A Review of Finite Element Models of Ligaments in the Foot and Considerations for Practical Application.

Finite element (FE) modeling has been used as a research tool for investigating underlying ligaments biomechanics and orthopedic applications. However, FE models of the ligament in the foot have been developed with various configurations, mainly due to their complex three-dimensional geometry, material properties, and boundary conditions. Therefore, the purpose of this review was to summarize the current state of finite element modeling approaches that have been used in the field of ligament biomechanics, to discuss their applicability to foot ligament modeling in a practical setting, and also to acknowledge current limitations and challenges. A comprehensive literature search was performed. Each article was analyzed in terms of the methods used for: (a) ligament geometry, (b) material property, (c) boundary and loading condition related to its application, and (d) model verification and validation. Of the reviewed studies, 79.8% of the studies used simplified representations of ligament geometry, the nonlinear mechanical behavior of ligaments was taken into account in only 19.2% of the studies, 33.6% of included studies did not include any kind of validation of the FE model. Further refinement in the functional modeling of ligaments, the microstructure level characteristics, nonlinearity, and time-dependent response, may be warranted to ensure the predictive ability of the models.