Abstract
BACKGROUND: The plantar vault, comprising the transverse and longitudinal arches of the human foot, is essential for impact absorption, elastic energy storage, and propulsion. Recent research underscores the importance of the transverse arch, contributing over 40% to midfoot stiffness. This study aimed to quantify biomechanical responses in the ankle-foot complex by varying the stiffness of the deep metatarsal transverse ligament (DTML). METHODS: Using CT image reconstruction, we constructed a complex three-dimensional finite element model of the foot and ankle joint complex, accounting for geometric complexity and nonlinear characteristics. The focus of our study was to evaluate the effect of different forefoot transverse arch stiffness, that is, different Young's modulus values of DTML (from 135 MPa to 405 MPa), on different biomechanical aspects of the foot and ankle complex. Notably, we analyzed their effects on plantar pressure distribution, metatarsal stress patterns, navicular subsidence, and plantar fascial strain. RESULTS: Increasing the stiffness of the DTML has significant effects on foot biomechanics. Specifically, higher DTML stiffness leads to elevate von Mises stress in the 1st, 2nd, and 3rd metatarsals, while concurrently reducing plantar pressure by 14.2% when the Young's modulus is doubled. This stiffening also impedes navicular bone subsidence and foot lengthening. Notably, a 100% increase in the Young's modulus of DTML results in a 54.1% decrease in scaphoid subsidence and a 2.5% decrease in foot lengthening, which collectively contribute to a 33.1% enhancement in foot longitudinal stiffness. Additionally, doubling the Young's modulus of DTML can reduce the strain stretch of the plantar fascia by 38.5%. CONCLUSION: Preserving DTML integrity sustains the transverse arch, enhancing foot longitudinal stiffness and elastic responsiveness. These findings have implications for treating arch dysfunction and provide insights for shoe developers seeking to enhance propulsion.