Finite element analysis of subtalar joint arthroereisis on adult-acquired flexible flatfoot deformity using customised sinus tarsi implant

Wai Chi Wong, Yan Wang, Wenxin Niu, Ming Zhang

Research output: Journal article publicationJournal articleAcademic researchpeer-review

11 Citations (Scopus)


Background: Subtalar arthroereisis may cause sinus tarsi pain complications. In this study, we aimed to introduce a customised implant that facilitated treatment effect and less impingement. The biomechanical outcome between the intact and implant conditions was compared using finite element analysis. Methods: A female patient with flatfoot (age: 36 years, height: 156 ​cm, body mass: 51 ​kg) was recruited as the model patient. The customised implant was designed from the extracted geometry. Boundary and loading conditions were assumed from the data of a normal participant. Four gait instants, including the ground reaction force first peak (25% stance), valley (45%), initial push-off (60%) and second peak (75%) were analyzed. Results: The navicular height was elevated by 4.2% at 25% stance, whereas the strain of the spring, plantar cuneonavicular and plantar cuboideonavicular ligaments were reduced. The talonavicular joint force decreased and the calcaneocuboid joint increased by half and 67%, respectively, representing a lateralised load pathway. There was a stress concentration at the sulcus tali reaching 15.29 ​MPa Conclusion: Subtalar arthroereisis using a customised implant may produce some positive treatment effects in terms of navicular height elevation, ligament strain relief and lateralised joint loading pathway. Although the concentrated stress at the sulcus tali did not exceed the threshold of bone breakdown, we could not rule out the potential of vascular disturbance owing to the remarkable elevation of stress. Future study may enlarge the contact area of the bone–implant interface by considering customisation based on the dynamic change of the sinus tarsi during walking gait. The translational potential of this article: Geometry mismatch of prefabricated implants could be the reason for complications. With the advancement of 3D printing, customising implant becomes possible and may improve treatment outcome. This study implemented a theoretical model approach to explore its potential under a simulation of walking.

Original languageEnglish
Pages (from-to)139-145
Number of pages7
JournalJournal of Orthopaedic Translation
Publication statusPublished - Mar 2021


  • Extra-osseous talotarsal stabilisation
  • Pes planus
  • Posterior tibial tendon dysfunction
  • Sinus tarsi implant
  • Talotarsal mechanism

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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