Novel Reconstruction of the Medial Ligamentous Complex in a Flatfoot Model

The purpose of this investigation was to create a flatfoot model and reconstruct the deformity with a novel static medial ligamentous complex (MLC) and to evaluate its ability to correct talar head subluxation and the radiographic flatfoot deformity. Four pairs of matched cadaveric specimens were sectioned to create a severe flatfoot model. Cyclic preconditioning and axial loading was applied to the intact foot, the flatfoot, and the reconstructed MLC foot. AP and lateral views were taken at each stage. For each set of films, the following parameters were measured: on the lateral view; talar-first metatarsal angle, medial cuneiform height, talocalcaneal angle, and the calcaneal pitch angle; and on the anteroposterior view, the talar-first metatarsal angle. Compared with the intact foot, the flatfoot model showed significant change in the AP talar -first metatarsal angle (p=0.001), the lateral talar-first metatarsal angle (p=0.002), the medial cuneiform height (p=0.007), the talocalcaneal angle (p=0.03) and the calcaneal pitch angle (p=0.018). After MLC reconstruction of the severe flatfoot model, the AP talar-first metatarsal angle, the lateral talar-first metatarsal angle and the medial cuneiform height were significantly different from the flatfoot model and was not significantly different than the intact foot. The talocalcaneal angle and the calcaneal pitch angle remained significantly undercorrected after static MLC reconstruction. Our results suggest that static MLC reconstruction is effective in correcting several key radiographic parameters in a flatfoot model and may be useful in the future as a new soft tissue reconstructive procedure for treating adult