Three-dimensional finite element biomechanical analysis of
stage II adult acquired flatfoot deformity after medial column stabilization

doi:10.3969/j.issn.2095-4344.2626

Abstract

Abstract:

BACKGROUND: Flatfoot is a commonly seen disease in foot and ankle surgery, and stage II adult acquired flatfoot is mostly seen in clinic, so this stage is a key to treatment. However, medial column instability occurs in stage II adult acquired flatfoot, which is an important cause for arch collapse. Medial column stabilization can correct the deformity to great extent, but there is a lack of biomechanical study to assess the effect of medial column stabilization on the whole foot.

OBJECTIVE: To investigate the biomechanical effects of medial column stabilization on stage II adult acquired flatfoot.

METHODS: A three-dimensional finite element model of stage IIa and IIb adult acquired flatfoot was established. Geomagic software, Solidwork software and Abaqus software were used to simulate medial column stabilization operation (naviculocuniform joint fusion, tarsometatarsal joint fusion, and both fusion). The maximum pressure of plantar soft tissue, medial column bone and medial ligaments was compared before and after simulated single-foot weight loading. Meanwhile, the related parameters were measured to carry out a comprehensive comparison.

RESULTS AND CONCLUSION: (1) The maximum plantar stress was located under the first metatarsal head after the simulated medial column stabilization operation. The maximum plantar stress increased significantly after the medial column stabilization in stage IIa flatfoot model, but did not change significantly after the medial column stabilization in stage IIb model. (2) After medial column fusion, the stress of the corresponding joint was reduced, but increased for the other joints of the first metatarsal column. (3) The stress of medial ligament and plantar fascia was not alleviated after medial column fusion. (4) These results indicate that simple medial column stabilization surgery cannot reduce the pressure of medial column of flatfoot in stage II acquired flatfoot adults. It can only be used as a combined surgery to stabilize joints with excessive motion and correct the deformity of supination of forefoot.

Key words: adult, flatfoot, medial column, three-dimensional finite element analysis, biomechanics

CLC Number:

Liu Fushenghua, Xu Jian, Zhao Bingcheng, Wei Gehan, Qin Wenbao. Three-dimensional finite element biomechanical analysis of stage II adult acquired flatfoot deformity after medial column stabilization[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(18): 2805-2810.

Figures/Tables 6

2.2 单纯跖楔关节融合在Ⅱa期及Ⅱb期平足模型行单纯跖楔关节融合后模拟负重，足底应力最大值出现在第一跖骨头下方。Ⅱa期模型足底应力最大值也从术前上升至112.1 kPa，见图4；Ⅱb期模型足底压应力较术前稍降低至76.6 kPa，见图5。行跖楔关节融合后Ⅱa期模型距骨、舟骨、内侧楔骨、第一跖骨、跟骨、骰骨、第五跖骨的最大应力值由术前依次变化为5.27，4.00，3.00，4.50，4.10，2.10，3.60 MPa；Ⅱb期平足模型中相对应的骨块则由术前变化为4.90，2.87，3.25，2.40，4.00，3.10，3.07 MPa，见表2。胫距前韧带、胫距后韧带、胫跟韧带、胫舟韧带、弹簧韧带、跖筋膜的最大应力值分别从术前变为0.92，0.35，0.72，1.64，3.50，2.00 MPa；Ⅱb期平足模型中相应韧带及跖筋膜最大应力值则分别为3.82，0.88，1.52，4.67，4.73，1.47 MPa，见表3。Ⅱa期模型上实施跖楔关节融合后距骨第一跖骨角、跟骨倾斜角、距舟覆盖角由术前负重变化为7.8°，14.5°，10.8°，足弓恢复到14 mm；Ⅱb期模型相应测量角度变化为21.9°，8.8°，17.2°，足弓恢复到 8 mm，见表4。 2.3 舟楔关节和跖楔关节均融合在Ⅱa期及Ⅱb期平足模型行舟楔关节和跖楔关节融合后模拟负重，足底应力最大值出现在第一跖骨头下方。Ⅱa期模型足底应力最大值也从术前上升至131.0 kPa，见图4；Ⅱb期模型足底压应力较术前稍降低至77.3 kPa，见图5。距骨、舟骨、内侧楔骨、第一跖骨、跟骨、骰骨、第五跖骨最大应力值由术前变化为5.83，3.57，1.96，4.45，3.90，2.20，3.46 MPa；Ⅱb期平足模型中相对应的骨块则由术前变化为5.20，4.40，3.07，2.09，4.10，2.57，3.50 MPa，见表2。 Ⅱa期平足模型经过舟楔关节融合后胫距前韧带、胫距后韧带、胫跟韧带、胫舟韧带、弹簧韧带、跖筋膜的最大应力值分别从术前变为0.56，0.45，0.55，1.35，4.6，1.67 MPa；Ⅱb期平足模型中相应韧带及跖筋膜最大应力值则分别为3.76，0.76，1.43，4.76，4.87，1.43 MPa，见表3。行舟楔关节和跖楔关节融合后Ⅱa期距骨第一跖骨角、跟骨倾斜角、距舟覆盖角测量角度变化为6.5°，15.9°，7.8°，足弓恢复到14 mm；Ⅱb期模型相应测量角度变化为18.9°，9.1°，15.3°，足弓恢复到9 mm，见表4。 "

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