Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Aug 8;6(1):33.
doi: 10.1186/1757-1146-6-33.

Relationship between foot function and medial knee joint loading in people with medial compartment knee osteoarthritis

Pazit Levinger  1 , Hylton B Menz, Adam D Morrow, John R Bartlett, Julian A Feller, Neil R Bergman
Affiliations

Relationship between foot function and medial knee joint loading in people with medial compartment knee osteoarthritis

Pazit Levinger et al. J Foot Ankle Res. .

Abstract

Background: Dynamic joint loading, particularly the external knee adduction moment (KAM), is an important surrogate measure for the medio-lateral distribution of force across the knee joint in people with knee osteoarthritis (OA). Foot motion may alter the load on the medial tibiofemoral joint and hence affect the KAM. Therefore, this study aimed to investigate the relationship between tibia, rearfoot and forefoot motion in the frontal and transverse planes and the KAM in people with medial compartment knee OA.

Method: Motion of the knee, tibia, rearfoot and forefoot and knee moments were evaluated in 32 patients with clinically and radiographically-confirmed OA, predominantly in the medial compartment. Pearson's correlation coefficient was used to investigate the association between peak values of tibia, rearfoot and forefoot motion in the frontal and transverse planes and 1st peak KAM, 2nd peak KAM, and the knee adduction angular impulse (KAAI).

Results: Lateral tilt of the tibia was significantly associated with increased 1st peak KAM (r = 0.60, p < 0.001), 2nd peak KAM (r = 0.67, p = 0.001) and KAAI (r = 0.82, p = 0.001). Increased peak rearfoot eversion was significantly correlated with decreased 2nd peak KAM (r = 0.59, p < 0.001) and KAAI (r = 0.50, p = 0.004). Decreased rearfoot internal rotation was significantly associated with increased 2nd peak KAM (r = -0.44, p = 0.01) and KAAI (r = -0.38, p = 0.02), while decreased rearfoot internal rotation relative to the tibia was significantly associated with increased 2nd peak KAM (r = 0.43, p = 0.01). Significant negative correlations were found between peak forefoot eversion relative to the rearfoot and 2nd peak KAM (r = -0.53, p = 0.002) and KAAI (r = -0.51, p = 0.003) and between peak forefoot inversion and 2nd peak KAM (r = -0.54, p = 0.001) and KAAI (r = -0.48, p = 0.005).

Conclusion: Increased rearfoot eversion, rearfoot internal rotation and forefoot inversion are associated with reduced knee adduction moments during the stance phase of gait, suggesting that medial knee joint loading is reduced in people with OA who walk with greater foot pronation. These findings have implications for the design of load-modifying interventions in people with knee OA.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The knee adduction moment (KAM) increases when walking with greater varus alignment of the knee (shown on the right) as the perpendicular distance of the ground reaction force vector from the knee joint centre is greater, resulting in a longer moment arm.
Figure 2
Figure 2
Frontal plane external KAMs: 1st peak KAM, 2nd peak KAM and knee adduction angular impulse (KAAI), which represents the area under the curve.
Figure 3
Figure 3
Mean motion of the tibia, rearfoot and forefoot in the frontal plane expressed relative to the percentage of the gait cycle.
Figure 4
Figure 4
Mean motion of the tibia, rearfoot and forefoot in the transverse plane expressed relative to the percentage of the gait cycle.
See this image and copyright information in PMC

References

    1. Access Economics Report. Painful realities: the economic impact of arthritis in Australia in 2007. Arthritis Australia; 2007.
    1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81:646–656. - PMC - PubMed
    1. Andriacchi TP. Dynamics of knee malalignment. Orthop Clin North Am. 1994;25:395–403. - PubMed
    1. Mills K, Blanch P, Chapman AR, McPoil TG, Vicenzino B. Foot orthoses and gait: a systematic review and meta-analysis of literature pertaining to potential mechanisms. Br J Sports Med. 2010;44:1035–1046. doi: 10.1136/bjsm.2009.066977. - DOI - PubMed
    1. Foroughi N, Smith R, Vanwanseele B. The association of external knee adduction moment with biomechanical variables in osteoarthritis: a systematic review. Knee. 2009;16:303–309. doi: 10.1016/j.knee.2008.12.007. - DOI - PubMed