Relationship Of Foot Pronation To Medial Tibiofemoral and Lateral Patellofemoral Cartilage Damage

NewsBot · Oct 27, 2013

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The Relationship Of Foot Pronation During Walking To Risk Of Incident Medial Tibiofemoral and Lateral Patellofemoral Cartilage Damage: The Multicenter Osteoarthritis Study
Gross, K. Douglas DPT, ScD, Hillstrom, Howard J. PhD; Zhang, Yuqing DSc, MPH; Quinn, Emily K. MPH; Nevitt, Michael C. MPH, PhD; Segal, Neil A. MD, MS; Lewis, Cora E. ; Felson, David T. MD, MPH
American College of Rheumatology Annual Meeting; Oct 26-30, 2013; San Diego

Description:
Background/Purpose: Studies of older adults suggest an association between plantar pressure measures of foot pronation and medial tibiofemoral (med TF) cartilage damage, while studies of younger adults suggest an association with lateral patellofemoral (lat PF) pain. These were cross-sectional studies, however. We assessed the longitudinal relationship of foot pronation in walking with 2-year risk of incident med TF and lat PF cartilage damage in at-risk older adults.

Methods: The Multicenter Osteoarthritis Study (MOST) includes adults aged 50-79 years that have or are at risk of knee OA. At the 60 month exam, plantar pressure was assessed using an EmedX to quantify Center of Pressure Excursion Index (CPEI) during 5 trials of self-paced walking (14-day retest ICC > 0.82). Smaller CPEI values indicate increased pronation. From 1.0 T MRIs obtained at 60 and 84 months readers scored one knee per subject for cartilage damage in each sub-region comprising the med TF and lat PF compartments using WORMS grades (weighted kappa > 0.63). Among sub-regions with WORMS < 2 at 60 months, incident cases had WORMS ≥ 2 at 84 months. With the highest quintile (least pronated feet) as a reference, separate logistic regression models estimated relative odds of incident med TF and lat PF damage in each case-based CPEI quintile while adjusting for age, BMI, sex, and using GEE to account for non-independent sub-regions of a compartment.

Results: 1123 participants (mean age 66.8 ± 7.5 yrs, BMI 29.7 ± 4.8 kg/m2, 62.4% female) contributed one knee each (mean CPEI 19.8 ± 6.6) to the analysis of med TF damage, while 904 participants with similar characteristics contributed to the analysis of lat PF damage. Only 3.6% and 2.6% of sub-regions had incident med TF and lat PF damage, respectively. Although relative odds of lat PF damage were increased (OR = 2.04; 95% CI: 0.72, 5.82) among the most pronated feet (CPEI 13.7 to -7.7), pronation was not strongly associated with odds of med TF damage (see table). With few incident cases contributing, no findings achieved statistical significance (p > 0.05).

Conclusion: In the first longitudinal data on foot pronation and risk of knee cartilage damage, we cannot confirm cross-sectional findings of an association between excessive pronation and med TF disease. Yet, this data does suggest a possible association between extreme foot pronation and elevated risk of lat PF damage. Studies with higher incidence rates are needed to confirm this.
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Admin2 · Oct 27, 2013

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NewsBot · Sep 10, 2014

Altered dynamic foot kinematics in people with medial knee osteoarthritis during walking: A cross-sectional study.
Arnold J, Mackintosh S, Jones S, Thewlis D.
Knee. 2014 Sep 4.

BACKGROUND:
Footwear and insoles are used to reduce knee load in people with medial knee osteoarthritis (OA), despite a limited understanding of foot function in this group. The aim of this study was to investigate the differences in foot kinematics between adults with and without medial knee OA during barefoot walking.
METHODS:
Foot kinematics were measured during walking in 30 adults; 15 with medial knee OA (mean age was 67.0 with a standard deviation (SD) of 8.9years; height was 1.66 with SD of 0.13m; body mass was 84.2 with SD of 15.8kg; BMI was 30.7 with SD of 6.2 kg/m2; K-L grade 3: 5, grade 4: 10) and 15 aged and gender matched control participants with 12 motion analysis cameras using the IOR multi-segment foot model. Motion of the knee joint, hindfoot, midfoot, forefoot and hallux were compared between groups using clustered linear regression.
RESULTS:
The knee OA group displayed reduced coronal plane range of motion of the midfoot (mean 3.8° vs. 5.4°, effect size=1.1, p=0.023), indicating reduced midfoot mobility. There was also a reduced sagittal plane range of motion at the hallux in the knee OA group compared to the control group (mean 29.6° vs. 36.3°, effect size=1.2, p=0.008). No statistically significant differences in hindfoot or forefoot motion were observed.
CONCLUSIONS:
People with medial knee OA display altered foot function compared to healthy controls. As foot and knee function are related, it is possible that altered foot function in people with knee OA may influence the effects of footwear and insoles.
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NewsBot · Jan 2, 2015

A positive association between foot posture index and medial compartment knee osteoarthritis in moroccan people.
Open Rheumatol J. 2014 Dec 11;8:96-9.

