Posterior tibial tendon dysfunction and flatfoot: analysis with simulated walking.
Posterior tibial tendon dysfunction and flatfoot: analysis with simulated walking.
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DOI：
10.1016/j.gaitpost.2012.07.015
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发表时间：
2013-02
期刊：
影响因子：
2.4
通讯作者：
An KN
中科院分区：
文献类型：
--
作者：
Watanabe K;Kitaoka HB;Fujii T;Crevoisier X;Berglund LJ;Zhao KD;Kaufman KR;An KN
许多生物力学研究对扁平足的病理和手术对扁平足的影响进行了研究。大多数身体研究仅限于对静态关节载荷的准静态响应。本研究利用动态足踝模拟器，模拟第二阶段胫后肌腱功能障碍(PTTD)，研究了站立阶段足部和踝部关节的自由运动。使用六个伺服气动气缸将肌力施加在脚的外部肌腱上，以模拟它们的动作。施加垂直剪切力和前后剪切力，并利用伺服马达执行胫骨推进。用磁力跟踪系统监测足部多个骨骼的三维运动。22条新鲜冷冻的小腿在完好的情况下进行研究，然后在切断跟腱周围的约束下形成扁平足，并卸载胫骨后肌力。完整状态下的运动学与正常人的步态分析数据是一致的。平足状态下运动学发生了改变，尤其是在冠状面和横断面上。跟骨相对于胫骨的外翻角度平均为11.1°±2.8°，正常情况下为5.8°±2.3°。平足患者的跟骨-胫骨外旋角度由平均2.3±1.7°增加到8.1±4.0°。在平足状态下，跖骨-胫骨外翻和外旋也有明显变化。模拟的平足PTTD与以往PTTD患者的数据一致。扁平足模型的使用将使人们能够更详细地研究扁平足的状况和/或手术治疗的效果。
Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot-ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment.
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