Chronic ankle instability (CAI) is a common sequela of ankle sprain, characterized by a high recurrence rate and long-term functional impairment. Traditional rehabilitation methods mainly focus on local ankle training, often neglecting the role of proximal muscle groups in maintaining the overall stability of the lower limbs, which limits the therapeutic effect. Both clinical and experimental studies have shown that poor hip function can alter the pattern of movement coordination and increase the compensatory burden on the ankle, allowing CAI to persist. Evidence shows that hip strengthening training, including open and closed kinetic chain exercises, can improve balance, motor control, and joint stability, sometimes surpassing ankle training alone. Combining hip training with gait retraining, neuromuscular control training, and specialized exercise practice can further enhance the rehabilitation effect. The use of quantitative assessment tools and the formulation of individualized rehabilitation pathways have received increasing attention. Currently, research still faces some challenges, such as the lack of standardized training programs, insufficient large-scale randomized controlled trials, and unclear neurophysiological mechanisms. This review aims to explore the role of hip muscle function in ankle stability, providing practical suggestions for incorporating hip-focused intervention measures into CAI rehabilitation to improve long-term recovery.

Effects of running technique characteristics on the patellofemoral joint load: A systematic review and meta-analysis.

Bilateral gait biomechanics change over time after anterior cruciate ligament reconstruction (ACLR) and have been suggested to contribute to the development of osteoarthritis. However, few studies have investigated the longitudinal changes in bilateral gait biomechanics in the same cohort within 24 months after ACLR. To evaluate the longitudinal changes in bilateral gait biomechanics compared with the healthy control cohort within 24 months after ACLR. Controlled laboratory study. A total of 24 patients who underwent primary unilateral ACLR surgery with autologous hamstring tendon grafts and 24 matched healthy participants were included. Also, 3-dimensional knee gait and ground-reaction forces (GRF) information were collected at 3, 6, 12, and 24 months after ACLR. Linear mixed-effects models were used to assess the influence of time and limb in ACLR participants and their interaction effect on each variable of interest. Two-way analysis of variance was used to compare intergroup and interleg dependent variables. Three months after ACLR, most biomechanical parameters of the operated limb (peak knee extension angle [pKEA]; peak knee extension moment [pKEM]; peak knee flexion moment [pKFM]; and vertical ground-reaction force [vGRF]) were lower than both the contralateral limb and healthy controls, and gradually increased over time. By 24 months postoperation, the pKEA and the pKEM returned to normal levels. The operated limb showed significantly reduced pKEA and pKEM compared with contralateral and control groups at 3 and 6 months (all P≤ .001), with no clinically meaningful differences at 12 and 24 months. pKFM analysis revealed significant between-group effects (ACLR group vs control group) without limb or interaction effects from 3 to 24 months, indicating bilateral compensatory reduction. Regarding vGRF, GRF_peak1 demonstrated bilateral compensatory reduction at 3 months (resolved by 6 months), while GRF_peak2 showed operated limb reduction at 3 months progressing to bilateral compensation at 6 months (resolved at 12 months). Notably, both vGRF parameters exhibited bilateral compensatory reductions again at 24 months postoperation. Three months after ACLR, sagittal plane biomechanical parameters of the operated knee (pKEA, pKFM, pKEM) and GRF_peak1/2 were significantly lower than those of controls, except pKFA, which showed no intergroup difference. Longitudinal analysis revealed partial recovery patterns: GRF_peak1 was normalized by 6 months, while GRF_peak2, pKEA, and pKEM reached control levels by 12 months. However, a secondary decline emerged at 24 months, with GRF_peak1/2 values again significantly lower than those of the controls, and the pKFM remained persistently lower than that of the controls throughout the 24-month follow-up. Early postoperative gait retraining and neuromuscular control training are recommended, with sustained interventions maintained for at least 24 months. Bilateral gait retraining and neuromuscular control training are recommended as early as possible and should be maintained for at least 24 months after surgery.

