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.

Automated summary

This study examined how altering the foot progression angle affects hip moments in individuals with knee osteoarthritis. The results showed that modifying the foot progression angle can reduce hip moments without increasing the joint loading.