title: 3D finite element model of the diabetic neuropathic foot: a gait analysis driven approach.
abstract: Diabetic foot is an invalidating complication of diabetes that can lead to foot ulcers. Three-dimensional (3D) finite element analysis (FEA) allows characterizing the loads developed in the different anatomical structures of the foot in dynamic conditions. The aim of this study was to develop a subject specific 3D foot FE model (FEM) of a diabetic neuropathic (DNS) and a healthy (HS) subject, whose subject specificity can be found in term of foot geometry and boundary conditions. Kinematics, kinetics and plantar pressure (PP) data were extracted from the gait analysis trials of the two subjects with this purpose. The FEM were developed segmenting bones, cartilage and skin from MRI and drawing a horizontal plate as ground support. Materials properties were adopted from previous literature. FE simulations were run with the kinematics and kinetics data of four different phases of the stance phase of gait (heel strike, loading response, midstance and push off). FEMs were then driven by group gait data of 10 neuropathic and 10 healthy subjects. Model validation focused on agreement between FEM-simulated and experimental PP. The peak values and the total distribution of the pressures were compared for this purpose. Results showed that the models were less robust when driven from group data and underestimated the PP in each foot subarea. In particular in the case of the neuropathic subject's model the mean errors between experimental and simulated data were around the 20% of the peak values. This knowledge is crucial in understanding the aetiology of diabetic foot.
authors.affiliation: Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy. Electronic address: annamaria.guiotto@dei.unipd.it.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guiotto
authors.affiliation: Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy. Electronic address: zimi.sawacha@dei.unipd.it.
authors.forename: Zimi
authors.initials: Z
authors.lastname: Sawacha
authors.affiliation: Department of Clinical Medicine and Metabolic Disease, University Polyclinic, Via Giustiniani 2, 35128 Padova, Italy. Electronic address: gabriella.guarneri@sanita.padova.it.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Guarneri
authors.affiliation: Department of Clinical Medicine and Metabolic Disease, University Polyclinic, Via Giustiniani 2, 35128 Padova, Italy. Electronic address: angelo.avogaro@unipd.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Avogaro
authors.affiliation: Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy. Electronic address: cobelli@dei.unipd.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D017719:Diabetic Foot / Q000503:physiopathology*; D005260:Female; D020342:Finite Element Analysis; D005528:Foot / Q000503:physiopathology; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D066230:Patient-Specific Modeling; D011312:Pressure; D013314:Stress, Mechanical
keywords: Diabetic foot; Finite element analysis; Gait analysis; Multidisciplinary biomechanics approach; Three-dimensional