ABSTRACT
La osteotomía medializante de calcáneo forma parte del elenco de opciones de tratamiento en el pie plano adquirido en adultos. La corrección estructural que se consigue es ampliamente conocida. Sin embargo, el efecto de este procedimiento sobre los tejidos blandos que soportan el arco plantar ha sido poco estudiado, pues experimentalmente no es posible cuantificar las variaciones de tensión y deformación generadas. Por lo tanto, el objetivo de este estudio fue evaluar el efecto que tiene la osteotomía medializante de calcáneo sobre el tejido blando que soporta el arco plantar, usando un modelo computacional de pie humano diseñado con un enfoque clínico. El modelo por elementos finitos propuesto fue reconstruido a partir de imágenes de tomografías computarizadas de un paciente sano. Se incluyeron todos los huesos del pie, la fascia plantar, cartílagos, ligamentos plantares y el ligamento calcáneo-navicular, respetando su distribución anatómica y propiedades biomecánicas. Las simulaciones fueron realizadas emulando la fase de apoyo monopodal de la marcha humana de un adulto. El efecto sobre cada tejido fue evaluado siguiendo criterios clínicos y biomecánicos. Los resultados muestran que la osteotomía de calcáneo reduce la tensión generada normalmente sobre los tejidos evaluados, siendo el efecto sobre el ligamento calcáneo-navicular y la fascia plantar los más notables. Los resultados de deformación obtenidos son consistentes con ensayos experimentales y el conocimiento clínico. La versatilidad de este modelo permite la valoración objetiva de diferentes condiciones y apoya la toma de decisión para el tratamiento del pie plano adquirido en adultos en estadios medio y avanzado
Medializing calcaneal osteotomy forms part of the treatment options for adult acquired flat foot. The structural correction that is achieved is widely known. However, the effect of this procedure on the soft tissues that support the plantar arch has been little studied, since it is not possible to quantify experimentally the tension and deformation variations generated. Therefore, the objective of this study was to evaluate the effect of medializing calcaneal osteotomy on the soft tissue that supports the plantar arch, using a computational model of the human foot designed with a clinical approach. The proposed finite element model was reconstructed from computerized tomography images of a healthy patient. All the bones of the foot, the plantar fascia, cartilages, plantar ligaments and the calcaneus-navicular ligament were included, respecting their anatomical distribution and biomechanical properties. Simulations were performed emulating the monopodal support phase of the human walk of an adult. The effect on each tissue was evaluated according to clinical and biomechanical criteria. The results show that calcaneal osteotomy reduces the tension normally generated on the evaluated tissues, with the effect on the calcaneus-navicular ligament and the plantar fascia being the most notable. The deformation results obtained are consistent with experimental tests and clinical knowledge. The versatility of this model allows the objective assessment of different conditions and supports decision making for the treatment of adult acquired flat foot in middle and advanced stages
Subject(s)
Humans , Calcaneus/surgery , Computer Simulation , Flatfoot/surgery , Foot/anatomy & histology , Osteotomy/methods , Finite Element Analysis , Imaging, Three-DimensionalABSTRACT
Medializing calcaneal osteotomy forms part of the treatment options for adult acquired flat foot. The structural correction that is achieved is widely known. However, the effect of this procedure on the soft tissues that support the plantar arch has been little studied, since it is not possible to quantify experimentally the tension and deformation variations generated. Therefore, the objective of this study was to evaluate the effect of medializing calcaneal osteotomy on the soft tissue that supports the plantar arch, using a computational model of the human foot designed with a clinical approach. The proposed finite element model was reconstructed from computerized tomography images of a healthy patient. All the bones of the foot, the plantar fascia, cartilages, plantar ligaments and the calcaneus-navicular ligament were included, respecting their anatomical distribution and biomechanical properties. Simulations were performed emulating the monopodal support phase of the human walk of an adult. The effect on each tissue was evaluated according to clinical and biomechanical criteria. The results show that calcaneal osteotomy reduces the tension normally generated on the evaluated tissues, with the effect on the calcaneus-navicular ligament and the plantar fascia being the most notable. The deformation results obtained are consistent with experimental tests and clinical knowledge. The versatility of this model allows the objective assessment of different conditions and supports decision making for the treatment of adult acquired flat foot in middle and advanced stages.
Subject(s)
Calcaneus/surgery , Computer Simulation , Flatfoot/surgery , Foot/anatomy & histology , Osteotomy/methods , Finite Element Analysis , Humans , Imaging, Three-DimensionalABSTRACT
Resumen: La inestabilidad de la postura y alteración del balance corporal son signos comúnmente observados en sujetos con afecciones que comprometen el sistema músculo-esquelético, visual, vestibular y propioceptivo, siendo la estabilometría la principal herramienta de valoración clínica. Sin embargo, no se ha podido establecer un gold standard o patrones cuantitativos que permitan clasificar sujetos sanos y patológicos basados en el grado de alteración del equilibrio. Objetivo: El objetivo principal de este estudio fue realizar un análisis estabilométrico preliminar con 38 sujetos sanos (19 mujeres y 19 hombres), con el fin de identificar un patrón de desplazamiento característico de la postura. Metodología: Este estudio se basó en la aplicación del test de Romberg. Se realizaron tres mediciones en cada paciente con ojos abiertos (OA) y ojos cerrados (OC), ubicados sobre una plataforma de fuerza en posición vertical. Resultado: se identificó un patrón característico de desplazamiento en los ejes medio-lateral X y antero-posterior Y, así como una estabilidad notable sobre el eje vertical Z, alrededor del centro de presión. Limitaciones: Sin embargo, debido al tamaño de la muestra, no se encontraron resultados concluyentes sobre las diferencias de índice de masa corporal, sexo o edad en el grupo de estudio. Originalidad: A pesar de ello, se encontraron parámetros prometedores para la evaluación de la estabilometría en personas jóvenes sanas, fortalenciendo con ellos las herramientas objetivas de valoración clínica. Conclusión: Esta investigación permitió identificar características de movimiento comunes para pacientes normales, que pueden ser consideradas como un patrón objetivo para el seguimiento y evaluación de tratamientos en pacientes con trastornos del equilibrio de origen patológico.
Abstract: The postur instability and body balance alteration, are signs commonly observed in patients with diseases associated with the musculoskeletal, visual, vestibular and proprioceptive systems, being the stabilometry the main clinical assessment study. However, it has not been established a standard or a quantitative pattern to classify healthy and pathological subjects based on the impaired balance level. Objective: The main objective of this study was to conduct a preliminary stabilometric analysis in 38 healthy subjects (19 women and 19 men) in order to identify a characteristic pattern of the position displacement. Methodology: This study was based on the Rombergś test. Three measurements was performed to each patient with open eyes (OA) and eyes closed (OC) stand over a force platform. Results: A characteristic pattern of the medio-lateral X and anteroposterior Y movement was identified, and remarkable stability on the vertical axis Z around the center of pressure. Limitations: However, because of the small sample size there was not found conclusive results related to Body-Mass-Index, sex or age. Originality: Despite, promising parameters were found for the evaluation of stabilometry in healthy young people, strengthening the objective tools of clinical assessment. Conclusion: This research identified common patient characteristics of normal movement, that could be considered as an objective standard for patient monitoring and treatment evaluation in patients with pathological balance disorders.
