ratio (86 %) in the compression-relaxation test, which may be due to large DP (2856).

Comparison of design methods for negative pressure gradient rotary bodies: A CFD study.

Computational fluid dynamics (CFD) simulation is used to test two body design methods which use negative pressure gradient to suppress laminar flow separation and drag reduction. The steady-state model of the Transition SST model is used to calculate the pressure distribution, wall shear stress, and drag coefficient under zero angle of attack at different velocities. Four bodies designed by two different methods are considered. Our results show the first method is superior to the body of Hansen in drag reduction and the body designed by the first method is more likely to obtain the characteristics of suppressing or eliminating separation, which can effectively improve laminar flow coverage to achieve drag reduction under higher Reynolds number conditions. The results show that the negative pressure gradient method can suppress separation and drag reduction better than the second method. This successful design method is expected to open a promising prospect for its application in the design of small drag, small noise subsonic hydrodynamic hull and underwater weapons.

Finite element model-based evaluation of tissue stress variations to fabricate corrective orthosis in feet with neutral subtalar joint.

BACKGROUND: The subtalar joint position during static stance is a crucial determinant of the peak plantar pressures and forms ideal reference point for any intervention in foot-related problems for leprosy-affected patients. OBJECTIVES: The study pursued the hypothesis through a three-dimensional model that stress will be minimal in the distal joints of the foot when the subtalar joint is in neutral static stance position. STUDY DESIGN: Finite element model. METHODS: The computed tomography images of the feet for five patients suffering from Hansen's disease having no muscle weakness and joint restriction were acquired. The gray intensities corresponding to the bones of the foot from the computed tomography images were three-dimensionally reconstructed. The three-dimensional model of the human foot, incorporating the realistic geometry, and the material properties of the hard tissues were then analyzed using a finite element solver for the stress distribution on bones of the foot. RESULTS: The results demonstrate that the position of the calcaneum in the static stance position does contribute to the varying stress in the foot. CONCLUSION: The stresses in the bones of the foot are minimal while the subtalar is in neutral position; this position will be suitable for foot orthotic fabrication. Clinical relevance The clinicians, therapists, and podiatrists having less engineering skills can quickly assess the patient and get optimal results on the stress associated with the joints of the foot.

Analysis of catheter contact force during atrial fibrillation ablation using the robotic navigation system: results from a randomized study.

PURPOSE: Contact with cardiac tissue is an important determinant of lesion efficacy during atrial fibrillation (AF) ablation. The Sensei X™ robotic navigation system (RNS) (Hansen Medical, Mountain View, CA, USA) has been validated for contact force (CF) sensing expressed in grams (g). The Thermocool® SmartTouch™ catheter enables the measurement of catheter tip CF and direction inside the heart. We aimed to investigate the catheter CF with and without RNS during pulmonary vein isolation (PVI) procedures. METHODS: Eighty patients with symptomatic AF (56 males, age 63 ± 18) were enrolled in this study. Fifty-seven patients had paroxysmal AF and 23 early persistent AF. All procedures were performed with the Thermocool® SmartTouch™ ablation catheter. Forty patients were randomized to perform PVI with the Sensei X™ RNS (group 1), while in the other 40 patients (group 2), PVI was performed without the RNS. RESULTS: AF ablation was performed successfully in all patients without complications, while contact force was kept in the established 10-40 g range. A significantly higher CF was documented on the PVs in group 1 compared to group 2. The 1-year freedom from AF recurrence was higher in group 1 compared to group 2 (90 vs. 65 %, p = 0.04). Moreover, a significant reduction of fluoroscopy time was noted in the RNS group (13 ± 10 vs. 20 ± 10 min, respectively, p = 0.05). CONCLUSIONS: The Sensei X™ RNS permits a significantly higher CF during transcatheter AF ablation with a low rate of AF recurrence at clinical follow-up.

Influence of solvent quality on the mechanical strength of ethylcellulose oleogels.

