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. 2020 Mar 5:27:139-145.
doi: 10.1016/j.jot.2020.02.004. eCollection 2021 Mar.

Finite element analysis of subtalar joint arthroereisis on adult-acquired flexible flatfoot deformity using customised sinus tarsi implant

Duo Wai-Chi Wong  1   2 , Yan Wang  1   2 , Wenxin Niu  3 , Ming Zhang  2   1
Affiliations

Finite element analysis of subtalar joint arthroereisis on adult-acquired flexible flatfoot deformity using customised sinus tarsi implant

Duo Wai-Chi Wong et al. J Orthop Translat. .

Abstract

Background: Subtalar arthroereisis may cause sinus tarsi pain complications. In this study, we aimed to introduce a customised implant that facilitated treatment effect and less impingement. The biomechanical outcome between the intact and implant conditions was compared using finite element analysis.

Methods: A female patient with flatfoot (age: 36 years, height: 156 ​cm, body mass: 51 ​kg) was recruited as the model patient. The customised implant was designed from the extracted geometry. Boundary and loading conditions were assumed from the data of a normal participant. Four gait instants, including the ground reaction force first peak (25% stance), valley (45%), initial push-off (60%) and second peak (75%) were analyzed.

Results: The navicular height was elevated by 4.2% at 25% stance, whereas the strain of the spring, plantar cuneonavicular and plantar cuboideonavicular ligaments were reduced. The talonavicular joint force decreased and the calcaneocuboid joint increased by half and 67%, respectively, representing a lateralised load pathway. There was a stress concentration at the sulcus tali reaching 15.29 ​MPa.

Conclusion: Subtalar arthroereisis using a customised implant may produce some positive treatment effects in terms of navicular height elevation, ligament strain relief and lateralised joint loading pathway. Although the concentrated stress at the sulcus tali did not exceed the threshold of bone breakdown, we could not rule out the potential of vascular disturbance owing to the remarkable elevation of stress. Future study may enlarge the contact area of the bone-implant interface by considering customisation based on the dynamic change of the sinus tarsi during walking gait.

The translational potential of this article: Geometry mismatch of prefabricated implants could be the reason for complications. With the advancement of 3D printing, customising implant becomes possible and may improve treatment outcome. This study implemented a theoretical model approach to explore its potential under a simulation of walking.

Keywords: Extra-osseous talotarsal stabilisation; Pes planus; Posterior tibial tendon dysfunction; Sinus tarsi implant; Talotarsal mechanism.

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Conflict of interest statement

The authors have no conflicts of interest to disclose in relation to this article.

Figures

Fig. 1
Figure 1
Finite element model of the foot and ankle complex of a patient with flatfoot.
Fig. 2
Figure 2
Finite element model of the customised sinus tarsi implant in the talotarsal joint.
Fig. 3
Figure 3
The maximum tensile strain of the navicular ligaments between the intact and implant conditions during gait. (A) Spring (plantar calcaneonavicular) ligament; (B) plantar cuneonavicular ligament ​and (C) plantar cuboideonavicular ligament).
Fig. 4
Figure 4
Rearfoot joint forces between the intact and implant conditions during gait. (A) Subtalar joint force; (B) talonavicular joint force and (C) calcaneocuboid joint force.
Fig. 5
Figure 5
Von Mises stress of the talus and the average von Mises stress values of the concentrated stress region at the sulcus tali and sinus tarsi between the intact and implant conditions during gait. (Inferior view).
Fig. 6
Figure 6
Plantar pressure distribution between the intact and implant conditions during gait.
Fig. 7
Figure 7
Comparison of peak plantar pressure of intact flatfoot in current and existing studies.
See this image and copyright information in PMC

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References

    1. Aenumulapalli A., Kulkarni M.M., Gandotra A.R. Prevalence of flexible flat foot in adults: a cross-sectional study. J Clin Diagn Res: JCDR. 2017;11(6):AC17. - PMC - PubMed
    1. Ross M.H., Smith M.D., Vicenzino B. Reported selection criteria for adult acquired flatfoot deformity and posterior tibial tendon dysfunction: are they one and the same? A systematic review. PloS One. 2017;12(12) e0187201. - PMC - PubMed
    1. Graham M.E., Jawrani N.T., Chikka A. Extraosseous talotarsal stabilization using HyProCure® in adults: a 5-year retrospective follow-up. J Foot Ankle Surg. 2012;51(1):23–29. - PubMed
    1. Graham M.E., Jawrani N.T., Chikka A., Rogers R.J. Surgical treatment of hyperpronation using an extraosseous talotarsal stabilization device: radiographic outcomes in 70 adult patients. J Foot Ankle Surg. 2012;51(5):548–555. - PubMed
    1. Graham M.E., Jawrani N.T., Goel V.K. Effect of extra-osseous talotarsal stabilization on posterior tibial nerve strain in hyperpronating feet: a cadaveric evaluation. J Foot Ankle Surg. 2011;50(6):672–675. - PubMed