Moment Of Patient Research Articles

Changes in the total knee joint moment in patients with medial compartment knee osteoarthritis over 5 years.

Progression of medial compartment knee osteoarthritis (OA) has been associated with repetitive mechanical loading during walking, often characterized by the peak knee adduction (KAM) and knee flexion moments (KFM). However, the relative contributions of these components to the knee total joint moment (TJM) can change as the disease progresses since KAM and KFM are influenced by different factors that change over time. This study tested the hypothesis that the relative contributions of KAM, KFM, and the rotational moment (KRM) to the TJM change over time in subjects with medial compartment knee OA. Patients with medial compartment knee OA (n = 19) were tested walking at their self-selected speed at baseline and a 5-year follow-up. For each frame during stance, the TJM was calculated using the KAM, KFM, and KRM. The peaks of the TJM and the relative contributions of the moment components at the time of the peaks of the TJM were tested for changes between baseline and follow-up. The percent contribution of KFM to the first peak of the TJM (TJM1) significantly decreased (p < 0.001) and the percent contribution of KAM to TJM1 significantly increased (p < 0.001), while the magnitude of the TJM1 did not significantly change over the 5-year follow-up. These gait changes with disease progression appear to maintain a constant TJM1, but the transition from a KFM to a KAM dominance appears to reflect gait changes associated with progressing OA and pain. Thus, the TJM and its component analysis captures a comprehensive metric for total loading on the knee over time. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. 36:2373-2379, 2018.

Effect of real-time biofeedback on peak knee adduction moment in patients with medial knee osteoarthritis: Is direct feedback effective?

BackgroundGait modifications can reduce the knee adduction moment, a representation of knee loading. Reduced loading may help to slow progression of medial knee osteoarthritis. We aimed to investigate the response of patients with medial knee osteoarthritis to direct feedback on the knee adduction moment as a method for modifying the gait pattern, before and after training with specific gait modifications. MethodsForty patients with medial knee osteoarthritis underwent 3D gait analysis on an instrumented-treadmill, while receiving real-time feedback on the peak knee adduction moment. Patients were trained with three different modifications; toe-in, wider steps and medial thrust gait. The response to real-time feedback on the knee adduction moment was measured before and after training. To evaluate the short term retention effect, we measured the changes without feedback. We also evaluated the effects on the knee flexion moment and at the hip and ankle joints. FindingsWith direct feedback on the knee adduction moment, patients were initially unable to reduce the knee adduction moment. After training with specific modifications, peak knee adduction moment was reduced by 14% in response to direct feedback. Without feedback a 9% reduction in peak knee adduction moment was maintained. Hip moments were not increased with modified gait, but small increases in ankle adduction moment and knee flexion moment were observed. InterpretationReal-time biofeedback directly on the knee adduction moment is a promising option for encouraging gait modifications to reduce knee loading, however only when combined with specific instructions on how to modify the gait.

Combined effect of toe out gait and high tibial osteotomy on knee adduction moment in patients with varus knee deformity

BackgroundGait adaptations, including toe out gait, have been proposed as treatments for knee osteoarthritis. The clinical application of toe out gait, however, is unclear.This study aims to identify the changes in Knee adduction moment in varus knee deformity assessing toe out gait as an alternative to high tibial osteotomy, and if any change in dynamic loading persists post operatively, when anatomical alignment is restored. MethodsThree-dimensional motion analysis was performed on 17 patients with medial compartment knee osteoarthritis and varus deformity prior to undergoing high tibial osteotomy, 13 patients were assessed post-operatively, and results compared to 13 healthy controls. FindingsPre-operatively, there was no significant difference between natural and toe out gait for measures of knee adduction moment. Post high tibial osteotomy, first (2.70 to 1.51% BW·h) and second peak (2.28 to 1.21% BW·h) knee adduction moment were significantly reduced, as was knee adduction angular impulse (1.00 to 0.52% BW·h·s), to a healthy level. Adopting toe out gait post-operatively reduced the second peak further to a level below that of healthy controls. InterpretationIncreasing the foot progression angle from 20° (natural) to 30° in isolation did not significantly alter the knee adduction moment or angular impulse. This suggests that adopting a toe out gait, in isolation, in an already high natural foot progression angle, is not of benefit. Adopting toe out gait post-operatively, however, resulted in a further reduction in the second peak to below that of the healthy control cohort, however, this may increase lateral compartment load.

