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An improved understanding of the individual ligament contributions to the deformity would aid in selecting among available treatments, optimizing current surgical techniques, and developing new ones. In this study, we evaluated the contribution of each ligament to the maintenance of foot alignment using a finite element model of the foot reconstructed from computed tomography\u00a0scan images. The collapsed foot was modeled by simulating the failure of all the ligaments involved in PCFD. The ligaments were removed one at a time to determine the impact of each ligament on foot alignment, and then restored one at a time to simulate isolated reconstruction. Our findings show that the failure of any one ligament did not immediately lead to deformity, but that combined failure of only a few (the plantar fascia, long plantar, short plantar, deltoid, and spring ligaments) could lead to significant deformity. The plantar fascia, deltoid, and spring ligaments were primarily responsible for the prevention of arch collapse, hindfoot valgus, and forefoot abduction, respectively. Moreover, to produce deformity, a considerable amount of attenuation in the spring, tibiocalcaneal, interosseous talocalcaneal, plantar naviculocuneiform, and first plantar tarsometatarsal ligaments, but only a small amount in the plantar fascia, long plantar, and short plantar ligaments was needed. The results of this study suggest that the ability of a ligament to prevent deformity may not correlate with its attenuation in a collapsed foot.<\/jats:p>","DOI":"10.1002\/jor.25244","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T04:09:16Z","timestamp":1641269356000},"page":"2209-2221","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["The contribution of the ligaments in progressive collapsing foot deformity: A comprehensive computational study"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7161-514X","authenticated-orcid":false,"given":"Hamed","family":"Malakoutikhah","sequence":"first","affiliation":[{"name":"Department of Aerospace and Mechanical Engineering University of Arizona Tucson Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2895-6111","authenticated-orcid":false,"given":"Erdogan","family":"Madenci","sequence":"additional","affiliation":[{"name":"Department of Aerospace and Mechanical Engineering University of Arizona Tucson Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9925-3440","authenticated-orcid":false,"given":"Leonard Daniel","family":"Latt","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Arizona Tucson Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198902000-00022"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/1071100720950722"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200807000-00005"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.176.5.1761137"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110070502600601"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110079301400609"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/781603"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.4000939"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.22471"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","unstructured":"WangZ ImaiK KidoM IkomaK HiraiS.\u00a0A finite element model of flatfoot (Pes Planus) for improving surgical plan. 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