Effect of Coexisting Foot Deformity on Disability in Women with Knee Osteoarthritis

Güler, Hayal; Karazincir, Sinem; Turhanoğlu, Ayşe Dicle; Şahin, Günşah; Balcı, Ali; Özer, Cahit

doi:10.7547/0980023

Cited by 28 publications

(38 citation statements)

References 25 publications

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“…Alterations of foot morphology in patients with knee OA are associated with knee pain, disability, and cartilage damage [10–12]. Although several studies suggest the existence of a biomechanical connection between frontal knee alignment and rearfoot angle, [16–22] the relationship of frontal plane alignment and foot posture of patients with knee OA has not been fully elucidated.…”

Section: Discussionmentioning

confidence: 99%

“…Flatfoot is associated with the presence of knee pain and medial cartilage damage in patients with knee OA [10]. Hallux valgus is associated with both knee and foot pain as well as the presence of nodal OA [11] and an increase in disability levels in women with knee OA [12]. A recent study showed that approximately 13–39% of individuals with knee OA, or at-risk of knee OA, have concurrent foot pain that adversely affects their functional status [13], knee symptoms [14], and clinical outcomes 1 year following total knee arthroplasty (TKA) [15].…”

Section: Introductionmentioning

confidence: 99%

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Association of frontal plane knee alignment with foot posture in patients with medial knee osteoarthritis

Ohi

Iijima

Aoyama

et al. 2017

BMC Musculoskelet Disord

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BackgroundTo examine the association of radiographic frontal plane knee alignment with three-dimensional foot posture in patients with medial knee osteoarthritis (OA).MethodsParticipants in orthopedic clinics with Kellgren/Lawrence (K/L) grade ≥1 (88 patients and 88 knees; age, 61–91 years; 65.9% female) were enrolled. An anteroposterior radiographic view was used to assess the anatomical axis angle (AAA) after subtracting a sex-specific correction factor. The three-dimensional foot posture was also evaluated.ResultsMultiple regression analyses showed that increased corrected AAA (i.e., valgus direction) was independently associated with a decrease in the hallux valgus angle (regression coefficient: −0.40 per degree, 95% confidence interval [CI]: −0.72, −0.09; P = 0.013) and increase in the pronation angle of the calcaneus relative to floor (regression coefficient: 0.33 per degree, 95% CI: 0.10, 0.56; P = 0.005) adjusted for age, sex, and body mass index. The relationship between the corrected AAA and hallux valgus angle strengthened (regression coefficient: −0.60 per degree, 95% CI: −1.08, −0.13; P = 0.014) in varus-aligned knees examined separately (63 knees). The other foot postures (navicular height, navicular height/foot length, and rearfoot angle) were not significantly associated with corrected AAA.ConclusionsRadiographic frontal plane knee alignment was associated with hallux valgus angle and calcaneus angle relative to the floor in patients with medial knee OA, particularly in varus-aligned knees. These results indicate a connection between altered frontal knee alignment and foot posture, which may be helpful in understanding the pathogenesis of altered foot posture observed in patients with knee OA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of frontal plane knee alignment with foot posture in patients with medial knee osteoarthritis

Ohi

Iijima

Aoyama

et al. 2017

BMC Musculoskelet Disord

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“…Methods of foot-type classification or as- 34 Two studies did not have an NF comparative group and were therefore excluded from the meta-analysis. 88, 101 The authors of 1 study did not report standard deviations or standard errors, 10 and the authors of 5 other studies did not report data on the number of lower extremity injuries (outcome) 1,12,56,72 or the number of participants (sample) 3 with each foot type.…”

Section: Foot-classification Methodsmentioning

confidence: 99%

“…Studies included in qualitative synthesis, n = 34 79 South Africa, 10 Turkey, 34 Taiwan, 41 Korea, 52 and China. 97 There were 12 prospective cohort studies, …”

Section: Study Populationsmentioning

confidence: 99%

“…Eleven studies either utilized more than 1 method to categorize foot type 12,46,53 or assessed the foot using continuous scales, 5,7,12,26,38,52,63,79,81 and 4 studies reported on more than 1 lower extremity injury using either a dichotomous outcome 24,38,41 or a continuous scale. 34 In the meta-analysis, to account for all genders, feet (right/left), study designs, low back and lower extremity injuries, and methods of foot-type classification/ assessment reported in the included studies, the outcome of each analysis was entered separately as a unique study. Accordingly, because Lakstein and colleagues 50 classified foot type as either FF flexible or FF rigid, the results of the analysis for each foot-type classification were entered as a study of its own.…”

