Research Article

Association of Flat Feet with Knee Moments and Western Ontario and McMaster Universities Arthritis Index in Knee Osteoarthritis

Abstract

Introduction: Flat feet are prevalent among individuals with medial compartment knee osteoarthritis (KOA), showing a correlation with elevated knee pain and cartilage degeneration. This study investigates the relationship between calcaneal eversion angle (CEA) and medial longitudinal arch angle (MLAA) with knee kinetics and pain.
Materials and Methods: This analytical observational study included 30 volunteers with moderate KOA. The Vicon motion analysis system and two synchronized force plates were employed to capture level walking and the static standing position to measure CEA and MLAA. The study assessed the first and second peaks of the knee adduction moment, knee adduction moment impulse, peak knee flexion moment, and the peak knee flexion angle at heel strike (PKFA-HS). The Western Ontario and McMaster Universities arthritis index (WOMAC) pain and physical function were evaluated.
Results: A significant positive correlation was found between CEA and the knee pain sub-score (Pearson correlation [PC]=0.446, P=0.011) and WOMAC total score (PC=0.363, P=0.049). Additionally, a significant negative correlation was observed between CEA and peak knee flexion moment/PKFA-HS (PC=-0.418, P=0.022, and PC=-0.479, P=0.001, respectively). The results also indicated a negative significant correlation between MLAA and WOMAC pain sub-score (PC=-0.389, P=0.034).
Conclusion: Increased CEA and decreased MLAA are associated with elevated WOMAC pain sub-score and decreased PKFA-HS in individuals with moderate KOA. Addressing flat feet should be considered in KOA management to enhance pain relief and functional outcomes.

Favre J, Jolles B. Gait analysis of patients with knee osteoarthritis highlights a pathological mechanical pathway and provides a basis for therapeutic interventions. EFORT Open Rev. 2016;1(10):368-74. doi:10.1302/2058-5241.1.000051

Heiden TL, LD, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clin Biomech (Bristol, Avon). 2009;24:833-841.

Sharma L, Hurwitz DE, Thonar EJ, Sum JA, Lenz M. The role of varus and valgus alignment in knee osteoarthritis. Arthritis Rheum. 2007;56:1044-1047. doi:10.1002/1529-0131(199807)41:7<1233::AID-ART14>3.0.CO;2-L

Felson D, Niu J, Gross KD, et al. Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Rheum. 2013;65:355-362. doi:10.1002/art.37726

Mundermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: Increased load at the ankle, knee, and hip during walking. Arthritis Rheum. 2005;52(9):2835-44. doi:10.1002/art.21262

Sharma L, Hurwitz DE, Thonar EJ, Sum JA, Lenz M. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis Rheumatism. 2002;41:1233–1240. doi:10.1002/1529-0131(199807)41:7<1233::AID-ART14>3.0.CO;2-L

Reilly K, Barker K, Shamley D. The role of foot and ankle assessment of patients with lower limb osteoarthritis. Physiotherapy. 2009;95:p.164–169. doi:10.1016/j.physio.2009.04.003

Souza TR, Pinto RZ, Trede RG, et al. Temporal couplings between rearfoot-shank complex and hip joint during walking. Clin Biomech (Bristol, Avon). 2010;25:p.745–748. doi:10.1016/j.clinbiomech.2010.04.012

Lafortune MA, Cavanagh PR, Sommer HJ 3rd, Kalenak A, et al. Foot inversion-eversion and knee kinematics during walking. J Orthop Res. 1994;12:412–420. doi:10.1002/jor.1100120314

Schwachmeyer V, Kutzner I, Bornschein J, Bender A, Bornschein J, et al. Medial and lateral foot loading and its effect on knee joint loading. Clin Biomech (Bristol, Avon). 2015;30:860–866. doi:10.1016/j.clinbiomech.2015.06.002

Levinger P, Menz HB, Fotoohabadi MR, et al. Foot posture in people with medial compartment knee osteoarthritis. J Foot Ankle Res. 2010;3(29). doi:10.1186/1757-1146-3-29

Reilly KA, Barker KL, Shamley D, et al. Influence of foot characteristics on the site of lower limb osteoarthritis. Foot Ankle Int. 2006;27:206–211. doi:10.1177/107110070602700310

Hirotaka Iijima, Hiroshi Ohi. Association of bilateral flat feet with knee pain and disability in patients with knee osteoarthritis: A cross-sectional study. Orthopaedic Research. 2017;35(11). doi:10.1002/jor.23565. Epub 2017 Apr 24

Guler H, KS, Turhanoglu AD, et al. Effect of coexisting foot deformity on disability in women with knee osteoarthritis. J Am Podiatr Med Assoc. 2009;99:23–27.

Gross KD, FD, Niu J, Hunter DJ, Guermazi A, Roemer FW, et al. Association of flat feet with knee pain and cartilage damage in older adults. Arthritis care & research. 2011;63(7):937-44. doi:10.7547/0980023

Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, Andriacchi. Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis and Cartilage. 2002;10:573–579. doi:10.1053/joca.2002.0797

Henriksen M, Tomas G, Aaboe J, Andriacchi TP, Bliddal H. Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain. Arthritis Care Res (Hoboken). 2010;62:501-509. doi:10.1002/acr.20033

Mundermann A, Dyrby CO, Hurwitz DE, Sharma L, Andriacchi TP. Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. Arthritis and Rheumatism. 2004;50:p.1172–1178. doi:10.1002/art.20132

Henriksen M, Aaboe J, and Bliddal H. relationship between pain and dynamic knee joint loading in knee osteoarthritis varies with radiographic disease severity. A cross sectional study. the knee. 2012;19(4):392-398. doi.org/10.1016/j.knee.2011.07.003

