Abstract
IntroductionBoth toe-out (TO) and toe-in (TI) gaits decrease knee load during walking and stair ascent. However, few reports have focused on stair descent, which requires a higher load compared with walking. ObjectivesThe purpose of this study was to investigate the effect of foot progression angle (FPA) on knee joint load and related variables during stair descent. MethodsTwenty-two healthy young adults performed a stair descent task at a predefined speed of 90 steps/min with normal gait, TO gait (15° > normal), and TI gait (15° < normal). 3D motion analysis was conducted. In addition, the ground reaction force (GRF) with 3 components, center of pressure (COP) positions, and sagittal and frontal plane hip and knee joint kinematic and kinetic variables were recorded during stair descent. ResultsThe medial GRF increased, and the COP position was more lateral in TO gait compared with normal and TI gait during stair descent. TO gait exhibited a significant decrease in the peak knee adduction moment by ∼20% compared with normal gait and by ∼23% compared with TI gait. In addition, the knee flexion moment in TI gait significantly increased compared with normal and TO gait. ConclusionsTO gait decreases knee joint load during stair descent. Our results might have important implications for patients with knee osteoarthritis (OA) or those at risk of developing knee OA. Moreover, it will be of great interest to those involved in the research or clinical practice dealing with the role of gait in pathologic conditions, such as OA.
Highlights
Both toe-out (TO) and toe-in (TI) gaits decrease knee load during walking and stair ascent
Some studies used an foot progression angle (FPA) of 20° > normal, the excessive FPA is unlikely to be realistic for patients with medial knee OA during stair descent, as there is a risk of falling due to poor control of lower limb movement, and excessive knee rotation due to foot rotation might cause pain
Their study indicated that the center of pressure (COP) positions at the peak knee adduction moment (KAM) change from significantly medial to lateral in the order of TO, normal, and TI gaits, which is different from this study
Summary
Both toe-out (TO) and toe-in (TI) gaits decrease knee load during walking and stair ascent. Varus alignment of the knee joint leads to a higher KAM during walking in most patients with medial knee OA compared with healthy people.[10,11]. Exercise therapy, such as hip abductor and knee extensor muscle strength training and squatting, does not decrease KAM during walking.[12,13] studies have explored how to decrease KAM by gait modification, including lateral trunk leaning,[14,15] medial knee thrust,[16,17] and foot progression angle (FPA) change. TO gait decreases the second peak KAM in medial knee OA.[19,20] In contrast, Khan et al (2017) and Bennett et al (2017) reported that TI gait is more effective as TI decreases both the first peak KAM and the knee adduction angular impulse (KAAI), which reflects the medial knee load throughout the stance phase.[21,22]
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