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Title: Finite element simulation on posterior tibial tendinopathy : load transfer alteration and implications to the onset of pes planus
Authors: Wong, DWC 
Wang, Y 
Leung, AKL 
Yang, M 
Zhang, M 
Issue Date: Mar-2018
Source: Clinical biomechanics, Mar. 2018, v. 51, p. 10-16
Abstract: Background Posterior tibial tendinopathy is a challenging foot condition resulting in pes planus, which is difficult to diagnose in the early stage. Prior to the deformity, abnormal internal load transfer and soft tissue attenuation are anticipated. The objective of this study was to investigate the internal load transfer and strain of the ligaments with posterior tibial tendinopathy, and the implications to pes planus and other deformities. Methods A three-dimensional finite element model of the foot and ankle was reconstructed from magnetic resonance images of a 28-year-old normal female. Thirty bones, plantar fascia, ligaments and tendons were reconstructed. With the gait analysis data of the model subject, walking stance was simulated. The onset of posterior tibial tendinopathy was resembled by unloading the tibialis posterior and compared to the normal condition. Findings The load transfer of the joints at the proximal medial column was weaken by posterior tibial tendinopathy, which was compromised by the increase along the lateral column and the intercuneiforms during late stance. Besides, the plantar tarsometatarsal and cuboideonavicular ligaments were consistently over-stretched during stance. Particularly, the maximum tensile strain of the plantar tarsometatarsal ligament was about 3-fold higher than normal at initial push-off. Interpretation Posterior tibial tendinopathy altered load transfer of the medial column and unbalanced the load between the proximal and distal side of the medial longitudinal arch. Posterior tibial tendinopathy also stretched the midfoot plantar ligaments that jeopardized midfoot stability, and attenuated the transverse arch. All these factors potentially contributed to the progress of pes planus and other foot deformities.
Keywords: Arch collapse
Pes planus
Posterior tibia tendon dysfunction
Publisher: Pergamon Press
Journal: Clinical biomechanics 
ISSN: 0268-0033
EISSN: 1879-1271
DOI: 10.1016/j.clinbiomech.2017.11.001
Rights: © 2017 Elsevier Ltd. All rights reserved.
© 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
The following publication Wong, D. W. C., Wang, Y., Leung, A. K. L., Yang, M., & Zhang, M. (2018). Finite element simulation on posterior tibial tendinopathy: load transfer alteration and implications to the onset of pes planus. Clinical Biomechanics, 51, 10-16 is available at
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