1
|
Moseng T, Vliet Vlieland TPM, Battista S, Beckwée D, Boyadzhieva V, Conaghan PG, Costa D, Doherty M, Finney AG, Georgiev T, Gobbo M, Kennedy N, Kjeken I, Kroon FPB, Lohmander LS, Lund H, Mallen CD, Pavelka K, Pitsillidou IA, Rayman MP, Tveter AT, Vriezekolk JE, Wiek D, Zanoli G, Østerås N. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis 2024; 83:730-740. [PMID: 38212040 PMCID: PMC11103326 DOI: 10.1136/ard-2023-225041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed. METHODS The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed. RESULTS The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work. CONCLUSIONS The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.
Collapse
Affiliation(s)
- Tuva Moseng
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Simone Battista
- University of Genoa Department of Neuroscience Ophthalmological Rehabilitation Genetics and Mother and Child Health, Genova, Italy
| | - David Beckwée
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Vladimira Boyadzhieva
- UMHAT "St. Iv. Rilski" Clinic of Rheumatology, Medical University Sofia, Sofia, Bulgaria
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomechanical Reserch Centre, Leeds, UK
| | - Daniela Costa
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Andrew G Finney
- Research Institute for Primary Care and Health Sciences, Keele University School of Medicine, Keele, UK
- School of Nursing and Midwifery, Keele University, Keele, UK
| | - Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital St. Marina, First Department of Internal Medicine, Medical University Varna, Varna, Bulgaria
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, Spain
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ingvild Kjeken
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Hans Lund
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Karel Pavelka
- Institute of Rheumatology, Department of Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Irene A Pitsillidou
- EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Margaret P Rayman
- Department of Nutritional Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Dieter Wiek
- EULAR Patient Research Partner, Deutsche Rheuma-Liga, Bonn, Germany
| | - Gustavo Zanoli
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Novara, Italy
| | - Nina Østerås
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
2
|
Diamond LE, Grant T, Uhlrich SD. Osteoarthritis year in review 2023: Biomechanics. Osteoarthritis Cartilage 2024; 32:138-147. [PMID: 38043858 DOI: 10.1016/j.joca.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Biomechanics plays a significant yet complex role in osteoarthritis (OA) onset and progression. Identifying alterations in biomechanical factors and their complex interactions is critical for gaining new insights into OA pathophysiology and identification of clearly defined and modifiable mechanical treatment targets. This review synthesized biomechanics studies from March 2022 to April 2023, from which three themes relating to human gait emerged: (1) new insights into the pathogenesis of OA using computational modeling and machine learning, (2) technology-enhanced biomechanical interventions for OA, and (3) out-of-lab biomechanical assessments of OA. We further highlighted future-focused areas which may continue to advance the field of biomechanics in OA, with a particular emphasis on exploiting technology to understand and treat biomechanical mechanisms of OA outside the laboratory. The breadth of studies included in this review highlights the complex role of biomechanics in OA and showcase numerous innovative and outstanding contributions to the field. Exciting cross-disciplinary efforts integrating computational modeling, mobile sensors, and machine learning methods show great promise for streamlining in vivo multi-scale biomechanics workflows and are expected to underpin future breakthroughs in the understanding and treatment of biomechanics in OA.
Collapse
Affiliation(s)
- Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - Tamara Grant
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - Scott D Uhlrich
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
| |
Collapse
|
3
|
Hunt MA, Tse CTF, Ryan MB, Scott A, Sayre EC. Clinically-accessible and laboratory-derived predictors of biomechanical response to standalone and supported lateral wedge insoles in people with knee osteoarthritis. J Foot Ankle Res 2023; 16:74. [PMID: 37885001 PMCID: PMC10601168 DOI: 10.1186/s13047-023-00671-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Lateral wedge insoles (both standalone and those incorporating individualized arch support) have been frequently studied for the effects on knee joint loading and pain in people with knee osteoarthritis. It has been shown that many people who use these insoles do not obtain the intended biomechanical effect, and thus may not experience a clinical benefit. The ability to identify biomechanical responders to lateral wedge insoles before research or clinical intervention is an important objective for efficient resource use and optimizing patient outcomes. The purpose of our exploratory, hypothesis-generating study was to provide an initial assessment of variables that are associated with the biomechanical response to lateral wedge insoles in people with knee osteoarthritis. METHODS We collected a number of demographic (age, sex, body mass index, foot posture), clinical (knee pain, foot pain, radiographic disease severity), and walking-related (speed, knee alignment, frontal plane subtalar movement, and foot rotation) outcomes from 53 individuals with painful, radiographically-confirmed knee osteoarthritis. The walking-related outcomes were obtained using equipment both from the research laboratory and the clinical setting. We used logistic regression to generate predictive models to determine candidate variables associated with a reduction in the knee adduction moment during walking - a surrogate for tibiofemoral load distribution, and a known biomechanical risk factor for osteoarthritis progression - with the use of standalone and arch-supported lateral wedge insoles. Three different response thresholds (2%, 6%, and 10% reductions in the knee adduction moment) were used. RESULTS In general, biomechanical responders were those who walked faster, were female, had less varus alignment, and had less severe radiographic severity. Findings were similar between the standalone and arch-supported lateral wedge insoles, as well as between models using the laboratory-derived or clinically-available measures of walking performance. CONCLUSIONS Our hypothesis-generating study provides valuable information that will inform future research into the efficient and effective use of lateral wedge insoles in the conservative management of knee osteoarthritis.
