Medial displacement calcaneal osteotomy reduces the excess forces in the medial longitudinal arch of the flat foot

Abstract

Objective. The hypothesis tested was that the increased load on the medial arch of the flat foot can be reduced through a medial displacement calcaneal osteotomy. Design. A three-dimensional, biomechanical, multisegment model was used in conjunction with experimental data from the literature. Background. Biomechanical models have been used to study the plantar fascia, medial arch height, subtalar motion and distribution of forces in the foot. Methods. Responses of a normal foot, a flat foot and a flat foot with a medial displacement calcaneal osteotomy to an applied load of 683 Newtons were analyzed, and the distribution of support among the metatarsal heads and moment about various joints were computed. Results. Compared to the normal foot, our flat foot model shifts the distribution of support from the lateral to the medial side, decreasing support provided by the fifth metatarsal from 11% to 1% of the total load, increasing support provided by the first metatarsal from 12% to 22% and increasing the moment about the talo-navicular joint from 20 to 28 Newton-meters. A ten millimeter medial displacement calcaneal osteotomy shifts support back toward the lateral side, with 11% provided by the fifth metatarsal and 13% by the first metatarsal. The moment at the talo-navicular joint decreases to eighteen Newton-meters. Conclusion. Our analysis indicates that a ten millimeter medial displacement calcaneal osteotomy in a flat foot model decreases the load on the medial arch. Relevance Our analysis adds a quantitative biomechanical rationale to medial displacement calcaneal osteotomy for the treatment of the flat foot.