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, CINAHL, Web of Science, and SPORTDiscus were searched from inception to February 2020 by two independent reviewers. Included studies compared FPA modification (toe‐in or toe‐out gait) interventions to lower EKAM and KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI.
Sixteen studies were included, and more than 85% of included patients were graded with Kellgren‐Lawrence II‐IV knee OA. Toe‐in gait reduced the first EKAM peak (standard mean difference (SMD): ‐0.75; 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.
The 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 future research is required.
Ref: https://onlinelibrary.wiley.com/doi/10.1002/acr.24420