OBJECTIVES:
To compare foot posture in people with and without medial compartment knee osteoarthritis (OA), and to assess association between its abnormalities and medial compartment knee OA.
METHODS:
We compared the foot posture of patients with clinically and radiographically-confirmed medial compartment knee OA and asymptomatic healthy controls using the foot posture index (FPI), navicular height, and the medial arch.
RESULTS:
We included 100 patients and 80 asymptomatic controls. The mean age of patients was 59 ± 7 (44-76) years and 48 ± 9 (28-60) years in the control (p=0.06). Patients group have more pronated foot for FPI (1.50 ± 2.68 vs 0.72 ± 2.63; p=0.05), more flat foot (42% vs 22%; p=0.03), and less pes cavus than the control group (58% vs 77%; p=0.004). However, there was no significant difference between the groups in the navicular height (3.90 ± 0.85 cm vs 4.00 ± 0.76 cm; p=0.41). In multivariate statistical analysis, after adjusting for age and body mass index, pronated foot in FPI (OR=1.22, 95%IC= [1.06-1.40], p=0.005), and pes cavus (OR=0.32, 95%IC= [0.11-0.93], p=0.03) had a significant correlation with the knee osteoarthritis.
CONCLUSION:
Pronated foot posture and flat foot are significantly associated with medial compartment knee osteoarthritis.
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NewsBot · Jan 22, 2015

Relationships among foot position, lower limb alignment, and knee adduction moment in patients with degenerative knee osteoarthritis
YuMi Cho, YoungJun Ko, Wanhee Lee
Journal of Physical Therapy Science; Vol. 27 (2015) No. 1 January p. 265-268

[Purpose] The aim of this study was to determine the relationships among the foot progression angle, foot rotation angle, lower limb alignment, and knee adduction moments in patients with degenerative knee osteoarthritis (OA).
[Subjects] Forty-eight patients diagnosed with degenerative knee OA (Kellgren-Lawrence grades 2 and 3) were included. [Methods] To assess the lower extremity alignment and weight-bearing ratio, static radiographic measurement was used. Foot progression angle, foot rotation angle, and knee adduction moments were measured by using a three-dimensional motion analysis system.
[Results] The results of this study were as follows: the foot progression angle in the early and late stance phase was significantly correlated with the first and second peak knee adduction moments; the weight-bearing ratio was significantly correlated with the first and second peak knee adduction moments; and the tibiofemoral angle was significantly correlated with the first and second peak knee adduction moments.
[Conclusion] The results of the present study indicated that as the foot progression angle and the foot lateral rotation angle increased, the knee adduction moment decreased. The weight-bearing ratio and tibiofemoral angle assessment with mechanical axis alignment were correlated with the knee adduction moments. These parameters may be helpful for selecting therapeutic options for patients with degenerative knee OA.
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NewsBot · Nov 15, 2016

Relation of Foot Pronation during Walking to Risk of Worsening Lateral Patellofemoral and Medial Tibiofemoral Cartilage Damage
K. Douglas Gross
2016 ACR/ARHP Annual Meeting

Background/Purpose: Foot pronation can lead to lateral patellofemoral (PF) maltracking with reduced tibiofemoral (TF) varum, inciting speculation that the highly pronated foot reported in knees with osteoarthritis (OA) could increase risk of worsening lateral PF joint damage, while reducing risk of worsening medial TF damage. Yet, longitudinal data is lacking and dynamic foot pronation measured during the early, mid, and terminal phases of walking may differ from measures in static standing. Our purpose was to explore the relation of foot pronation measured during each phase of walking to the 2-year risk of worsening lateral PF and medial TF cartilage damage. Pronation effects on PF tracking and knee varus moment tend to be maximal during the early stance phase.