ABSTRACTIntroductionFoot progression angle affects gait and lowerlimb alignment. Altered angles may increase knee and ankle loading and produce tissue loading patterns previously linked to musculoskeletal injury. This study investigates how different foot progression angles modify knee and ankle biomechanics in young adults with flexible flatfoot.Methods28 participants (aged 18–35 years) with flexible flatfoot completed gait trials under three foot progression angle conditions. Kinematic and kinetic variables were analyzed using one‐dimensional statistical parametric mapping. A 1D convolutional neural network was applied to classify progression angle patterns based on flexible flatfoot severity and gait biomechanics.ResultsDecreasing foot progression angle reduced the ankle eversion/inversion range and knee abduction and external rotation (p < 0.05). Increasing foot progression angle lowered early stance ankle plantarflexion and increased knee abduction/external rotation (p < 0.05). Kinetically, a smaller foot progression angle reduced peak ankle plantarflexion moment and knee extension moment but increased the first peak of the knee adduction moment and rotational moment fluctuations (p < 0.05). A larger foot progression angle reduced rotational fluctuations and terminal stance knee extension moment (p < 0.05). The convolutional neural network model was most accurate for moderate flexible flatfoot cases, and ankle coronal and knee transverse biomechanics showed the strongest discriminative power.ConclusionModifying the foot progression angle can meaningfully alter knee and ankle loading in young adults with flexible flatfoot. Neutral or mild toe‐in angles may help mitigate excessive eversion and rotational stress, suggesting a simple noninvasive adjustment that clinicians can incorporate during gait retraining or orthotic prescription. Because biomechanical responses vary across individuals, FPA modification may be the most effective when tailored to patient‐specific gait characteristics. In addition, deep‐learning‐based gait classification shows promise for supporting personalized monitoring and guiding clinical decision‐making during rehabilitation.

Osteoarthritis (OA) is a degenerative joint disease driven by complex biomechanical and inflammatory mechanisms, particularly in weight-bearing joints such as the knee. This review explores the pivotal role of biomechanics in OA pathogenesis, focusing on abnormal joint loading, malalignment, and instability as key contributors to cartilage degeneration and subchondral bone remodeling. Special attention is given to the interplay between obesity and OA, highlighting how mechanical overload and adipokine-mediated inflammation synergistically accelerate disease progression. Emerging interventions-including physical therapy, gait retraining, orthotics, high tibial osteotomy (HTO), and total knee arthroplasty (TKA)-are analyzed for their biomechanical impact. Novel technologies such as wearable sensors, finite element analysis (FEA), and digital twin models are discussed as tools for real-time assessment, predictive modeling, and personalized treatment planning. The review emphasizes the need for integrated, multiscale research strategies that account for individual biomechanical profiles and systemic factors like obesity. Advancing biomechanical precision in OA management holds promise for improving early diagnosis, optimizing interventions, and informing regenerative therapies aimed at restoring joint function and delaying disease progression.

Stroke is one of the leading causes of death globally. Advancements in medical science and technology have contributed to a reduction in the mortality rate among individuals who have experienced a stroke. The present study presents findings from a single case report employing a single-subject research design. To achieve optimal rehabilitation outcomes, Functional Electrical Stimulation (FES) was incorporated with Treadmill Training (TT), accompanied by challenging tasks during physiotherapy. Hereby, the authors present a case report of a 66-year-old male post-stroke patient with left-sided weakness, impaired grip strength, and mobility issues following a right Middle Cerebral Artery (MCA) ischaemic stroke. His medical history includes type 2 diabetes mellitus and systemic hypertension, with no significant family medical history reported. The patient presented with notable motor deficits and functional limitations resulting from the right MCA ischaemic stroke. Interventions targeting spasticity reduction, muscle strengthening, endurance, and gait retraining were essential to improve the patient’s functional mobility and overall quality of life. The findings revealed significant improvement in various outcome measures, including the Modified Ashworth Scale (MAS), Voluntary Motor Control (VMC), Dynamic Gait Index (DGI), Berg Balance Scale (BBS), and Functional Independence Measure (FIM), indicating positive changes and enhanced quality of life in stroke survivors. The cumulative effect of FES and TT with challenging tasks can significantly improve gait, muscle strength, and balance in patients recovering from stroke.

Effects of step rate based gait training on running biomechanics: A systematic review and meta-analysis.