Collapse
Affiliation(s)
- Michael A Hunt
- Department of Physical Therapy, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.
| | - Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Kintec Footlabs Inc., Surrey, BC, Canada
| | - Michael B Ryan
- Kintec Footlabs Inc., Surrey, BC, Canada
- School of Mechatronic Systems Engineering, Simon Fraser University, Burnaby, BC, Canada
| | - Alexander Scott
- Department of Physical Therapy, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eric C Sayre
- British Columbia Centre On Substance Use, Vancouver, BC, Canada
| |
Collapse
|
4
|
Uhlrich SD, Falisse A, Kidziński Ł, Muccini J, Ko M, Chaudhari AS, Hicks JL, Delp SL. OpenCap: Human movement dynamics from smartphone videos. PLoS Comput Biol 2023; 19:e1011462. [PMID: 37856442 PMCID: PMC10586693 DOI: 10.1371/journal.pcbi.1011462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/24/2023] [Indexed: 10/21/2023] Open
Abstract
Measures of human movement dynamics can predict outcomes like injury risk or musculoskeletal disease progression. However, these measures are rarely quantified in large-scale research studies or clinical practice due to the prohibitive cost, time, and expertise required. Here we present and validate OpenCap, an open-source platform for computing both the kinematics (i.e., motion) and dynamics (i.e., forces) of human movement using videos captured from two or more smartphones. OpenCap leverages pose estimation algorithms to identify body landmarks from videos; deep learning and biomechanical models to estimate three-dimensional kinematics; and physics-based simulations to estimate muscle activations and musculoskeletal dynamics. OpenCap's web application enables users to collect synchronous videos and visualize movement data that is automatically processed in the cloud, thereby eliminating the need for specialized hardware, software, and expertise. We show that OpenCap accurately predicts dynamic measures, like muscle activations, joint loads, and joint moments, which can be used to screen for disease risk, evaluate intervention efficacy, assess between-group movement differences, and inform rehabilitation decisions. Additionally, we demonstrate OpenCap's practical utility through a 100-subject field study, where a clinician using OpenCap estimated musculoskeletal dynamics 25 times faster than a laboratory-based approach at less than 1% of the cost. By democratizing access to human movement analysis, OpenCap can accelerate the incorporation of biomechanical metrics into large-scale research studies, clinical trials, and clinical practice.
Collapse
Affiliation(s)
- Scott D. Uhlrich
- Departments of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Antoine Falisse
- Departments of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Łukasz Kidziński
- Departments of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Julie Muccini
- Radiology, Stanford University, Stanford, California, United States of America
| | - Michael Ko
- Radiology, Stanford University, Stanford, California, United States of America
| | - Akshay S. Chaudhari
- Radiology, Stanford University, Stanford, California, United States of America
- Biomedical Data Science, Stanford University, Stanford, California, United States of America
| | - Jennifer L. Hicks
- Departments of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Scott L. Delp
- Departments of Bioengineering, Stanford University, Stanford, California, United States of America
- Mechanical Engineering, Stanford University, Stanford, California, United States of America
- Orthopaedic Surgery, Stanford University, Stanford, California, United States of America
| |
Collapse
|
5
|
Ueda T, Chikamoto T, Asaeda M, Araki T, Ueda K, Ushio K, Mikami Y. Kinematic effects of lateral wedged insoles in patients with medial knee osteoarthritis. J Phys Ther Sci 2023; 35:667-672. [PMID: 37670760 PMCID: PMC10475640 DOI: 10.1589/jpts.35.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/31/2023] [Indexed: 09/07/2023] Open
Abstract
[Purpose] To examine the effect of lateral wedged insoles on the rotation mechanism of the knee joint in patients with knee osteoarthritis. [Participants and Methods] The participants included 11 patients with medial knee osteoarthritis. We asked all participants to stand up from a 40-cm-high chair, and we measured the rotation angle of the knee joint during the movement. The standing motion was performed under four conditions: barefoot and with 7-, 10-, and 13-mm lateral wedged insoles. We also measured four healthy participants as controls for comparison. [Results] During the standing motion, we internally rotated the tibia relative to the femur. In healthy participants, we measured 19.6° internal rotation of the tibia relative to the femur. Patients with knee osteoarthritis had internal rotations of approximately 9.8° when barefoot and 7.1°, 6.4°, and 7.1° when wearing lateral wedged insoles of 7, 10, and 13 mm, respectively. [Conclusion] Lateral wedged insoles do not modify the knee joint rotation motion of patients with knee OA to the correct style.
Collapse
Affiliation(s)
- Takehito Ueda
- Department of Rehabilitation, Merry Hospital: 3-1-20 Ohzuka
Nishi, Asaminami-ku, Hrioshima-shi, Hiroshima 731-3167, Japan
| | | | - Makoto Asaeda
- Takarazuka University of Medical and Health Care,
Japan
| | - Takeya Araki
- Department of Rehabilitation, Hiroshima University
Hospital, Japan
| | - Kiyo Ueda
- Department of Rehabilitation, Hiroshima University
Hospital, Japan
| | - Kai Ushio
- Department of Rehabilitation, Hiroshima University
Hospital, Japan
| | - Yukio Mikami
- Department of Rehabilitation, Hiroshima University
Hospital, Japan
| |
Collapse
|
6
|
Charlton JM, Krowchuk NM, Eng JJ, Li LC, Hunt MA. Remotely delivered, individualized, and self-directed gait modification for knee osteoarthritis: A pilot trial. Clin Biomech (Bristol, Avon) 2023; 106:105981. [PMID: 37201438 DOI: 10.1016/j.clinbiomech.2023.105981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Gait modification interventions have reported variable results and relied on in-person biofeedback limiting clinical accessibility. Our objective was to assess a remotely delivered and self-directed gait modification for knee osteoarthritis. METHODS This was an unblinded, 2-arm, delayed control, randomized pilot trial (NCT04683913). Adults aged ≥50 years with symptomatic medial knee osteoarthritis were randomized to an immediate group (Week 0: Baseline, Intervention; Week 6: Follow-up, Week 10: Retention) or delayed group (Week 0: Baseline, Wait Period, Week 6: Secondary Baseline, Intervention, Week 12: Follow-up, Week 16: Retention). Participants practiced modifying their foot progression angle "as much as was comfortable" while receiving support via weekly telerehabilitation appointments and remote monitoring with an instrumented shoe. Primary outcomes included participation, foot progression angle modification magnitude, confidence, difficulty, and satisfaction while secondary outcomes included symptoms and knee biomechanics during gait. RESULTS We screened 134 people and randomized 20. There was no loss to follow up and 100% attendance at the telerehabilitation appointments. By follow up, participants reported high confidence (8.6/10), low difficulty (2.0/10), and satisfaction (75%) with the intervention and no significant adverse events. Foot progression angle was modified by 11.4° ± 5.6, which was significantly different (p < 0.001, η2g = 0.8) when compared between groups. No other between-group differences were significant, while several significant pre-post improvements in pain (d = 0.6, p = 0.006) and knee moments (d = 0.6, p = 0.01) were observed. INTERPRETATION A personalized, self-directed gait modification supported with telerehabilitation is feasible, and the preliminary effects on symptoms and biomechanics align with past trials. A larger trial is warranted to evaluate efficacy.
