An ex vivo sequential ligament transection model of flatfoot

The ligaments implicated in the earliest stages of developing a progressive collapsing foot deformity are poorly understood. Commonly employed cadaveric flatfoot models are created from simultaneous transection of multiple ligaments, making it difficult to assess early changes in pressure distributi...

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Bibliographic Details
Published in:Clinical biomechanics (Bristol) 2024-08, Vol.118, p.106302, Article 106302
Main Authors: Renfree, Sean, Malakoutikhah, Hamed, Borgstrom, Mark, Latt, Leonard Daniel
Format: Article
Language:English
Subjects:
Adult acquired flat foot
Cadaveric study
Foot biomechanics
Pedobarography
Posterior tibial tendon dysfunction
Progressive collapsing foot deformity
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Summary:The ligaments implicated in the earliest stages of developing a progressive collapsing foot deformity are poorly understood. Commonly employed cadaveric flatfoot models are created from simultaneous transection of multiple ligaments, making it difficult to assess early changes in pressure distribution from ligaments critical for maintaining load distribution. A serial transection of ligaments may provide insight into changes in pressure distribution under the foot to identify a potential combination of ligaments that may be involved in early deformities. Specimens were loaded using a custom designed axial and tendon loading system. Plantar pressure data for the forefoot and hindfoot were recorded before and after six sequential ligament complex transections. Sectioning the plantar fascia (first) and short/long plantar ligaments (second) failed to generate appreciable differences in load distribution. Dividing the spring ligament (third) led to changes in hindfoot load distribution with a shift towards the lateral column indicative of hindfoot valgus angulation. All subsequent conditions resulted in similar patterns in hindfoot plantar load distribution. An anterior shift in the center of pressure only occurred after transection of all six ligament complexes. Loss of the plantar fascia and short/long plantar ligaments are not critical in maintaining plantar load distribution or contact area. However, the additional loss of the spring ligament caused notable changes in hindfoot load distribution, indicating the combination of these three ligament complexes is particularly critical for preventing peritalar subluxation. Minimal changes in load distribution occurred when performing additional transections to reach a complete flatfoot deformity. •The ligaments involved in early flatfoot development are poorly understood.•There is limited pedobarographic data for ex vivo flatfoot deformity models.•Loss of plantar and spring ligaments mimics complete flatfoot in load distribution.•Flatfoot involves hindfoot valgus, causing increased load on its lateral aspect.
ISSN:0268-0033
1879-1271
1879-1271
DOI:10.1016/j.clinbiomech.2024.106302