Methods: The Multicenter Osteoarthritis Study (MOST) includes adults aged 50-79 years with or at risk of knee OA. At the 60 month exam, high-resolution plantar pressure profiles were acquired during 5 trials of self-paced walking. From these, we measured foot pronation during the early, mid, and terminal stance phases using the Pronation-Supination Index (PSI), as described by Motooka, et al. (same-day retest ICC 0.46 to 0.94), where lower values indicate greater pronation. From 1.0 T MRIs, readers scored (0-6) one knee per subject for cartilage damage in each sub-region of the lateral PF (2 sub-regions) and medial TF (5 sub-regions) compartments using WORMS (weighted kappa > 0.63). Among sub-regions with submaximal scores at 60 months, worsening damage was any increase in WORMS score at 84 months. Separate logistic regression models estimated the relative odds of worsening lateral PF and medial TF cartilage damage within quintiles of increasing foot pronation compared to feet with the least pronation. Adjustments were made for age, sex, and BMI. GEE accounted for non-independent knee sub-regions.

Results: 1067 and 1104 subjects (mean age 66.8 ± 7.6 years, BMI 29.6 ± 4.8 kg/m2, 60.7% female) contributed to the analysis of worsening lateral PF and medial TF cartilage damage, respectively. Compared to feet with the least pronation, odds of worsening lateral PF damage were 2.35 (95% CI: 1.38, 4.01) times greater in limbs with the greatest foot pronation during early stance (p < 0.002). A non-significant trend suggested a possible relation between greater early phase foot pronation and reduced odds of medial TF worsening. There was no association between foot pronation during other phases of walking and risk of worsening knee damage (Table).

Conclusion: In adults with or at-risk of knee OA, feet with the greatest foot pronation during the early stance phase of walking are at increased risk of worsening knee cartilage damage in the lateral PF compartment. These findings could inform efforts to refine preventative footwear interventions for compartment-specific knee OA.
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NewsBot · Nov 8, 2017

Relation of Foot Pronation to Medial Knee Load in Persons with Medial Knee Osteoarthritis
K. Douglas Gross et
November 7, 2017

Background/Purpose: The knee adduction moment (KAM) estimates medial knee load during gait, with high KAM fueling worsening OA. Understanding how foot mechanics contribute to KAM would inform the development of more effective footwear and insoles to prevent worsening knee OA. During the initial and early stance phases, a neutrally aligned foot with adequate pronation could dissipate impact loads, reduce varus thrust, and minimize KAM as it rises to an initial peak. Yet, excessive pronation in late stance redistributes load medially, possibly increasing KAM as it reaches a second peak. In persons with medial knee OA, we assessed: 1) the relation of foot pronation during the initial and early stance phases to 1st peak KAM; and 2) the relation of foot pronation during late stance to 2nd peak KAM. Given possible effects of both diminished and excessive pronation, we assessed both linear and u-shaped trends.

Methods: The Effectiveness of Shoes and Insoles on Loading at the Knee (SILK) Study included adults aged 45-70 yrs with medial knee OA. Plantar pressure profiles of the index limb were acquired during 5 trials of self-paced barefoot walking using an Emed-X platform. From these, we measured foot pronation during the initial, early, and late stance phases using the Pronation-Supination Index (PSI) as described by Motooka et al., where lower PSI values indicate greater pronation (retest ICC 0.46-0.90). Concurrently, a Qualisys motion capture system with AMTI force plates measured 1st and 2nd peak KAM in Newton-meters per kg of body weight (retest ICC= 0.86). In tertiles of increasing pronation (decreasing PSI), generalized linear models estimated mean 1st and 2nd peak KAM while adjusting for age, sex, body mass, and walking velocity. Tests for linear and u-shaped trend identified dose-response relationships.

Results: In 70 SILK participants (mean age 60.3 ± 9.6 yrs, body mass 87.3 ± 18.5 kg, walking velocity 1.12 ± 0.23 m/sec, 61.4% female), mean 1st and 2nd peak KAM was 0.36 and 0.32 Nm/kg, respectively. At initial contact, feet with diminished (PSI ≥ 58.14) or increased (PSI ≤ 55.09) pronation in comparison to the middle PSI tertile (PSI 55.10, 58.13) had increased 1st peak KAM (mean difference = 0.07 and 0.10 Nm/kg, respectively), resulting in a significant u-shaped trend (p for trend = 0.02). During early stance, 1st peak KAM was greatest among feet with the least pronation and declined linearly across tertiles of increasing pronation (p for trend = 0.06). There was no association between foot pronation in late stance and 2nd peak KAM (see table).

