Mild PTTD was simulated by unloading the tibialis posterior on the intact model.
To simulate severe PTTD, in addition to the unloading, the stiffness values of some stabilization structures were reduced by half, including those of the spring ligament, the short plantar ligament, and the medial portions (1 st to 3 rd columns) of the long plantar ligament and the plantar aponeurosis (Arangio et al. 2004 ). Subtalar arthroereisis was then performed under the mild and severe PTTD conditions. In all, five sets of simulations/conditions were completed.
The FE analysis was carried out using the commercially available FE software ABAQUS 6.11 (SIMULIA, Dassault Systèmes, USA) with the standard (quasi-static) solver. The load transfers through the midfoot and the medial column were studied, which were represented by the contact force magnitudes across the joints. In addition, the von Mises stress of the metatarsal shafts was extracted for analysis.