Evaluation of assumptions in foot and ankle biomechanical models

Background: A variety of biomechanical models have been used in studies of foot and ankle disorders. As-sumptions about the element types, material properties, and loading and boundary conditions are inherent in every model. It was hypothesized that the choice of these modeling assumptions could have a significant impact on the findings of the model.Methods: We investigated the assumptions made in a number of biomechanical models of the foot and ankle and evaluated their effects on the results of the studies. Specifically, we focused on: (1) element choice for simulation of ligaments and tendons, (2) material properties of ligaments, cortical and trabecular bones, and encapsulating soft tissue, (3) loading and boundary conditions of the tibia, fibula, tendons, and ground support.Findings: Our principal findings are: (1) the use of isotropic solid elements to model ligaments and tendons is not appropriate because it allows them to transmit unrealistic bending and twisting moments and compressive forces; (2) ignoring the difference in elastic modulus between cortical and trabecular bones creates non -physiological stress distribution in the bones; (3) over-constraining tibial motion prevents anticipated defor-mity within the foot when simulating foot deformities, such as progressive collapsing foot deformity; (4) neglecting the Achilles tendon force affects almost all kinetic and kinematic parameters through the foot; (5) the axial force applied to the tibia and fibula is not equal to the ground reaction force due to the presence of tendon forces.Interpretation: The predicted outcomes of a foot model are highly sensitive to the model assumptions.