Toe-out Gait Research Articles

Toe-in and toe-out gait retraining interventions for individuals with knee osteoarthritis trial: A pilot randomised clinical trial

BackgroundGait retraining, through altering foot progression angle, has the potential to reduce pain and offload the medial tibiofemoral compartment in people with knee osteoarthritis. This pilot study aimed to evaluate the feasibility of toe-in and toe-out gait retraining on self-reported pain and physical function, and proxy measures of medial knee load, in individuals with medial knee osteoarthritis. MethodsTwenty participants with symptomatic medial knee osteoarthritis were randomly allocated to receive either toe-in or toe-out gait retraining for six-weeks, consisting of weekly clinician-supervised sessions and ≥ 30 min of daily self-practice. Feedback was guided by wearable sensors and a pressure-sensitive mat. Primary outcomes included recruitment rate, data completeness, adverse events, adherence, achievability, and intervention acceptability. Secondary outcomes were proxy measures of medial knee load, self-reported pain and physical function. Differences in feasibility and self-reported outcomes were interpreted via sample t-test using intention-to-treat analysis. The effect of the intervention group on knee biomechanics was evaluated using linear mixed modelling. FindingsRecruitment was acceptable (n = 4/month) with excellent data completeness (93 %) and attendance (82 %). Acceptability was moderate and similar between groups. There were no differences in average knee pain and physical function between groups over time, and both groups reduced maximum knee pain following the intervention (35 % improvement, p = 0.012). There were no differences in biomechanical outcomes between groups over time. InterpretationToe-in and toe-out gait retraining is feasible and improves pain in people with knee osteoarthritis. A full-scale randomised clinical trial is warranted and should consider individualising the intervention.

Toe-in and toe-out gait retraining interventions to reduce proxy measures of medial knee joint load in people with medial knee osteoarthritis: Protocol for a randomised placebo-controlled trial

ObjectiveOur primary aim is to determine the effect of a six-week toe-in, toe-out and active placebo gait retraining program on proxy measures of medial knee joint load and varus thrust in people with medial knee osteoarthritis. Our secondary aim is to determine the intervention effects on patient reported outcomes and physical function and determine if changes are maintained at three-months follow-up. MethodsWe will conduct a three-arm randomised placebo-controlled trial. Ninety participants with medial knee osteoarthritis will be randomised and stratified via varus thrust status (presence/absence) to: toe-in, toe-out or placebo gait retraining (an intervention that does not change proxy measures of medial knee joint load). The intervention involves weekly clinician-supervised sessions with biofeedback, knee osteoarthritis education, motor learning and behaviour change principles, and daily gait retraining practice. Primary outcomes are proxy measures of medial knee joint load: knee adduction moment (early- and late-stance peaks and impulse), and varus thrust (presence/absence). Secondary outcomes include pain, physical function, medication and health care utilisation, quality of life, work ability, treatment blinding, intervention credibility and other biomechanical outcomes. Assessment timepoints are at baseline, six weeks (post intensive training), and three-months following the six-week intervention. ConclusionOur trial will determine whether toe-in or toe-out gait retraining is most effective at reducing proxy measures of medial knee joint load and varus thrust in people with medial knee osteoarthritis. This study will also evaluate if toe-in or toe-out gait retraining interventions are superior at improving pain, physical function and quality of life compared to placebo. Clinical trial registrationThis clinical trial protocol is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000414819).

Effect of toe-out gait modification on patellofemoral joint loading.

