Computational Modeling of Peritalar Joint Contact Mechanics in Flexible Flatfoot Deformity

Abstract

Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: Patients with longstanding progressive collapsing foot deformity (PCFD) often develop osteoarthritis of the peritalar (tibiotalar, subtalar, and talonavicular) joints, which can be symptomatic or can lead to fixed deformities that further complicate the treatment of other sequalae of the deformity (Mann, 1992). Degeneration and subsequent tearing of the arch supporting ligaments leads to altered joint contact mechanics which is a likely causative factor in the development of arthrosis (Hauser and Dolan, 2011). However, the initial effect of ligament tears on changes in joint contact mechanics in the collapsing foot has not been well characterized. The goal of this work was to compare the joint contact mechanics between the neutrally aligned and the flexible flatfoot (collapsed foot). Methods: A validated finite element model of the foot (Malakoutikhah et al., 2022a) was used to compare joint contact pressures between the normally aligned and the collapsed foot. The model of the foot constructed from CT scan images of a female cadaveric foot weighing 60 kg included all 28 bones, 72 ligaments, cartilage, and an encapsulating soft tissue. The model was loaded with 0.5 body weight applied at the center of mass and 0.25 body weight applied to the Achilles tendon simulating quiet stance. The collapsed foot model was created by simulated transection of the plantar fascia, long plantar, short plantar, deltoid, and spring ligaments and unloading of the posterior tibial tendon (Malakoutikhah et al., 2022b). The joint contact pressure maps were determined for both the neutrally aligned and collapsed foot models. The average and peak contact pressures were compared. Results: The peak contact pressures were increased in the tibiotalar and subtalar joints, but paradoxically were decreased in the talonavicular joint in the collapsed as compared to the neutrally aligned foot (Figure 1). The center of pressure was markedly different in all three joints between the neutral and collapsed foot conditions. Specifically, collapsing the foot caused two centers of the talonavicular joint peak pressure to shift towards the central region of the navicular bone, which were evenly distributed in the lateral and medial regions in the neutrally aligned foot. In the subtalar joint, the peak pressure that was uniformly distributed in the lateral and medial regions of the posterior facet in the neutrally aligned foot shifted towards the lateral region in the collapsed foot. Similarly, the peak contact pressure across the tibiotalar joint moved from the center to the lateral region when the foot collapsed. Conclusion: Degenerative tearing of the arch supporting ligaments in PCFD leads to an increase and laterization of the contact pressure in the tibiotalar and subtalar joints with a decrease of the pressure in the talonavicular joint. The paradoxical unloading of the talonavicular joint may be a result of the inability of the malaligned medial column to transmit force from the hindfoot to the forefoot. One implication of this work is that future treatments of PCFD might be directed towards normalizing contact pressure within the peritalar joints to prevent the progression of disease and the development of arthrosis.