Background: Therapeutic exercises have gained great prominence due to the benefits shown in the treatment of knee osteoarthritis (OA). However, to date, there is no evidence on the effects of an exercise program combined with balance and gait training with visual feedback. Objective: To evaluate the therapeutic effect of an intervention program combining lower-limb muscle strengthening, balance training, and gait exercises with visual feedback on the chronic pain, functional, and biomechanical aspects of older women with and without OA knee. Methods: Clinical trials study with stratified allocation based on disease status (two-arm, triple-blind-assessor, interventionist, and data manager, parallel-group). In total, 40 older women were recruited: 20 in the OA knee group (OAG, n = 20) and 20 in the control group (CG, n = 20). The intervention included a muscular resistance training program in the lower limbs, and reactive and proactive balance and gait training associated with visual feedback. Both groups received the same intervention. The primary outcomes were pain measured by the Visual Analogue Scale and the questionnaires Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne Algofunctional Index. The secondary outcomes were the six-minute walk test, the Falls Risk Awareness Questionnaire, the Timed Up and Go Test, plantar load distribution during gait, and patients' acceptability. Results: The intervention was effective in improving pain and increasing functionality in older women with OA knee, as measured pre- and post-intervention, compared to the control, with a moderate to high effect size. Body balance increased in older women with OA, as indicated by perceptions of fall risk and walk-test pre- and post-intervention. During gait, a reduction in plantar load (midfoot and rearfoot areas) was observed pre- and post-intervention in OAG compared to the CG. Both groups showed excellent acceptability, suitability, and feasibility of the intervention program. Conclusions: The intervention protocol was effective over 2 consecutive months in reducing pain and increasing knee functionality, balance, walking distance, and perception of falls in older women with OA of the knee compared with women without the condition. During gait, when visual feedback was combined with the intervention protocol, it promoted a better distribution of plantar load over the midfoot and the medial and lateral rearfoot regions in older women with knee OA. Clinical Trial: ReBEC (RBR-5w67pz4). Ethics Committee approval (number: 4.091.004).

OBJECTIVE: To systematically review, map, and appraise the existing prospective evidence on risk factors for, and preventive strategies against, the development of patellofemoral pain (PFP), and to identify key gaps. DESIGN: The study design was a systematic evidence and gap map (EGM). LITERATURE SEARCH: Nine electronic databases (PubMed, CINAHL, PEDro, Scopus, SPORTDiscus, Embase, Cochrane, Web of Science, CENTRAL) were searched from inception to the end of March 2024. STUDY SELECTION CRITERIA: Published prospective observational studies and randomized controlled trials (RCTs) investigating the development of PFP in individuals without baseline PFP were included. Studies of other knee conditions, older adults (mean age > 45), or retrospective designs were excluded. DATA SYNTHESIS: Evidence was mapped across the following domains: sociodemographic, neurobiological, anthropometric, psychological, biomechanical, and behavioral. RESULTS: From 57,897 identified records, 36 studies were included: 24 prospective observational studies and 12 RCTs. Most studies focused on biomechanical risk factors (n=22), with limited exploration of psychological (n=1), behavioral (n=2), and neurobiological (n=1) domains. Preventive interventions involved orthoses (n=4), exercise (n=3), bracing (n=2), gait retraining (n=1), stretching (n=1), or running intensity/volume modification. Nonbiomechanical strategies such as education or graded exposure were rarely tested. Risk of bias was low to moderate for most prospective observational studies and moderate to high for most RCTs. CONCLUSION: This EGM reveals an overreliance on biomechanical perspectives within the context of PFP risk factor research, with limited attention to psychosocial, behavioral, and load-related risk factors. Preventive trials are few, often low in quality, and narrowly focused. Addressing these evidence gaps is essential for developing effective, multifactorial prevention strategies for PFP. J Orthop Sports Phys Ther 2026;56(2):85-97. Epub 15 December 2025. doi:10.2519/jospt.2025.13489.