BackgroundToe-out gait has been proposed as a conservative treatment to reduce medial tibiofemoral joint loading. However, patellofemoral joint loading during toe-out gait is not yet understood. Research questionDoes the toe-out gait modification affect patellofemoral joint loading? MethodsSixteen healthy adults were enrolled in this study. The natural gait and toe-out gait were measured using a three-dimensional motion analysis and a force plate. The knee flexion angle and external knee flexion moment during the stance phase were calculated. Thus, dynamic knee joint stiffness, a proxy of patellofemoral joint loading, was defined as a linear regression of the knee flexion moment and knee flexion angle during the early stance. Additionally, the peak patellofemoral compressive force during the early stance was calculated using a musculoskeletal simulation. A paired t-test was used to compare these biomechanical parameters during the natural gait and toe-out gait. ResultsThe toe-out gait significantly increased the peak patellofemoral compressive force (mean difference = 0.37 BW, P = 0.017) and dynamic knee joint stiffness (mean difference = 0.07%BW*Ht/°, P = 0.001). The 1st peak of the knee flexion moment also significantly increased in the toe-out gait (mean difference = 1.01%BW*Ht, P = 0.003); however, the knee flexion angle did not change significantly (initial contact: mean difference = 1.7°, P = 0.078; peak: mean difference = 1.3°, P = 0.224). SignificanceToe-out gait increased the patellofemoral compressive force and dynamic knee joint stiffness because of increasing knee flexion moment, but not the knee flexion angle. When the toe-out gait is adapted, clinicians should pay attention to an increase in the patellofemoral joint loading.

Toe-out gait inhibits medial meniscus extrusion associated with the second peak of knee adduction moment during gait in patients with knee osteoarthritis

BackgroundA medial meniscus extrusion (MME) gradually expands during activities of daily living according to the mechanical stress on the medial compartment of the knee. Increase in MME occurs during the stance phase of the gait cycle, which is key for its expand. The knee adduction moment (KAM) represents the mechanical stress on the medial compartment; however, the relationship between the increase in MME and KAM is still unknown. Therefore, the present study aimed to investigate the relationship between MME during gait and KAM. MethodsTwenty-one patients with medial knee osteoarthritis and 11 healthy middle-aged adults were recruited. Three-dimensional motion analysis system and ultrasonography were used to measure the KAM and MME in the stance phase. The increase in MME was identified as the difference in MME between the maximum and minimum (ΔMME). Patients with knee osteoarthritis performed two conditions as normal and toe-out gait. The difference in KAM and ΔMME between conditions were evaluated. ResultsΔMME was correlated with the KAM second peak in normal gait of knee osteoarthritis patients (r = 0.51, p < 0.05). Toe-out gait reduced the KAM second peak and the ΔMME, and these reductions were correlated (r = 0.50, p < 0.05). ConclusionsToe-out gait immediately inhibited the expansion of MME associated with the KAM second peak.

The effect of gait modification on the response of medial meniscus extrusion during gait in patients with knee osteoarthritis

BackgroundAn increase in medial meniscus extrusion during weight-bearing conditions is associated with the progression of medial knee osteoarthritis (OA). Toe-out gait modification has been known to reduce the knee adduction moment (KAM); however, its effect on reducing the increase in medial meniscus extrusion in patients with knee OA remains unclear. Research questionTo (1) evaluate the effect of toe-out gait on the increase in medial meniscus extrusion and the KAM in patients with medial knee OA and (2) investigate the synergetic effect of lateral wedge insoles in combination with toe-out gait in determining the most effective intervention for reducing medial meniscus extrusion during gait. MethodsTwenty-five patients with medial knee OA were enrolled in this study. Participants walked under four conditions: normal gait, toe-out gait, normal gait with lateral wedge insoles, and toe-out gait with lateral wedge insoles. Medial meniscus extrusion and KAM peaks during gait were measured using ultrasound and a three-dimensional motion analysis system in each condition. These parameters were compared among the four conditions using repeated measures analysis of variance. ResultsThe increase in medial meniscus extrusion and the second KAM peak were significantly lower in all interventions compared with those observed during normal gait. However, there was no significant difference among the interventions. SignificanceThis study suggested that toe-out gait reduces the increase in medial meniscus extrusion and is associated with the reduction of the second KAM peak. However, no synergistic effect of lateral wedge insoles and toe-out gait was observed.

