Journal of Mechanics in Medicine and Biology

Vol. 17, No. 5 (2017) 1750055 (12 pages)

°c World Scientific Publishing Company
DOI: 10.1142/S0219519417500555

INFLUENCE OF THREE DIFFERENT CURVATURES

FLEX-FOOT PROSTHESIS WHILE SINGLE-LEG
STANDING OR RUNNING: A FINITE ELEMENT
ANALYSIS STUDY

MING-JEN KE*, KUI-CHOU HUANG†,‡,§, CHENG-HUNG LEE†,¶,

HENG-YI CHU*, YUNG-TSAN WU*, SHIN-TSU CHANG*,||,
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SHANG-LIN CHIANG*,** and KUO-CHIH SU††,‡‡,§§

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*Department of Physical Medicine and Rehabilitation

Tri-Service General Hospital, School of Medicine
National Defense Medical Center, Taipei, Taiwan
†Department of Orthopedics, Taichung Veterans General Hospital
Taichung, Taiwan
‡
Department of Occupational Therapy
Asia University, Taichung, Taiwan
§Department of Orthopedics
Asia University Hospital, Taichung, Taiwan
¶
Department of Biotechnology
Hung Kuang University, Taichung, Taiwan
||Department of Rehabilitation

Taichung Veterans General Hospital, Taichung, Taiwan

**Department of Physical Therapy and Assistive Technology
National Yang-Ming University, Taipei, Taiwan
††Department of Medical Research

Taichung Veterans General Hospital, Taichung, Taiwan

‡‡
Department of Biomedical Engineering
Hung Kuang University, Taichung, Taiwan
§ §kcsu@vghtc.gov.tw

Received 3 February 2016

Revised 2 July 2016
Accepted 11 August 2016
Published 6 February 2017

Flex foot device was one of the most common prosthesis for the athletes with the transtibial
amputation on the recent market. Thus, the results of investigation with biomechanics on the
flex foot would be a considerable impact on the performance of disabled athletes wearing the
flex foots. This study was designed to investigate the biomechanical condition of the flex foot
prosthesis with different curvatures while standing and running by finite element analysis. This
study demonstrated finite element models of flex foot established with three different

§§Corresponding author.

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 M.-J. Ke et al.

curvatures 20
(small bending), 35
(medium bending) and 50
(big bending). Besides, it
simulates and investigates the condition of flex foot while a person is wearing it with single-leg
standing or running. The evaluation indices were selected as von Mises stress and displace-
ments at top of socket surface. The results show that the big-bending flex foot generated the
higher stress and the larger deformed displacement. Without exceeding the material tolerance
of the flex foot, the larger displacement of big-bending flex foot could generate more energy,
which possessed larger resilient potential energy and enabled the athletes to have better per-
formance after using the flex foot. As a result, due to its beneficial property of energy storage
and return, the large-bending flex foot user could have better effect. In the future, more
innovative designs of the flex foot prosthesis can be laid out with the reference of the result in
this study.

Keywords: Flex foot; finite element analysis; biomechanics.

1. Introduction
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Amputation of lower limbs may result from vessel occlusion, diabetes mellitus,
trauma, and so forth. Previous literatures showed that the rate of amputation
incidence due to the peripheral artery disease was near 12 to 50 per 100,000 indi-
viduals per year.1 Amputations usually cause movement inconvenience and inca-
pability of exercise. Especially, victims of diabetes mellitus with amputation may
easily fall to severe disability. However, literatures demonstrated that physical
activities provided large mental and physical health benefits.2 If amputees could
wear helpful prostheses with regular exercise and diet control, it could lower the
risks of cardiovascular events.3 Nowadays, the flex foot prosthesis was mostly used
to help amputees capable of exercise, running or participating in the competitions
like Paralympics.
Previous studies indicated that Brüggemann et al. examined the overall kinetic
condition of the lower limb joints on sprinting at maximum speed for comparing the
manifestations of a double transtibial amputee with capable-bodied controls run-
ning at the same-level performance. The study showed that there were lower
metabolic costs with the prostheses at maximum sprinting than that in the healthy
ankle joint because of the diminished work and less energy loss with the prosthesis
use.4 Therefore, by means of prostheses use, the amputees may increase their
physical activities with lower energy consumption, which could promote their car-
diovascular benefits. Besides, the flex foot prosthesis was one of the most common-
use prosthesis for the knee-amputation athletes on the recent market. Therefore, the
results of investigation with biomechanics on the flex foot would be a considerable
impact on the performance of the disabled athletes wearing the flex foots. However,
there were few articles with regard to the research of the flex foot prosthesis.
With the advances of the computer technology, the finite element analysis is
widely used in biomechanical researches, such as orthopedics or dentistry.5,6
In addition to the advantages of its cost savings of expensive experiments, it also
provides analysis of computed models with specific shapes and materials. Although
there is few articles investigating the flex foot prosthesis by the method of finite