Section: Meta-analysismentioning

confidence: 99%

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Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review With Meta-analysis

Tong

Kong²

2013

Journal of Orthopaedic & Sports Physical Therapy

145

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T he human foot is often classified into 3 structural categories: high, normal, and low arch, based on its anatomical alignment 89 and the height of the medial longitudinal arch. 27 Classification in these 3 categories is typically based on cutoff values determined from the distribution of data (standard deviations 65,93,102 or percentiles 15,16 ) from measurements taken on a large population. The interest in such classification is the belief that nonneutral foot morphology, such as a high or low arch (flatfoot), may lead to less than optimal foot function and be associated with the development of lower extremity and low back injuries. 23,28,29,59 A review of the literature provides conflicting evidence on the potential relationship between foot type and lower extremity injuries. Although a number of published reports have found no relationships between nonneutral foot types and lower extremity injuries, 40,94,96,99 the authors of a recent systematic review concluded that both high-and low-arch foot types were associated with runningrelated injuries. 14 The results of this systematic review, 14 which did not include a meta-analysis and effect-size estimates, contrast those of a few qualitative reviews that failed to demonstrate a relationship between foot type and future lower extremity injuries. 4,8,20,70 This lack of consensus in the literature could be attributed, in part, to the variation in the operational definition of foot type among investigators. 4,70 A large variety of methods have been developed to classify the foot based on structure and alignment. These T T OBJECTIVES:To investigate the association between nonneutral foot types (high arch and flatfoot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification. T T METHODS:A search of 5 electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses), Google Scholar, and the reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, casecontrol, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated, and data synthesis for the level of association between foot types and injuries was conducted. A randomeffects model was used to pool odds ratio (OR) and standardized mean difference (SMD) results for meta-analysis. T T RESULTS:Twenty-nine studies were included for meta-analysis. A significant association between nonneutral foot types and lower extremity injuries was determined (OR = 1.23; 95% confidence interval [CI]: 1.11, 1.37; P<.001). Foot posture index (OR = 2.58; 95% CI: 1.33, 5.02; P<.01) and visual/ physical examination (OR = 1.17; 95% CI: 1.06, 1.28; P<.01) were 2 assessment methods using distinct foot-type categories that showed a significant association with lower extremity injuries.

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The Association of Forefoot Varus Deformity with Patellofemoral Cartilage Damage in Older Adult Cadavers

Lufler

Stefanik

Niu

et al. 2017

The Anatomical Record

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Forefoot alignment may contribute to patellofemoral joint (PFJ) osteoarthritis (OA) via its influence on the closed chain kinematics of the lower limb. The purpose of this cadaveric study was to investigate the relationship between forefoot varus and ipsilateral cartilage damage in the medial and lateral PFJ. Forefoot alignment measurements were obtained from the feet of 25 cadavers (n = 50). Cartilage damage in the medial and lateral PFJ of each knee was scored using the Outerbridge scale. The relative odds of medial and lateral PFJ cartilage damage in limbs with forefoot varus and valgus were determined using logistic regression. The relationship between increasing varus alignment and increasing odds of medial and lateral PFJ cartilage damage was assessed. Of the 51% of limbs with forefoot varus, 91.3% had medial, and 78.3% had lateral PFJ cartilage damage, compared with 54.6% and 68.2% of those with forefoot valgus. The former also had 3.0 times (95% CI 1.2, 7.7) the odds of medial PFJ damage; no association was found with lateral damage (OR 1.4, 95% CI 0.7, 3.0). Feet in the highest tertile of varus alignment had 3.9 times (95% CI 10, 15.3, P = 0.058) the odds of medial PFJ damage as those in the lowest tertile. The results of this study suggest a relationship between forefoot varus and medial PFJ cartilage damage in older adults. As forefoot varus may be modified with foot orthoses, these findings indicate a potential role for orthoses in the treatment of medial PFJ OA. Anat Rec, 300:1032-1038, 2017. © 2016 Wiley Periodicals, Inc.

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Effect of Coexisting Foot Deformity on Disability in Women with Knee Osteoarthritis

Abstract: There is a significant correlation between indicators of pain and disability (visual analog scale and WOMAC scores). Also, the presence of foot deformities increased disability levels in women with knee osteoarthritis.

Cited by 28 publications

References 25 publications

Association of frontal plane knee alignment with foot posture in patients with medial knee osteoarthritis

Association of frontal plane knee alignment with foot posture in patients with medial knee osteoarthritis

Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review With Meta-analysis

The Association of Forefoot Varus Deformity with Patellofemoral Cartilage Damage in Older Adult Cadavers

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