Foot progression angle and knee osteoarthritis

NewsBot · Jan 10, 2008

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Foot progression angle and the knee adduction moment: a cross-sectional investigation in knee osteoarthritis.
Rutherford DJ, Hubley-Kozey CL, Deluzio KJ, Stanish WD, Dunbar M.
Osteoarthritis Cartilage. 2008 Jan 5 [Epub ahead of print]

OBJECTIVE: To test the hypothesis that an association exists between the characteristics of the knee adduction moment and foot progression angle (FPA) in asymptomatic individuals and those with mild to moderate and severe knee osteoarthritis (OA).

DESIGN: Fifty asymptomatic individuals, 46 patients with mild to moderate and 44 patients with severe knee OA were recruited. Maximum knee adduction moment during late stance and principal component analysis (PCA) were used to describe the knee adduction moment captured during gait. Multiple regression models were used for each of the three group assignments to analyze the association between the independent variables and the knee adduction moment.

RESULTS: FPA explained a significant amount of the variability associated with the shape of the knee adduction moment waveform for the asymptomatic and mild to moderate groups (P<0.05), but not for the severe group (P>0.05). Walking velocity alone explained significant variance associated with the shape of the knee adduction moment in the severe OA group (P<0.05).

CONCLUSION: A toe out FPA was associated with altered knee adduction moment waveform characteristics, extracted using PCA, in asymptomatic individuals and those with mild to moderate knee OA only. These findings are directly implicated in medial knee compartment loading. This relationship was not evident in those with severe knee OA.
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Admin2 · Jan 10, 2008

Related thread:
Lateral foot wedging for medial knee OA

NewsBot · May 2, 2008

Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: a tri-planar kinetic mechanism.
Jenkyn TR, Hunt MA, Jones IC, Giffin JR, Birmingham TB.
J Biomech. 2008;41(2):276-83.

Altered gait kinematics and kinetics are observed in patients with medial compartment knee osteoarthritis. Although various kinematic adaptations are proposed to be compensatory mechanisms that unload the knee, the nature of these mechanisms is presently unclear. We hypothesized that an increased toe-out angle during early stance phase of gait shifts load away from the knee medial compartment, quantified as the external adduction moment about the knee. Specifically, we hypothesized that by externally rotating the lower limb anatomy, primarily about the hip joint, toe-out gait alters the lengths of ground reaction force lever arms acting about the knee joint in the frontal and sagittal planes and transforms a portion of knee adduction moment into flexion moment. To test this hypothesis, gait data from 180 subjects diagnosed with medial compartment knee osteoarthritis were examined using two frames of reference. The first frame was attached to the tibia (reporting actual toe-out) and the second frame was attached to the laboratory (simulating no-toe-out). Four measures were compared within subjects in both frames of reference: the lengths of ground reaction force lever arms acting about the knee joint in the frontal and sagittal planes, and the adduction and flexion components of the external knee moment. The mean toe-out angle was 11.4 degrees (S.D. 7.8 degrees , range -2.2 degrees to 28.4 degrees ). Toe-out resulted in significant reductions in the frontal plane lever arm (-6.7%) and the adduction moment (-11.7%) in early stance phase when compared to the simulated no-toe-out values. These reductions were coincident with significant increases in the sagittal plane lever arm (+33.7%) and flexion moment (+25.0%). Peak adduction lever arm and moment were also reduced significantly in late stance phase (by -22.9% and -34.4%, respectively) without a corresponding increase in sagittal plane lever arm or flexion moment. These results indicate that toe-out gait in patients with medial compartment knee osteoarthritis transforms a portion of the adduction moment into flexion moment in early stance phase, suggesting that load is partially shifted away from the medial compartment to other structures.
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NewsBot · Apr 16, 2010

Self-reported knee and foot alignments in early adult life and risk of osteoarthritis.
McWilliams DF, Doherty S, Maciewicz RA, Muir KR, Zhang W, Doherty M.
Arthritis Care Res (Hoboken). 2010 Apr;62(4):489-95.