Collapse
Affiliation(s)
- Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada.
| | - Natasha M Krowchuk
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
| |
Collapse
|
7
|
Walking with Different Insoles Changes Lower-Limb Biomechanics Globally in Patients with Medial Knee Osteoarthritis. J Clin Med 2023; 12:jcm12052016. [PMID: 36902803 PMCID: PMC10004584 DOI: 10.3390/jcm12052016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Using insoles to modify walking biomechanics is of keen interest for the treatment of medial-compartment knee osteoarthritis. So far, insole interventions have focused on reducing the peak of the knee adduction moment (pKAM) and have led to inconsistent clinical outcomes. This study aimed to evaluate the changes in other gait variables related to knee osteoarthritis when patients walk with different insoles to provide insights into the necessity to enlarge the biomechanical analyses to other variables. Walking trials were recorded for 10 patients in four insole conditions. Changes among conditions were computed for six gait variables, including the pKAM. The associations between the changes in pKAM and the changes in the other variables were also assessed individually. Walking with different insoles had noticeable effects on the six gait variables, with high heterogeneity among patients. For all variables, at least 36.67% of the changes were of medium-to-large effect size. The associations with the changes in pKAM varied among variables and patients. In conclusion, this study showed that varying the insole could globally influence ambulatory biomechanics and that limiting measurement to the pKAM could lead to an important loss of information. Beyond the consideration of additional gait variables, this study also encourages personalized interventions to address inter-patient variability.
Collapse
|
8
|
Jeong BO, Jeong SJ, Park K, Kim BH, Yim SV, Kim S. Effects of three-dimensional image based insole for healthy volunteers: a pilot clinical trial. Transl Clin Pharmacol 2023; 31:49-58. [PMID: 37034127 PMCID: PMC10079510 DOI: 10.12793/tcp.2023.31.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Insoles are used to treat various foot diseases, including plantar foot, diabetic foot ulcers, and refractory plantar fasciitis. In this study, we investigated the effects of 3-dimensional image-based (3-D) insole in healthy volunteers with no foot diseases. Additionally, the comfort of the 3-D insole was compared with that of a custom-molded insole. A single-center, randomized, open clinical trial was conducted to address the effectiveness of insole use in a healthy population with no foot or knee disease. Two types of arch support insoles were evaluated for their effectiveness: a 3-D insole and a custom-molded insole. Fifty Korean volunteers participated in the study and were randomly allocated into the "3-D insole" (n = 40) or "custom-molding insole" (n = 10) groups. All subjects wore 3-D insoles or custom-molded insoles for 2 weeks. The sense of wearing shoes (Visual Analog Scale [VAS] and score) and fatigue of the foot were used to assess the insole effects at the end of the 2-week study period. The 3-D insole groups showed significantly improved sense of wearing shoes (VAS, p = 0.0001; score, p = 0.0002) and foot fatigue (p = 0.0005) throughout the study period. Although the number of subjects was different, the custom-molding insole group showed no significant changes in the sense of wearing shoes (VAS, 0.1188; score, p = 0.1483). Foot fatigue in the 3-D insole group improved significantly (p = 0.0005), which shows that a 3-D insole might have favorable effects on foot health in a healthy population. Trial Registration Clinical Research Information Service Identifier: KCT0008100.
Collapse
Affiliation(s)
- Bi O Jeong
- Department of Orthopedic Surgery, Kyung Hee University Medical Center, Seoul 02447, Korea
| | - Su Jin Jeong
- Medical Science Research Institute, Kyung Hee University Medical Center, Seoul 02447, Korea
| | | | - Bo-Hyung Kim
- Department of Clinical Pharmacology and Therapeutics, Kyung Hee University Medical Center, Seoul 02447, Korea
- East-West Medical Research Institute, Kyung Hee University, Seoul 02447, Korea
| | - Sung-Vin Yim
- Department of Clinical Pharmacology and Therapeutics, Kyung Hee University Medical Center, Seoul 02447, Korea
| | - Sehyun Kim
- Graduate School of Dankook University, Yongin 16890, Korea
| |
Collapse
|
9
|
Walking with shorter stride length could improve knee kinetics of patients with medial knee osteoarthritis. J Biomech 2023; 147:111449. [PMID: 36680887 DOI: 10.1016/j.jbiomech.2023.111449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 12/07/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Walking with a shorter stride length (SL) was recently proposed for gait retraining in medial knee osteoarthritis; however it was never assessed in this patient population. This study tested the hypothesis that shortening SL while maintaining walking speed reduces knee adduction (KAM) and flexion (KFM) moments in patients with medial knee osteoarthritis. Walking trials with normal SL and SL reduced by 0.10 m and 0.15 m were recorded for 15 patients (10 men, 55.5 ± 8.7 years old, 24.6 ± 3.0 kg/m2). SL was modified using an augmented reality system displaying target footprints on the floor. Repeated one-way ANOVAs and post-hoc paired t-tests were performed to compare gait measures between normal and reduced SL. The individual effects of SL reduction were analyzed using descriptive statistics. Group analysis indicated significant decreases in KAM impulse with both SL reductions (p < 0.05). No systematic change was observed in the first peaks KAM and KFM when walking with reduced SL (p > 0.05). Individually, 33 % of the patients decreased the peak KAM, whereas 20 % decreased the KAM impulse. Among these patients with a decrease in peak KAM or in KAM impulse, 0 % and 33 % had a simultaneous increase in peak KFM, respectively. In conclusion, this study showed that SL shortening can decrease kinetic measures associated with the progression of medial knee osteoarthritis in some patients, demonstrating the importance of considering SL modifications on an individual basis. While further research is necessary, notably regarding dose-response relationships and long-term effects, these findings are particularly encouraging because SL reductions could be easily integrated into rehabilitation protocols.
