Novel reconstruction of a static medial ligamentous complex in a flatfoot model

Little progress has been made addressing reconstruction of the static medial ligamentous structures of the foot. The purpose of this investigation was to reconstruct a flatfoot deformity with a novel static medial ligamentous complex (MLC) and evaluate its ability to correct talar head subluxation and radiographic deformity in a cadaveric model.

Eight fresh frozen cadaveric specimens underwent cyclic preconditioning and static axial loading. Loading was applied to the intact foot, the severe flatfoot, and the reconstructed MLC foot. Anteroposterior (AP) and lateral radiographs were taken at each stage. The talo-first metatarsal angle, medial cuneiform height, talocalcaneal angle, and the calcaneal pitch angle were measured on the lateral views and the talo-first metatarsal angle was measured on the anteroposterior views.

Compared with the intact foot, the flatfoot showed significant change in the AP talo-first metatarsal angle (p = 0.001), the lateral talo-first metatarsal angle (p = 0.002), the medial cuneiform height (p = 0.007), the talocalcaneal angle (p = 0.03), and the calcaneal pitch angle (p = 0.018). After MLC reconstruction, there was a significant change in the AP talo-first metatarsal angle (p = 0.001), the lateral talo-first metatarsal angle (p = 0.002), and the medial cuneiform height (p = 0.007) and these values were not significantly different than the intact foot. The talocalcaneal angle and the calcaneal pitch angle remained significantly undercorrected after static MLC reconstruction.

Static MLC reconstruction was effective in correcting several key radiographic parameters in a cadaveric flatfoot model.

The surgical technique evaluated here may be useful as a new soft tissue reconstructive procedure for treating adult flatfoot.