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J Biomech. 2019 Feb 14;84:183-190. doi: 10.1016/j.jbiomech.2018.12.047. Epub 2019 Jan 9.

Analysis of the main passive soft tissues associated with adult acquired flatfoot deformity development: A computational modeling approach.

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Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain; Facultad de Ciencias Médicas, Departamento de Medicina, Universidad Espíritu Santo, Ecuador.
Orthopaedics and Trauma Department, Medicine School, Universidad Complutense - Hospital Universitario Infanta Leonor, Madrid, Spain. Electronic address:
Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain.


Adult acquired flatfoot deformity (AAFD) is a pathology with a wide range of treatment options. Physicians decide the best treatment based on their experience, so the process is entirely subjective. A better understanding of soft tissue stress and its contribution in supporting the plantar arch could help to guide the clinical decision. Traditional experimental trials cannot consistently evaluate the contribution of each tissue. Therefore, in this research a 3-Dimensional FE foot model was reconstructed from a normal patient in order to measure the stress of the passive stabilizers of the arch, and its variation in different scenarios related with intermediate stages of AAFD development. All bones, the plantar fascia (PF), cartilages, plantar ligaments and the spring ligament (SL) were included, respecting their anatomical distribution and biomechanical characteristics. An AAFD evaluation scenario was simulated. The relative contribution of each tissue was obtained comparing each result with a normal case. The results show that PF is the main tissue that prevents the arch elongation, while SL mainly reduces the foot pronation. Long and short plantar ligaments play a secondary role in this process. The stress increment on both PF and SL when one of two fails suggests that these tissues complement each other. These findings support the theory that regards the tibialis posterior tendon as a secondary actor in the arch maintenance, compared with the PF and the SL, because this tendon is overstretched by the hindfoot pronation around the talonavicular joint. This approach could help to improve the understanding of AAFD.


Biomechanics; FE modeling; Flatfoot; Pes planus

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