BackgroundEnhancing the efficacy of gait rehabilitation is an important area of need as most persons with a history of stroke continue to experience gait deficits following discharge from rehabilitation. Incorporating gamification and real-time biofeedback into gait retraining may provide benefits by increasing engagement and salience of stepping practice to target specific gait parameters, maximizing therapeutic impact on walking function. The objective of this study was to evaluate the feasibility and preliminary effects of a novel, customized, gamified gait biofeedback interface specifically designed to enhance propulsion during gait training.MethodsA repeated-measures design was used to compare 3 speed-matched treadmill walking bouts: (1) walking without biofeedback (noBF); (2) walking while receiving simple, real-time audiovisual conventional biofeedback (cBF); and (3) walking while receiving gamified, real-time audiovisual biofeedback (gBF). Gait biomechanics, physiological intensity, and self-reports of task workload, user experience, and engagement were obtained from 15 participants (9 able-bodied, 6 post-stroke).ResultsCompared to noBF, both gBF and cBF showed significantly greater increases in peak anterior ground reaction force, trailing limb angle, and ankle moment of the targeted leg during biofeedback exposure (Min. 3) and during the post-test without biofeedback exposure (Post), with moderate to large effect sizes. Compared to walking without biofeedback, both biofeedback conditions induced significantly greater physiological intensity (heart rate and rating of perceived exertion). NASA-Task Load Index results showed that gBF induced a higher workload than cBF for mental demand, temporal demand, performance, frustration, and effort. Also, gBF was rated higher in the novelty component of the User Experience Questionnaire.ConclusionsThis preliminary study confirmed the feasibility of real-time gamified gait biofeedback, suggesting that gBF can induce similar enhancements in gait biomechanics and physiological intensity as cBF, while promoting greater task load and mental demand during walking practice. This work lays foundations for future studies that further refine and customize the game design, as well as evaluate the effects of gBF in larger samples and greater training dosage.Trial registration:This study was registered on ClinicalTrials.gov (NCT04013971) and all study procedures were approved by the human subjects review board (IRB00106866). The study started 04/04/2022 and ended 03/31/2023.

To investigate the effect of gait alterations associated with osteoarthritis (OA) on the frictional properties of porcine articular cartilage (AC) in intact and degenerative conditions. Forty-eight cylindrical AC samples were harvested from 12 porcine femur condyles and equally divided between four groups with n = 12 samples each: fresh intact control (Ctrfresh), mechanical surface damage (OAmech), enzymatically degraded with chondroitinase ABC to mimic OA-related glycosaminoglycan depletion (OAenzym) and a buffer-incubated control (Ctrbuffer). Friction experiments were performed in a dynamic tribometer with a cartilage-against-glass configuration. Four gait-like loading profiles were applied for 10 min in a randomised order: normal gait, reduced walking speed with physiologic stance phase loading, altered stance phase loading with normal walking speed and OA specific gait with both, altered stance phase loading and reduced walking speed. Friction coefficients were calculated both at the beginning (µ0) and end of testing (µend) for both the stance- and swing phase conditions. Statistical analyses were carried out with linear mixed models. In intact AC samples (Ctrfresh, Ctrbuffer), friction did not differ between the four gait patterns. In both OA groups (OAmech, OAenzym), the OA-specific gait resulted in the highest friction (µend > 0.03), which was always significantly higher (p < 0.05) than the values assessed under normal gait (µend > 0.01). OA gait increased friction only in degenerated AC. The combination of altered stance phase loading and reduced walking speed characteristic of OA gait may disrupt biphasic lubrication mechanisms, thereby contributing to increased friction. This might be important because it is assumed that altered friction is involved in OA pathogenesis. From a tribological perspective, gait retraining should be considered in OA prevention and its conservative management to mitigate the effect of alterations in gait on the tribological functionality of the AC. N/A.

In South Africa, persons with lower limb amputations face significant barriers to accessing prosthetic rehabilitation due to geographic, financial, and systemic constraints. mHealth applications offer a promising alternative, but evidence-based guidelines tailored to the study population are limited. To identify evidence-based rehabilitation interventions that can inform a rehabilitation application for transtibial prosthetic users in South Africa. A qualitative descriptive design was applied in the study. Telephonic semistructured interviews were conducted with prosthetic users (n = 8), prosthetists (n = 8), and physiotherapists (n = 10). Content data analysis was performed, and data were triangulated to identify essential rehabilitation interventions that can be included in an application. Findings recommended exercise interventions focusing on balance, weight-bearing, joint mobility, muscle strength, and gait retraining. Additional application features should include a rehabilitation roadmap, patient education, and access to peer support networks. An mHealth application incorporating evidence-based exercises and user-informed features can help overcome access barriers to prosthetic rehabilitation in South Africa. Such an application has the potential to enhance functional outcomes, promote self-management, and support healthcare providers in delivering consistent, quality rehabilitation.

Immediate reductions in compressive and shear forces in the knee from gait retraining are associated with slowed cartilage degeneration after 1 year in medial knee osteoarthritis: A retrospective observational cohort study.

