基于生物力学有限元法的足跟痛发生与康复机制

目的 研究足跟痛病症的发生与康复机制，为临床上足跟痛治疗方法的有效性提供理论依据。方法 对足跟痛患者足膝部CT、MRI影像数据进行三维重建，建立患者足膝部的骨骼-肌肉复合有限元模型。基于所建模型采用有限元方法，仿真模拟小腿肌肉挛缩对足踝部生物力学性能的影响。结果 在小腿肌肉提升力的作用下，足底压力从足跟区向足掌区转移，且不同肌肉作用力组合方案对压力分布不产生明显差异。足底筋膜张力升高，跟骨表面产生应力集中。在240 N作用力下，跟腱附着位置和跟骨结节处产生应力峰值，分别高达10.82、11.2 MPa。结论 小腿部肌肉和跟腱中产生应力集中，会导致足踝部生物力学特性发生变化，引发足跟部疼痛。释放集中应力恢复踝关节中各骨骼和关节的位置，从而改善整体生物力学环境的方法是治疗足跟痛的康复机制。

The Mechanism of Occurrence and Rehabilitation of Heel Pain Based on Finite Element Method

Objective To investigate the mechanism of occurrence and rehabilitation of heel pain, so as to provide a theoretical basis for the effectiveness of heel pain treatment. Methods The CT and MRI data acquired from feet and knees of patients with heel pain were reconstructed to establish the bone-muscle composite finite element model. Based on the established model, the effect of calf muscle contracture on biomechanical properties of the foot and ankle was simulated by using the finite element method . Results When the calf muscles produce upward lifting power, plantar pressure was transferred from the heel area to the forefoot area, and there was no significant difference in pressure distribution by different combination schemes of muscle forces. The strain of the plantar fascia was increased, with stress concentration on the calcaneus surface. Under 240 N force, the peak stress at the Achilles tendon attachment position and the calcaneus nodules was up to 10.82 MPa and 11.2 MPa, respectively. Conclusions The stress concentration in calf muscles and Achilles led to the changes in biomechanics of the ankle, which resulted in heel pain. The method of improving the overall biomechanical environment by releasing concentrated stress to restore the position of the bones and joints of the ankle joint is the mechanism for rehabilitation of heel pain.