Conclusion: In adults with medial knee OA, feet with diminished or excessive pronation at initial contact, and feet with reduced pronation during the early stance phase of walking, experience increased peak medial knee loads. These findings could inform efforts to refine more effective footwear or insole interventions to minimize loads for persons with medial knee OA.
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NewsBot · Jan 17, 2018

Correlation between Foot Overpronation and Angle of Inclination of Hip Joint
Malik Manoj et al
Indian Journal of Physiotherapy and Occupational Therapy - An International Journal; Year : 2017, Volume : 11, Issue : 4

Background
Foot arches play an important role in shock absorption and energy transfer during walking. Overpronation of foot due to ligament laxity and repetitive stresses leads to fall risk, patellofemoral syndrome, ACL injury, low back pain, increased strain on soft tissues, increased compressive forces on joints and induces anterior pelvic tilt of the lumbo-pelvic-hip complex Coxa valga increases the load on femoral head and reduces the effectiveness of hip abductors can cause the hip to drop. The resulting hip adduction and internal rotation result knee valgus, patellar tracking and excessive pronation.

Objective
The purpose of this study was to check correlation between foot overpronation and angle of inclination.

Methodology
Experimental control group. A total of 60 femoral necks were analyzed from 30 subjects, measuring the NSAs of A-P views of pelvic radiographs showing angle of inclination of hip joint. Foot overpronation is measured by NDT. It is a highly reliable and valuable measurement method that can determine injury and weakness of the musculoskeletal system.

Result
Result shows a statically significant correlation between angle of inclination of femur and navicular drop test of both sides. Increase in foot overpronation is correlated with increase in angle of inclination.

Conclusion
Result suggests that coxa valga may be a positive correlated with foot overpronation.
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NewsBot · Jul 14, 2022

Association between foot posture and tibiofemoral contact forces during barefoot walking in patients with knee osteoarthritis
Takanari Kubo, Daisuke Uritani, Shinya Ogaya, Shunsuke Kita, Takahiko Fukumoto, Tadashi Fujii, Yusuke Inagaki, Yasuhito Tanaka & Hidetaka Imagita
BMC Musculoskeletal Disorders volume 23, Article number: 660 (2022)

Background
Accumulating evidence indicates that abnormal foot posture are risk factors for knee osteoarthritis (OA). However, the relationship between foot posture and tibiofemoral contact force (CF) during habitual weight-bearing activities remains unclear. This study aimed to determine the association between tibiofemoral CF and foot posture while walking.

Methods
In total, 18 patients with knee OA and 18 healthy individuals participated in this cross-sectional study. Foot parameters were evaluated by Foot Posture Index (FPI), Staheli Arch Index (SAI), hallux valgus angle, calcaneus inverted angle relative to the floor as a static rearfoot posture, navicular height, and toe grip strength. In addition, all participants underwent kinetic and kinematic measurements during a self-selected speed gait. The measurement device used was the three-dimensional motion analysis system with a sampling rate of 120 Hz. The musculoskeletal model, which has 92 Hill-type muscle–tendon units with 23 degrees of freedom, was used to calculate tibiofemoral CF. Partial correlations was used to investigate the association between foot parameters and total, medial, and lateral tibiofemoral CF of the first and second peaks while controlling for gait speed.

Results
A significant negative correlation was observed between Walking SAI and first peak medial tibiofemoral CF in control participants (r = -0.505, p = 0.039). SAI was also significantly positively correlated with first peak medial tibiofemoral CF in patients with knee OA (r = 0.482, p = 0.042).

Conclusions
Our findings revealed a correlation between the medial first peak tibiofemoral CF and the SAI. This study indicates that people with knee OA and flatfoot have excessive first medial tibiofemoral CF during walking.
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Relationship Of Foot Pronation To Medial Tibiofemoral and Lateral Patellofemoral Cartilage Damage

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Relationship Of Foot Pronation To Medial Tibiofemoral and Lateral Patellofemoral Cartilage Damage

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Relationship Between Plantar Callosity and Foot Deformity in Hallux Valgus

Relationship between plantar pressure distribution and the intrinsic foot muscles

Relationship between foot arch flexibility and medial-lateral ground reaction force

The relationship of hip muscle performance to leg, ankle and foot injuries

The Relationship Between Arch Height And Foot Length: Implications For Size Grading

Relationship between maceration and wound healing on diabetic foot ulcers

The relationship between foot arch measurements and walking parameters in children

Share This Page

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