Effect of plantar fascia stiffness on plantar windlass mechanism and arch: Finite element method and dual fluoroscopic imaging system verification

This study explored the relationship between the foot arch stiffness and windlass mechanism, focusing on the contribution of the posterior transverse arch. Understanding the changing characteristics of foot stiffness is critical for providing a scientific basis for treating foot-related diseases. Based on a healthy male's computed tomography, kinematic, and dynamics data, a foot musculoskeletal finite element model with a dorsiflexion angle of 30°of metatarsophalangeal joint was established. Analyze the changes in stress distribution of the plantar fascia, metatarsophalangeal joint angle, arch height, and length during barefoot walking as the stiffness of the plantar fascia varies from 25 % to 200 %. For validation, the simulated arch parameters were compared with the dual fluorescence imaging system measurements. The width of transverse arch, height, and length of longitudinal arch measured by the dual fluorescence imaging system were 45.14 ± 1.63 mm, 29.29 ± 1.57 mm, and 155.16 ± 2.69 mm, respectively. The results of the simulation were 46.51 mm, 29.96 mm, and 156.71 mm, respectively. With the increase of plantar fascia stiffness, the effect of the windlass mechanism increased, the flexion angle of the metatarsophalangeal joint decreased, the distal stress of plantar fascia decreased gradually, while the proximal and middle stress increased, the transverse arch angle increased, but when the plantar fascia stiffness exceeds 150 %, the transverse arch angle decreases. The increase of plantar fascia stiffness will increase the effect of the windlass mechanism but decrease the flexion angle of the metatarsophalangeal joint. The stiffness of the plantar fascia influences the behavior of the plantar fascia. The plantar fascia stiffness affects the distal tension of the plantar fascia by affecting the flexion of the metatarsophalangeal joint in the plantar windlass mechanism. It affects the stiffness of the transverse arch of the foot together with the ground reaction force acting on the distal metatarsal.