Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis

Shull, Peter B.; Shultz, Rebecca; Silder, Amy; Dragoo, Jason L.; Besier, Thor F.; Cutkosky, Mark R.; Delp, Scott L.

doi:10.1016/j.jbiomech.2012.10.019

Cited by 176 publications

(174 citation statements)

References 32 publications

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“…Much emphasis has been placed on reducing the KAM for OA patients with the intent of reducing the risk of accelerated progression of OA and OA severity. Shull et al (2013) showed promising results during gait with a 13% reduction in KAM by using a foot progression angle that was 5°less (toe-in) than the subject's baseline value. During cycling, previous literature has suggested a potential for a decreased risk of overuse knee injuries with a decrease in KAM when some amount of movement is allowed between the foot and the pedal (Boyd et al, 1997;Ruby and Hull, 1993) and when the cyclists adapts a more everted foot position (Gregersen et al, 2006).…”

Section: Ankle Kinematicsmentioning

confidence: 99%

“…Simple gait modification strategies have been shown to reduce KAM (Fregly et al, 2007;Guo et al, 2007;Mundermann et al, 2008;Shull et al, 2013). Guo et al (2007) attempted to reduce the KAM by requiring their participants to walk in an increased toe-out (foot progression) angle during walking.…”

Section: Introductionmentioning

confidence: 99%

“…However, no changes were noted for the first peak KAM, which is more closely related to loading response during gait and severity and progression of medial knee OA. Shull et al (2013) attempted to reduce the KAM by having their participants walk in a toe-in foot progression angle (0.75°s hank angle increase from baseline). They found that this method of walking reduced the first peak knee adduction moment by about 11%, but the second peak KAM remained unchanged.…”

Section: Introductionmentioning

confidence: 99%

“…Changes in lower extremity alignment using an increased toe-in foot progression angle could alter the frontal plane kinematics by placing the knee in a more medial position (Shull et al, 2013). This alignment change would decrease the length of the frontal plane moment arm of the pedal reaction force to the knee joint center, thus decreasing the KAM.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis

Gardner

Zhang

Liu

et al. 2015

Clinical Biomechanics

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Section: Ankle Kinematicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis

Gardner

Zhang

Liu

et al. 2015

Clinical Biomechanics

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“…The net outcome will decrease the lever arm for the vertical ground reaction force in early stance. Toe in gait cannot cause changes in peak knee flexion moment [23].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Knee Osteoarthritis on Excursions of Lower Limb Joints During Gait

Jalalvand

Anbarian

Ahanjan

et al. 2017

PTJ

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Purpose: This study aimed to investigate excursion changes at the hip, knee, and ankle joints during gait in patients with knee osteoarthritis (KOA) of varying severity. Methods:The method of research was causal-comparative (Ex Post Facto). A Vicon motion analysis system with 4 T-Series cameras was used to measure the kinematics variables. Fifteen normal subjects without KOA and thirty patients with KOA participated in this study. According to Kellgren and Lawrence radiologic scale, the patients were divided into three groups of mild (n=10), moderate (n=10), and severe (n=10). Kinematics parameters of gait includes the range of motion (ROM) in all three planes of motion at the hip, knee, and ankle joints during gait, which were calculated by Vicon Nexus 1.8.5 software. All data were extracted by Polygon 3.5.1 and then were analyzed in SPSS20 using 1-way ANOVA test. The level of significance was set at P<0.05.Results: There were no significant differences in all kinematics parameters (joint angles) between the healthy and KOA groups (P>0.05). There were significant differences observed between groups of mild, moderate, and severe KOA with healthy one with respect to foot progress angles in the transverse plane, foot eversion/inversion excursion, knee flexion/extension excursion, knee abduction/adduction excursion, hip internal/external rotation excursion, anterior/posterior pelvic tilt, and lateral pelvic tilt (P<0.05). Conclusion:The results showed that some ROM parameters in all three planes of motion can estimate the severity of osteoarthritis. Some observed changes in kinematics parameters are due to effects of compensatory mechanisms, and some might be considered as the severity of the osteoarthritis. In addition, osteoarthritis in one joint had strong effects on other joints.

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

Wang

Chung

et al. 2021

Arthritis Care & Research

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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.

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Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis

Cited by 176 publications

References 32 publications

Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis

Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis

The Effect of Knee Osteoarthritis on Excursions of Lower Limb Joints During Gait

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

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