Changes in Foot Loading Following Plantar Fasciotomy: A Computer Modeling Study

[+] Author and Article Information
Ahmet Erdemir

Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA

Stephen J. Piazza

Center for Locomotion Studies, Departments of Kinesiology, Mechanical Engineering, and Bioengineering, The Pennsylvania State University, University Park, PA 16802, USADepartment of Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, PA 17033, USA

J Biomech Eng 126(2), 237-243 (May 04, 2004) (7 pages) doi:10.1115/1.1691447 History: Revised June 13, 2002; Received November 15, 2002; Online May 04, 2004
Copyright © 2004 by ASME
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(a) The musculoskeletal model included four segments, a rigid segment representing the body above the ankle, rearfoot, forefoot and phalanges; and three joints, ankle (ANK), talonavicular (TN) and metatarsophalangeal (MTP). (b) Twelve muscles controlled the movement of the foot.
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Vertical and horizontal ground reaction forces measured during toe-rise experiments (mean±SD) and predicted by the model (heavy solid line: plantar aponeurosis intact; dashed line: after plantar fasciotomy; measured forces are indicated by light solid lines with shading). Results were normalized by body weight (BW).
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Motion of the pelvis measured during toe-rise experiments (mean±SD) and predicted by the model (heavy solid line: plantar aponeurosis intact; dashed line: after plantar fasciotomy; measured motions are indicated by light solid lines with shading).
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Muscle excitations calculated by the model (heavy solid line: plantar aponeurosis intact; dashed line after plantar fasciotomy). Muscle groups were triceps surae (TS), tibialis posterior (TP), toe flexors (FHD), tibialis anterior (TA), peronei (PER) and toe extensors (EHD). Solution predicted for the excitation of triceps surae group was in good agreement with the mean±SD of the linear envelope of the medial and lateral gastrocnemius EMG, but tibialis anterior excitation was not predicted by the model (measured EMGs are indicated by light solid lines with shading).
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Plantar aponeurosis forces (FPA) peaked at 363 N at an instant during which ground reaction forces and Achilles tendon loads were maximum. An increase in toe flexor force (FFHD) was observed after plantar fasciotomy.
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Plantar fasciotomy caused toe contact forces to shift underneath the metatarsal heads (MTH). Peak contact force at the metatarsal head changed from 405 N to 478 N. Changes in load distribution were normalized to body weight (BW).
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Passive talonavicular torque increased as a result of arch deformation caused by the release of the plantar aponeurosis (solid line: plantar aponeurosis intact; dashed line after plantar fasciotomy).



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