Ethylcellulose (EC) is the only known food-grade polymer able to structure edible oils. The gelation process and gel properties are similar to those of polymer hydrogels, the main difference being the nature of the solvent. The present study examines the influence of solvent quality on the large deformation mechanical behavior of EC oleogels. Two alternative strategies for manipulating the mechanical response of these gels were evaluated; manipulating the bulk solvent polarity and the addition of surface active small molecules. Gel strength was positively correlated to solvent polarity when blending soybean oil with either mineral oil or castor oil. This behavior was attributed to the ability of the polar entities present in the oil phase to interact with the EC gel network. The addition of the small molecules oleic acid and oleyl alcohol resulted in a substantial enhancement in gel strength up to 10wt% addition, followed by a gradual decrease with increasing proportions. Binding interactions between EC and these molecules were successfully modeled using a Langmuir adsorption isotherm below 10wt% addition. Furthermore, the thermal behavior of stearic acid and stearyl alcohol also indicated a direct interaction between these molecules and the EC network. Differences in the mechanical behavior of gels prepared using refined, bleached, and deodorized canola or soybean oils, and those made with cold-pressed flaxseed oil could be attributed to both oil polarity, and the presence of minor components (free fatty acids). Shorter pulsed NMR T2 relaxation times were observed for stronger gels due to the more restricted mobility of the solvent when interacting with the polymer. This work has demonstrated the strong influence of the solvent composition on the mechanical properties of EC oleogels, which will allow for the tailoring of mechanical properties for various applications.

Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study.

BACKGROUND: This study compared mid-term functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation (SER) ankle fractures with intraoperatively confirmed syndesmosis disruption. Our hypothesis was that early-stage good functional results would remain and unfixed syndesmosis disruption in SER IV ankle fractures would not lead to an increased incidence of osteoarthritis. METHODS: A prospective study of 140 operatively treated patients with Lauge-Hansen SER IV (Weber B) ankle fractures was performed. After bony fixation, the 7.5-Nm standardized external rotation stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. The patients were randomized to either syndesmotic screw fixation (13 patients) or no syndesmotic fixation (11 patients). After a minimum of 4 years of follow-up (mean, 58 months), ankle function and pain (Olerud-Molander, a 100-mm visual analogue scale [VAS] for ankle function and pain) and quality of life (RAND-36) of all 24 patients were assessed. Ankle joint congruity and osteoarthritis were assessed using mortise and lateral projection plain weight-bearing radiographs and magnetic resonance imaging (MRI; 3T) scans. RESULTS: Improvement in Olerud-Molander score, VAS, and RAND-36 showed no significant difference between groups during the follow-up. In the syndesmotic transfixation group, improvements in all functional parameters and pain measurements were not significant, whereas in the group without syndesmotic fixation, the Olerud-Molander score improved from 84 to 93 (P = .007) and the pain (VAS) score improved from 11 to 4 (P = .038) from 1 year to last follow-up. X-ray or MRI imaging showed no difference between groups at the last follow-up visit. CONCLUSION: With the numbers available, no significant difference in functional outcome or radiologic findings could be detected between syndesmosis transfixation and no-fixation patients with SER IV ankle fracture after a minimum of 4 years of follow-up. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Stress-whitening occurs in demineralized bone.

INTRODUCTION: The incidence of age-related bone fracture is increasing with average population age. Bone scatters more light (stress-whitens) during loading, immediately prior to failure, in a manner visually similar to polymer crazing. We wish to understand the stress-whitening process because of its possible effect on bone toughness. The goals of this investigation were a) to establish that stress-whitening is a property of the demineralized organic matrix of bone rather than only a property of mineralized tissue and that stress whitening within the demineralized bone is dependent upon both b) hydrogen bonding and, c) the orientation of loading. METHODS: Demineralized cortical bone specimens were loaded in tension to failure (0.08 strain/s). The effect of hydrogen bonding on mechanical properties and the stress-whitening process was probed by altering the Hansen's hydrogen bonding parameter (δh) of the immersing solution. RESULTS: Stress-whitening occurred in the demineralized bone. Stress-whitening was negatively correlated with δh (R(2)=0.81, p<0.0001). Stress-whitening was significantly lower (p<0.0001) in specimens loaded orthogonally compared to those loaded parallel to the long (strong) axis. CONCLUSION: The stress-whitening observed was consistent with increased Mie scattering. We suggest that the change in Mie scattering was due to collagen fibril dehydration driven by the externally applied stress. The presence of stress-whitening in demineralized bone suggests that this process may be a property of the collagenous matrix and hence may be present in other collagenous tissues rather than an emergent property of the bone composite.

