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Patient specific computational models to optimize surgical correction for flatfoot deformity.

Brian A Smith1, Robert S Adelaar1, Jennifer S Wayne1

  • 1Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 843067, Richmond, Virginia, 23284-3067.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
|August 25, 2016
PubMed
Summary

Patient-specific models reveal that combining Medializing Calcaneal Osteotomy (MCO) with Evans or Z osteotomy offers the most correction for Adult Acquired Flatfoot Deformity (AAFD). However, these procedures increase joint and ground reaction forces.

Keywords:
adult acquired flatfoot deformitycomputational simulationkinematicslateral column lengtheningmedial calcaneal osteotomy

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Area of Science:

  • Orthopaedic Surgery
  • Biomechanics
  • Computational Modeling

Background:

  • Adult Acquired Flatfoot Deformity (AAFD) treatment involves various surgical procedures.
  • Patient-specific models have been developed to predict AAFD surgical outcomes.
  • Previous models analyzed standard procedures without considering alternative surgical combinations.

Purpose of the Study:

  • To expand patient-specific computational models of AAFD.
  • To determine if alternative surgical procedures are more effective for individual patients.
  • To compare the biomechanical effects of different surgical combinations for AAFD.

Main Methods:

  • Developed patient-specific computational models incorporating bodyweight, soft tissues, muscle loading, and joint contact.
  • Simulated surgical procedures including a tendon transfer, Medializing Calcaneal Osteotomy (MCO), and three lateral column procedures (Evans osteotomy, Calcaneocuboid Distraction Arthrodesis (CCDA), Z osteotomy).
  • Evaluated combined MCO with each lateral column procedure, analyzing forefoot abduction, hindfoot valgus, joint contact forces, ground reaction forces, and ligamentous strain.

Main Results:

  • MCO combined with Evans osteotomy or Z osteotomy provided the greatest correction for forefoot abduction and hindfoot valgus.
  • These combination procedures significantly increased calcaneocuboid joint contact force and lateral column ground reaction force.
  • Strain in plantar fascia, spring, and deltoid ligaments decreased post-surgery, except for lateral bands of the plantar fascia and middle spring ligament.

Conclusions:

  • Patient-specific computational models are valuable for investigating the biomechanical effects of surgical interventions for AAFD.
  • Combined MCO and Evans or Z osteotomy yield significant correction but increase joint and ground reaction forces.
  • Further research is needed to balance correction efficacy with potential increases in joint loading.