Effects of active feedback gait retraining to produce a medial weight transfer at the foot in subjects with symptomatic medial knee osteoarthritis.

This study aimed to determine if active feedback gait retraining to produce a medial weight transfer at the foot significantly reduces the knee adduction moment in subjects with medial compartment knee osteoarthritis. Secondarily, changes in peak knee flexion moment, frontal plane knee and ankle kinematics, and center of pressure were investigated. Ten individuals with medial compartment knee osteoarthritis (9 males; age: 65.3 ± 9.8 years; BMI: 27.8 ± 3.0 kg/m2 ) were tested at self-selected normal and fast speeds in two conditions: Intervention, with an active feedback device attached to the shoe of their more affected leg, and control, with the device de-activated. Kinematics and kinetics were assessed using a motion capture system and force plate. The first peak, second peak, and impulse of the knee adduction moment were significantly reduced by 6.0%, 13.9%, and 9.2%, respectively, at normal speed, with reductions of 10.7% and 8.6% in first peak and impulse at fast speed, respectively, with the active feedback system, with no significant effect on the peak knee flexion moment. Significant reductions in peak varus knee angle and medialized center of pressure in the first half of stance were observed, with reductions in peak varus knee angle associated with reductions in the knee adduction moment. This study demonstrated that active feedback to produce a medial weight-bearing shift at the foot reduces the peaks and impulse of the knee adduction moment in patients with medial compartment knee osteoarthritis. Future research should determine the long-term effect of the active feedback intervention on joint loading, pain, and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2251-2259, 2017.

New evidence in support of staging approaches in schizophrenia: Differences in clinical profiles between first episode, early stage, and late stage

Few studies have examined the progression of symptom dimensions in schizophrenia patients over the course of the illness. The objective of this study was to investigate whether clinical and psychopathological differences exist between first-episode schizophrenia (FES) and multiple-episode patients in an inpatient setting. Patients (N=203) were evaluated using the Positive and Negative Syndrome Scale (PANSS) over time. Five different generalized estimating equations were built for the PANSS factors using the following as covariates: sex, patient's age, assessment time point (i.e., moment of patient's evaluation, with a minimum of two and a maximum of four assessments throughout the study timeframe). The FES group was used as the reference to which the groups with up to five years of illness and more than five years of illness were compared. Remission rates and treatment resistance (TRS) rates were also compared. Generalized estimating equations were used to allow for different numbers of assessments over the study period. Patients with FES showed significantly milder severity in positive, disorganized, and hostility factors. Also, FES patients were more likely to achieve remission (P=0.002) and had lower rates of TRS (P=0.001). First-episode schizophrenia seems to be the critical period to improve outcome, as multiple-episode patients were similar in clinical characteristics regardless of illness duration.

Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis.

There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. To verify if such effects occur in participants with medial knee osteoarthritis. Randomized single-blinded study. Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.

View of surgeon on multidisciplinary approach in pediatric hematology-oncology

Multidisciplinary approach is widely used worldwide among the specialists of different specialties. Joint efforts of oncologist, hematologist, surgeon, radiologist, pathomorphologist, anesthesiologist, ICU-staff, recreation therapist and other specialists are aimed on treatment of patients with hematological and oncological diseases. This manuscript showed the view of physicians on place of surgery in this complex system. Progress of surgery with the help of endoscopic technique, intraoperational navigation, reconstructive and microscopic technique open the width range of possibilities in diagnosing and treatment of patients. Only harmonious work of all staff members from the moment of patient’s entering to clinic to the successful healing, work of clinical-scientific parties allows to reach good oncological and functional results, to prepare new methods and introduce it to the practical usage. This will allow the early social adaption of children and adolescents.

