Sabashi K, Chiba T, Yamanaka M, Tohyama H. Effect of toe-out gait modification on patellofemoral joint loading.
Gait Posture 2023;
104:135-139. [PMID:
37419054 DOI:
10.1016/j.gaitpost.2023.06.019]
[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: 12/01/2022] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND
Toe-out gait has been proposed as a conservative treatment to reduce medial tibiofemoral joint loading. However, patellofemoral joint loading during toe-out gait is not yet understood.
RESEARCH QUESTION
Does the toe-out gait modification affect patellofemoral joint loading?
METHODS
Sixteen healthy adults were enrolled in this study. The natural gait and toe-out gait were measured using a three-dimensional motion analysis and a force plate. The knee flexion angle and external knee flexion moment during the stance phase were calculated. Thus, dynamic knee joint stiffness, a proxy of patellofemoral joint loading, was defined as a linear regression of the knee flexion moment and knee flexion angle during the early stance. Additionally, the peak patellofemoral compressive force during the early stance was calculated using a musculoskeletal simulation. A paired t-test was used to compare these biomechanical parameters during the natural gait and toe-out gait.
RESULTS
The toe-out gait significantly increased the peak patellofemoral compressive force (mean difference = 0.37 BW, P = 0.017) and dynamic knee joint stiffness (mean difference = 0.07%BW*Ht/°, P = 0.001). The 1st peak of the knee flexion moment also significantly increased in the toe-out gait (mean difference = 1.01%BW*Ht, P = 0.003); however, the knee flexion angle did not change significantly (initial contact: mean difference = 1.7°, P = 0.078; peak: mean difference = 1.3°, P = 0.224).
SIGNIFICANCE
Toe-out gait increased the patellofemoral compressive force and dynamic knee joint stiffness because of increasing knee flexion moment, but not the knee flexion angle. When the toe-out gait is adapted, clinicians should pay attention to an increase in the patellofemoral joint loading.
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