Do stress-whitening and optical clearing of collagenous tissue occur by the same mechanism?

Bone is biphasic with an organic matrix and an inorganic mineral component. As we age bone's susceptibility to fracture increases. It has been shown that there is no change in mean mineralization with aging, but bone nevertheless becomes less tough. This aging effect is therefore likely related to the organic phase. Under mechanical loading, immediately prior to failure, bone has been observed to visually become more opaque and has been termed stress-whitening. Stress-whitening is known to make materials tougher. The goal of this investigation was to investigate stress-whitening in the collagenous matrix of bone. Hydrogen bonds play a key role in collagen stability and we hypothesize that changes in hydrogen bonding will significantly affect matrix stiffness, toughness and stress whitening. Demineralized bone specimens were loaded in tension and stress-whitening was monitored. The effect of hydrogen bonding on mechanical properties and stress-whitening process was probed by altering the Hansen's hydrogen bonding parameter (δh) of the immersing solution. The Hansen's hydrogen bonding parameter of the immersing fluid affected the morphology, mechanical properties and stress whitening of specimens. Specimens were visually whiter in the absence of mechanical load in low δh solvents (the specimens solvent-whitened). Both the observed stress-whitening and solvent-whitening were reversible and repeatable processes. The observed solvent-whitening that occurred without the presence of load was consistent with solvent-induced optical clearing (the opposite of whitening) in skin caused by collagen fibril swelling. Stress whitening and solvent whitening can be explained by a common mechanism, collagen fibril densification and thinning, leading to an increased distinction between the collagen fibrillar phase and immersing fluid, ultimately leading to more scattering. Bones may be at a greater risk for fracture as we age because solubility of the matrix changes, thus making the collagen less hydrated (and more brittle) even in the same solvent.

Plantar pressure and daily cumulative stress in persons affected by leprosy with current, previous and no previous foot ulceration.

Not only plantar pressure but also weight-bearing activity affects accumulated mechanical stress to the foot and may be related to foot ulceration. To date, activity has not been accounted for in leprosy. The purpose was to compare barefoot pressure, in-shoe pressure and daily cumulative stress between persons affected by leprosy with and without previous or current foot ulceration. Nine persons with current plantar ulceration were compared to 15 with previous and 15 without previous ulceration. Barefoot peak pressure (EMED-X), in-shoe peak pressure (Pedar-X) and daily cumulative stress (in-shoe forefoot pressure time integral×mean daily strides (Stepwatch™ Activity Monitor)) were measured. Barefoot peak pressure was increased in persons with current and previous compared to no previous foot ulceration (mean±SD=888±222 and 763±335 vs 465±262kPa, p<0.05). In-shoe peak pressure was only increased in persons with current compared to without previous ulceration (mean±SD=412±145 vs 269±70kPa, p<0.05). Daily cumulative stress was not different between groups, although persons with current and previous foot ulceration were less active. Although barefoot peak pressure was increased in people with current and previous plantar ulceration, it did not discriminate between these groups. While in-shoe peak pressure was increased in persons with current ulceration, they were less active, resulting in no difference in daily cumulative stress. Increased in-shoe peak pressure suggests insufficient pressure reducing footwear in persons with current ulceration, highlighting the importance of pressure reducing qualities of footwear.

Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury.