ABSTRACT Gait retraining has gained attention as a practical intervention to improve running biomechanics and reduce injury risk. This study investigated the carryover effects of treadmill-based gait retraining on footstrike pattern, cadence, and vertical loading rate during overground running. Twelve recreational runners who habitually adopted a rearfoot strike (RFS) pattern participated in an eight-session treadmill-based gait retraining programme aimed at footstrike transition to a midfoot strike (MFS). The programme utilised real-time visual feedback and progressively reduced guidance to encourage sustainable biomechanical adaptations. Biomechanical assessments were conducted on both treadmill and overground surfaces before and after training. Results demonstrated significant reductions in footstrike angle (FSA) (95%CI interval −13.9 to −5.1; Cohen’s d = 2.22), vertical loading rate (95%CI −0.49 to −41.56; Cohen’s d = 0.76), and increased cadence (95%CI 2.47 to 14.06; Cohen’s d = 0.87) during treadmill running. However, only the reduction in FSA transferred to overground running, with only 33% of participants exhibiting an MFS pattern during overground running after training, suggesting limited carryover of other biomechanical changes and highlighting discrepancies between trained and untrained conditions. These findings underscore the potential of gait retraining to modify running biomechanics while emphasising the need for overground-specific protocols to ensure effective transfer of improvements to real-world running environments.

BackgroundKnee osteoarthritis is a prevalent condition worldwide that leads to pain and limits daily living activities. Among the treatment approaches, gait retraining strategies have been studied in recent years, and exercise therapy is considered a core treatment for knee osteoarthritis. However, studies addressing gait retraining associated with a lower limb strengthening program are scarce. In this way, the objective of this protocol is to present a randomized clinical trial protocol that aims to investigate the effects of gait retraining in toe-out associated with knee and hip muscle strengthening and an educational program in patients with knee osteoarthritis.MethodsFifty-six subjects will be recruited. Gait kinematics, muscle torque, and physical function via the WOMAC questionnaire will be assessed. The participants will be randomly assigned to control or intervention groups. The control group will undergo a lower limb strengthening exercises program and an osteoarthritis educational process delivered through digital audio materials. The intervention group will receive the strategies applied to the control group associated with gait retraining in toe-out.DiscussionThe results of this study will show whether gait retraining adds an effect to knee osteoarthritis core treatment. In this way, it will provide physical therapists with guidance in the knee osteoarthritis treatment plan to promote clinical and biomechanical improvements.Trial registrationReBEC platform trial: RBR-4pzsfxw. Registered 09 August 2023. https://ensaiosclinicos.gov.br/rg/RBR-4pzsfxwSupplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09155-4.

Knee osteoarthritis (OA) is not only prevalent among older adults but also affects younger men in their productive years, particularly those with risk factors such as obesity, prior trauma, or high-intensity sports participation. This study evaluated the effects of a 12-week structured rehabilitation program in male patients with knee OA and musculoskeletal impairments at RSUD Hanau, Central Kalimantan. Five male patients aged 35–45 years participated: (1) knee OA with obesity, (2) early OA in a long-distance runner, (3) post-traumatic OA after tibial ORIF, (4) ligamentous laxity with early OA in a badminton athlete, and (5) knee OA with chronic pain syndrome in a sports teacher. The standardized 12-week rehabilitation protocol included supervised physiotherapy (3–5 sessions weekly) with quadriceps strengthening, straight leg raises, joint mobilization, balance training, gait retraining, and adjunctive modalities such as cryotherapy and TENS. All patients showed clinically meaningful improvements in at least four domains. On average, pain reduced by 2–3 points on the VAS, knee flexion increased by 10°–20°, and 6MWT distance improved by 80–150 meters. Lequesne Index scores decreased, indicating reduced symptoms, while WOMAC and KOOS scores demonstrated improved pain, stiffness, function, and knee-related quality of life. The 12-week structured rehabilitation program produced significant functional and symptomatic improvements in middle-aged men with knee OA and related musculoskeletal impairments, underscoring its clinical relevance in managing early to moderate stages of OA among working adults.

