Validation of a population of patient‐specific adult acquired flatfoot deformity models

Spratley, E. Meade; Matheis, Erika A.; Hayes, Curtis W.; Adelaar, Robert S.; Wayne, Jennifer S.

doi:10.1002/jor.22471

Cited by 32 publications

(36 citation statements)

References 46 publications

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“…The patient specific models were originally created from 1 mm MRI scans of the lower extremity of each of six patients with a 1.5T MRI scanner (GE Healthcare Technologies Waukesha, WI) in a prospective IRB approved study (Level of evidence: Level II) . Briefly, the 2D scans were visualized in the software package MIMICS® (v12.0, Materialise's Interactive Medical Imaging Control System, Materialise, Ann Arbor, MI) and transformed into three dimensional bodies representing the bones of the foot and ankle.…”

Section: Methodsmentioning

confidence: 99%

“…A). Ligament stiffness and muscle tendon activation values were assigned from the literature as tension only structures . Insertion locations were determined by inspection of patient anatomy as presented in the MRI scans and in consultation with anatomic literature and previous dissection .…”

Section: Methodsmentioning

confidence: 99%

“…The challenge with having multiple surgical combinations available is to select the optimal procedure(s) for the individual patient. Computer Aided‐Design (CAD) modeling has been employed to recreate the anatomy and kinematics of the foot and ankle complex in both the intact and diseased states as well as replicating possible surgical procedures . While providing insight into function of the foot/ankle complex as a whole, the use of the CAD models also allowed for exploration into the variations in surgical techniques employed, specifically the amount of MCO translation, from 5 to 15 mm.…”

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confidence: 99%

“…While providing insight into function of the foot/ankle complex as a whole, the use of the CAD models also allowed for exploration into the variations in surgical techniques employed, specifically the amount of MCO translation, from 5 to 15 mm. More recently, rigid‐body kinematic analyses have been used to create patient specific models replicating both the diseased state at initial presentation and the corrected surgical state of each patient . The current work expands on these patient specific models by investigating the effects of adding lateral column treatments to the MCO and FHL tendon transfer, the treatment used by the surgeon for such patients, as these other surgical procedures would be considered clinically to treat a presenting patient.…”

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confidence: 99%

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Patient specific computational models to optimize surgical correction for flatfoot deformity

2016

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Several surgically corrective procedures are considered to treat Adult Acquired Flatfoot Deformity (AAFD) patients, relieve pain, and restore function. Procedure selection is based on best practices and surgeon preference. Recent research created patient specific models of AAFD to explore their predictive capabilities and examine effectiveness of the surgical procedure used to treat the deformity. The models' behavior was governed solely by patient bodyweight, soft tissue constraints, muscle loading, and joint contact without the assumption of idealized joints. The current work expanded those models to determine if an alternate procedure would be more effective for the individual. All procedures incorporated first a tendon transfer and then included one hindfoot procedure, the Medializing Calcaneal Osteotomy (MCO), and one of three lateral column procedures: Evans osteotomy, Calcaneocuboid Distraction Arthrodesis (CCDA), Z osteotomy, and the combination procedures MCO & Evans osteotomy, MCO & CCDA, and MCO & Z osteotomy. The combination MCO & Evans and MCO & Z procedures were shown to provide the greatest amount of correction for both forefoot abduction and hindfoot valgus. However, these two procedures significantly increased joint contact force, specifically at the calcaneocuboid joint, and ground reaction force along the lateral column. With exception to the lateral bands of the plantar fascia and middle spring ligament, the strain present in the plantar fascia, spring, and deltoid ligaments decreased after all procedures. The use of patient specific computational models provided the ability to investigate effects of alternate surgical corrections on restoring biomechanical function in these flatfoot patients. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1523-1531, 2017.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Patient specific computational models to optimize surgical correction for flatfoot deformity