Collapse
|
10
|
Hsu WC, Chou LW, Chiu HY, Hsieh CW, Hu WP. A Study on the Effects of Lateral-Wedge Insoles on Plantar-Pressure Pattern for Medial Knee Osteoarthritis Using the Wearable Sensing Insole. SENSORS (BASEL, SWITZERLAND) 2022; 23:84. [PMID: 36616681 PMCID: PMC9824433 DOI: 10.3390/s23010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Patients with knee osteoarthritis have a unique plantar-pressure pattern during walking, and lateral-wedge insoles are one of the treatment options. Participants were randomly assigned to either the lateral-wedge insole group or the ordinary insole group. The Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and plantar-pressure test scores were evaluated at the baseline and at 20 weeks. Plantar pressure data were collected using a pressure insole with 89 sensing locations. In the ordinary insole group, the function and total WOMAC scores decreased significantly (function score, 24.8 (baseline) to 16.5 (week 20); total score, 34.9 (baseline) to 24.6 (week 20)). During walking, the transverse width of the center of pressure as a percentage of foot width (%Trans) significantly increased in the ordinary insole group (baseline, 6.3%; week 20, 14.8%). In addition, the values of partial foot pressure as a percentage of body weight (%PFP) on the forefoot (baseline, 30.3%; week 20, 39.2%) and heel (baseline, 28.1%; week 20, 16.9%) also increased significantly in the ordinary insole group. Significant group-by-time interaction effects were observed for partial foot pressure per body weight in the forefoot (p = 0.031) and heel (p = 0.024). In the ordinary insole group, the plantar pressure on the heel significantly decreased (p = 0.011) and that on the forefoot significantly increased (p = 0.023). In contrast, plantar pressure remained stable in all regions in the lateral-wedge insole group. Thus, lateral-wedge insoles may protect against plantar pressure deterioration in patients with knee osteoarthritis.
Collapse
Affiliation(s)
- Wei-Ching Hsu
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung City 41354, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Taichung City 41354, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Taichung City 41354, Taiwan
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung City 40402, Taiwan
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung City 40402, Taiwan
| | - Hsiao-Yen Chiu
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung City 41354, Taiwan
| | - Chang-Wei Hsieh
- Department of Computer Science & Information Engineering, Asia University, Taichung City 41354, Taiwan
| | - Wen-Pin Hu
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung City 41354, Taiwan
| |
Collapse
|
11
|
Toyooka S, Tsukada K, Yasui Y, Saho Y, Okawa Y, Ando S, Nakagawa T, Kawano H, Miyamoto W. Association of medial arch support of foot orthoses with knee valgus angle at initial contact during cutting maneuvers in female athletes: a controlled laboratory study. BMC Sports Sci Med Rehabil 2022; 14:214. [PMID: 36536460 PMCID: PMC9762016 DOI: 10.1186/s13102-022-00608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The effect of medial arch support foot orthoses on kinematics and kinetics of the knee joint has remained unknown. METHODS Sixteen female collegiate-level athletes volunteered to participate. Participants were asked to perform a 30° sidestep cut using orthoses of 3 different medial arch heights, comprising of the following: (1) "low," a full flat foot orthosis without arch support, (2) "mid," a commercially available foot orthosis with general height arch support, and (3) "high," a foot orthosis with double the commercially available height for arch support to observe the effect on the knee when overcorrected. Kinematics and kinetics of the knee joint were collected by a markerless motion capture system with 2 force plates and compared between orthosis types using linear regression analysis, assuming a correlation between the measurements of the same cases in the error term. RESULTS The knee valgus angle at initial contact was 2.3 ± 5.2 degrees for "low" medial arch support height, 2.1 ± 5.8 degrees for "mid," and 0.4 ± 6.6 degrees for "high". Increased arch support height significantly decreased the knee valgus angle at initial contact (p = 0.002). Other kinematic and kinetic measurements did not differ between groups. CONCLUSIONS The valgus angle of the knee at initial contact was decreased by the height of the medial arch support provided by foot orthosis during cutting manoeuvres. Increasing the arch support height may decrease knee valgus angle at initial contact. Medial arch support of foot orthosis may be effective in risk reduction of ACL injury. Clinical trial registration numbers and date of registration: UMIN000046071, 15/11/2021.
Collapse
Affiliation(s)
- Seikai Toyooka
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Keisuke Tsukada
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Youich Yasui
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Yasuaki Saho
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan ,grid.264706.10000 0000 9239 9995Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yasuaki Okawa
- grid.264706.10000 0000 9239 9995Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Shuji Ando
- grid.143643.70000 0001 0660 6861Tokyo University of Science, Tokyo, Japan
| | - Takumi Nakagawa
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Hirotaka Kawano
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Wataru Miyamoto
- grid.264706.10000 0000 9239 9995Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| |
Collapse
|
12
|
Uhlrich SD, Kolesar JA, Kidziński Ł, Boswell MA, Silder A, Gold GE, Delp SL, Beaupre GS. Personalization improves the biomechanical efficacy of foot progression angle modifications in individuals with medial knee osteoarthritis. J Biomech 2022; 144:111312. [PMID: 36191434 PMCID: PMC9889103 DOI: 10.1016/j.jbiomech.2022.111312] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 09/13/2022] [Indexed: 02/02/2023]
Abstract
Modifying the foot progression angle during walking can reduce the knee adduction moment, a surrogate measure of medial knee loading. However, not all individuals reduce their knee adduction moment with the same modification. This study evaluates whether a personalized approach to prescribing foot progression angle modifications increases the proportion of individuals with medial knee osteoarthritis who reduce their knee adduction moment, compared to a non-personalized approach. Individuals with medial knee osteoarthritis (N=107) walked with biofeedback instructing them to toe-in and toe-out by 5° and 10° relative to their self-selected angle. We selected individuals' personalized foot progression angle as the modification that maximally reduced their larger knee adduction moment peak. Additionally, we used lasso regression to identify which secondary kinematic changes made a 10° toe-in gait modification more effective at reducing the first knee adduction moment peak. Seventy percent of individuals reduced their larger knee adduction moment peak by at least 5% with a personalized foot progression angle modification, which was more than (p≤0.002) the 23-57% of individuals who reduced it with a uniformly assigned 5° or 10° toe-in or toe-out modification. When toeing-in, greater reductions in the first knee adduction moment peak were related to an increased frontal-plane tibia angle (knee more medial than ankle), a more valgus knee abduction angle, reduced contralateral pelvic drop, and a more medialized center of pressure in the foot reference frame. In summary, personalization increases the proportion of individuals with medial knee osteoarthritis who may benefit from a foot progression angle modification.