The aim of this thesis was to confirm the utility of stability-based ankle fracture classification in choosing between non-operative and operative treatment of ankle fractures, to determine how many ankle fractures are amenable to non-operative treatment, to assess the roles of the exploration and anatomical repair of the AITFL in the outcome of patients with SER ankle fractures, to establish the sensitivities, specificities and interobserver reliabilities of the hook and intraoperative stress tests for diagnosing syndesmosis instability in SER ankle fractures, and to determine whether transfixation of unstable syndesmosis is necessary in SER ankle fractures. The utility of stability based fracture classification to choose between non-operative and operative treatment was assessed in a retrospective study (1) of 253 ankle fractures in skeletally mature patients, 160 of whom were included in the study to obtain an epidemiological profile in a population of 130,000. Outcome was assessed after a minimum follow-up of two years. The role of AITFL repairs was assessed in a retrospective study (2) of 288 patients with Lauge-Hansen SE4 ankle fractures; the AITFL was explored and repaired in one group (n=165), and a similar operative method was used but the AITFL was not explored in another group (n=123). Outcome was measured with a minimum follow-up of two years. Interobserver reliability of clinical syndesomosis tests (study 3) and the role of syndesmosis transfixation (study 4) were assessed in a prospective study of 140 patients with Lauge-Hansen SE4 ankle fractures. The stability of the distal tibiofibular joint was evaluated by the hook and ER stress tests. Clinical tests were carried out by the main surgeon and assistant, separately, after which a 7.5-Nm standardized ER stress test for both ankles was performed; if it was positive, the patient was randomized to either syndesmosis transfixation (13 patients) or no fixation (11 patients) treatment groups. The sensitivity and specificity of both clinical tests were calculated using the standard 7.5-Nm external rotation stress test as reference. Outcome was assessed after a minimum of one year of follow-up. Olerud-Molander (OM) scoring system, RAND 36-Item Health Survey, and VAS to measure pain and function were used as outcome measures in all studies. In study 1, 85 (53%) fractures were treated operatively using the stability based fracture classification. Non-operatively treated patients reported less pain and better OM (good or excellent 89% vs. 71%) and VAS functional scores compared to operatively treated patients although they experienced more displacement of the distal fibula (0 mm 30% vs. 69%; 0-2 mm 65% vs. 25%) after treatment. No non-operatively treated patients required operative fracture fixation during follow-up. In study 2, AITFL exploration and suture lead to equal functional outcome (OM mean, 77 vs. 73) to no exploration or fixation. In study 3, the hook test had a sensitivity of 0.25 and a specificity of 0.98. The external rotation stress test had a sensitivity of 0.58 and a specificity of 0.9. Both tests had excellent interobserver reliability; the agreement was 99% for the hook test and 98% for the stress test. There was no statistically significant difference in functional scores (OM mean, 79.6 vs. 83.6) or pain between syndesmosis transfixation and no fixation groups (Study 4). Our results suggest that a simple stability-based fracture classification is useful in choosing between non-operative and operative treatment of ankle fractures; approximately half of the ankle fractures can be treated non-operatively with success. Our observations also suggest that relevant syndesmosis injuries are rare in ankle fractures due to an SER mechanism of injury. According to our research, syndesmotic repair or fixation in SER ankle fracture has no influence on functional outcome or pain after minimum one year compared with no fixation.

Correlation of weightbearing radiographs and stability of stress positive ankle fractures.

BACKGROUND: A positive external rotation stress test has been used as an indication for operative treatment of fractures of the lateral malleolus. The objective of the current study was to ascertain the results of a protocol initially treating stress positive ankle fractures nonoperatively and utilizing weightbearing radiographs in surgical decision making. METHODS: We performed a prospective study of lateral malleolar fractures with an associated medial ligamentous injury. All patients with fractures of the lateral malleolus with medial sided symptoms and/or signs, and an intact ankle mortise underwent an external rotation stress test to confirm injury to the deltoid ligament (stress positive). Patients with a positive stress test were placed in a short-leg walking cast and seen in 7 days where weightbearing radiographs of the ankle were obtained. If the radiographs demonstrated an intact mortise, then nonoperative treatment was continued. If the weightbearing radiographs demonstrated medial clear space widening, then the patient was offered operative treatment to restore the congruency of the ankle mortise. Patients were assessed for conversion to operative treatment, complications, and functional outcome. Thirty-eight patients were enrolled in the study. Using Lauge-Hansen classification 36 (95%) were stress positive supination-external rotation fractures and 2 (5%) were stress positive pronation-external rotation fractures. Followup assessment was performed at a minimum of 6 months and averaged 12 months. RESULTS: Weightbearing radiographs at the first post-injury clinic visit had an average medial clear space of 2.9 ±0.9 mm. Three (8%) patients met our criteria for medial clear space widening and underwent operative treatment. Of these three patients, two were pronation-external rotation fracture patterns. Therefore, 3% of the supination-external rotation IV fractures, and all of the pronation-external III/IV rotation fractures ultimately required operative treatment. At final followup, the average AOFAS hindfoot score was 92 ±8.1. CONCLUSION: Ligamentous supination-external rotation Stage IV fractures with an intact mortise on static radiographs can be initially treated nonoperatively. Weightbearing radiographs should be utilized to assess congruency of the ankle mortise during an early post-injury visit. Utilizing this approach, a significant number of surgeries were avoided, and good to excellent results were obtained. From our early experience, nonoperative treatment of pronation-external rotation III/IV injuries using this protocol is not recommended.