OBJECTIVE: To determine whether self-reported early adult life malalignment of knees or feet are risk factors for knee or hip osteoarthritis (OA).

METHODS: Participants in the Genetics of Osteoarthritis and Lifestyle case-control database were sent a questionnaire (n = 3,022) containing line-drawing instruments for self-reported knee and foot alignment at ages 20-29 years. Respondents were categorized as having straight, valgus, or varus knee, and straight, toe-in, or toe-out feet. Radiographic criteria were used to define current isolated knee or hip OA, combined knee and hip OA, or non-OA controls. Odds ratios (ORs), adjusted ORs, and 95% confidence intervals (95% CIs) were calculated and logistic regression was performed.

RESULTS: The response rate was 72%; 87.5% of responders (n = 1,901) completed the alignment questions. Increased risk of isolated knee OA occurred with early adult varus (adjusted OR 5.16, 95% CI 2.87-9.41) and valgus knees (adjusted OR 3.16, 95% CI 1.04-9.64). The positive association between knee OA and toe-in foot was explained by varus knee. There was an increased risk of combined knee/hip OA from varus (adjusted OR 4.52, 95% CI 2.39-8.53) and valgus knees (adjusted OR 3.07, 95% CI 0.99-9.54). Varus knee was associated with risk of medial tibiofemoral OA, whereas valgus knee was associated with risk of lateral tibiofemoral and lateral patellofemoral OA. Toe-out foot was associated with reduced medial patellofemoral OA. For knee OA, a multiplicative interaction analysis between occupational risks and varus/valgus yielded an OR(int) of 3.20 (95% CI 1.08-9.49).

CONCLUSION: Constitutional alignment of the leg in terms of varus or valgus knee or foot rotation may be a significant factor in determining development and distribution of knee but not hip OA.
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NewsBot · Nov 14, 2017

Subject-Specific Toe-in or Toe-out Gait Modifications Reduce the Larger Knee Adduction Moment Peak More Than a Non-Personalized Approach
Scott D.Uhlrichad et al
Journal of Biomechanics; 8 November 2017

The knee adduction moment (KAM) is a surrogate measure for medial compartment knee loading and is related to the progression of knee osteoarthritis. Toe-in and toe-out gait modifications typically reduce the first and second KAM peaks, respectively. We investigated whether assigning a subject-specific foot progression angle (FPA) modification reduces the peak KAM by more than assigning the same modification to everyone. To explore the effects of motor learning on muscle coordination and kinetics, we also evaluated the peak knee flexion moment and quadriceps-hamstring co-contraction during normal walking, when subjects first learned their subject-specific FPA, and following 20 minutes of training. Using vibrotactile feedback, we trained 20 healthy adults to toe-in and toe-out by 5° and 10° relative to their natural FPA, then identified the subject-specific FPA as the angle where each subject maximally reduced their larger KAM peak. When walking at their subject-specific FPA, 18 subjects significantly reduced their larger KAM peak; 8 by toeing-in and 10 by toeing-out. On average, subjects reduced their larger KAM peak by 18.6±16.2% when walking at their subject-specific FPA, which was more than the reductions achieved when all subjects toed-in by 10° (10.0±17.1%, p=0.013) or toed-out by 10° (11.0±18.3%, p=0.002). Quadriceps-hamstring co-contraction and the peak knee flexion moment increased when subjects first learned their subject-specific FPA, but only co-contraction returned to baseline levels following training. These findings demonstrate that subject-specific gait modifications reduce the peak KAM more than uniformly assigned modifications and have the potential to slow the progression of medial compartment knee osteoarthritis.
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NewsBot · Sep 7, 2018

Ankle joint and rearfoot biomechanics during toe-in and toe-out walking in people with medial compartment knee osteoarthritis
Jesse M. Charlton et al
PM & R; Article in Press

Background
Toe-in and toe-out walking are two strategies which have been shown to be effective in reducing the knee adduction moment in people with knee osteoarthritis. However, despite a positive biomechanical impact on the knee, altering foot rotation may impart unintended forces or joint positions on the ankle that could impact joint health. The kinematic and kinetic changes at the ankle during toe-in or toe-out walking have yet to be examined.