Placebo gait retraining for use in knee osteoarthritis clinical trials does not change surrogate knee load measures: A randomized pilot study

Introduction: Gait retraining is a novel management strategy which has shown ability to reduce pain and the peak knee adduction moment (KAM) (a surrogate measure of medial knee load) in people with medial knee osteoarthritis. However, no published study has compared gait retraining to placebo gait retraining (a gait change which does not affect KAM). Therefore, it is unknown whether pain improvement with gait retraining is due to KAM reduction. Our primary aim was to determine knee joint loading outcomes during placebo, toe-in, and toe-out gait retraining compared to baseline.

Reliability and Validity of IMU-Based Foot Progression Angle Measurement under Different Gait Retraining Strategies

Load modifying gait retraining strategies, such as changing the foot progression angle (FPA) to toe-in and toe-out gait, are used for people with medial knee osteoarthritis. The FPA can be measured using a pressure sensitive walkway (PSW), but inertial measurement units (IMUs) are considered more suitable for clinical use. This study evaluated the reliability and validity of an IMU system, to measure FPA under different gait retraining strategies. Twenty healthy participants walked a 10-m-long path using different gait strategies (natural (2), toe-out gait (1), toe-in gait (1)) during four 90-s trials. FPA was measured simultaneously with IMUs and a PSW, the latter considered the reference standard. There was good and excellent reliability for the IMUs and PSW FPA measurements, respectively (ICC: IMU, 0.89; PSW, 0.97). Minimal detectable change (MDC) was 4.5° for the IMUs and 2.7° for the PSW. Repeated measures ANOVA indicated a significant effect of gait type on FPA (p &lt; 0.001), but not the measurement instrument (p = 0.875). Bland–Altman plots demonstrated the good agreement of both systems for the baseline condition, though the IMUs seemed to consistently overestimate the FPA value compared to the PSW. In conclusion, IMUs are a reliable and valid measurement system for measuring FPA under different gait retraining strategies. The differences between the systems are significant for all gait strategies, so the systems should not be used interchangeably.

Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis

People with knee osteoarthritis who adopt a modified foot progression angle (FPA) during gait often benefit from a reduction in the knee adduction moment. It is unknown, however, whether changes in the FPA increase hip moments, a surrogate measure of hip loading, which will increase the mechanical demand on the joint. This study examined how altering the FPA affects hip moments. Individuals with knee osteoarthritis walked on an instrumented treadmill with their baseline gait, 10° toe-in gait, and 10° toe-out gait. A musculoskeletal modeling package was used to compute joint moments from the experimental data. Fifty participants were selected from a larger study who reduced their peak knee adduction moment with a modified FPA. In this group, participants reduced the first peak of the knee adduction moment by 7.6% with 10° toe-in gait and reduced the second peak by 11.0% with 10° toe-out gait. Modifying the FPA reduced the early-stance hip abduction moment, at the time of peak hip contact force, by 4.3% ± 1.3% for 10° toe-in gait (p = 0.005, d = 0.49) and by 4.6% ± 1.1% for 10° toe-out gait (p < 0.001, d = 0.59) without increasing the flexion and internal rotation moments (p > 0.15). Additionally, 74% of individuals reduced their total hip moment at time of peak hip contact force with a modified FPA. In summary, when adopting a FPA modification that reduced the knee adduction moment, participants, on average, did not increase surrogate measures of hip loading.

The dynamic characteristics of the center of pressure for toe-out gait: implications for footwear design

BackgroundToe-out gait is often used as a conservative technique to reduce knee adduction moment, which has been targeted to modify knee osteoarthritis progression. The center of pressure (COP) can not only be used to evaluate gait stability, but is also more reliable and practical than local plantar pressures as it does not depend on accurate foot zone divisions. However, to the authors’ knowledge, few study has reported the influence of the foot progression angle on the dynamic characteristics of the COP.Research questionThe aim of the study was to investigate the effects of the deliberately toe-out gait on the COP trajectory and stability during walking in healthy individuals.MethodsThirty healthy young adults were asked to walk along an 8-m walkway. A Footscan 1 m pressure plate was used to measure the center of pressure during walking.ResultsCompared to the normal gait, the COP of the toe-out gait shifted laterally during the initial contact phase, and shifted laterally and anteriorly during the forefoot contact phase. The mean anterior–posterior velocity of COP reduced by 0.109 m/s during the foot flat phase and the duration of the foot flat phase and forefoot push off phase increased by 4.5% and reduced by 7.0%, respectively.SignificanceCompared to the normal gait, the findings of this study suggest that biomechanical alteration of foot under our experimental conditions may decrease gait stability and increase forefoot load during toe-out walking. The situation may be improved by well-designed footwear or custom-made insole and the biomechanics analysis method can be used to test the efficacy of therapeutic footwear or insole for individuals with deliberately toe-out walking.Graphical

