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Finite Element Simulation of Clubfoot Correction: A Feasibility Study Toward Patient-Specific Casting
Ayush Nankani1, Sean Tabaie2, Matthew Oetgen3
1Sheikh Zayed Institute, Children's National Hospital, Washington, DC 20010, USA.
Insights
Computational modeling using iterative finite element analysis (iFEA) can simulate the geometric corrections of congenital talipes equinovarus (clubfoot) treated with the Ponseti method. This approach shows promise for developing customized casts and understanding treatment biomechanics.
Area of Science:
- Biomechanics
- Medical Imaging
- Computational Modeling
Background:
- Congenital talipes equinovarus (clubfoot) is a common birth defect affecting 1-2 per 1000 newborns globally.
- The Ponseti method is the standard treatment, but its underlying biomechanical processes are not fully understood due to limited imaging.
- Computational modeling offers a non-invasive method to study clubfoot correction and explore applications like custom casts.
Purpose of the Study:
- To develop and validate a computational framework using iterative finite element analysis (iFEA) for simulating Ponseti method corrections.
- To assess the impact of model simplification (homogeneous vs. non-homogeneous) on the accuracy of clubfoot correction simulations.
- To lay the groundwork for advanced applications such as patient-specific modeling and customized cast design.
Main Methods:
- A 3D surface model of a clubfoot was created and subjected to stepwise deformations using iFEA.
- Correction was quantified using standard angular measurements (Cavus, Adductus, Varus, Equinus, Derotation).
- A homogeneous soft tissue model and a non-homogeneous model with bone structure were compared using an adult leg model.
Main Results:
- The iFEA framework successfully reproduced progressive geometric changes consistent with Ponseti correction in the training model (mean angular deviation ±3.2°).
- Homogeneous and non-homogeneous adult leg models yielded comparable correction geometries (<2° difference), with the homogeneous model being computationally efficient.
- The study utilized computational loads, not direct physiological forces, to drive the simulated corrections.
Conclusions:
- Iterative finite element analysis (iFEA) can effectively simulate surface-level geometric changes associated with Ponseti clubfoot correction, irrespective of model homogeneity.
- This computational framework provides a feasible basis for future research incorporating clinical forces, pediatric tissue properties, and patient-specific geometries.
- Potential applications include the development of customized 3D-printed casts for clubfoot treatment.
Abstract:
Background: Congenital talipes equinovarus (clubfoot) affects 1-2 per 1000 newborns worldwide. The Ponseti method, based on staged manipulations and casting, is the gold standard for correction. However, the biomechanical processes underlying these corrections remain poorly understood, as infants rarely undergo imaging. Computational modeling may offer a non-invasive approach to studying correction pathways and exploring novel applications, such as customized casts. Methods: We developed a proof-of-concept framework using iterative finite element analysis (iFEA) to approximate the surface-level geometric corrections targeted in Ponseti treatment. A 3D surface model of a training clubfoot foot was scanned, meshed, and deformed stepwise under applied computational loads. The model was assumed to be homogeneous and hyperelastic, and correction was quantified using Cavus, Adductus, Varus, Equinus, and Derotation angles. We also introduced a secondary adult leg 3D surface model to assess whether model simplification influences correction outcomes, by comparing a homogeneous soft tissue model with a non-homogeneous model incorporating bone structure. Results: In the training model, iFEA generated progressive deformations consistent with Ponseti correction, with mean angular deviations of ±3.2°. In the adult leg model, homogeneous and non-homogeneous versions produced comparable correction geometries, differing by <2° in outcomes. The homogeneous model required less computation, supporting its use for feasibility testing. Applied loads were computational drivers, not physiological forces. Conclusions: This feasibility study shows that iFEA can reproduce surface-level geometric changes consistent with Ponseti correction, independent of model homogeneity. While not replicating clinical biomechanics, this framework lays the groundwork for future work that incorporates clinician-applied forces, pediatric tissue properties, and patient-specific geometries, with potential applications in customized 3D-printed casts.