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element in recent literatures, it is still necessary to evaluate the biomechanical

condition of the flex foot prosthesis with specific shapes and materials. Although
previous studies investigate the biomechanics condition of the prosthetic liner by
the finite element analysis while weared, there was no investigation in detail about
the condition of the flex-foot’s contact with the ground while standing or running.7
Another research investigated the biomechanics of the prosthetic foot, but there was
no further study of the effects with different geometric shapes.8 As a result, the
method of finite element analysis is very suitable for investigating such a expensive
flex foot prosthesis in entity.
Currently there were miscellaneous kinds of the flex foot prostheses with various
geometric shapes on the market. Nevertheless, there were no related researches
about the curvature influence on the flex foot performance. For that reason, in order
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to make the disabled athletes able to choose the suitable flex foot prosthesis. The
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main hypothesis of this study is to study the biomechanics of flex-foot prostheses

with different curvatures, which showed the bigger-bending flex-foot prosthesis will
have better results. As a result, it can help the users choose the flex-foot prosthesis.
Thus, this study was designed to investigate the biomechanical condition of the
flex foot prosthesis with different curvatures while standing and running. It would
render the best results when the disabled athletes choose the correct and suitable
flex foot prostheses. The results of the study can provide the users with the refer-
ential information of the variation of the different-geometric flex-foot prostheses.
Besides, it could also be the referential data while the medical equipment manu-
facturers is going to design the flex-foot prosthesis.

2. Methods
2.1. Build a simulation geometry model
This study established finite element models of flex foot with three different cur-
vatures. This biomechanics study by the finite element model was mainly based on
the establishment of computer-simulated model so the collected data of this study
were all produced by the computer. In addition, this finite element analysis study
doesn’t need the approval of the Ethics Committee for Human investigation.
The three computer models were mainly classified into 20
(small bending), 35

(medium bending) and 50
(big bending) (Fig. 1). For the simulation of finite ele-
ment, these three-dimensional (3D) models were built with the components of
the socket, base plate, adjusting screw, flex foot and ground by 3D CAD program
(Solidworks 2015, Dassault Systems SolidWorks Corp, Waltham, MA, USA). Be-
sides, the geometric shape of the flex foot was made with the reference of the
common-seen models of the flex foot prosthesis on the market. The flex foot as-
sembly of the 3D geometric models was subsequently imported into the finite ele-
ment analysis software package (ANSYS Workbench 15.0, ANSYS, Inc.,
Canonsburg, PA) to perform the finite element analysis simulation.

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Fig. 1. Three finite element simulation models of the flex foot.

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2.2. Convergence test

Before the analysis with the finite element, the previously-established models should
be tested with convergence test for the more accurate results of the finite element
analysis. Based on the models in the convergence test, the simulation model meshes
were generated, with the element sizes of 12 mm, 10 mm, 8 mm, 6 mm, and 4 mm,
by using quadratic tetrahedral elements in ANSYS Workbench. The external forces
were directed to the top of socket surface in the vertical direction with a magnitude
of 1000 N. The boundary conditions were fixed in all degrees of freedom on the below
ground [Fig. 2(a)]. The maximum von Mises stress values on the anterior surface of
the flex foot were checked for FEA mesh convergence. After the convergence test, all
of the finite-element models were meshed with the element size of 6 mm for the
investigation in ANSYS workbench. In this study, 10 nodes of the quadratic tet-
rahedral elements were utilized. (Fig. 3). The results frame the simulation model
meshes were made up of nearly 26000 nodes and 15000 elements (Table 1).

(a) (b)

Fig. 2. (a) Boundary conditions and loading conditions while single-leg standing. (b) Boundary con-
ditions and loading conditions while running.