Delirium, hallucinations and criminal liability

IntroductionThe relationship between psychotic motivation and the genesis of medico-legal acts is well documented in the literature. Delirium and hallucinations, in particular, have been widely reported in this context.ObjectiveThe aim was to identify socio-demographic, clinical, and criminological profile of patients hospitalized for forensic acts committed in psychotic context.MethodsWe conducted a descriptive retrospective study, including 7 patients committing a forensic act in psychotic context, selected among all patients hospitalized after a judgement of dismissal (Tunisian law), in psychiatry department, Hedi Chaker university hospital, Sfax, Tunisia. Socio-demographic and clinical data were collected through patients’ observations.ResultsThe mean age was 37.7 years. Sex-ratio (M/F) was 6. The criminological act was an attack in 57.1% and homicide in 42.9% of cases. It was committed on the outside in 42.9% of cases. The tool was a bladed weapon in all cases. The victim was a family member in 71.4% of cases. The context was a delirium in 71.4% (theme: 80% persecution, 20% jealousy; mechanism: 40% hallucinatory, 60% interpretative) and hallucinations in 42.9% of cases. Among our patients, 57.1% were indifferent and 28.6% regretted the act. Psychiatric diagnosis was: schizophrenia 57.1%; delusional disorder 28.5% and brief psychotic disorder 14.2%. Personality disorder was reported in 28.6% of patients.ConclusionThe acting out in a psychotic moment in patients with mental illness remains the most formidable event, causing sometimes the problem of criminal liability. Control of attendance at psychotherapy and psychotropic treatment are preventive and curative necessary measures to avoid crossing the dangerous acts.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pentafecta: The more fair self-assessment at the moment of patients' consultation prior to radical prostatectomy

Pentafecta: The more fair self-assessment at the moment of patients' consultation prior to radical prostatectomy

Comparison of Analgesic Effects of Epidural Infusion of Fentanyl and Fentanyl-bupivacaine in Spine Surgery: A Randomized Clinical Trial Study

Background & Aim: Although most patients experience severe pain after major spinal fixation surgery, little attention has been paid to control it with a multi-modal approach. The aim of this study is to select appropriate method of pain management after spinal surgery. Methods & Materials/Patients: This study was a randomized clinically controlled trial in candidates of spondylolisthesis and spinal fixation surgery under general anesthesia. 90 patients were divided into three groups, as follows: 1) Intervention group of epidural fentanyl (F): patient-controlled analgesia (PCA) pump infused 100 µg of fentanyl and 98cc of normal saline at the rate of 3-5 ml/h in the epidural space via an epidural catheter placed by surgeon 2) Intervention group of epidural fentanyl-bupivacaine (FB): PCA pump infused 100 µg of fentanyl and bupivacaine 0.125% at the rate of 3-5 ml/h in the epidural space. 3) IV morphine group (M): No medication was received epidurally. In case of visual analog scale (VAS) score more than four, one mg of IV morphine bolus was administered to patient. The blood pressure, heart rate, respiratory rate and pain severity were recorded at the moment of patient’s transfer from recovery room to the ward and compared in three groups every six hours for 24 hours. The results of this study were analyzed by statistical tests including repeated measures ANOVA, Kruskal-Wallis, Fisher’s exact test and SPSS software 16. P values less than 0.05 were considered statistically significant. Results: The results of the study showed that VAS score in fentanyl-bupivacaine group was significantly lower than that in the two other groups during the first 18 hours. However, VAS score in all groups decreased at 24th hour postoperatively (less than three) suggesting that there was no statistically significant difference between the three groups. In this study, no serious and severe complications were observed except for a few cases of nausea in the control group. Conclusion: Epidural analgesia with fentanyl-bupivacaine is a safe and effective way to postoperative pain management in listhesis and spinal surgeries.

Relationships among foot position, lower limb alignment, and knee adduction moment in patients with degenerative knee osteoarthritis.

[Purpose] The aim of this study was to determine the relationships among the foot progression angle, foot rotation angle, lower limb alignment, and knee adduction moments in patients with degenerative knee osteoarthritis (OA). [Subjects] Forty-eight patients diagnosed with degenerative knee OA (Kellgren-Lawrence grades 2 and 3) were included. [Methods] To assess the lower extremity alignment and weight-bearing ratio, static radiographic measurement was used. Foot progression angle, foot rotation angle, and knee adduction moments were measured by using a three-dimensional motion analysis system. [Results] The results of this study were as follows: the foot progression angle in the early and late stance phase was significantly correlated with the first and second peak knee adduction moments; the weight-bearing ratio was significantly correlated with the first and second peak knee adduction moments; and the tibiofemoral angle was significantly correlated with the first and second peak knee adduction moments. [Conclusion] The results of the present study indicated that as the foot progression angle and the foot lateral rotation angle increased, the knee adduction moment decreased. The weight-bearing ratio and tibiofemoral angle assessment with mechanical axis alignment were correlated with the knee adduction moments. These parameters may be helpful for selecting therapeutic options for patients with degenerative knee OA.

