Asymptomatic foot and ankle structural injuries: a 3D imaging and finite element analysis of elite fencers

Congfei Lu; Yuxuan Fan; Genyu Yu; Hua Chen; Jonathan Sinclair; Yifang Fan

doi:10.1186/s13102-022-00444-y

Asymptomatic foot and ankle structural injuries: a 3D imaging and finite element analysis of elite fencers

BMC Sports Sci Med Rehabil. 2022 Mar 27;14(1):50. doi: 10.1186/s13102-022-00444-y.

Authors

Congfei Lu¹, Yuxuan Fan¹, Genyu Yu¹, Hua Chen¹, Jonathan Sinclair², Yifang Fan³

Affiliations

¹ Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China.
² Research Centre for Applied Sport, Physical Activity and Performance, School of Sport and Health Sciences, University of Central Lancashire, Lancashire, Preston, PR1 2HE, UK.
³ Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China. tfyf@fjnu.edu.cn.

Abstract

Background: Fencing is a highly asymmetrical combat sport, that imposes high mechanical demands over repeated exposures on the musculoskeletal structures, a primary cause of injuries in fencers. However, there are limited epidemiological studies on the structural injuries of the foot and ankle in fencers. This study aimed to investigate foot and ankle structural injuries, and explore how metatarsophalangeal joint structural changes may affect the mechanisms of foot and ankle injuries in asymptomatic fencers.

Methods: 3D images of foot and ankle morphology using computed tomography were obtained from ten elite fencers. We then constructed finite element models of the first metatarsophalangeal joint in the foot of their trail legs. The validated models were used to simulate stress distribution changes from different ankle joint angles during lunging.

Results: The findings showed that stress distribution changes at the medial and lateral sesamoid may have caused sesamoid fractures, and that habitual and concentrated stress on the metatarsal bones might have flattened the sesamoid groove. This process may damage the integrity of the first metatarsophalangeal joint, and consequently affect the efficiency of the windlass mechanism in fencers. During lunging, different ankle joint angles of the trail foot increased the total stress difference of the medial and lateral foot, and thus influenced the lunging quality and its stability.

Conclusions: Our findings revealed that the asymmetric nature of fencing might have caused asymptomatic foot and ankle structural injuries, and finite element analysis results indicated that this might increase the incidence of the serious injuries if unattended. Regular computed tomography examination should be introduced to monitor elite fencers' lower limb alterations, permitting unique angle adjustments in the trail foot without sacrificing technical or physiologic properties based on the exam results and reduce the lower limb injury risk.

Keywords: Biomechanical monitoring; Elite fencers; First metatarsophalangeal joint; Lunge; Sesamoid; Trail foot.

Abstract

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