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 Review. 2016; 1(10):368-74. [DOI:10.1302/2058-5241.1.000051]
Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clinical Biomechanics. 2009; 24(10):833-41. [DOI:10.1016/j.clinbiomech.2009.08.005]
Sharma L. The role of varus and valgus alignment in knee osteoarthritis. Arthritis and Rheumatism. 2007; 56(4):1044-7. [DOI:10.1002/art.22514] [PMID]
Felson DT, Niu J, Gross KD, Englund M, Sharma L, Cooke TD, 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 & Rheumatism. 2013; 65(2):355-62. [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 & Rheumatology. 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 & Rheumatology. 2002; 41(7):1233-40. [DOI:10.1002/1529-0131(199807)41:7<1233::AID-ART14>3.0.CO;2-L]
Reilly K, Barker K, Shamley D, Newman M, Oskrochi GR, Sandall S. The role of foot and ankle assessment of patients with lower limb osteoarthritis. Physiotherapy. 2009; 95(3):164-69. [DOI:10.1016/j.physio.2009.04.003]
Souza TR, Pinto RZ, Trede RG, Kirkwood RN, Fonseca ST. Temporal couplings between rearfoot-shank complex and hip joint during walking. Clinical Biomechanics. 2010; 25(7):745-8. [DOI:10.1016/j.clinbiomech.2010.04.012]
Lafortune MA, Cavanagh PR, Sommer HJ 3rd, Kalenak A. Foot inversion-eversion and knee kinematics during walking. Journal of Orthopaedic Research. 1994; 12(3):412-20. [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. Clinical Biomechanics. 2015; 30:860-6. [DOI:10.1016/j.clinbiomech.2015.06.002]
Levinger P, Menz HB, Fotoohabadi MR, Feller JA, Bartlett JR, Bergman NR. Foot posture in people with medial compartment knee osteoarthritis. Journal of Foot and Ankle Research. 2010; 3(1):1-8. [DOI:10.1186/1757-1146-3-29]
Reilly KA, Barker KL, Shamley D, Sandall S. Influence of foot characteristics on the site of lower limb osteoarthritis. Foot & Ankle International. 2006; 27(3):206-11.[DOI:10.1177/107110070602700310]
Iijima H, Ohi H, Isho T, Aoyama T, Fukutani N, Kaneda E, et al. Association of bilateral flat feet with knee pain and disability in patients with knee osteoarthritis: A cross-sectional study. Journal of Orthopaedic Research. 2017; 35(11):2490-8. [DOI:10.1002/jor.23565]
Guler H, Karazincir S, Turhanoglu AD, Sahin G, Balci A, Ozer C. Effect of coexisting foot deformity on disability in women with knee osteoarthritis. Journal of the American Podiatric Medical Association. 2009; 99(1):23-7.[DOI:10.7547/0980023]
Gross KD, Felson DT, 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:10.1002/acr.20431] [PMID]
Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, et al. Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis and Cartilage. 2002; 10:573-9. [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 & Research. 2010; 62(4):501-9. [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(4):1172-8. [DOI:10.1002/art.20132]
Henriksen M, Aaboe J, 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):392-8. [DOI: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(5):520-3. [DOI: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. Journal of Biomechanics. 2016; 49(9):1859-64. [DOI:10.1016/j.jbiomech.2016.04.029]
Buldt AK, Levinger P, Murley GS, Menz HB, Nester CJ, Landorf KB. Foot posture and function have only minor effects on knee function during barefoot walking in healthy individuals. Clinical Biomechanics. 2015; 30(5):431-7.[DOI:10.1016/j.clinbiomech.2015.03.014]
Byrnes SK, Wearing S, Böhm H, Dussa CU, Horstmann T. Effects of idiopathic flatfoot deformity on knee adduction moments during walking. Gait & Posture. 2021; 84:280-6. [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. Journal of Foot and Ankle Research. 2013; 6(1):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. Exercise Physiology. 2019; 10:573. [DOI:10.3389/fphys.2019.00573]
Farahpour N, Sharifmoradi K, Azizi S. Effect of fatigue on knee kinematics and kinetics during walking in individuals with flat feet. Physical Therapy & Rehabilitation Journal. 2017; 7(3):141-8. [Link]
Hughes LY. Biomechanical analysis of the foot and ankle for predisposition to developing stress fractures. Physical Therapy in Sport. 1985; 7(3):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. Journal of Orthopaedic & Sports Physical Therapy. 1990; 11(7):301-12. [DOI:10.2519/jospt.1990.11.7.301]
Rodgers M, Leveau BF. Effectiveness of foot orthotic devices used to modify pronation in runners. Journal of Orthopaedic & Sports Physical Therapy. 1982; 4(2):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. Journal of Orthopaedic & Sports Physical Therapy. 1997; 25(4):253-63. [DOI:10.2519/jospt.1997.25.4.253]
Genova JM, Gross MT. Effect of foot orthotics on calcaneal eversion during standing and treadmill walking for subjects with abnormal pronation. Journal of Orthopaedic & Sports Physical Therapy. 2000; 30(11):664-75. [DOI:10.2519/jospt.2000.30.11.664]
McCulloch MU, Brunt D, Vander Linden D. The effect of foot orthotics and gait velocity on lower limb kinematics and temporal events of stance. Journal of Orthopaedic & Sports Physical Therapy. 1993; 17(1):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 & Research. 2008; 59(3):408-15. [DOI:10.1002/art.23326]
Nadrian H, Moghimi N, Nadrian E, Moradzadeh R, Bahmanpour K, et al. Validity and reliability of the Persian versions of WOMAC osteoarthritis index and lequesne algofunctional index. Clinical Rheumatology. 2012; 31:1097-102. [DOI:10.1007/s10067-012-1983-7]
King LK, Kendzerska T, Waugh EJ, Hawker GA. Impact of osteoarthritis on difficulty walking: A population-based study. Arthritis Care & Research. 2018; 70(1):71-9. [DOI:10.1002/acr.23250]
Williams DSB, David IS, Hamill J, Buchanan TS. Lower extremity kinematic and kinetic differences in runners with high and low arches. Journal of Applied Biomechanics. 2001; 17(2):153-63. [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; 8:96-9. [DOI:10.2174/1874312901408010096] [PMID]
Nester CJ, Hutchins S, Bowker P. Shank rotation: A measure of rearfoot motion during normal walking. Foot & Ankle International. 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. Journal of Modern Rehabilitation. 2023; 17(4):363-74. [DOI:10.18502/jmr.v17i4.13884]
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Issue | Vol 18 No 4 (2024) | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/jmr.v18i4.16915 | |
Keywords | ||
Knee joint Osteoarthritis Flat feet Pain |
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