A Biomodeling Investigation of Bracing on Clubfoot Children Treated by the Method of Ponseti Public Deposited

Downloadable Content

Download PDF
Last Modified
  • March 19, 2019
  • DiMeo, Andrew John, Sr.
    • Affiliation: School of Medicine, UNC/NCSU Joint Department of Biomedical Engineering
  • Congenital talipes equinovarus (clubfoot) is a complex deformity occurring in otherwise normal children. It presents in utero bilaterally or unilaterally with the affected feet turned inward. Clubfoot is the most common congenital musculoskeletal birth defect, with an annual worldwide occurrence of 150,000-200,000. Regardless of treatment, whether surgical or conservative, clubfoot has a stubborn tendency to relapse, thus requiring post-correction bracing. While newborn treatment lasts weeks, brace wear is often maintained to five years of age. To date, there are no investigations specifically focused on clubfoot bracing from an engineering perspective. This dissertation applies engineering principles to the condition; concluding that surrogate biomodeling is an accurate and repeatable method to investigate clubfoot bracing. Results show standard-of-care brace parameters (external rotation, width, and dorsiflexion) impact muscle-tendon tension. Increasing external rotation from 0-80 degrees results in a range of tension increase of 12%-18% in the gastrocnemius medial head, 22%-26% in the lateral head, 10%-16% in the soleus, and 0%-13% in the tibialis posterior. The range of tension increase when decreasing brace width from 4-inches greater to 4-inches less than shoulder width is 11%-29% for the medial head, 10%-28% for the lateral head, 4%-25% for the soleus, and 8%-18% for the tibialis posterior. The range of tension increase when increasing brace dorsiflexion from 0-30 degrees is 27%-44% for the medial head, 24%-50% for the lateral head, 19%-32% for the soleus, and 13%-23% for the tibialis posterior. Comparing brace options, such as articulating and standard-of-care braces, produces unique tension characteristics. The results indicate that external rotation and width parameters serve to enable the dorsiflexion parameter. The standard-of-care is the only investigated-brace containing all three parameters. Limitations in effectiveness are observed for brace options that do not have all three parameters, such as the articulating brace, with no ability to set dorsiflexion. It is concluded that surrogate biomodeling is an effective method to evaluate wide ranging brace options, and may potentially be used to assist in future clubfoot brace development. The surrogate biomodel may be used to impact patient care by tuning brace parameters to maximize benefit and minimize over-correction.
Date of publication
Resource type
Rights statement
  • In Copyright
  • Lalush, David Scott
  • Open access

This work has no parents.