2016

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“…However, the toes and dorsal soft tissue were not included. Other than FE models, a rigid-body flatfoot model was proposed by Spratley et al for studying the kinematic behavior of the flatfoot skeleton [6].…”

Section: Introductionmentioning

confidence: 99%

A finite element model of flatfoot (Pes Planus) for improving surgical plan

Wang

Imai

Kido

et al. 2014

2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Flatfoot is a foot condition caused by the collapse of the medial arch of the foot, and it can result in problems such as severe pain, swelling, abnormal gait, and difficulty walking. Despite being a very common foot deformity, flatfoot is one of the least understood orthopaedic problems, and the opinions regarding its optimal treatment vary widely. In this paper, an FE model of a flatfoot is proposed that is based on CT measurements. Surface meshes of the bones and soft tissue were generated from CT images and then simplified to reduce the node density. A total of 62 ligaments, 9 tendons, and the plantar fascia were modeled manually. Volume meshes of the different components were generated and combined to form the completed flatfoot model. A dynamic FE formulation was derived, and a balanced standing simulation was performed. The model was validated by comparing stress distribution results from the simulation to experimental data.

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The contribution of the ligaments in progressive collapsing foot deformity: A comprehensive computational study

Malakoutikhah

Madenci

Latt

2022

Journal Orthopaedic Research

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The contribution of each of the ligaments in preventing the arch loss, hindfoot valgus, and forefoot abduction seen in progressive collapsing foot deformity (PCFD) has not been well characterized. An improved understanding of the individual ligament contributions to the deformity would aid in selecting among available treatments, optimizing current surgical techniques, and developing new ones. In this study, we evaluated the contribution of each ligament to the maintenance of foot alignment using a finite element model of the foot reconstructed from computed tomography scan images. The collapsed foot was modeled by simulating the failure of all the ligaments involved in PCFD. The ligaments were removed one at a time to determine the impact of each ligament on foot alignment, and then restored one at a time to simulate isolated reconstruction. Our findings show that the failure of any one ligament did not immediately lead to deformity, but that combined failure of only a few (the plantar fascia, long plantar, short plantar, deltoid, and spring ligaments) could lead to significant deformity. The plantar fascia, deltoid, and spring ligaments were primarily responsible for the prevention of arch collapse, hindfoot valgus, and forefoot abduction, respectively. Moreover, to produce deformity, a considerable amount of attenuation in the spring, tibiocalcaneal, interosseous talocalcaneal, plantar naviculocuneiform, and first plantar tarsometatarsal ligaments, but only a small amount in the plantar fascia, long plantar, and short plantar ligaments was needed.The results of this study suggest that the ability of a ligament to prevent deformity may not correlate with its attenuation in a collapsed foot.adult-acquired flatfoot deformity, biomechanics, finite element modeling, posterior tibial tendon dysfunction, progressive collapsing foot deformity | INTRODUCTIONProgressive collapsing foot deformity (PCFD), previously known as adult-acquired flatfoot deformity (AAFD), is a common degenerative condition affecting up to 10% of the adults over the age of 65 years. 1,2 As the structures supporting the foot degenerate, a complex three-dimensional (3D) deformity develops at multiple locations in the foot, including hindfoot valgus, midfoot planus (arch collapse), and forefoot abduction, leading to foot and ankle pain, swelling, and decreased ambulatory capacity. It was initially thought that posterior tibial tendon dysfunction (PTTD) leads to the PCFD. 1 However, later studies revealed that the degeneration of the arch and hindfoot supporting ligaments also plays a significant role. 2,3 Once the posterior tibial tendon

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Validation of a population of patient‐specific adult acquired flatfoot deformity models

Cited by 32 publications

References 46 publications

Patient specific computational models to optimize surgical correction for flatfoot deformity

Patient specific computational models to optimize surgical correction for flatfoot deformity

A finite element model of flatfoot (Pes Planus) for improving surgical plan

The contribution of the ligaments in progressive collapsing foot deformity: A comprehensive computational study

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