Increased plantar foot pressure in persons affected by leprosy.

Although foot pressure has been reported to be increased in people affected by leprosy, studies on foot pressure and its determinants are limited. Therefore, the aim was to assess barefoot plantar foot pressure and to identify clinical determinants of increased plantar foot pressure in leprosy affected persons. Plantar pressure in both feet was assessed using the Novel EMED-X platform in 39 persons affected by leprosy. Peak pressure was determined for the total foot and four regions: hallux, metatarsal heads, midfoot and heel. Potential determinants were: age, weight, nerve function (Neuropathy Disability Score, Pressure Perception Threshold and Vibration Perception Threshold), toe and foot deformities, joint mobility, ankle muscle strength and callus. Increased peak pressure (>600kPa) was observed in 46% of the participants. The highest peak pressure (mean) was found in the metatarsal heads region (right 549 (SD 321)kPa; left 530 (SD 298)kPa). Multilevel regression analysis showed that Neuropathy Disability Score, amputation/absorption of toes and hallux valgus independently contributed to metatarsal heads peak pressure in persons affected with leprosy. To conclude, peak pressure is increased in people affected by leprosy. The highest peak pressure is found in the forefoot region and is significantly associated to Neuropathy Disability Score, toe amputation/absorption and hallux valgus. Screening for clinical characteristics can be used to identify individual persons affected by leprosy at risk of excessive pressure.

Intraoperative assessment of the stability of the distal tibiofibular joint in supination-external rotation injuries of the ankle: sensitivity, specificity, and reliability of two clinical tests.

BACKGROUND: This study was designed to assess the sensitivity, specificity, and interobserver reliability of the hook test and the stress test for the intraoperative diagnosis of instability of the distal tibiofibular joint following fixation of ankle fractures resulting from supination-external rotation forces. METHODS: We conducted a prospective study of 140 patients with an unstable unilateral ankle fracture resulting from a supination-external rotation mechanism (Lauge-Hansen SE). After internal fixation of the malleolar fracture, a hook test and an external rotation stress test under fluoroscopy were performed independently by the lead surgeon and assisting surgeon, followed by a standardized 7.5-Nm external rotation stress test of each ankle under fluoroscopy. A positive stress test result was defined as a side-to-side difference of >2 mm in the tibiotalar or the tibiofibular clear space on mortise radiographs. The sensitivity and specificity of each test were calculated with use of the standardized 7.5-Nm external rotation stress test as a reference. RESULTS: Twenty-four (17%) of the 140 patients had a positive standardized 7.5-Nm external rotation stress test after internal fixation of the malleolar fracture. The hook test had a sensitivity of 0.25 (95% confidence interval, 0.12 to 0.45) and a specificity of 0.98 (95% confidence interval, 0.94 to 1.0) for the detection of the same instabilities. The external rotation stress test had a sensitivity of 0.58 (95% confidence interval, 0.39 to 0.76) and a specificity of 0.96 (95% confidence interval, 0.90 to 0.98). Both tests had excellent interobserver reliability, with 99% agreement for the hook test and 98% for the stress test. CONCLUSIONS: Interobserver agreement for the hook test and the clinical stress test was excellent, but the sensitivity of these tests was insufficient to adequately detect instability of the syndesmosis intraoperatively.

