Finite Element Simulation of Clubfoot Correction: A Feasibility Study Toward Patient-Specific Casting

<b>Background:</b> Congenital talipes equinovarus (clubfoot) affects 1-2 per 1000 newborns worldwide. The Ponseti method, based on staged manipulations and casting, is the gold standard for correction. However, the biomechanical processes underlying these corrections remain poorly understood, as infants rarely undergo imaging. Computational modeling may offer a non-invasive approach to studying correction pathways and exploring novel applications, such as customized casts. <b>Methods:</b> We developed a proof-of-concept framework using iterative finite element analysis (iFEA) to approximate the surface-level geometric corrections targeted in Ponseti treatment. A 3D surface model of a training clubfoot foot was scanned, meshed, and deformed stepwise under applied computational loads. The model was assumed to be homogeneous and hyperelastic, and correction was quantified using Cavus, Adductus, Varus, Equinus, and Derotation angles. We also introduced a secondary adult leg 3D surface model to assess whether model simplification influences correction outcomes, by comparing a homogeneous soft tissue model with a non-homogeneous model incorporating bone structure. <b>Results:</b> In the training model, iFEA generated progressive deformations consistent with Ponseti correction, with mean angular deviations of ±3.2°. In the adult leg model, homogeneous and non-homogeneous versions produced comparable correction geometries, differing by <2° in outcomes. The homogeneous model required less computation, supporting its use for feasibility testing. Applied loads were computational drivers, not physiological forces. <b>Conclusions:</b> This feasibility study shows that iFEA can reproduce surface-level geometric changes consistent with Ponseti correction, independent of model homogeneity. While not replicating clinical biomechanics, this framework lays the groundwork for future work that incorporates clinician-applied forces, pediatric tissue properties, and patient-specific geometries, with potential applications in customized 3D-printed casts.