Modeling toes contributes to realistic stance knee mechanics in three-dimensional predictive simulations of walking

Abstract

Physics-based predictive simulations have been shown to capture many salient features of human walking. Yet they often fail to produce realistic stance knee mechanics and terminal stance ankle plantarflexion. While the influence of the performance criterion on the predicted walking pattern has been previously studied, the influence of the mechanics has been less explored. Here, we investigated the influence of two mechanical assumptions on the predicted walking pattern: the complexity of the foot segment and the stiffness of the Achilles tendon. We found, through three-dimensional muscle-driven predictive simulations of walking, that modeling the toes and metatarsophalangeal joints, and thus using two-segment instead of single-segment foot models, contributed to robustly eliciting physiological stance knee flexion angles, knee extension torques, and knee extensor activity. Yet modeling toe joints did not improve ankle kinematics, nor did decreasing the Achilles tendon stiffness. The lack of predicted terminal stance ankle plantarflexion thereby remains an open question. Overall, this simulation study shows that not only the performance criterion but also mechanical assumptions affect predictive simulations of walking. Improving the realism of predictive simulations is required for their application in clinical contexts. Here, we suggest that using complex models is needed to yield such realism.