Effects of Toe-Out and Toe-In Gaits on Lower-Extremity Kinematics, Dynamics, and Electromyography

Weiling Cui,Chenyan Wang,Yuan Guo,Weijin Du,Changjiang Wang,Weiyi Chen,Yi Jia

doi:10.3390/app9235245

Weiling Cui, Chenyan Wang + Show 5 more

Open Access

https://doi.org/10.3390/app9235245

Copy DOI

Abstract

Toe-in and toe-out gait modifications have received increasing attention as an effective, conservative treatment for individuals without severe osteoarthritis because of its potential for improving knee adduction moment (KAM) and knee flexion moment (KFM). Although toe-in and toe-out gaits have positive effects on tibiofemoral (TF) joint pain in the short term, negative impacts on other joints of the lower extremity may arise. The main purpose of this study was to quantitatively compare the effects of foot progression angle (FPA) gait modification with normal walking speeds in healthy individuals on lower-extremity joint, ground reaction force (GRF), muscle electromyography, joint moment, and TF contact force. Experimental measurements using the Vicon system and multi-body dynamics musculoskeletal modelling using OpenSim were conducted in this study. Gait analysis of 12 subjects (n = 12) was conducted with natural gait, toe-in gait, and toe-out gait. One-way repeated measures of ANOVA (p < 0.05) with Tukey’s test was used for statistical analysis. Results showed that the toe-in and toe-out gait modifications decreased the max angle of knee flexion by 8.8 and 12.18 degrees respectively (p < 0.05) and the max angle of hip adduction by 1.28 and 0.99 degrees respectively (p < 0.05) compared to the natural gait. Changes of TF contact forces caused by FPA gait modifications were not statistically significant; however, the effect on KAM and KFM were significant (p < 0.05). KAM or combination of KAM and KFM can be used as surrogate measures for TF medial contact force. Toe-in and toe-out gait modifications could relieve knee joint pain probably due to redistribution of TF contact forces on medial and lateral condylar through changing lateral contact centers and shifting bilateral contact locations.

Highlights

Being a critical load-bearing and movement joint for the lower extremity, the knee joint is often afflicted by diseases, and a variety of complicated factors are associated with the development, maintenance, and health of the joint tissues [1,2]
The toe-in and toe-out gaits resulted in higher values for quadriceps and peroneus longus while reduced peak values for biceps femoris and gastrocnemius lateralis
The results showed that differences among hip joint moments and knee flexion moment were not statistically significant (p > 0.05), differences in knee adduction moment and ankle plantarflexion moment were statistically significant (p < 0.05)

Summary

Introduction

Being a critical load-bearing and movement joint for the lower extremity, the knee joint is often afflicted by diseases, and a variety of complicated factors are associated with the development, maintenance, and health of the joint tissues [1,2]. It is not surprising that a significant level of research is devoted to the knee joint. For patients with mild knee disease, joint replacement and medication (associated with a high risk of side effects) are not necessarily required to reduce knee joint load and pain [3]. There is a need for conservative treatments to reduce peak values of tibiofemoral.

Objectives

Methods

Results

Discussion

Conclusion