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. 2023 Jul 20;11(7):23259671231183416.
doi: 10.1177/23259671231183416. eCollection 2023 Jul.

Effect of Footwear Type on Biomechanical Risk Factors for Knee Osteoarthritis

Jan Malus  1 , Jan Urbaczka  1 , Marketa Rygelova  1 , Victor Casula  2 , Miika Nieminen  2 , Andrea Monte  3 , Veronika Horka  1 , Jaroslav Uchytil  1
Affiliations

Effect of Footwear Type on Biomechanical Risk Factors for Knee Osteoarthritis

Jan Malus et al. Orthop J Sports Med. .

Abstract

Background: Regular walking in different types of footwear may increase the mediolateral shear force, knee adduction moment, or vertical ground-reaction forces that could increase the risk of early development of knee osteoarthritis (OA).

Purpose: To compare kinematic and kinetic parameters that could affect the development of knee OA in 3 footwear conditions.

Study design: Controlled laboratory study.

Methods: A total of 40 asymptomatic participants performed walking trials in the laboratory at self-selected walking speeds under barefoot (BF), minimalistic (MF), and neutral (NF) footwear conditions. Knee joint parameters were described using discrete point values, and continuous curves were evaluated using statistical parametric mapping. A 3 × 1 repeated-measures analysis of variance was used to determine the main effect of footwear for both discrete and continuous data. To compare differences between footwear conditions, a post hoc paired t test was used.

Results: Discrete point analyses showed a significantly greater knee power in NF compared with MF and BF in the weight absorption phase (P < .001 for both). Statistical parametric mapping analysis indicated a significantly greater knee angle in the sagittal plane at the end of the propulsive phase in BF compared with NF and MF (P = .043). Knee joint moment was significantly greater in the propulsive phase for the sagittal (P = .038) and frontal planes (P = .035) in BF compared with NF and MF and in the absorption phase in the sagittal plane (P = .034) in BF compared with MF and NF. A significant main effect of footwear was found for anteroposterior (propulsion, ↑MF, NF, ↓BF [P = .008]; absorption, ↑BF, MF, ↓NF [P = .001]), mediolateral (propulsion, ↑MF, NF, ↓BF [P = .005]; absorption, ↑NF, MF, ↓BF [P = .044]), and vertical (propulsion, ↑NF, BF, ↓MF [P = .001]; absorption, ↑MF, BF, ↓NF [P < .001]) ground-reaction forces. Knee power showed a significant main effect of footwear (absorption, ↑NF, MF, ↓BF [P = .015]; propulsion, ↑MF, NF, ↓BF [P = .039]).

Conclusion: Walking in MF without sufficient accommodation affected kinetic and kinematic parameters and could increase the risk of early development of knee OA.

Keywords: SPM; barefoot; footwear; knee; minimalistic; osteoarthritis; walking.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported by the University of Ostrava (grant SGS08/PDF/22) and by the European Union and Ministry of Education, Youth and Sports of the Czech Republic (grant CZ.02.1.01/0.0/0.0/16_019/0000798, Program 4 Healthy Aging in Industrial Environment). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Measurement setup. C, camera; FP, force platform.
Figure 2.
Figure 2.
Knee angles during the stance phase in the (A) sagittal plane, (B) frontal plane, and (C) transverse plane. For each plane, curves in the top part show the mean and standard deviation of the stance phase for all 3 footwear conditions, curves in the middle part show the main effect of all 3 footwear conditions (SPM{F}), and curves in the lower part show the results of the post hoc t test between 2 of the 3 conditions separately (SPM{t}). The critical threshold was set to α ≤ .05 (dashed red line). BF, barefoot; MF, minimalistic footwear; NF, neutral running footwear; SPM, statistical parameter mapping.
Figure 3.
Figure 3.
Knee moment during the stance phase in the (A) sagittal plane, (B) frontal plane, and (C) transverse plane. For each plane, curves in the top part show the mean and standard deviation of the stance phase for all 3 footwear conditions, curves in the middle part show the main effect of all 3 footwear conditions (SPM{F}), and curves in the lower part show the results of the post hoc t test between 2 of the 3 conditions separately (SPM{t}). The critical threshold was set to α ≤ .05 (dashed red line). BF, barefoot; MF, minimalistic footwear; NF, neutral running footwear; SPM, statistical parameter mapping.
Figure 4.
Figure 4.
(A) Anteroposterior, (B) mediolateral, and (C) vertical ground-reaction forces. For each ground-reaction force, curves in the top part show the mean and standard deviation of the stance phase for all 3 footwear conditions, curves in the middle part show the main effect of all 3 footwear conditions (SPM{F}), and curves in the lower part show the results of the post hoc t test between 2 of the 3 conditions separately (SPM{t}). The critical threshold was set to α ≤ .05 (dashed red line). BF, barefoot; MF, minimalistic footwear; NF, neutral running footwear; SPM, statistical parameter mapping.
Figure 5.
Figure 5.
Knee power during the stance phase. Curves in the top part show the mean and standard deviation of the stance phase for all 3 footwear conditions, curves in the middle part show the main effect of all 3 footwear conditions (SPM{F}), and curves in the lower part show the results of the post hoc t test between 2 of the 3 conditions separately (SPM{t}). The critical threshold was set to α ≤ .05 (dashed red line). BF, barefoot; MF, minimalistic footwear; NF, neutral running footwear; SPM, statistical parameter mapping.
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