Finite element analysis of the foot:​ model validation and comparison between two common treatments of the clawed hallux deformity

Isvilanonda, Vara<sup>1</sup>; Dengler, Evan<sup>1</sup>; Iaquinto, Joseph M.<sup>1</sup>; Sangeorzan, Bruce J.<sup>1</sup>; Ledoux, William R.<sup>1</sup>

Affiliations

¹RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Department of Veterans Affairs, Seattle, WA, USA

²Department of Mechanical Engineering, University of Washington, Seattle, WA, USA

³Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA

Abstract and keywords

Background: Clawed hallux is defined by first metatarsophalangeal joint extension and first interphalangeal joint flexion; it can increase plantar pressures and ulceration risk. We investigated two corrective surgical techniques, the modified Jones and flexor hallucis longus tendon transfer.

Methods: A finite element foot model was modified to generate muscle overpulls, including extensor hallucis longus, flexor hallucis longus and peroneus longus. Both corrective procedures were simulated, predicting joint angle and plantar pressure changes.

Findings: The clawed hallux deformity was generated by overpulling: 1) extensor hallucis longus, 2) peroneus longus + extensor hallucis longus, 3) extensor hallucis longus + flexor hallucis longus and 4) all three together. The modified Jones reduced metatarsophalangeal joint angles, but acceptable hallux pressure was found only when there was no flexor hallucis longus overpull. The flexor hallucis longus tendon transfer reduced deformity at the metatarsophalangeal and interphalangeal joints but may extended the hallux due to the unopposed extensor hallucis longus. Additionally, metatarsal head pressure increased with overpulling of the extensor hallucis longus + flexor hallucis longus, and all three muscles together.

Interpretation: The modified Jones was effective in correcting clawed hallux deformity involving extensor hallucis longus overpull without flexor hallucis longus overpull. The flexor hallucis longus tendon transfer was effective in correcting clawed hallux deformity resulting from the combined overpull of both extensor and flexor hallucis longus, but not with isolated extensor hallucis longus overpull. An additional procedure to reduce the metatarsal head pressure may be required concomitant to the flexor hallucis longus tendon transfer. However this procedure avoids interphalangeal joint fusion.

Keywords: Modified Jones; FHL tendon transfer; Foot; Finite element analysis; Clawed hallux deformity

Links

DOI: 10.1016/j.clinbiomech.2012.05.005

PubMed: 22694884

WoS: 000308850800016

History

Received: 2012-01-13

Accepted: 2012-05-14

Online: 2012-06-11

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2016	Morales-Orcajo E, Bayod J, Barbosa de Las Casas E. Computational foot modeling: scope and applications. Arch Comput Methods Eng. September 2016;23(3):389-416.
2020	Ellison MA. Beam Theory and Finite Element Approaches to Modelling the Stresses in the Second Metatarsal During Running [PhD thesis]. Exeter, UK: University of Exeter; March 2020.
2013	Spratley EM. Patient-Specific Modeling of Adult Acquired Flatfoot Deformity Before and After Surgery [PhD thesis]. Richmond, VA: Virginia Commonwealth University; 2013.