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A Population of Patient-Specific Adult Acquired Flatfoot Deformity Models Before and After Surgery

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Abstract

Following IRB approval, a cohort of 3-D rigid-body computational models was created from submillimeter MRIs of clinically diagnosed Adult Acquired Flatfoot Deformity patients and employed to investigate postoperative foot/ankle function and surgical effect during single-leg stance. Models were constrained through physiologic joint contact, passive soft-tissue tension, active muscle force, full body weight, and without idealized joints. Models were validated against patient-matched controls using clinically utilized radiographic angle and distance measures and plantar force distributions in the medial forefoot, lateral forefoot, and hindfoot. Each model further predicted changes in strain for the spring ligament, deltoid ligament, and plantar fascia, as well as joint contact loads for three midfoot joints, the talonavicular, navicular-1st cuneiform, and calcaneocuboid. Radiographic agreement ranged across measures, with average absolute deviations of <5° and <4 mm indicating generally good agreement. Postoperative plantar force loading in patients and models was reduced for the medial forefoot and hindfoot concomitant with increases in the lateral forefoot. Model predicted reductions in medial soft-tissue strain and increases in lateral joint contact load were consistent with in vitro observations and elucidate the biomechanical mechanisms of repair. Thus, validated rigid-body models offer promise for the investigation of foot/ankle kinematics and biomechanical behaviors that are difficult to measure in vivo.

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Acknowledgments

The authors received no external financial support for the research, authorship, and/or production of this work. The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA

    E. M. Spratley, E. A. Matheis, R. S. Adelaar & J. S. Wayne

  2. Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA

    C. W. Hayes

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  1. E. M. Spratley
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  2. E. A. Matheis
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  4. R. S. Adelaar
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Correspondence to J. S. Wayne.

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Associate Editor Amit Gefen oversaw the review of this article.

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Supplemental Fig. 1 - Measurements for ML view adapted from Spratley et al. 47The axis of the calcaneus is formed by a line passing through the midpoints of the widest points of the anterior and posterior aspects. The talar axis is formed by lines connecting the superior most point on the talar dome to the tip of the lateral process and across the anterior margins of the talar neck; the axis bisects these two lines. The first metatarsal axis is formed by bisecting lines across the width of the proximal and distal diaphysis. θ1: The calcaneal pitch angle (ML-CP) is measured between a line tracing the inferior border of the calcaneus and the horizontal. θ2: The intersection of the talar axis and the 1st metatarsal axis forms the ML talo-1st metatarsal angle (ML-T1MT). θ3: The intersection of the talar axis and the calcaneal axis forms the talocalcaneal angle (ML-TC). θ4: The talar declination angle (ML-Tdec) is measured between the talar axis and the horizontal. θ5: Finally, the calcaneal 1st metatarsal angle (ML-C1MT) is measured between the axis of the calcaneus and the 1st metatarsal axis. The heights of the δ1: talar (ML-Tal-h), δ2:navicular (ML-Nav-h), δ3:first cuneiform (ML-1CN-h), and δ4:cuboid (ML-Cub-h) were measured from the inferior most point perpendicular to a line connecting the inferior margin of the calcaneus and that of the medial sesamoid. δ5:The first cuneiform to the fifth metatarsal height (ML-1CN/5MT) was measured from the same inferior most point on the cuboid to the inferior most point on the base of the fifth metatarsal.

Supplemental Fig. 2 - Measurements for standard AP view adapted from Spratley et al. 47 θ6: The talonavicular angle (AP-TN) is measured between the talar and navicular AP axes as described by Sangeorzan. These axes are defined as the orthogonal projections of lines spanning the medial and lateral margins of the respective articular surfaces. The axes of the first and second metatarsals are formed in a similar fashion for the AP view as in the ML view wherein the axes bisect lines crossing the proximal and distal widths of the diaphyses. θ7: The talar first metatarsal (AP-T1MT) and θ8: talar second metatarsal angles (AP-T2MT) are formed between the talar axis and the axis of the first and second metatarsals, respectively. δ6: The talonavicular uncoverage distance was measured as the AP distance separating the medial margins of the talar and navicular articular surfaces.

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Spratley, E.M., Matheis, E.A., Hayes, C.W. et al. A Population of Patient-Specific Adult Acquired Flatfoot Deformity Models Before and After Surgery. Ann Biomed Eng 42, 1913–1922 (2014). https://doi.org/10.1007/s10439-014-1048-y

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