A new interpretation of the mechanism of ankle fracture.

BACKGROUND: Researchers have found it difficult to recreate a Lauge-Hansen supination-external rotation-type ankle fracture in experimental settings. We hypothesized that a pronation-external rotation mechanism could cause both distal, short oblique and high fibular fractures and that the fracture type would be affected by associated, laterally directed forces applied to the foot. Methlods: Twenty-three cadaver ankles were subjected to fracture loading that replicated the Lauge-Hansen pronation-external rotation mechanism with or without applying an external lateral force. In Phase I, an axial load was applied to fifteen specimens mounted on a materials testing machine. Each foot was rotated externally to failure. In Phase II, eight specimens were tested according to the Phase-I protocol, but external forces were applied laterally at the foot to increase the abduction moment at the ankle. Load and position versus time curves were recorded and were correlated with video image data to establish the sequence of failure of specific anatomic structures. RESULTS: Eight specimens tested in Phase I sustained an oblique fracture of the distal end of the fibula with both medial and posterior injuries that occurred after the fibular fracture. Increasing the external lateral force and hence the abduction moment within the ankle (Phase II) resulted in three of eight specimens sustaining a high fibular fracture with a reversed fracture line (anterosuperior to posteroinferior) and/or a comminuted high fibular fracture. The distribution of traditional pronation-external rotation-type fractures differed significantly between Phase I and Phase II (p=0.032). CONCLUSIONS: This study generated counterexamples to the Lauge-Hansen classification system by showing that a short oblique fracture of the distal end of the fibula can occur with the foot in the pronated position. Furthermore, a high fibular fracture was recreated by increasing the abduction moment at the ankle.

Microcracking damage and the fracture process in relation to strain rate in human cortical bone tensile failure.

It is difficult to define the 'physiological' mechanical properties of bone. Traumatic failures in-vivo are more likely to be orders of magnitude faster than the quasistatic tests usually employed in-vitro. We have reported recently [Hansen, U., Zioupos, P., Simpson, R., Currey, J.D., Hynd, D., 2008. The effect of strain rate on the mechanical properties of human cortical bone. Journal of Biomechanical Engineering/Transactions of the ASME 130, 011011-1-8] results from tests on specimens of human femoral cortical bone loaded in tension at strain rates (epsilon ) ranging from low (0.08s(-1)) to high (18s(-1)). Across this strain rate range the modulus of elasticity generally increased, stress at yield and failure and strain at failure decreased for rates higher than 1s(-1), while strain at yield was invariant for most strain rates and only decreased at rates higher than 10s(-1). The results showed that strain rate has a stronger effect on post-yield deformation than on initiation of macroscopic yielding. In general, specimens loaded at high strain rates were brittle, while those loaded at low strain rates were much tougher. Here, a post-test examination of the microcracking damage reveals that microcracking was inversely related to the strain rate. Specimens loaded at low strain rates showed considerable post-yield strain and also much more microcracking. Partial correlation and regression analysis suggested that the development of post-yield strain was a function of the amount of microcracking incurred (the cause), rather than being a direct result of the strain rate (the excitation). Presumably low strain rates allow time for microcracking to develop, which increases the compliance of the specimen, making them tougher. This behaviour confirms a more general rule that the degree to which bone is brittle or tough depends on the amount of microcracking damage it is able to sustain. More importantly, the key to bone toughness is its ability to avoid a ductile-to-brittle transition for as long as possible during the deformation. The key to bone's brittleness, on the other hand, is the strain and damage localisation early on in the process, which leads to low post-yield strains and low-energy absorption to failure.

Mechanics of tarsal disintegration and plantar ulcers in leprosy by stress analysis in three dimensional foot models.