TOE-IN AND TOE-OUT GAIT RETRAINING FOR PEOPLE WITH MEDIAL KNEE OSTEOARTHRITIS: A PILOT RANDOMISED CLINICAL TRIAL

Purpose: Gait retraining has the potential to offload the medial tibiofemoral compartment to potentially reduce pain and slow osteoarthritis (OA) progression. Altering the foot progression angle (FPA), by toeing-in or toeing-out has demonstrated immediate proportional loading effects on indices of the knee adduction moment (KAM), a valid and reliable proxy measure of load, and a confirmed risk factor of disease progression. Previous randomised controlled trials (RCTs) have independently assessed either toe-in or toe-out gait, and it remains unknown which intervention is most achievable and their effects on proxy measures of medial knee load have not been directly compared.

How Foot Progression Angle Affects Knee Adduction Moment and Angular Impulse in Patients With and Without Medial Knee Osteoarthritis: A Meta-Analysis.

To investigate effects of foot progression angle (FPA) modification on the first and second peaks of external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) in individuals with and without medial knee osteoarthritis (OA) during level walking. PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and SPORTDiscus were searched from inception to February 2020 by 2 independent reviewers. Included studies compared FPA modification (toe-in or toe-out gait) interventions to lower EKAM and/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI. Sixteen studies were included, and >85% of included patients were graded with Kellgren/Lawrence grade II-IV knee OA. Toe-in gait reduced the first EKAM peak (standardized mean difference [SMD] -0.75 [95% confidence interval (95% CI) -1.05, -0.45]) and KAAI (SMD -0.46 [95% CI -0.86, -0.07]), while toe-out gait reduced the second EKAM peak (SMD -1.04 [95% CI -1.34, -0.75]) in healthy individuals. For patients with knee OA, toe-out gait reduced the second EKAM peak (SMD -0.53 [95% CI -0.75, -0.31]) and KAAI (SMD -0.26 [95% CI -0.49, -0.03]), while toe-in gait did not affect both EKAM peaks and KAAI. Discrepancy in biomechanical effects of FPA modification was demonstrated between individuals with and without medial knee OA. Compared with natural walking, both toe-in and toe-out gait may be more effective in lowering EKAM and KAAI in healthy individuals. Toe-out gait may reduce EKAM and KAAI in patients with mild-to-severe knee OA. There is insufficient data from patients with early-stage knee OA, indicating that future research is required.

Study on the relationship between the toe-out gait and foot hallux valgus in the elderly Chinese

The study selects 50 senior people at the age of more than 60 and 30 young people at the age of 18-26 as test group and control group respectively, including people with mild foot disease, such as flat feet, pes cavus and hallux valgus. Questionnaire survey of effective data volume and observation are used to understand common problems of the foot in the elderly, collect shape photos of the foot in senior people, and subjectively analyze their foot shape and gait characteristics. Footscan plate plantar pressure test system and Kistler 3D force platform are used to objectively analyze plantar pressure distribution and gait characteristics of subjects. According to study results: Toe-out gait causes the plantar pressure to move to the forefoot, therefore, the forefoot is the part with the highest risk of injury of foot in toe-out gait, especially the first toe, causing hallux valgus and various foot problems. The toe-out gait causes increase of gait cycle, slow walking speed, poor buffer effect, and may bring pain in feet and lower extremities, thus affecting the dynamic characteristics of the entire lower limb.

