Highlights
- •Toe out gait suggested method of reducing the knee adduction moment.
- •First to study toe out gait and high tibial osteotomy.
- •No significant reduction in first or second peak knee adduction moment or adduction angular impulse with toe out gait.
- •High tibial osteotomy significantly reduced both knee adduction moment peaks to within healthy limits.
- •Toe out gait post high tibial osteotomy lowered knee adduction moment to below healthy controls.
Abstract
Background
Gait 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.
Methods
Three-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.
Findings
Pre-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.
Interpretation
Increasing 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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical BiomechanicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Biomechanics of high tibial osteotomy.Knee Surg. Sports Traumatol. Arthrosc. 2013; 21: 197-205
- Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: a critical analysis of the reliability of gait analysis data.J. Orthop. Res. 1996; 14: 289-295
- Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis.Ann. Rheum. Dis. 2011; 70: 1770-1774
- Internal kinetic changes in the knee due to high tibial osteotomy are well correlated with change in external adduction moment: an osteoarthritic knee model.J. Biomech. 2010; 43: 2261-2266
- Medial opening wedge high tibial osteotomy: a prospective cohort study of gait, radiographic, and patient-reported outcomes.Arthritis Rheum. 2009; 61: 648-657
- Effects of the amount of valgus correction for medial compartment knee osteoarthritis on clinical outcome, knee kinetics and muscle co-contraction after opening wedge high tibial osteotomy.J. Orthop. Res. 2007; 25: 311-318
- Effect of specific gait modifications on medial knee loading, metabolic cost and perception of task difficulty.Clin. Biomech. 2013; 28: 649-654
- The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis.Ann. Rheum. Dis. 2007; 66: 1271-1275
- Questionnaire on the perceptions of patients about total knee replacement.J. Bone Joint Surg. (Br.). 1998; 80-B: 63-69
- Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length.Clin. Orthop. Relat. Res. 1992; 274: 248-264
- High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci's method.Knee Surg. Sports Traumatol. Arthrosc. 2014; (Available as ePub)
- The influence of foot progression angle on the knee adduction moment during walking and stair climbing in pain free individuals with knee osteoarthritis.Gait Posture. 2007; 26: 436-441
- Open wedge tibial osteotomy: combined coronal and sagittal correction.Knee. 2002; 9: 15-20
- Predicting dynamic knee joint load with clinical measures in people with medial knee osteoarthritis.Knee. 2011; 18: 231-234
- Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study.Osteoarthr. Cartil. 2014; 22: 904-911
- The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain.J. Orthop. Res. 2002; 20: 101-107
- Toe-out gait in patients with knee osteoarthritis partially transforms the external knee adduction moment into flexion moment during early stance phase of gait: a tri-planar kinetic mechanism.J. Biomech. 2008; 41: 276-283
- Comparison of peak knee adduction moment and knee adduction moment impulse in distinguishing between severities of knee osteoarthritis.Clin. Biochem. 2012; 27: 520-523
- Radiological assessment of osteo-arthrosis.Ann. Rheum. Dis. 1957; 16: 494-502
- The effect of changing the foot progression angle on the knee adduction moment in normal teenagers.Gait Posture. 2001; 14: 85-91
- Gait analysis of walking before and after medial opening wedge high tibial osteotomy.Knee Surg. Sports Traumatol. Arthrosc. 2013; 21: 74-81
- Improvements in surgical technique of valgus high tibial osteotomy.Knee Surg. Sports Traumatol. Arthrosc. 2003; 11: 132-138
- Effect of foot rotation on knee kinetics and hamstring activation in older adults with and without signs of knee osteoarthritis.Clin. Biomech. 2008; 23: 779-786
- The effect of internal and external foot rotation on the adduction moment and lateral-medial shear force at the knee during gait.J. Sci. Med. Sport. 2008; 11: 444-451
- Dynamic load at baseline can predict radiographic disease progression in medial compartment knee steoarthritis.Ann. Rheum. Dis. 2002; 61: 617-622
- Secondary gait changes in patients with medial compartment knee osteoarthritis increased load at the ankle, knee, and hip during walking.Arthritis Rheum. 2005; 52: 2835-2844
- Deformity planning for frontal and sagittal plane corrective osteotomies.Orthop. Clin. North Am. 1994; 25: 425-465
- Uncertainties surrounding the choice of surgical treatment for ‘bone on bone’ medial compartment arthritis of the knee.Knee. 2013; 20: S16-S20
- A relationship between gait and clinical changes following high tibial osteotomy.J. Bone Joint Surg. Am. 1985; 67: 1188-1194
- A computational framework to predict post-treatment outcome for gait-related disorders.Med. Eng. Phys. 2008; 30: 434-443
- Foot progression angle and the knee adduction moment: a cross-sectional investigation in knee osteoarthritis.Osteoarthr. Cartil. 2008; 16: 883-889
- The effect of gait modification on the external knee adduction moment is reference frame dependent.Clin. Biomech. 2008; 23: 601-608
- Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis.J. Biomech. 2013; 46: 122-128
- Gait modification strategies for altering medial knee joint load: a systematic review.Arthritis Care Res. 2011; 63: 405-426
- Altering foot progression angle in people with medial knee osteoarthritis: the effects of varying toe-in and toe-out angles are mediated by pain and malalignment.Osteoarthr. Cartil. 2013; 21: 1272-1280
- Bone mineral density in the proximal tibia varies as a function of static alignment and knee adduction angular momentum in individuals with medial knee osteoarthritis.Bone. 2006; 39: 1116-1122
- Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis.Arthritis Rheum. 2007; 57: 1254-1260
- The effectiveness of voluntary modifications of gait pattern to reduce the knee adduction moment.Hum. Mov. Sci. 2013; 32: 412-424
- Decreased knee adduction moment does not guarantee decreased medial contact force during gait.J. Orthop. Res. 2010; 28: 1348-1354
- The influence of walking mechanics and time on the results of proximal tibial osteotomy.JBJS. 1990; 6: 905-909
- Change of adduction moment about the hip, knee and ankle joints after high tibial osteotomy in osteoarthrosis of the knee.Clin. Biomech. 1992; 7: 177-180
- Correlation between the knee adduction torque and medial contact force for a variety of gait patterns.J. Orthop. Res. 2007; 25: 789-797
Article Info
Publication History
Published online: February 14, 2017
Accepted:
February 13,
2017
Received:
August 12,
2015
Identification
Copyright
© 2017 Published by Elsevier Ltd.
