How Foot Progression Angle Affects Knee Adduction Moment and Angular Impulse in Patients With and Without Medial Knee Osteoarthritis: A Meta‐Analysis

Abstract

Objective. To investigate effects of foot progression angle (FPA) modification on the first and second peaks of external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) in individuals with and without medial knee osteoarthritis (OA) during level walking.Methods. PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and SPORTDiscus were searched from inception to February 2020 by 2 independent reviewers. Included studies compared FPA modification (toe-in or toe-out gait) interventions to lower EKAM and/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI.Results. Sixteen studies were included, and >85% of included patients were graded with Kellgren/Lawrence grade II-IV knee OA. Toe-in gait reduced the first EKAM peak (standardized mean difference [SMD] -0.75 [95% confidence interval (95% CI) -1.05, -0.45]) and KAAI (SMD -0.46 [95% CI -0.86, -0.07]), while toe-out gait reduced the second EKAM peak (SMD -1.04 [95% CI -1.34, -0.75]) in healthy individuals. For patients with knee OA, toe-out gait reduced the second EKAM peak (SMD -0.53 [95% CI -0.75, -0.31]) and KAAI (SMD -0.26 [95% CI -0.49, -0.03]), while toe-in gait did not affect both EKAM peaks and KAAI.Conclusion. Discrepancy in biomechanical effects of FPA modification was demonstrated between individuals with and without medial knee OA. Compared with natural walking, both toe-in and toe-out gait may be more effective in lowering EKAM and KAAI in healthy individuals. Toe-out gait may reduce EKAM and KAAI in patients with mild-tosevere knee OA. There is insufficient data from patients with early-stage knee OA, indicating that future research is required.

Effects of neuromuscular gait modification strategies on indicators of knee joint load in people with medial knee osteoarthritis: A systematic review and meta-analysis

“…Toe-in reduced KAM1 (medium effect) but increased KAM2 (small effect). Our findings support three previous systematic reviews [ 13 – 15 ]. Simic et al in 2011 suggested that trunk lean consistently reduced KAM1 and toe-out consistently reduced KAM2 [ 13 ].…”

Osteoarthritis year in review 2021: mechanics

“…A systematic review found that in healthy individuals, both toein and toe-out gait reduced KAM and KAM angular impulse compared to natural gait, while in individuals with knee OA, only toe-out gait appeared to reduce these gait parameters 81 . Using standing MRI, a small amount of lateralization of contact for both toe-out and toe-in postures in individuals with mild knee OA was found 82 , indicating accurate analyses of joint kinematics during gait may be needed to reveal more subtle changes.…”

Sensor-Based Gait Retraining Lowers Knee Adduction Moment and Improves Symptoms in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

“…Given knee loading can be redistributed from medial to lateral compartment of the knee joint, gait retraining has been suggested to lower medial knee loading, and modification of foot progression angle is a commonly adopted strategy [ 8 , 9 ]. It has been reported that individuals with medial knee OA may report an improvement in knee symptoms following a six-week gait retraining to lower medial knee loading by toe-in gait [ 10 ].…”

“…However, its clinical efficacy has yet been examined. Additionally, the effectiveness of gait retraining on patients with early-stage knee OA is insufficient [ 9 ].…”