This paper describes three dimensional two arch models of feet of a normal subject and two leprosy subjects, one in the early stage and the other in the advanced stage of tarsal disintegration, used for analysis of skeletal and plantar soft tissue stresses by finite element technique using NISA software package. The model considered the foot geometry (obtained from X-rays), foot bone, cartilages, ligaments, important muscle forces and sole soft tissue. The stress analysis is carried out for the foot models simulating quasi-static walking phases of heel-strike, mid-stance and push-off. The analysis of the normal foot model shows that highest stresses occur at push-off over the dorsal central part of lateral and medial metatarsals and dorsal junction of calcaneus and cuboid and neck of talus. The skeletal stresses, in early state leprosy with muscle paralysis and in the advanced stage of tarsal distintegration (TD), are higher than those for the normal foot model, by 24% to 65% and 30% to 400%, respectively. The vertical stresses in the soft tissue at the foot-ground interface match well with experimentally measured foot pressures and for the normal and leprosy subjects they are the highest in the push-off phase. In the leprosy subject with advanced TD, the highest soft tissue stresses and shear stresses (about three times the normal value) occur in push-off phase in the scar tissue region. The difference in shear stresses between the sole and the adjacent soft tissue layer in the scar tissue for the same subject is about three times the normal value. It is concluded that the high bone stresses in leprosy may be responsible for tarsal distintegration when the bone mechanical strength decreases due to osteoporosis and the combined effect of high value of footsole vertical stresses, shear stresses and the relative shear stresses between two adjacent soft tissue layers may be responsible for plantar ulcers in the neuropathic leprosy feet.

Stress analysis in three-dimensional foot models of normal and diabetic neuropathy.

In this paper, a three-dimensional two-arch model of the foot is developed, taking foot geometry from X-rays of normal and diabetic subjects, which considered bones, cartilages, ligaments, important muscle forces and foot-sole soft-tissue. The stress analysis is carried out by a finite element technique using NISA software for the foot models simulating quasi-static walking phases of heel-strike, mid-stance and push-off. The analysis shows that the highest stresses occur during the push-off phase in the dorsal central part of the lateral and medial metatarsals and the dorsal junction of the calcaneus and cuboid. The vertical stresses, in the foot-sole soft-tissue at the foot-ground interface, for normal and diabetic neuropathic subjects, are the highest in the push-off phase and were in good agreement with the experimentally measured foot pressures. It is found that the foot-sole vertical stresses (at the foot-ground interface), in diabetic neuropathy, increase considerably in the heel region in the heel-strike phase and in the fore-foot regions in the push-off phase. The high stress concentration areas, in the plantar surfaces indicated above, are of great importance since it is found from clinical reports that in diabetic neuropathic patients these areas of the foot-sole are prone to ulcers. Thus, this investigation could possibly provide information on the areas of high stress concentration of the foot bones in the normal foot giving rise to arthritis when the mechanical strength decreases and possible high stress regions of foot bone giving rise to disintegration of tarsal bones in leprosy, as well as an insight into the factors contributing to plantar ulcers in diabetic neuropathy.

Three-dimensional foot modeling and analysis of stresses in normal and early stage Hansen's disease with muscle paralysis.

The models of the foot available in the literature are either two- or three-dimensional (3-D), representing a part of the foot without considering different segments of bones, cartilages, ligaments, and important muscles. Hence, there is a need to develop a 3-D model with sufficient details. In this paper, a 3-D, two-arch model of the foot is developed, taking foot geometry from the X-rays of nondisabled controls and a Hansen's disease (HD) subject, and taking into consideration bones, cartilages, ligaments, important muscle forces, and foot sole soft tissue. The stress analysis is carried out by finite element (FE) technique using NISA software for the foot models, simulating quasi-static walking phases of heel-strike, midstance, and push-off. The analysis shows that the highest stresses occur during push-off phase in the dorsal central part of the lateral and medial metatarsals, the dorsal junction of the calcaneus, and the cuboid and plantar central part of the lateral metatarsals in the foot. The stresses in push-off phase in critical tarsal bone regions, for the early stage of HD with muscle paralysis, increase by 25-50% as compared with the control foot model. The model calculated stress results at the plantar surfaces are of the same order of magnitude as the measured foot pressures (0.2-0.5 MPa). The high stress concentration areas in the foot bones indicated above are of great importance, since it is found from clinical reports that in some subjects with pathogenic decrease in the mechanical strength of the bone from HD, these areas of bone are disintegrated. Therefore, this investigation could possibly provide an insight into the factors contributing to disintegration of tarsal bones in HD.