Effect of proprioceptive training on foot posture, lower limb alignment, and knee adduction moment in patients with degenerative knee osteoarthritis: a randomized controlled trial.

[Purpose] The purpose of this study was to determine the effect of proprioceptive training on foot progression angle, weight-bearing ratio, and knee adduction moment in patients with degenerative osteoarthritis of the knee. [Subjects] The subjects were 37 patients diagnosed with Kellgren-Lawrence grade 2 or 3 degenerative knee osteoarthritis. They were randomly allocated to three groups: a proprioceptive training group (PT group), quadriceps strengthening group (QS group), and control group. [Methods] The study parameters of the three groups were compared before and after a 12-week training period. Therapeutic exercises were performed twice per week for 12 weeks. Outcomes included the foot progression angle, weight-bearing ratio, and knee adduction moment. [Results] First, a significant difference in the foot progression angle was observed among the groups, significantly increasing in the PTG compared with the CG. Second, a significant difference in the weight-bearing ratio was observed among the groups, significantly increasing in the PTG compared with the CG. Third, a significant difference in the first peak knee adduction moment was observed among the groups, significantly decreasing in the PTG compared with the CG. [Conclusion] The results of the present study indicate that proprioceptive training increased the foot progression angle and weight-bearing ratio and decreased the first peak knee adduction moment. Moreover, incorporating proprioceptive training into a physical therapy exercise program could improve functional ability and delay the progression of degenerative osteoarthritis.

Adaptive Support Ventilation Versus Synchronized Intermittent Mandatory Ventilation With Pressure Support in Weaning Patients After Orthotopic Liver Transplantation

BackgroundThe extubation phase is an extremely critical moment in patients who have undergone orthotopic liver transplantation, who do not always have the advantage of long-lasting positive-pressure ventilation and positive expiratory end pressure; these factors can lead to splanchnic venous congestion, and this is why a rapid extubation can represent a great benefit for the graft. MethodsThe aim of this study was to compare the adaptive support ventilation (ASV) mode with the standard mode of weaning in our intensive care unit, synchronized intermittent mandatory ventilation with pressure support (P-SIMV), in patients who received orthotopic liver transplantation. ASV is a positive-pressure mode, in which pressure level and respiratory rate are automatically adjusted according to measured lung dynamics at each breath. Eligible patients were assigned to either ASV or P-SIMV group. The weaning protocol was based on the individual respiratory activity and structured in 4 different phases. ResultsThe average length of intubation was significantly shorter in the ASV group than in the P-SIMV group (90 ± 13 vs 153 ± 22 minutes, P = .05). The total modifications to the ventilator settings were significantly larger in the P-SIMV group (1.5 ± 1 vs 6 ± 2; P = .003). ConclusionsOur results suggest that although both procedures are safe and easy to apply, ASV is superior in terms of weaning times, and it simplifies respiratory management. The better patient-machine interaction in ASV has been highlighted by other authors for different clusters of patients.

