Experimental flatfoot model: The contribution of dynamic loading

The goal of this study was to determine if the application of muscle forces (simulating the dynamic phase of the midstance part of gait) had an effect on flatfoot deformity. We created a flatfoot model in each of seven cadaver foot specimens by grasping the Achilles, peroneus longus, peroneus brevis, flexor digitorum longus, and flexor hallucis longus tendons with soft-tissue vice clamps connected via wire cables to pneumatic cylinders. The experiment included four stages: 1) initial static axial loading; 2) axial loading after 3,000 load cycles (average, 735 N; range, 70 to 1400 N); 3) axial loading after releasing the spring ligament and plantar fascia; and 4) axial loading after an additional 3,000 load cycles. At each stage, both static (with axial loading only) and dynamic (axial loading with tensioning of the tendons to simulate the muscle forces at midstance) conditions were evaluated radiographically. No change was observed between the static and dynamic conditions in the first two phases of the experiment. After the third phase, changes in the talar-first metatarsal angle and the height of the medial cuneiform were noted, particularly in the dynamic condition. These and additional radiographic changes were magnified in the fourth phase, but only in the dynamic condition. We concluded that, to create an effective flatfoot model, the medial structures, including the spring ligament and possibly the plantar fascia, must be severed. Cyclic loading of the foot further increased the arch flattening, and this effect was magnified by dynamic loading.