Kean CO, Hinman RS, Bowles KA , Cicuttini F, Davies-Tuck M, Bennell KL. Comparison of peak knee adduction moment and knee adduction moment impulse in distinguishing between severities of knee osteoarthritis. Clinical Biomechanics. 2012;27:520-523. doi.org/10.1016/j.clinbiomech.2011.12.007

Favre J, Erhart-Hledik JC, Chehab EF, Andriacchi TP. Baseline ambulatory knee kinematics are associated with changes in cartilage thickness in osteoarthritic patients over 5 years. J Biomech. 2016;49:1859-1864. doi.org/10.1016/j.jbiomech.2016.04.029

Buldt AK , Levinger P, Murley GS, Menz BH, et al. Foot posture and function have only minor effects on knee function during barefoot walking in healthy individuals. Clin Biomech (Bristol, Avon). 2015 Jun;30(5):431-7. doi:10.1016/j.clinbiomech.2015.03.014. Epub 2015 Mar 18

Kimberly Byrnes, Scott Wearing bc, Harald Bohm a, Chakravarthy U, Dussa a. Effects of idiopathic flatfoot deformity on knee adduction moments during walking. Gait & Posture. 2021;84:280–286. doi:10.1016/j.gaitpost.2020.12.021

Levinger P, Menz HB, Morrow AD, Bartlett JR, Feller JA, Bergman NR. Relationship between foot function and medial knee joint loading in people with medial compartment knee osteoarthritis. J Foot Ankle Res. 2013;6(33). doi:10.1186/1757-1146-6-33

Qichang M, Yaodong G, Liangliang X, Julien SB, Justin F. Foot Pronation Contributes to Altered Lower Extremity Loading After Long Distance Running. Front Physiol. 2019 May 22:10:573. doi:10.3389/fphys.2019.00573. eCollection 2019

Farahpoor N, Sharifmoradi K, Azizi S. Effect of Fatigue on Knee Kinematics and Kinetics During Walking in Individuals With Flat Feet. physical treatment. 2018;7:0-0.

Hughes LY. Biomechanical analysis of the foot and ankle for predisposition to developing stress fractures. Sports Phys Ther. 1985;7:96-101. doi:10.2519/jospt.1985.7.3.96

Novick A, Kelly DL. Position and movement changes of the foot with orthotic intervention during the loading response of gait. Orthop Sports Phys Ther. 1990;11:301-312. doi:10.2519/jospt.1990.11.7.301

Rodgers M, Leveau BF. Effectiveness of foot orthotic devices used to modify pronation in runners. Orthop Sports Phys Ther. 1982;4:86-90. doi:10.2519/jospt.1982.4.2.86

Jonson SR, Gross MT. Intraexaminer reliability, interexaminer reliability, and mean values for nine lower extremity skeletal measures in healthy naval midshipmen. J Orthop Sports Phys Ther. 1997;25(4):253-63. doi:10.2519/jospt.1997.25.4.253

Genova J, Gross MT, Michael T. Gross PhD PT. Effect of Foot Orthotics on Calcaneal Eversion During Standing and Treadmill Walking for Subjects With abnormal pronation. J Orthop Sports Phys Ther. 2000;30(11):664-675.

McCulloch MU, Brunt D, Vander Linden D. The effect of foot orthotics and gait velocity on lower limb kinematics and temporal events of stance. Orthop Sports Phys Ther. 1993;17:2-10. doi:10.2519/jospt.1993.17.1.2

Hinman RS, Payne C, Metcalf BR, Wrigley TV, Bennell KL. Lateral wedges in knee osteoarthritis: What are their immediate clinical and biomechanical effects and can these predict a three-month clinical outcome? Arthritis Care Res. 2008;59(3):408-15. doi:10.1002/art.23326

Naderian H, Moghimi N, Nadrian E, et al. Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index. Clin Rheumatol. 2012 Jul;31(7):1097-102. doi:10.1007/s10067-012-1983-7. Epub 2012 Apr 14

King LK, Kendzerska T, Waugh EJ, Hawker GA. Impact of osteoarthritis on difficulty walking: A population-based study. Arthritis Care Res. 2018 Jan;70(1):71-79. doi:10.1002/acr.23250. Epub 2017 Dec 15

Williams DSB, David IS, Hamill J, Buchanan TS. Lower Extremity Kinematic and Kinetic Differences in Runners With High and Low Arches. J Appl Biomech. 2001;17(2). doi:10.1123/jab.17.2.153

Abourazzak FE, Kadi N, Azzouzi H, Lazrak F, Najdi A, Nejjari C. A positive association between foot posture index and medial compartment knee osteoarthritis in Moroccan people. The open rheumatology journal. 2014;8:96. doi:10.2174/1874312901408010096

Nester CJ, Hutchins S, Bowker P. Shank rotation: A measure of rearfoot motion during normal walking. Foot Ankle Int. 2000;21(7):578–83. doi:10.1177/107110070002100709

Sedaghati P, Kazemi Pakdel F, Zarei Z. Investigating the Effects of High-Arch and Flat Foot Deformities on Postural Control: A Systematic Review and Meta-Analysis. J Modern Rehabilitation. 2023;17(4):363-374. doi.org/10.18502/jmr.v17i4.13884

Files
IssueVol 18 No 4 (2024) QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/jmr.v18i4.16915
Keywords
Knee joint Osteoarthritis Flat feet Pain

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sohrabi M, Torkaman G, Bahrami F. Association of Flat Feet with Knee Moments and Western Ontario and McMaster Universities Arthritis Index in Knee Osteoarthritis. jmr. 2024;18(4):461-470.