Tibiofemoral Contact Measures During Standing in Toe-In and Toe-Out Postures.

Knee osteoarthritis is thought to result, in part, from excessive and unbalanced joint loading. Toe-in and toe-out gait modifications produce alterations in external knee joint moments, and some improvements in pain over the short- and long-term. The aim of this study was to probe mechanisms of altered joint loading through the assessment of tibiofemoral contact in standing with toe-in and toe-out positions using an open magnetic resonance scanner. In this study, 15 young, healthy participants underwent standing magnetic resonance imaging of one of their knees in 3 foot positions. Images were analyzed to determine contact in the tibiofemoral joint, with primary outcomes including centroid of contact and contact area for each compartment and overall. The centroid of contact shifted laterally in the lateral compartment with both toe-in and toe-out postures, compared with the neutral position (P < .01), while contact area in the medial and lateral compartments showed no statistical differences. Findings from this study indicate that changes in the loading anatomy are present in the tibiofemoral joint with toe-in and toe-out and that a small amount of lateralization of contact, especially in the lateral compartment, does occur with these altered lower limb orientations.

Toe-out gait decreases knee load during stair descent in healthy individuals

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.

Wearable Real-Time Haptic Biofeedback Foot Progression Angle Gait Modification to Assess Short-Term Retention and Cognitive Demand.

Foot progression angle gait (FPA) modification is an important part of rehabilitation for a variety of neuromuscular and musculoskeletal diseases. While wearable haptic biofeedback could enable FPA gait modification for more widespread use than traditional tethered, laboratory-based approaches, retention, and cognitive demand in FPA gait modification via wearable haptic biofeedback are currently unknown and may be important to real-life implementation. Thus, the purpose of this study was to assess the feasibility of wearable haptic biofeedback to assess short-term retention and cognitive demand during FPA gait modification. Ten healthy participants performed toe-in (target 10 degrees change in internal rotation) and toe-out (target 10 degrees change in external rotation) haptic gait training trials followed by short-term retention trials, and cognitive multitasking trials. Results showed that participants were able to initially respond to the wearable haptic feedback to modify their FPA to adopt the new toe-in (9.7 ± 0.8 degree change in internal rotation) and toe-out (8.9 ± 1.0 degree change in external rotation) gait patterns. Participants retained the modified gait pattern on average within 3.9 ± 3.6 deg of the final haptic gait training FPA values. Furthermore, cognitive multitasking did not influence short-term retention in that there were no differences in gait performance during retention trials with or without cognitive multitasking. These results demonstrate that wearable haptic biofeedback can be used to assess short-term retention and cognitive demand during FPA gait modification without the need for traditional, tethered systems.

Comparing the kinematic output of the Oxford and Rizzoli Foot Models during normal gait and voluntary pathological gait in healthy adults

BackgroundThe Oxford Foot Model (OFM) and Rizzoli Foot Model (RFM) are the two most frequently used multi-segment models to measure foot kinematics. However, a comprehensive comparison of the kinematic output of these models is lacking. Research questionWhat are the differences in kinematic output between OFM and RFM during normal gait and typical pathological gait patterns in healthy adults?. MethodsA combined OFM and RFM marker set was placed on the right foot of ten healthy subjects. A static standing trial and six level walking trials were collected for normal gait and for four voluntarily adopted gait types: equinus, crouch, toe-in and toe-out. Joint angles were calculated for every trial for the hindfoot relative to shank (HF-SH), forefoot relative to hindfoot (FF-HF) and hallux relative to forefoot (HX-FF). Average static joint angles of both models were compared between models. After subtracting these offsets, the remaining dynamic angles were compared using statistical parametric mapping repeated measures ANOVAs and t-tests. Furthermore, range of motion was compared between models for every angle. ResultsFor the static posture, RFM compared to OFM measured more plantar flexion (Δ = 6°) and internal rotation (Δ = 7°) for HF-SH, more plantar flexion (Δ = 34°) and inversion (Δ = 13°) for FF-HF and more dorsal flexion (Δ = 37°) and abduction (Δ = 12°) for HX-FF. During normal walking, kinematic differences were found in various parts of the gait cycle. Moreover, range of motion was larger in the HF-SH for OFM and in FF-HF and HX-FF for RFM. The differences between models were not the same for all gait types. Equinus and toe-out gait demonstrated most pronounced differences. SignificanceDifferences are present in kinematic output between OFM and RFM, which also depend on gait type. Therefore, kinematic output of foot and ankle studies should be interpreted with careful consideration of the multi-segment foot model used.