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Fig. 3. Three finite element mesh models.

Table 1. Numbers of nodes and elements of finite element mesh model.

Small bending Medium bending Big bending

Numbers of nodes 26 827 25 818 27 162

Numbers of elements 15 526 14 901 15 718

2.3. Loading conditions and boundary conditions

This study aims to simulate and investigate the condition of the flex foot prosthesis
while a person wears it with single-leg standing or running. The flex-foot prosthesis
is primarily used for running, so this study is mainly focused on investigating the
biomechanics change of the user wearing a flex-foot prosthesis while running.
Therefore, this study gave two different loading conditions. Figure 2(a) showed an
800-N externally vertical force to the top of socket surface while single-leg standing
with the flex foot worn. Figure 2(b) showed externally transmitted force to the
socket while running with the flex foot worn. Known from the previous literatures,9
the reaction force while running, measured from the ground, was 1.14 W (Human
weight). While the axis of the flex foot showed included angle of 35
compared to the
vertical line, the axial force to flex foot from external one was equivalent to 1.39W
(about 1112 N). Therefore, a 1112 N vertical force was applied to the top of socket
surface for simulating mechanics condition of running with the flex foot worn. Be-
sides, for the boundary conditions of this study, the ground bottom was set as fixed
and unmovable in all degrees of freedom for the boundary constraints. In addition,
all materials, except the interface condition between the flex foot and the ground
were set without separation contact, the contacts between socket, base plate,

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Table 2. Material properties of parts (see Refs. 11 and 12).

Material Young’s modulus (MPa) Poisson’s ratio

Socket 1600 0.39

Base plate 2 10 000 0.3
Adjusting screw 2 10 000 0.3
Flex foot 58 500 0.3

adjusting screw and flex foot were perfectly bonded. The interface condition be-
tween the flex foot and the ground was set without separation contact, which is the
definition as two interfaces with a contact condition that allows small sliding rela-
tive to each other and avoids separation in their normal direction in ANSYS
Workbench.10
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2.4. Material properties of the model

The models in this study consist of five parts. The material property of these parts
was obtained based on the previous study11,12 except that the material property of
the ground was set as rigid body. All materials were considered as being homoge-
neous, isotropic, and linear elastic. Consequently, two independent elastic constants
[Young’s modulus (E) and Poisson’s ratio (v)] were required to describe their me-
chanical behavior. The two constants for four flex foot assemblies are summarized in
Table 2.
In this study, the evaluation indices were selected as follows: the displace-
ments at top of socket surface, the maximum von Mises stress at flex foot (Fig. 4),
the maximum von Mises stress on the anterior surface of flex foot (Fig. 5), the
maximum von Mises stress on the posterior surface of flex foot (Fig. 6), the

Fig. 4. The distribution of von Mises stress on the flex foot while single-leg standing.

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Fig. 5. The distribution of von Mises stress on the anterior and posterior surface of the flex foot while
single-leg standing.

Fig. 6. The distribution of von Mises stress on the flex foot while running.

maximum von Mises stress at top of flex foot contact with the ground (Figs. 4
and 6).

3. Results
The von Mises stresses over the anterior surface of flex foot on the convergence test
were listed in Tables 3. With regard to the evaluation of FEA-mesh convergence
test, the differences in the von Mises stress values on the anterior surface of the flex
foot are 1.06%, 1.40% and 4.65%, respectively (the level of convergence reaching

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98.93%, 98.59% and 95.34% were acceptable in this study), which was lower than
those in the previous studies (5% stop criteria of convergence test).13
Figure 4 demonstrated the distribution of von Mises stresses on the flex foot with
vertical loading (single-leg standing) for: (a) small bending, (b) Medium bending
and (c) Big bending. The figure showed the peak von Mises stresses (on the side of
the contact surface between the flex foot and ground) in the magnitude order of Big
bending (100.37 MPa) > Medium bending (78.91 MPa) > Small bending
(70.51 MPa). Besides, it could be discovered that there was a high stress over the
curved site of flex foot generated by bending force. The stresses presented in the
magnitude order of Big bending (80.49 MPa) > Medium bending (69.15 MPa) >
Small bending (64.62 MPa). Among these values of the displacement on the top of
socket surface, it showed larger amount of deformation on big-bending model after
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the force applied than that on the others.

