2023

International Orthopedics

Functional gait analysis reveals insufficient hindfoot compensation for varus and valgus osteoarthritis of the knee

Marlene Rühling, Stephanie Kirschbaum, Carsten Perka, Frank Graef

Charité – Universitätsmedizin Berlin

Keywords

Ankle, TKA, Knee osteoarthritis, Kinematic chain, Foot posture

Abstract

Purpose The hindfoot is believed to compensate varus and valgus deformities of the knee by eversion and inversion movements. But these mechanisms were merely found in static radiologic measurements. The aim of this study was, therefore, to assess dynamic foot posture during gait using pressure-sensitive wireless insoles in patients with osteoarthritis of the knee and frontal knee deformities. Methods Patients with osteoarthritis of the knee were prospectively included in this study. Patients were clinically and radiologically (mechanical tibiofemoral angle (mTFA), hindfoot alignment view angle (HAVA), and talar tilt (TT)) exa mined. Gait line analysis was conducted using pressure-sensitive digital shoe insoles. Results Eighty-two patients (varus n = 52, valgus n = 30) were included in this prospective clinical study. Radiologically, the mTFA significantly correlated with the HAVA (cor = −0.72, p < 0.001) and with the TT (Pearson’s cor = 0.32, p < 0.006). Gait analysis revealed that the gait lines in varus knee osteoarthritis were lateralized, despite the hindfoot valgus. In valgus knee osteoarthritis, gait lines were medialized, although the hindfoot compensated by varization. Conclusions Functional dynamic gait analysis could demonstrate that the hindfoot is not able to sufficiently compensate for frontal malalignments of the knee joint, contrary to static radiologic findings. This led to a narrowing of the joint space of the ankle medially in varus and laterally in valgus knee osteoarthritis.

Moticon's Summary

In this study it was aimed to investigate potential compensatory eversion and inversion movements due to varus and valgus deformities of the knee in the hindfoot. Moticon sensor insoles were used to assess the occurrence of these compensatory movements during gait in patients with osteoarthritis of the knee and frontal knee deformities. In this context Moticon sensor insoles were used to derive vertical ground reaction forces and center o pressure data. Center of pressure data was later used to calculate subjects' gait line. In contrast to preliminary static radiologic findings the hindfoot was not able to sufficiently compensate for frontal malalignments of the knee joint.

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