ABSTRACT In-field gait retraining using metronomes is a common sports medicine intervention. Many runners prefer to listen to music. Removing music may impact exercise performance and possibly gait retraining adherence. Increased step-rate accuracy and adherence were compared between music and metronome in-field gait retraining. Thirty healthy individuals were allocated to groups (music or metronome) then completed a pretest running assessment while step-rate was collected. Target step-rate was calculated (+5% above preferred). After five in-lab, guided gait retraining sessions, participants were told to continue practicing on their own for approximately 1-month while step-rate and running mileage were monitored remotely via an app. Participants returned for a posttest to collect step-rate and were categorized as adherent or nonadherent based on their monthly activity. A 2 × 2repeated measures ANOVA was performed to determine differences in step-rate (group by time). A Fisher’s exact test and odds ratio examined the relationship between group and adherence. The music and metronome groups increased step-rate (p < .001) from pretest to posttest. A significant association between group and adherence was found (p = .045). The music group was more adherent to in-field gait retraining. Music and metronome auditory cueing effectively increased step-rate, but music auditory cueing led to improved adherence.

Personalised gait retraining for medial compartment knee osteoarthritis: a randomised controlled trial.

Precise prediction of upcoming gait signals, especially over an extended time scale like the entire gait cycle, is crucial. During this period, devices or gait retraining programs can respond to dynamic changes while considering multiple factors in the neurological and musculoskeletal systems. This enables effective adjustments, ultimately optimising outcomes based on the unique rehabilitation goals. However, current state-of-the-art models, whether driven by physical modelling or data modelling approaches, are constrained by short prediction time scales, limited accuracy, and high computational costs, which hinder their use on edge devices. We developed TFNet, a dual-stream neural network model that integrates temporal and frequency domain analyses to accurately predict biomechanical signals across the entire gait cycle. TFNet predicted lower limb joint angles and ground reaction forces with high precision, within 5 degrees and 0.1 body weight, respectively. The model demonstrated the feasibility for deployment on edge devices and adaptability to patients with gait impairments. Explainability analysis highlighted key biomechanical features throughout the gait cycle, improving interpretability and clinical relevance. These comprehensive validations demonstrate the potential of TFNet as a reliable and cost-effective solution for clinical applications aimed at restoring and enhancing gait function.

Background: Early-onset knee osteoarthritis (OA) is increasingly being reported among young adults, challenging the conventional view of OA as a disease of aging. Biomechanical factors, particularly foot posture abnormalities such as excessive pronation or supination, may contribute to altered lower limb mechanics, abnormal load distribution, and accelerated cartilage degeneration. Understanding the role of these modifiable risk factors in early disease development is essential for designing preventive strategies. Objective: To investigate the association between foot posture abnormalities and the prevalence of early knee osteoarthritis in young adults aged 18–40 years. Methods: A cross-sectional study was conducted on 180 participants recruited from physiotherapy and orthopedic clinics in Peshawar. Foot posture was assessed using the Foot Posture Index (FPI-6), and early knee OA was identified based on American College of Rheumatology (ACR) clinical criteria and Kellgren–Lawrence (K–L) grading (0–2). Pain intensity was measured using the Visual Analogue Scale (VAS), and function was evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS). Statistical analyses included chi-square tests, t-tests, ANOVA, and logistic regression, with significance set at p &lt; 0.05. Results: The mean age of participants was 29.4 ± 5.6 years, and the mean BMI was 26.1 ± 3.9 kg/m². Early knee OA was more prevalent among participants with pronated feet (50%) and supinated feet (39%) than those with neutral posture (22%) (p &lt; 0.001). Individuals with pronated feet reported significantly higher pain scores (VAS: 5.1 ± 1.9) and poorer functional outcomes (KOOS: 68.4 ± 11.5) compared to those with neutral feet (VAS: 2.8 ± 1.4; KOOS: 82.6 ± 9.8). Logistic regression analysis identified abnormal foot posture (OR = 2.71, 95% CI: 1.45–5.06, p = 0.002) and elevated BMI (OR = 1.89, 95% CI: 1.02–3.52, p = 0.041) as independent predictors of early knee OA. Conclusion: Foot posture abnormalities — particularly excessive pronation — are significantly associated with early knee osteoarthritis in young adults. Along with elevated BMI, these findings underscore the importance of early screening for biomechanical risk factors and the implementation of targeted preventive interventions, including orthotic support, gait retraining, strengthening programs, and weight management, to reduce the long-term burden of OA