Objective
To examine ankle/rearfoot biomechanics during toe-in and toe-out walking in those with knee osteoarthritis.

Design
Single session repeated measures design to compare ankle biomechanics during walking with four different foot rotations.

Setting
University motion analysis laboratory.

Participants
A convenience sample (N=15) of men and women with a diagnosis of medial knee osteoarthritis confirmed by radiographs.

Methods
Participants walked in four conditions guided by real-time biofeedback: 1) toe-in (+10°), 2) zero rotation (0°), 3) toe-out (-10°) and 4) toe-out (-20°). Ankle/rearfoot kinematics and kinetics were examined during barefoot over-ground walking.

Main Outcome Measures
Ankle joint angles, moments, moment impulses and foot rotation.

Results
Overall, toe-in compared to toe-out walking decreased (P=.03) peak rearfoot eversion (toe-in = -1.6°; 10° toe-out = -3.7°; 20° toe-out = -4.1°). Toe-in compared to toe-out walking also increased rearfoot inversion at initial contact (7.4° versus 3.1° at 10° toe-out and 1.9° at 20° toe-out; P<.001) and frontal plane rearfoot angle excursion (9.0° versus 6.8° at 10° toe-out and 6.0° at 20° toe-out; P<.006). Toe-in compared to all other conditions increased peak external ankle inversion moments (0.04 Nm/kg versus 0.02 Nm/kg at 0°, 0.02 Nm/kg at 10° toe-out and 0.01 Nm/kg at 20° toe-out; P<.003).

Conclusions
Toe-in and toe-out walking require different ankle/rearfoot biomechanics, though no differences in discomfort were observed. Longer-term studies are required to properly assess these relationships in knee OA populations.
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NewsBot · Dec 28, 2023

Relationship between ankle–foot-complex mobility during static loading and frontal moment impulses of knee and hip joints during the stance phase
Toshihiko Sato et al
Gait & Posture; 22 December 2023

Background:
Ankle–foot-complex mobility impairments, which can be assessed by the difference between the sitting and standing positions, are related to an increase in the load on the knee and hip joints during the stance phase of the gait.

Research question
What is the relationship between the ankle–foot-complex mobility during static weight bearing and the mechanical stresses on the knee and hip joints throughout the stance phase?

Methods:
Ankle–foot-complex mobility and gait data were collected from 26 healthy adults. The complex mobility was established by comparing the foot indices, measured using a three-dimensional foot scanner, in sitting and standing positions. The gait data were acquired using eight cameras (recording at 100 Hz) and three force plates (recording at 1000 Hz). Stance phase data were collected via ground reaction forces. The stance phase was dissected into shock absorption and propulsion phases, during which the external knee and hip adduction moment impulses (KAMi, HAMi) were recorded. The correlation between the ankle–foot-complex mobility during static weight bearing and KAMi and HAMi during the stance phase was examined using Pearson's product–moment correlation coefficients.

Results:
This study revealed that KAMi correlated with medial malleolus mobility (r = −0.44) throughout the stance phase. Furthermore, in the propulsive phase, KAMi correlated with calcaneus (r = 0.51) and navicular (r = −0.50) mobilities, whereas HAMi correlated with calcaneus mobility (r = −0.40).

Significance
The study provides insights into the relationship between the static mobility of the ankle–foot complex in healthy individuals and mechanical stress during the stance phase. Calcaneus and navicular mobilities were related to efficient push-off in the propulsive phase. Medial malleolus mobility was related to the control of the lateral tilt of the lower limb and ankle dorsiflexion motion throughout the stance phase.
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