Collapse
Affiliation(s)
- Scott D Uhlrich
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, United States; Department of Bioengineering, Stanford University, Stanford, CA 94305, United States; Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, CA 94304, United States.
| | - Julie A Kolesar
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States; Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, CA 94304, United States
| | - Łukasz Kidziński
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States
| | - Melissa A Boswell
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States
| | - Amy Silder
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States; Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, CA 94304, United States
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, CA 94305, United States
| | - Scott L Delp
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, United States; Department of Bioengineering, Stanford University, Stanford, CA 94305, United States; Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, United States
| | - Gary S Beaupre
- Department of Bioengineering, Stanford University, Stanford, CA 94305, United States; Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, CA 94304, United States
| |
Collapse
|
13
|
Gómez Carrión Á, Atín Arratibe MDLÁ, Morales Lozano MR, Martínez Rincón C, Martínez Sebastián C, Saura Sempere Á, Nuñez-Fernandez A, Sánchez-Gómez R. Changes in the Kinematics of Midfoot and Rearfoot Joints with the Use of Lateral Wedge Insoles. J Clin Med 2022; 11:jcm11154536. [PMID: 35956151 PMCID: PMC9369829 DOI: 10.3390/jcm11154536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 01/27/2023] Open
Abstract
The lateral wedge insole (LWI) is a typical orthopedic treatment for medial knee osteoarthritis pain, chronic ankle instability, and peroneal tendon disorders. It is still unknown what the effects are in the most important joints of the foot when using LWIs as a treatment for knee and ankle pathologies. Objectives: The aim of this study was to determine the influence of LWIs on the position of the midfoot and rearfoot joints by measuring the changes using a tracking device. Methods: The study was carried out with a total of 69 subjects. Movement measurements for the midfoot were made on the navicular bone, and for the rearfoot on the calcaneus bone. The Polhemus system was used, with two motion sensors fixed to each bone. Subjects were compared by having them use LWIs versus being barefoot. Results: There were statistically significant differences in the varus movement when wearing a 4 mm LWI (1.23 ± 2.08°, p < 0.001) versus the barefoot condition (0.35 ± 0.95°), and in the plantarflexion movement when wearing a 4 mm LWI (3.02 ± 4.58°, p < 0.001) versus the barefoot condition (0.68 ± 1.34°), in the midfoot. There were also statistically significant differences in the valgus movement when wearing a 7 mm LWI (1.74 ± 2.61°, p < 0.001) versus the barefoot condition (0.40 ± 0.90°), and in the plantar flexion movement when wearing a 4 mm LWI (2.88 ± 4.31°, p < 0.001) versus the barefoot condition (0.35 ± 0.90°), in the rearfoot. Conclusions: In the navicular bone, a varus, an abduction, and plantar flexion movements were generated. In the calcaneus, a valgus, an adduction, and plantar flexion movements were generated with the use of LWIs.
Collapse
|
14
|
Seagers K, Uhlrich SD, Kolesar JA, Berkson M, Kaneda JM, Beaupre GS, Delp SL. Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis. J Biomech 2022; 141:111204. [PMID: 35772243 PMCID: PMC9466647 DOI: 10.1016/j.jbiomech.2022.111204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
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.
Collapse
|
15
|
Muscle coordination retraining inspired by musculoskeletal simulations reduces knee contact force. Sci Rep 2022; 12:9842. [PMID: 35798755 PMCID: PMC9262899 DOI: 10.1038/s41598-022-13386-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Humans typically coordinate their muscles to meet movement objectives like minimizing energy expenditure. In the presence of pathology, new objectives gain importance, like reducing loading in an osteoarthritic joint, but people often do not change their muscle coordination patterns to meet these new objectives. Here we use musculoskeletal simulations to identify simple changes in coordination that can be taught using electromyographic biofeedback, achieving the therapeutic goal of reducing joint loading. Our simulations predicted that changing the relative activation of two redundant ankle plantarflexor muscles—the gastrocnemius and soleus—could reduce knee contact force during walking, but it was unclear whether humans could re-coordinate redundant muscles during a complex task like walking. Our experiments showed that after a single session of walking with biofeedback of summary measures of plantarflexor muscle activation, healthy individuals reduced the ratio of gastrocnemius-to-soleus muscle activation by 25 ± 15% (p = 0.004, paired t test, n = 10). Participants who walked with this “gastrocnemius avoidance” gait pattern reduced late-stance knee contact force by 12 ± 12% (p = 0.029, paired t test, n = 8). Simulation-informed coordination retraining could be a promising treatment for knee osteoarthritis and a powerful tool for optimizing coordination for a variety of rehabilitation and performance applications.
Collapse
|
16
|
Chen SF, Wang Y, Peng Y, Zhang M. Effects of Attrition Shoes on Kinematics and Kinetics of Lower Limb Joints During Walking. Front Bioeng Biotechnol 2022; 10:824297. [PMID: 35223791 PMCID: PMC8863942 DOI: 10.3389/fbioe.2022.824297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
Shoe attrition is inevitable as wearing time increases, which may produce diverse influences on kinematics and kinetics of lower limb joints. Excessive attrition may change support alignment and lead to deleterious impacts on the joints. The study identifies the biomechanical influences of aging shoes on lower limb joints. The shoes in the experiment were manually worn in the lateral heel. Nineteen healthy participants, including thirteen males and six females, were recruited to conduct walking experiments wearing attrition shoes (AS) and new shoes (NS) with a random order. A Vicon motion analysis system was used to collect kinematic data and ground reaction force. Kinematic and kinetic parameters of the hip, knee, and ankle joints were calculated using the Anybody Musculoskeletal Model and compared between the two conditions, AS and NS. The results showed that wearing an attrition shoe decreased the plantarflexion angle and plantarflexion moment of the ankle joint, while significantly increasing the magnitude of the first peak of the knee adduction moment and hip abduction moment and hip internal rotation moment (p < .05). The results of the study implied that wearing attrition shoes is not recommended for those people with knee problems due to increase in medial loading.
