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Peer-reviewedCC BYAnnals of 3D Printed Medicine

3D virtual surgical planning and patient-specific guides for Charcot midfoot reconstruction: a technical note

  • Sam F. Kroezen1
  • Wouter A. ten Cate2
  • Gabriëlle J.M. Tuijthof3
  • Charles M.M. Peeters4
  • Adelgunde V.C.M. Zeegers4
  • Kilian D.R. Kappert5
  • Femke F. Schröder6
6 affiliations
  1. 1Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands; Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; Medical 3D Lab, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands; Corresponding author at: Drienerlolaan 5, Enschede 7522NB, the Netherlands.
  2. 2Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
  3. 3Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
  4. 4Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
  5. 5Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands; Department of Biomedical Imaging and Sensing, University of Twente, Enschede, the Netherlands
  6. 6Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; Medical 3D Lab, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
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Abstract

Introduction: Charcot neuroarthropathy (CN) of the foot can lead to severe foot deformity, increased plantar pressures, and ulcer formation. Surgical reconstruction is challenging due to the complex 3D nature of the deformity. Conventional freehand reconstruction based on visual assessment and 2D fluoroscopy may result in suboptimal correction. To address the 3D nature of the foot, this paper presents a novel 3D virtual surgical planning (VSP) and patient specific guide (PSG) applied to a single patient with CN to assess technical feasibility. Methods: For one patient with CN, a 3D foot model was created from a preoperative CT-scan. A VSP was developed by defining target foot alignment using clinical 3D reference angles and surgical expertise. Patient-specific osteotomy and reposition guides were designed to execute the planned closing wedge osteotomy and align the foot according to the VSP. Postoperative alignment was assessed by comparing the VSP with a 3D model of the peroperative CT-scan. Results: Creation of the VSP and PSG required approximately 210 min. The osteotomy guide fitted the bones as intended and guided osteotomy. Fluoroscopy confirmed K-wire placement according to the planned trajectory, and the reposition guide enabled alignment of the distal foot part. Postoperative 3D angle analysis demonstrated correction towards the VSP, with differences ranging from 2.3° to 10.3°. Conclusion: This paper demonstrates the feasibility of a novel 3D VSP and PSG for Charcot midfoot reconstruction. Further optimization of guide design is required to improve correction accuracy and stability during repositioning. Larger studies are needed to determine its clinical value.

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Cite

BibTeXRIS
BibTeX
@article{kroezen2026virtual,
  title = {{3D virtual surgical planning and patient-specific guides for Charcot midfoot reconstruction: a technical note}},
  author = {Sam F. Kroezen and Wouter A. ten Cate and Gabriëlle J.M. Tuijthof and Charles M.M. Peeters and Adelgunde V.C.M. Zeegers and Kilian D.R. Kappert and Femke F. Schröder},
  journal = {Annals of 3D Printed Medicine},
  year = {2026},
  month = oct,
  doi = {10.1016/j.stlm.2026.100242},
  url = {https://doi.org/10.1016/j.stlm.2026.100242},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - 3D virtual surgical planning and patient-specific guides for Charcot midfoot reconstruction: a technical note
AU  - Sam F. Kroezen
AU  - Wouter A. ten Cate
AU  - Gabriëlle J.M. Tuijthof
AU  - Charles M.M. Peeters
AU  - Adelgunde V.C.M. Zeegers
AU  - Kilian D.R. Kappert
AU  - Femke F. Schröder
PY  - 2026
DA  - 2026/10/30
JO  - Annals of 3D Printed Medicine
DO  - 10.1016/j.stlm.2026.100242
UR  - https://doi.org/10.1016/j.stlm.2026.100242
AB  - Introduction: Charcot neuroarthropathy (CN) of the foot can lead to severe foot deformity, increased plantar pressures, and ulcer formation. Surgical reconstruction is challenging due to the complex 3D nature of the deformity. Conventional freehand reconstruction based on visual assessment and 2D fluoroscopy may result in suboptimal correction. To address the 3D nature of the foot, this paper presents a novel 3D virtual surgical planning (VSP) and patient specific guide (PSG) applied to a single patient with CN to assess technical feasibility. Methods: For one patient with CN, a 3D foot model was created from a preoperative CT-scan. A VSP was developed by defining target foot alignment using clinical 3D reference angles and surgical expertise. Patient-specific osteotomy and reposition guides were designed to execute the planned closing wedge osteotomy and align the foot according to the VSP. Postoperative alignment was assessed by comparing the VSP with a 3D model of the peroperative CT-scan. Results: Creation of the VSP and PSG required approximately 210 min. The osteotomy guide fitted the bones as intended and guided osteotomy. Fluoroscopy confirmed K-wire placement according to the planned trajectory, and the reposition guide enabled alignment of the distal foot part. Postoperative 3D angle analysis demonstrated correction towards the VSP, with differences ranging from 2.3° to 10.3°. Conclusion: This paper demonstrates the feasibility of a novel 3D VSP and PSG for Charcot midfoot reconstruction. Further optimization of guide design is required to improve correction accuracy and stability during repositioning. Larger studies are needed to determine its clinical value.
SN  - 2666-9641
ER  -