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Figure 5 demonstrated the distribution of von Mises stress over the anterior
surface of the flex foot with single-leg standing on three different curved models. The
magnitude order of the peak von Mises stress was Big bending (69.49 MPa) >
Medium bending (57.16 MPa) > Small bending (51.15 MPa). Figure 5 also dem-
onstrated the distribution of von Mises stress over the posterior surface of the flex
foot on three different curved models. The magnitude order of the peak von Mises
stress showed Big bending (66.82 MPa) > Medium bending (58.21 MPa) > Small
bending (47.18 MPa).
Figure 6 demonstrated the distribution of von Mises stress on three flex foot
models with vertical loading while running. The magnitude order of the peak von
Mises stress (on the side of the contact surface between the flex foot and ground) in
the figure revealed small bending (790.18 MPa) > big bending (771.00 MPa) >
medium bending (300.23 MPa). Besides, there was high stress over the curved site of
the flex foot, which was generated by bending. It showed the biggest oblique force
was on the big-bending model. The stresses at this site presented in the magnitude
order of big bending (148.91 MPa) > small bending (129.49 MPa) > medium
bending (121.44 MPa).

Table 3. The peak von Mises stress on the anterior surface of the flex foot in the FEA convergence test.

The peak von The peak von The peak von

Mises stress Mises stress Mises stress
Element (MPa) small Levels of con- (MPa) medi- Levels of con- (MPa) big Levels of con-
size bending vergence (%) um bending vergence (%) bending vergence (%)

12 mm 75.269 88.68 76.208 88.61 88.782 82.77

10 mm 71.553 84.30 82.117 95.48 93.424 87.10
8 mm 76.694 90.36 75.359 87.62 90.752 84.61
6 mm 85.783 98.93 84.791 98.59 102.264 95.34
4 mm 84.875 
 86.003 
 107.258 


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Table 4. The results of several evaluation indices.

The max von The max von The max von

The dis- The max Mises stress Mises stress Mises stress at
placements von Mises on the anteri- on the poste- top of flex foot
at top of stress at or surface of rior surface of contact with
socket sur- flex foot flex foot flex foot the ground
face (mm) (MPa) (MPa) (MPa) (MPa)

Small bending (single-leg) 0.9329 70.51 51.15 47.18 69.15

Medium bending (single-leg) 1.2492 78.91 57.16 58.21 64.62
Big bending (single-leg) 2.1091 100.37 69.49 66.82 80.49
Small bending (Running) 2.8847 790.18 101.54 95.27 129.49
Medium bending (Running) 2.8761 300.23 100.06 96.83 121.44
Big bending (Running) 4.7843 771.00 109.92 107.76 148.91
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Table 4 demonstrated the various numerical results while single-leg standing or

running. It included the values of the displacement on the top of socket surface, the
max von Mises stress on flex foot, the max von Mises stress on the anterior surface of
flex foot, the max von Mises stress on the posterior surface of flex foot, the max von
Mises stress on the tip of flex foot with contact to the ground. Among these values of
the displacement on the top of socket surface, it showed larger amount of defor-
mation on big-bending model after the force application than on the others.

4. Discussion
Finite element analysis is often used in the biomechanical study such as orthopedic,
dentistry, and so forth. By means of finite element analysis, this study successfully
investigated the condition of the flex foot with different bending degrees while
single-leg standing and running. The results not only observed the structural dis-
placement under different circumstances but also investigated the distribution of
stress on the flex foot model after the application of force. Therefore, it is suitable for
finite element analysis to observe the mechanical behavior of the flex foot.
When external force was applied on the flex foot, there would be a displacement
in the axial direction [Fig. 2(a) Y -axis axial direction]. It also showed that the larger
the bending angle of flex foot is, the greater the displacement (big bending > me-
dium bending > small bending) is. From the viewpoint of spring capacity
(U ¼ 12 k
2 , k: spring coefficient,
: deformed amount), if a spring was given
a force
(F ¼ k
Þ, which could be simplified as k ¼ F
, it would be inferred U ¼ 12 F

2 and
the result of U ¼ 1/2F
. Under the circumstances of all the same external forces
(F ¼ constant), the larger deformed amount produced the greater energy and
therefore the big bending flex foot would have the larger capacity of energy storage.
Even though the deformed amount of small-bending flex foot under the condition
of running was greater than that of the medium-bending flex foot, the values were
insignificant. The reason of these insignificant values may be lied in the little dif-
ference of geometric shapes between small bending and medium bending. Under the