Gait neuromechanics in women with and without joint hypermobility

s / Gait & Posture 39S (2014) S1–S141 S7 legs, dependent on affected side, and three trials of participants were considered. Linear MixedModels were used to determine the main effects within retained principal components (PCs). Results: PatientsmeanAntetorsionwas38.6◦(SD6.1◦), basedon CT-scans. There were no significant group differences in sex, age, BMI and walking speed, but patients showed significant less hip external rotation in clinical examination. Group effects based on LinearMixedModels revealed that patientswalkedwith significant more internal foot progression angle (FPA) andmore external ankle rotation (ARA) than controls. There were no alterations observed in knee kinematics. Patients walked with significant more anterior pelvic tilt (SPA) and at hip joint level with more internally rotated (THA) and flexed (SHA) hips. Group effects in kinetics revealed that patients showed a significant lower knee adductionmoment (FKM) andhip adductionmoment (FHM).Differentiation into primary and secondary passive effects was derived from clinical considerations. Discussion and conclusions: Deviations in FPA and THA were stated as primary deviations. Due to the reduced hip external rotation patientswere not able to counterbalance for primary deviations. Passive secondary effects were detected in ARA, SHA, SPA, FKM and FHM. In order to achieve normal gait, patients walked with external ankle rotation, flexed hips and more anterior pelvic tilt. During gait internal hip rotation induced anterior pelvic tilt andmore hip flexion by straining iliofemoral ligaments. Moreover, anterior pelvic tilt may have wide-ranging consequences as it may induce increased lordosis of the lumbar spine and extension of the thoracic spine. Although in the current study FKM mean gait waveform indicated a tendency for an increased knee adduction moment in patients, the application of Linear Mixed Models on PC-scores of retained PCs showed a significant group effect in PC3 (explaining 16.74% of total variance), representing a lower knee adduction moment in patients. In hip the only significant group effect corresponded to a lower hip adduction moment in patients (PC2, explaining 15.32% of total variance), whereas mean gait waveform indicated a higher hip adduction moment. In summary coxa antetorta is not mainly a cosmetic problem in general. Modifications in kinematics and kinetics may cause physical complaints and osteoarthritis in future. Therefore, conducting 3DGA is recommended for individual clinical decision-making and planning surgical corrections in patients with coxa antetorta.

Gait deviations and compensations in adolescents with coxa antetorta

s / Gait & Posture 39S (2014) S1–S141 S7 legs, dependent on affected side, and three trials of participants were considered. Linear MixedModels were used to determine the main effects within retained principal components (PCs). Results: PatientsmeanAntetorsionwas38.6◦(SD6.1◦), basedon CT-scans. There were no significant group differences in sex, age, BMI and walking speed, but patients showed significant less hip external rotation in clinical examination. Group effects based on LinearMixedModels revealed that patientswalkedwith significant more internal foot progression angle (FPA) andmore external ankle rotation (ARA) than controls. There were no alterations observed in knee kinematics. Patients walked with significant more anterior pelvic tilt (SPA) and at hip joint level with more internally rotated (THA) and flexed (SHA) hips. Group effects in kinetics revealed that patients showed a significant lower knee adductionmoment (FKM) andhip adductionmoment (FHM).Differentiation into primary and secondary passive effects was derived from clinical considerations. Discussion and conclusions: Deviations in FPA and THA were stated as primary deviations. Due to the reduced hip external rotation patientswere not able to counterbalance for primary deviations. Passive secondary effects were detected in ARA, SHA, SPA, FKM and FHM. In order to achieve normal gait, patients walked with external ankle rotation, flexed hips and more anterior pelvic tilt. During gait internal hip rotation induced anterior pelvic tilt andmore hip flexion by straining iliofemoral ligaments. Moreover, anterior pelvic tilt may have wide-ranging consequences as it may induce increased lordosis of the lumbar spine and extension of the thoracic spine. Although in the current study FKM mean gait waveform indicated a tendency for an increased knee adduction moment in patients, the application of Linear Mixed Models on PC-scores of retained PCs showed a significant group effect in PC3 (explaining 16.74% of total variance), representing a lower knee adduction moment in patients. In hip the only significant group effect corresponded to a lower hip adduction moment in patients (PC2, explaining 15.32% of total variance), whereas mean gait waveform indicated a higher hip adduction moment. In summary coxa antetorta is not mainly a cosmetic problem in general. Modifications in kinematics and kinetics may cause physical complaints and osteoarthritis in future. Therefore, conducting 3DGA is recommended for individual clinical decision-making and planning surgical corrections in patients with coxa antetorta.

