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Ankle Joint and Rearfoot Biomechanics During Toe‐In and Toe‐Out Walking in People With Medial Compartment Knee Osteoarthritis
Author(s) -
Charlton Jesse M.,
Hatfield Gillian L.,
Guenette Jordan A.,
Hunt Michael A.
Publication year - 2019
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2018.08.388
Subject(s) - osteoarthritis , ankle , medicine , biomechanics , physical medicine and rehabilitation , compartment (ship) , knee joint , joint (building) , toe , physical therapy , anatomy , surgery , pathology , engineering , alternative medicine , architectural engineering , oceanography , automotive engineering , geology
Background Toe‐in and toe‐out walking are 2 strategies that have been shown to be effective in reducing the knee adduction moment in people with knee osteoarthritis. However, despite a positive biomechanical impact on the knee, altering foot rotation may impart unintended forces or joint positions on the ankle that could impact joint health. The kinematic and kinetic changes at the ankle during toe‐in or toe‐out walking have yet to be examined. Objective To examine ankle/rearfoot biomechanics during toe‐in and toe‐out walking in those with knee osteoarthritis. Design Single‐session repeated measures design to compare ankle biomechanics during walking with 4 different foot rotations. Setting University motion analysis laboratory. Participants A convenience sample (N = 15) of males and females with a diagnosis of medial knee osteoarthritis confirmed by radiographs. Methods Participants walked in 4 conditions guided by real‐time biofeedback: (1) toe‐in (+10°), (2) zero rotation (0°), (3) toe‐out (−10°), and (4) toe‐out (−20°). Ankle and rearfoot kinematics and kinetics were examined during barefoot over‐ground walking. Main Outcome Measures Ankle joint angles, moments, moment impulses, and foot rotation. Results Overall, toe‐in compared to toe‐out walking decreased ( P = .03) peak rearfoot eversion (toe‐in = −1.6°; 10° toe‐out = −3.7°; 20° toe‐out = −4.1°). Toe‐in compared to toe‐out walking also increased rearfoot inversion at initial contact (7.4° vs 3.1° at 10° toe‐out and 1.9° at 20° toe‐out; P < .001) and frontal plane rearfoot angle excursion (9.0° vs 6.8° at 10° toe‐out and 6.0° at 20° toe‐out; P < .006). Toe‐in compared to all other conditions increased peak external ankle inversion moments (0.04 Nm/kg vs 0.02 Nm/kg at 0°, 0.02 Nm/kg at 10° toe‐out, and 0.01 Nm/kg at 20° toe‐out; P < .003). Conclusions Toe‐in and toe‐out walking require different ankle/rearfoot biomechanics, though no differences in discomfort were observed. Longer‐term studies are required to properly assess these relationships in knee osteoarthritis populations. Level of Evidence IV