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situation of running, it still showed the big-bending flex foot possessed the greater
displacement. Therefore, it enabled the big-bending flex foot to have larger storage
energy and spring power, which made the user run quicker and farther. Under the
same condition of given force on the flex foot, the large bending flex foot would have
greater displacement and enough time for response due to its beneficial property of
energy storage.14 The distance per step became larger because the larger bending
flex foot had the larger displacement and then the larger displacement could render
faster speed at per unit time.
In addition to the high stress at the portion of the flex foot with contact to the
ground, the result of stress analysis in this study (Figs. 4 and 6) also showed high
stress over the curved site of the flex foot, resulted from the bending force, the
compressive stress over the anterior site and the tensile stress over the posterior site.
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In Fig. 5, it revealed that the high stress at the anterior site was at the mid-part of
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the flex foot and the high stress at the posterior site was at both sides of the flex foot,
where the magnitude order of stress showed big bending > medium bending > small
bending. Thus, under the same external loading, the big-bending flex foot would
have a higher stress over the curved site. Therefore, the ground-contacting area of
the flex foot must be carefully designed in the future.
Under the situation of running, the highest stress generated on the flex foot lied
in the ground-contacting portion. Its magnitude order of high stress showed small
bending > big bending > medium bending, which was due to small ground-con-
tacting area while running, causing higher stress under the same external force
( ¼ FA Þ. In the field of finite element analysis, the point with high stress due to small
ground-contacting area was called singular point, which was not usually used while
analyzing. Besides, the curved portion of the big-bending flex foot had higher stress
while bending force was applied.
Owing to the curved structure of the flex foot, it generated the higher stress over
the curved site. Besides, the material tensile strength of the flex foot was about
1240 MPa. The stress value from the simulation model in this study was farther
lower than the tensile strength of carbon fiber. Therefore, it would not break the flex
foot. By means of this property, it could have more various designs for bending of
flex foot.
There were some limitations in the finite element simulation. For the structural
analysis of the flex foot assemblies, all material properties were deemed as homo-
geneous, isotropic and linearly elastic, just like the most previous FEM stud-
ies.12,15,16 Generally, the material of flex foot was carbon fibers of linear elastic
orthotropic and transversally isotropic materials. But for only investigation of
mechanical behavior of the flex foot with different geometric shapes and simplifi-
cation of study results, this study excluded the utilization of linear elastic ortho-
tropic and transversally isotropic materials. However, the main purpose of this
study was to discuss the effects of the flex-foot prosthesis with different geometric
shapes. Besides, in order to make the discussed factors more specific, this study
chose isotropic and homogeneous condition for the flex-foot prosthesis material

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 Influence of Three Different Curvatures Flex-Foot Prosthesis

setting in this study. Even though the results will be different from the real situa-
tion, the trend is the same. Besides, as for the geometric shapes concerned, this
study also simplified the geometric shape of socket, which used regular geometric
shape for socket instead of irregular one. By this way, it could be easier to observe
the displacement and deformation of the flex foot after external force given.
By means of observation of finite element analysis in this study, the flex foot
possessed the ability of resiliency owing to its bending design. Its resilient energy
was stored in proportion to the bending degrees, which had impact on the degrees of
rebounding. In the future, more innovative designs of flex foot can be laid out with
the reference of the result in this study, which may help athletes for better per-
formance in the competition.
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5. Conclusion
By means of finite element analysis, this study investigated the mechanical analysis
of the flex foot models with different curvatures. The result revealed the big-bending
flex foot generated the higher stress and larger deformed displacement. Without
exceeding the material tolerance of flex foot, the larger displacement of big-bending
flex foot could generate more energy, which possessed larger resilient potential
energy and enabled the athletes to have better performance after using the flex foot.
As a result, under the same condition of given force on the flex foot, the large
bending flex foot would have greater displacement and enough time for user re-
sponse due to its beneficial property of energy storage.

Acknowledgments
We would like to thank Taichung Veterans General Hospital (TCVGH-1037321B
and TCVGH-1047303B) in Taiwan for providing the funding for this research to use
finite element analysis software (ANSYS) and CAD Software (Solidworks).

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