Collapse
Affiliation(s)
- Shane Fei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.,Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.,Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| |
Collapse
|
17
|
Bartsch LP, Schwarze M, Block J, Alimusaj M, Hadzic A, Renkawitz T, Wolf SI. Hindfoot flexibility influences the biomechanical effects of laterally wedged insoles and ankle-foot orthoses in medial knee osteoarthritis. Arch Phys Med Rehabil 2022; 103:1699-1706. [DOI: 10.1016/j.apmr.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/15/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
|
18
|
Oláh T, Reinhard J, Laschke MW, Goebel LKH, Walter F, Schmitt G, Speicher-Mentges S, Menger MD, Cucchiarini M, Pape D, Madry H. Axial alignment is a critical regulator of knee osteoarthritis. Sci Transl Med 2022; 14:eabn0179. [PMID: 35080913 DOI: 10.1126/scitranslmed.abn0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although osteoarthritis (OA), a leading cause of disability, has been associated with joint malalignment, scientific translational evidence for this link is lacking. In a clinical case study, we provide evidence of osteochondral recovery upon unloading symptomatic isolated medial tibiofemoral knee OA associated with varus malalignment. By mapping response correlations at high resolution, we identify spatially complex degenerative changes in cartilage after overloading in a clinically relevant ovine model. We further report that unloading diminishes OA cartilage degeneration and alterations of critical parameters of the subchondral bone plate in a similar topographic fashion. Last, therapeutic unloading shifted the articular cartilage and subchondral bone phenotype to normal and restored several physiological correlations disturbed in neutral and varus OA, suggesting a protective effect on the integrity of the entire osteochondral unit. Collectively, these findings identify modifiable trajectories with considerable translational potential to reduce the burden of human OA.
Collapse
Affiliation(s)
- Tamás Oláh
- Institute of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg 66421, Germany.,Cartilage Net of the Greater Region, Saarland University, Homburg 66421, Germany
| | - Jan Reinhard
- Institute of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg 66421, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University Medical Center and Saarland University, Homburg 66421, Germany
| | - Lars K H Goebel
- Institute of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg 66421, Germany.,Cartilage Net of the Greater Region, Saarland University, Homburg 66421, Germany
| | - Frédéric Walter
- Clinique d'Eich, Centre Hospitalier de Luxembourg, Eich 1460, Luxembourg
| | - Gertrud Schmitt
- Institute of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg 66421, Germany
| | - Susanne Speicher-Mentges
- Institute of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg 66421, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University Medical Center and Saarland University, Homburg 66421, Germany
| | - Magali Cucchiarini
- Institute of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg 66421, Germany.,Cartilage Net of the Greater Region, Saarland University, Homburg 66421, Germany
| | - Dietrich Pape
- Cartilage Net of the Greater Region, Saarland University, Homburg 66421, Germany.,Clinique d'Eich, Centre Hospitalier de Luxembourg, Eich 1460, Luxembourg
| | - Henning Madry
- Institute of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg 66421, Germany.,Cartilage Net of the Greater Region, Saarland University, Homburg 66421, Germany
| |
Collapse
|
19
|
Ferreira V, Machado L, Vilaça A, Xará-Leite F, Roriz P. Effects of tailored lateral wedge insoles on medial knee osteoarthritis based on biomechanical analysis: 12-week randomized controlled trial. Clin Rehabil 2021; 35:1235-1246. [PMID: 33715477 DOI: 10.1177/0269215521997988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lateral wedge insoles adjusted by biomechanical analysis may improve the condition of patients with medial knee osteoarthritis. DESIGN This is a prospective, randomized, controlled, single-blind clinical trial. SETTING The study was conducted in a biomechanics laboratory. SUBJECTS A total of 38 patients with medial knee osteoarthritis were allocated to either an experimental group (lateral wedge insoles) or a control group (neutral insoles). INTERVENTIONS Experimental group (n = 20) received an adjusted lateral wedge insole of 2, 4, 6, 8, or 10 degrees, after previous biomechanical analysis. Control group (n = 18) received a neutral insole (0 degrees). All patients used the insoles for 12 weeks. MAIN MEASURES Visual analogue scale, Knee Injury and Osteoarthritis Outcome Score questionnaire, biomechanical parameters: first and second peak of the external knee adduction moment and knee adduction angular impulse, and physical performance tests: 30-second sit-to-stand test, the 40-m fast-paced walk test, and the 12-step stair-climb test. RESULTS After 12 weeks, between-group differences did not differ significantly for pain intensity (-12.5 mm, (95% CI -29.4-4.4)), biomechanical parameters (p = 0.05), Knee Injury and Osteoarthritis Outcome Score, and physical performance tests, except on the Knee Injury and Osteoarthritis Outcome Score subscale other symptoms (p = 0.002; 13.8 points, (95% CI 5.6-22.0)). CONCLUSION Tailored wedge insoles were no more effective at improving biomechanical or clinically meaningful outcomes than neutral insoles, except on symptoms. More participants from the experimental group reported they felt some improvement. However, these effects were minimal and without clinical significance.
