Simple model of arch support: Relevance to Charcot Neuroarthropathy.

backgroundCharcot neuropathy is a common complication resulting from poorly controlled diabetes and peripheral neuropathy leading to the collapse, and ultimately the breakdown, of the midfoot. Mechanically, it is likely that a compromised arch support in this, or any other patient group that experiences foot flattening, would be associated with slippage at the distal and proximal interface regions of the plantar surface of the foot and the adjacent support surface. This slippage, although difficult to quantify with standard motion capture systems used in a gait laboratory, could potentially be assessed with systems for monitoring interface shear stresses. However, before investing in such systems, a correlation between arch flattening and interface shear stresses needs to be verified.

methodsFor this purpose, a sagittal plane model of a foot was developed using a multi-body dynamics package (MSC Adams). This model mimicked a subject swaying back and forth, and was constructed to show the dependence of interface stresses on altered arch support.

findingsThe model's predictions matched typical FootSTEPS data: lengthening of the arch of 1-2 mm, sway oscillations of 0.22-0.33 s and frictional force differences (calcaneus relative to forefoot) of 60 N. Of clinical relevance, when the stiffness of the plantar spring (representing aponeurosis and intrinsic muscles) was reduced by 10%, the frictional force difference increased by about 6.5%.

interpretationThe clinical implications of this study are that, while arch lengthening of less than 2 mm might be difficult to measure reliably in a gait lab, using shear sensors under the forefoot and hindfoot should allow arch support to be assessed in a repeatable manner.