The effect of mono- versus multi-segment musculoskeletal models of the foot on simulated triceps surae lengths in pathological and healthy gait

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BackgroundEstimating muscle-tendon complex (MTC) lengths is important for planning of soft tissue surgery and evaluating outcomes, e.g. in children with cerebral palsy (CP). Conventional musculoskeletal models often represent the foot as one rigid segment, called a mono-segment foot model (mono-SFM). However, a multi-segment foot model (multi-SFM) might provide better estimates of triceps surae MTC lengths, especially in patients with foot deformities. Research questionWhat is the effect of a mono- versus a multi-SFM on simulated ankle angles and triceps surae MTC lengths during gait in typically developing subjects and in children with CP with equinus, cavovarus or planovalgus foot deformities? Methods50 subjects were included, 10 non-affected adults, 10 typically developing children, and 30 children with spastic CP and foot deformities. During walking trials, marker trajectories were collected for two marker models, including a mono- and multi-segment foot; respectively Newington gait model and Oxford foot model. Two musculoskeletal lower body models were constructed in OpenSim with either a mono- or multi-SFM based on the corresponding marker models. Normalized triceps surae MTC lengths (soleus, gastrocnemius medialis and lateralis) and ankle angles were calculated and compared between models using statistical parametric mapping RM-ANOVAs. Root mean square error values between simulated MTC lengths were compared using Wilcoxon signed-rank and rank-sum tests. ResultsMono-SFM simulated significantly more ankle dorsiflexion (7.5 ± 1.2°) and longer triceps surae lengths (difference; soleus:2.6 ± 0.29 %, gastrocnemius medialis:1.7 ± 0.2 %, gastrocnemius lateralis:1.8 ± 0.2%) than a multi-SFM. Differences between models were larger in children with CP compared to typically developing children and larger in the stance compared to the swing phase of gait. Largest differences were found in children with CP presenting with planovalgus (4.8 %) or cavovarus (3.8 %) foot deformities. SignificanceIt is advisable to use a multi-SFM in musculoskeletal models when simulating triceps surae MTC lengths, especially in individuals with planovalgus or cavovarus foot deformities.