Collapse
Affiliation(s)
- Vitor Ferreira
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
| | - Leandro Machado
- CIF2D, LABIOMEP, Faculdade de Desporto da Universidade do Porto, Porto, Portugal
| | - Adélio Vilaça
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Francisco Xará-Leite
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paulo Roriz
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, LABIOMEP (Porto Biomechanics Laboratory), 4475-690 Maia, Portugal
| |
Collapse
|
20
|
Khosravi M, Babaee T, Daryabor A, Jalali M. Effect of knee braces and insoles on clinical outcomes of individuals with medial knee osteoarthritis: A systematic review and meta-analysis. Assist Technol 2021; 34:501-517. [PMID: 33507124 DOI: 10.1080/10400435.2021.1880495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Knee osteoarthritis is a disabling disease, causing pain and reduced function.Orthoses are used to manage this problem, including knee braces and lateral wedge insoles. However, there is still controversy on which type of intervention is more effective. This systematic review and meta-analysis aimed toevaluate the effect of knee braces and lateral wedge insoles and compare their clinical outcomes onindividuals with medial knee osteoarthritis. We conducted the search strategy based on the population, intervention, comparison, andoutcome (PICO) method. We searched with PubMed, EMBASE, Web of Science, and Scopus databases for the related studies. The articles quality assessment was done based on the modified Downs and Black checklist. Totally, we chose 32 controlled trials, including 1.849 participants, for the final evaluation. Almosttwo-thirds of the studies had a moderate quality. The overall outcome suggested that both interventionshad improved pain and function. The difference between both interventions on pain reduction was not significant (standardized mean difference = 0.12, 95% confidence interval = 0.34 to 0.1) based on meta-analysis. Both knee brace and lateral wedge insole can improve pain and function in people with knee osteoarthritis. Using either separately or both of them together are effective.
Collapse
Affiliation(s)
- Mobina Khosravi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aliyeh Daryabor
- Department of Physiotherapy, Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
21
|
Ishii Y, Ishikawa M, Hayashi S, Kanemitsu M, Omoto T, Kurumadani H, Kuwahara W, Date S, Deie M, Adachi N, Sunagawa T. The correlation between osteoarthritis stage and the effect of the lateral wedge insole for 3 months on medial meniscus extrusion in the knee joint. Knee 2021; 28:110-116. [PMID: 33333466 DOI: 10.1016/j.knee.2020.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/23/2020] [Accepted: 11/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medial meniscus extrusion (MME) leads to symptomatic knee osteoarthritis (OA) due to increased mechanical stress. MME increases with weight-bearing, and the difference in MME between non-weight-bearing and weight-bearing status (ΔMME) is a factor that causes greater MME. The lateral wedge insole (LWI) is an ideal approach for decreasing the amount of ΔMME associated with the reduction of medial loading stress in the early stage of knee OA. However, the effect of the LWI for 3 months on the ΔMME and its response to OA stage have not been elucidated. OBJECTIVE To investigate the effects of the LWI for 3 months on MME and the ΔMME in each stage of OA. METHODS Participants were divided into three groups: no intervention with the LWI (control group; n = 9) and intervention with the LWI in early OA (early OA group: Kellgren-Lawrence (K/L) stage = 2, n = 17) and late OA (late OA group: K/L stage > 2, n = 13). MME was evaluated using ultrasound, and the ΔMME was obtained as the difference in MME from non-weight-bearing and weight-bearing conditions. These measurements were performed at two time points: the initial office visit as a baseline and post-3 months. RESULTS The weight-bearing MME and ΔMME values post-3 months were significantly decreased compared with those at baseline in the early OA group but not in the control or late OA groups. CONCLUSIONS The use of the LWI for 3 months decreased weight-bearing MME and ΔMME values, and its effectiveness was more pronounced in the early stage of knee OA.
Collapse
Affiliation(s)
- Yosuke Ishii
- Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Masakazu Ishikawa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Seiju Hayashi
- Department of Orthopedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Munekazu Kanemitsu
- Department of Orthopedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takenori Omoto
- Department of Orthopedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Kurumadani
- Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Wataru Kuwahara
- Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shota Date
- Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Aichi Medical University, Aichi, Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Sunagawa
- Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
22
|
Parkes MJ, Jones RK, Carter SC, Liu A, Callaghan MJ, Felson DT. Change in pain and its relation to change in activity in osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100063. [PMID: 36474674 PMCID: PMC9718134 DOI: 10.1016/j.ocarto.2020.100063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/01/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Trials testing promising interventions in knee osteoarthritis (OA) often fail to show pain reductions. This may be due to change in activity whereby a person's pain decreases, leading them to increase their activity levels, in turn increasing pain back to baseline levels. Using data from a trial of a beneficial treatment for knee pain, we explored whether activity changes might mask a treatment's effect on pain, by looking at whether activity levels increased with effective treatment and whether change in activity level related to change in pain. Design During the InRespond trial (ISRCTN55059760) participants wore an accelerometer for 7 days before and during treatments. We assessed change in pain on treatment using scores for overall knee pain and pain in a nominated pain-aggravating activity both in the last week and evaluated change in different types of activity using accelerometer data. Principal components analysis tested whether change in activity and pain outcomes were correlated and created composites combining them. We then tested whether activity, pain or the composites showed a treatment effect, and examined their responsiveness. Results In the 61 participants (mean age 64.5 years, 38% women, mean overall knee pain score 5.08 (0-10)), activity levels mostly decreased during the trial. Principal component analyses suggested that pain and activity did not correlate highly, loading on different components. Treatment that showed significant effects on pain did not show similar effects on either activity (e.g. the active treatment had a slightly greater reduction in total steps taken than the control treatment (difference 1942.6 steps/week, p = 0.42) nor on composites combining activity and pain. Pain outcomes were the most responsive; static loading (standing) outcomes were the most responsive activity outcome. Conclusion We found no evidence to support the hypothesis that activity levels increase during effective OA treatment and might account for the negligible pain effects of OA treatments.