Ivabradine Significantly Decreases hsCRP and Increases the Activity of Glutathione Peroxidase in Patients with Stable Coronary Artery Disease

Introduction: Ivabradine treatment is considered to be a new approach in the coronary artery disease treatment based on the principle of the heart rate lowering. The aim of this project was to determine whether the heart rate decrease achieved by the ivabradine is accompanied by the improvement of antioxidant activity and reduction of the vascular inflammation, which can lead to the enhancement of the endothelial function. Patients and methods: There were 30 patients with coronary artery disease in this study. They received treatment with the daily 2x5 mg dose of ivabradine in addition to their long- term treatment. Plasmatic level of hsCRP and activity of glutathione peroxidase was assessed at the beginning of the study and after three months (± one week) of the treatment. Results: There were 25 (83.3%) men and 5 (16.7%) women in the study. Average age of the patients was 65.4 ± 6.7 years. 28 (93.3%) patients survived myocardial infarction (STEMI or NSTEMI), 23 (76.6%) experienced revascularization (PCI or CABG), 16 (53.3%) patients suffered from diabetes mellitus of the 2. type, 29 (96.6%) patients experienced arterial hypertension. The mean heart rate at the moment of patient’s admission was 77 ± 7 beats in a minute. There was observed a significant increase in the activity of glutathione peroxidase, which increased from 36.31 ± 8.02 U/gHb to 39.96 ± 8.56 U/gHb (p?0.0001). We also observed statistically significant decrease of the hsCRP level, from 4.05 ± 3.28 mg/l to 1.82 ± 1.54 mg/l, p?0.0001. Conclusion: Not only is the addition of ivabradine to the treatment of patients with coronary artery disease lowering the heart rate, it also positively affects the antioxidant activity and reduces vascular component of inflammation. However, it is necessary to conduct broader clinical, randomized, double-blind, placebo controlled trials to support the findings.

Real-time tracking of knee adduction moment in patients with knee osteoarthritis.

The external knee adduction moment (EKAM) is closely associated with the presence, progression, and severity of knee osteoarthritis (OA). However, there is a lack of convenient and practical method to estimate and track in real-time the EKAM of patients with knee OA for clinical evaluation and gait training, especially outside of gait laboratories. A real-time EKAM estimation method was developed and applied to track and investigate the EKAM and other knee moments during stepping on an elliptical trainer in both healthy subjects and a patient with knee OA. Substantial changes were observed in the EKAM and other knee moments during stepping in the patient with knee OA. This is the first study to develop and test feasibility of real-time tracking method of the EKAM on patients with knee OA using 3-D inverse dynamics. The study provides us an accurate and practical method to evaluate in real-time the critical EKAM associated with knee OA, which is expected to help us to diagnose and evaluate patients with knee OA and provide the patients with real-time EKAM feedback rehabilitation training.

AB0411 Renal involvement in patients with rheumatoid arthritis

BackgroundThere is no doubt that renal lesion is one of the most unfavorable forms of visceral involvement in patients with rheumatoid arthritis (RA). There are several types of renal damage...

The position of the center of the mass from the knee center correlates closely with the knee adduction moment in patients with knee osteoarthritis

The position of the center of the mass from the knee center correlates closely with the knee adduction moment in patients with knee osteoarthritis

Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis

The first peak of the knee adduction moment has been linked to the presence, severity, and progression of medial compartment knee osteoarthritis. The objective of this study was to evaluate toe-in gait (decreased foot progression angle from baseline through internal foot rotation) as a means to reduce the first peak of the knee adduction moment in subjects with medial compartment knee osteoarthritis. Additionally, we examined whether the first peak in the knee adduction moment would cause a concomitant increase in the peak external knee flexion moment, which can eliminate reductions in the medial compartment force that result from lowering the knee adduction moment. We tested the following hypotheses: (a) toe-in gait reduces the first peak of the knee adduction moment, and (b) toe-in gait does not increase the peak external knee flexion moment. Twelve patients with medial compartment knee osteoarthritis first performed baseline walking trials and then toe-in gait trials at their self-selected speed on an instrumented treadmill in a motion capture laboratory. Subjects altered their foot progression angle from baseline to toe-in gait by an average of 5° (p<0.01), which reduced the first peak of the knee adduction moment by an average of 13% (p<0.01). Toe-in gait did not increase the peak external knee flexion moment (p=0.85). The reduced knee adduction moment was accompanied by a medially-shifted knee joint center and a laterally-shifted center of pressure during early stance. These results suggest that toe-in gait may be a promising non-surgical treatment for patients with medial compartment knee osteoarthritis.