{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:09:51Z","timestamp":1789564191880,"version":"build-2803163510"},"reference-count":23,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Proc Inst Mech Eng H"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    Medial displacement calcaneal osteotomy (MDCO) is commonly used to correct valgus hindfoot alignment in progressive collapsing foot deformity, but the biomechanical effects of osteotomy placement and Chevron apex geometry within the surgical safe zone remain unclear. This study evaluated how oblique cut position and Chevron apex orientation affect construct stiffness and stress distribution using patient-specific finite element models. Weight-bearing CT-derived models of the distal tibia, talus, and calcaneus were generated for seven patients. Nine MDCO configurations were simulated per patient: three oblique cut positions (anterior, middle, posterior) and six Chevron configurations varying by apex angle (130\u00b0, 150\u00b0, 170\u00b0) and apex position (anterior, posterior), yielding 63 simulations. Models incorporated cortical\u2013cancellous bone separation, frictional osteotomy contact, patient-specific body-weight loading, and simplified Achilles tendon and plantar fascia forces. Axial stiffness, screw top 5% average von Mises stress, and osteotomy top 5% average von Mises stress were compared using within-subject analyses. Oblique cut position did not significantly affect stiffness (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.149) or screw stress (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.349), but significantly affected osteotomy stress (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Anterior oblique placement produced higher osteotomy stress (5.23\u2009\u00b1\u20091.25\u2009MPa) than middle (4.18\u2009\u00b1\u20090.84\u2009MPa,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.005) and posterior placement (3.70\u2009\u00b1\u20090.98\u2009MPa,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.002). Chevron apex angle did not significantly affect any outcome. However, posterior Chevron apex placement produced higher osteotomy stress than anterior placement (4.79\u2009\u00b1\u20090.69 vs 4.07\u2009\u00b1\u20090.53\u2009MPa,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.011). These findings suggest that local osteotomy-surface stress is more sensitive to MDCO geometry than global stiffness or screw stress.\n                  <\/jats:p>","DOI":"10.1177\/09544119261480789","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:58:16Z","timestamp":1787821096000},"page":"911-920","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Computational biomechanical analysis of medial displacement calcaneal osteotomy placement and orientation"],"prefix":"10.1177","volume":"240","author":[{"given":"Cecily James","family":"Marden","sequence":"first","affiliation":[{"name":"Foot &amp; Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Biomedical Engineering, Tufts University, Medford, MA, USA"},{"name":"OMER (Orthopaedic and Mechanical Engineering Research) Lab Collaborative Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo Aletha","family":"Pilarczyk","sequence":"additional","affiliation":[{"name":"Foot &amp; Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Biomedical Engineering, Tufts University, Medford, MA, USA"},{"name":"OMER (Orthopaedic and Mechanical Engineering Research) Lab Collaborative Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Bhattachan","sequence":"additional","affiliation":[{"name":"OMER (Orthopaedic and Mechanical Engineering Research) Lab Collaborative Network"},{"name":"Bioengineering Department, Northeastern University, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem","family":"Koenders","sequence":"additional","affiliation":[{"name":"Foot &amp; Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bedri","family":"Karaismailoglu","sequence":"additional","affiliation":[{"name":"Foot &amp; Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA"},{"name":"CAST (Cerrahpasa Research Simulation and Design) Laboratory, Istanbul University\u2014Cerrahpasa, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soheil","family":"Ashkani-Esfahani","sequence":"additional","affiliation":[{"name":"Foot &amp; Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8383-6000","authenticated-orcid":false,"given":"Omer","family":"Subasi","sequence":"additional","affiliation":[{"name":"Foot &amp; Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA, USA"},{"name":"OMER (Orthopaedic and Mechanical Engineering Research) Lab Collaborative Network"},{"name":"Bioengineering Department, Northeastern University, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Li S Zhu M Gu W et al. 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Determining the changes in morphology and loading status following medial displacement calcaneal osteotomy for flatfoot using patient-specific finite element models. Sci Rep 2024; 14: 14766. https:\/\/doi.org\/10.1038\/s41598-024-65565-5","DOI":"10.1038\/s41598-024-65565-5"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","unstructured":"Kendal AR Khalid A Ball T et al. Complications of minimally invasive calcaneal osteotomy versus open osteotomy. Foot Ankle Int 2015; 36: 685\u2013690. https:\/\/doi.org\/10.1177\/1071100715571438","DOI":"10.1177\/1071100715571438"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Gutteck N Haase K Kielstein H et al. Biomechanical results of percutaneous calcaneal osteotomy using two different osteotomy designs. Foot Ankle Surg 2020; 26: 551\u2013555. https:\/\/doi.org\/10.1016\/j.fas.2019.07.004","DOI":"10.1016\/j.fas.2019.07.004"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","unstructured":"Talusan PG Cata E Tan EW et al. Safe zone for neural structures in medial displacement calcaneal osteotomy: a cadaveric and radiographic investigation. Foot Ankle Int 2015; 36: 1493\u20131498. https:\/\/doi.org\/10.1177\/1071100715595696","DOI":"10.1177\/1071100715595696"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"Subasi O Sharma S Karaismailoglu B et al. In silico comparative biomechanical analysis of oblique and chevron medial displacement calcaneal osteotomies for pes planus deformity. Comput Biol Med 2024; 169: 107945. https:\/\/doi.org\/10.1016\/j.compbiomed.2024.107945","DOI":"10.1016\/j.compbiomed.2024.107945"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Lopes R Moussa MK Hardy A. Percutaneous calcaneal osteotomy combined with arthroscopic lateral ankle ligament reconstruction for chronic ankle instability with hindfoot varus. 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