Collapse
Affiliation(s)
- Matthew J. Parkes
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Richard K. Jones
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- School of Health Sciences, University of Salford, Salford, UK
| | - Suzanne C. Carter
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anmin Liu
- School of Health Sciences, University of Salford, Salford, UK
| | - Michael J. Callaghan
- Faculty of Health, Psychology, and Social Care, Department of Health Professions, Manchester Metropolitan University, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - David T. Felson
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
23
|
Tse CTF, Ryan MB, Hunt MA. Influence of foot posture on immediate biomechanical responses during walking to variable-stiffness supported lateral wedge insole designs. Gait Posture 2020; 81:21-26. [PMID: 32650239 DOI: 10.1016/j.gaitpost.2020.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Novel designs of lateral wedge insoles with arch support can alter walking biomechanics as a conservative treatment option for knee osteoarthritis. However, variations in foot posture may influence individual responses to insole intervention and these effects are not yet known. RESEARCH QUESTION How does foot posture influence biomechanical responses to novel designs of lateral wedge insoles with arch support? METHODS This exploratory biomechanical investigation categorized forty healthy volunteers (age 23-34) into pronated (n = 16), neutral (n = 15), and supinated (n = 9) foot posture groups based on the Foot Posture Index. Three-dimensional gait analysis was conducted during walking with six orthotic insole conditions: flat control, lateral wedge, uniform-stiffness arch support, variable-stiffness arch support, and lateral wedge + each arch support. Frontal plane knee and ankle/subtalar joint kinetic and kinematic outcomes were compared among insole conditions and foot posture groups using a repeated measures analysis of variance. RESULTS The lateral wedge alone and lateral wedge + variable-stiffness arch support were the only insole conditions effective at reducing the knee adduction moment. However, the lateral wedge + variable-stiffness arch support had a smaller increase in peak ankle/subtalar eversion moment than the lateral wedge alone. Supinated feet had smaller ankle/subtalar eversion excursion and moment impulse than neutral and pronated feet, across all insole conditions. SIGNIFICANCE Supinated feet have less mobile ankle/subtalar joints than neutral and pronated feet and, as a result, may be less likely to respond to biomechanical intervention from orthotic insoles. Supported lateral wedge insoles incorporating an arch support design that is variable-stiffness may be better than uniform-stiffness since reductions in the knee adduction moment can be achieved while minimizing increases in the ankle/subtalar eversion moment.
Collapse
Affiliation(s)
- Calvin T F Tse
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 1Z7, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Kintec Footlabs, 13645 King George Blvd., Surrey, BC V3T 2TB, Canada
| | - Michael B Ryan
- Kintec Footlabs, 13645 King George Blvd., Surrey, BC V3T 2TB, Canada; Biomedical Physiological and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Department of Physical Therapy, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3.
| |
Collapse
|
24
|
Wang S, Mo S, Chung RCK, Shull PB, Ribeiro DC, Cheung RTH. How foot progression angle affects knee adduction moment and angular impulse in people with and without medial knee osteoarthritis: a meta-analysis. Arthritis Care Res (Hoboken) 2020; 73:1763-1776. [PMID: 33242375 DOI: 10.1002/acr.24420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE 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. METHODS 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/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI. RESULTS 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. CONCLUSION 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.
Collapse
Affiliation(s)
- Sizhong Wang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Shiwei Mo
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Division of Sports Science and Physical Education, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Peter B Shull
- State Key Laboratory of Mechanical Systems and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand
| | - Roy T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,School of Health Sciences, Western Sydney University, NSW, Australia, Penrith South
| |
Collapse
|
25
|
Ulrich B, Hoffmann L, Jolles BM, Favre J. Changes in ambulatory knee adduction moment with lateral wedge insoles differ with respect to the natural foot progression angle. J Biomech 2020; 103:109655. [PMID: 32057444 DOI: 10.1016/j.jbiomech.2020.109655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
Abstract
Lateral wedge insoles (LWI) have been proposed to reduce the knee adduction moment (KAM) during walking; a biomechanical modification notably sought in case of medial knee osteoarthritis. However, the inter-individual inconsistency in KAM changes with LWI limits their therapeutic use. Although the foot progression angle (FPA) has been frequently discussed in KAM modifications literature, there is a lack of data regarding a possible relationship between this gait measure and changes in KAM with LWI. This study aimed to test if KAM changes with LWI differ with respect to the natural FPA and to compare KAM-related variables between individuals walking with smaller and larger natural FPA. Twenty-two healthy participants (14 males, 24 ± 3 years, 22.7 ± 2.7 kg/m2) underwent gait analysis with and without LWI. They were divided into two groups based on their natural FPA, and changes in KAM 1st peak, KAM impulse, and KAM-related variables were compared between groups. KAM 1st peak and impulse decreased with LWI in the smaller natural FPA group (p ≤ 0.006), while only KAM impulse decreased in the larger natural FPA group (p < 0.001). The difference in KAM 1st peak changes was explained by a less reduced lever arm in participants walking with larger natural FPA. In conclusion, this study brought new insight into the variability in KAM response to LWI. If the findings are confirmed in patients with medial knee osteoarthritis, the FPA could become a simple measure to help identify the patients more likely to reduce their KAM with LWI.
Collapse
Affiliation(s)
- Baptiste Ulrich
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland
| | | | - Brigitte M Jolles
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland
| | - Julien Favre
- Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne, Switzerland.
| |
Collapse
|
26
|
Katoh H. Effect of lateral-wedge insole on the center of foot pressure and lower extremity muscle activity at gait initiation in patients with medial knee osteoarthritis. J Phys Ther Sci 2019; 31:776-779. [PMID: 31645805 PMCID: PMC6801347 DOI: 10.1589/jpts.31.776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] In clinical settings, patients with knee osteoarthritis often complain of pain
at gait initiation. In the present study, we aimed to determine the differences in the
center of foot pressure and lower extremity muscle activity at gait initiation in healthy
volunteers compared to patients with medial knee osteoarthritis. [Participants and
Methods] The study comprised of 10 females without medial knee osteoarthritis (healthy
group) and 10 females with medial knee osteoarthritis (medial knee osteoarthritis group).
We measured the center of foot pressure trajectory and muscle activity onset times of the
tibialis anterior and internal gastrocnemius at gait initiation. Moreover, we examined the
effects of insole use in the medial knee osteoarthritis group. [Results] The posterior
center of foot pressure displacement was significantly smaller in the medial knee
osteoarthritis group (barefoot and insole) than in the healthy group. The anterior center
of foot pressure displacement significantly improved with insole use. The muscle activity
onset time of the tibialis anterior was significantly delayed in the medial knee
osteoarthritis group (barefoot) than in the healthy group. [Conclusion] Postural control
decreased at gait initiation in the medial knee osteoarthritis group.
Collapse
Affiliation(s)
- Hiroshi Katoh
- Department of Rehabilitation, Kyushu University of Nursing and Social Welfare: 888 Tominoo, Tamana-shi, Kumamoto 865-0062, Japan
| |
Collapse
|