The effect of modifying foot progression angle on the knee loading parameters in healthy participants with different static foot postures

BackgroundStudies have found that toe-in gait reduced the peak knee adduction moment (KAM) during early stance, while toe-out gait reduced the peak KAM during late stance. However, some other studies found that toe-in or toe-out gait could reduce the KAM throughout stance phase. There is still a divergence of opinion on the use of toe-in or toe-out gait for reducing the KAM. Research questionThis study aimed to investigate whether static foot posture affected participants’ biomechanical responses to three self-selected foot progression angles (FPA): neutral, toe-out and toe-in. MethodsTwenty-seven healthy participants were recruited for this FPA gait modification experiment and classified into three groups: neutral (n = 8), supination (n = 9) and pronation (n = 10), based on the Foot Posture Index (FPI). The kinematic and kinetic data were recorded with Vicon motion capture system and three force plates. The knee adduction moment and ankle eversion moment were calculated using an inverse dynamics model. The effect of the FPA modification on the knee loading parameters was analysed by the Friedman non-parametric test. ResultsThe KAM results in the neutral group showed that the toe-in gait modification reduced the first peak of the KAM (KAM1), while the KAM1 was increased in the supination group. The effect of the FPA modification on the KAM1 did not reach significance in the pronation group. The toe-out gait modification reduced the second peak (KAM2) regardless of the static posture. SignificanceDifferent static foot postures were correlated with different peak KAM during the early stance phase due to FPA modification. These data suggest that the assessment of static foot posture provides a reference on how to offer adequate FPA modification for knee OA patients with different foot postures.

Orthoses versus gait retraining: Immediate response in improving physical performance measures in healthy and medial knee osteoarthritic adults.

The conservative techniques of treating knee osteoarthritis (kOA) include wearing orthoses such as knee braces and laterally wedged insoles and applying gait modification techniques such as toe-in gait and toe-out gait. This study aimed at assessing the immediate effects of these techniques in improving physical function of healthy and kOA participants. Five Osteoarthritis Research Society International (OARSI) recommended performance-based tests were randomly applied to measure physical function: (1) 30-second chair stand test (30CST), (2) 40-m (4 × 10) fast-paced walk test (40FPW), (3) stair climb test (SCT), (4) timed up and go test (TUGT) and (5) 6-minute walk test (6MWT) during a single-visit on 20 healthy and 20 kOA patients (age: 59.5 ± 7.33 and 61.5 ± 8.63 years, BMI: 69.95 ± 9.86 and 70.45 ± 8.80 kg/m2). The interventions included natural gait, toe-out gait, toe-in gait, laterally wedged insoles and knee brace. Analysis was performed through repeated-measures ANOVA and independent sample t-test. 30CST and TUGT showed no significant differences for the five test conditions (p > 0.05). Toe-out showed profound effects via pairwise comparison in impairing the physical function while knee brace improved it during 40FPW, SCT and 6MWT. In general, all the tested conservative techniques except laterally wedged insoles had immediate effects on physical performance measures in both healthy and medial knee osteoarthritis participants. The valgus knee brace improved the parameters the most, while toe-out gait impaired them the most. Future studies can develop strategies for improving gait retraining methods on the basis of issues identified by this study.

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

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 &lt; 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 &lt; 0.05) and the max angle of hip adduction by 1.28 and 0.99 degrees respectively (p &lt; 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 &lt; 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.

Does dynamic knee adduction angle impact clinical response to a toe-out gait modification intervention?

Does dynamic knee adduction angle impact clinical response to a toe-out gait modification intervention?