Influence of alteration of foot progression angle on three-dimensional pelvic kinematics in individuals with knee osteoarthritis during walking: A randomized crossover study
Clinical Snapshot
PICO Framework
| P — Population | 37 participants with medial compartment knee osteoarthritis |
| I — Intervention | Maximal internal and external foot progression angle modification during walking |
| C — Comparator | Free walking condition (natural foot progression angle) |
| O — Outcomes | Three-dimensional pelvic kinematics (depression, internal/external rotation) measured via motion capture system |
Bottom Line
This crossover study of 37 patients with medial knee osteoarthritis demonstrates that foot progression angle modifications during walking significantly alter pelvic kinematics. Internal foot rotation decreased pelvic depression and external rotation while increasing internal rotation, with opposite effects observed for external foot rotation. While the crossover design provides good internal validity by eliminating inter-individual differences, the study has important limitations including inability to blind participants, lack of patient-reported outcomes, and missing effect size data. Most critically, the findings suggest potential unintended consequences of gait modification interventions, including possible back pain and pelvic instability. Clinicians should exercise caution when implementing foot progression angle modifications for knee osteoarthritis, considering whole-body biomechanical effects rather than focusing solely on knee joint loading. The study provides valuable mechanistic insights but requires replication with comprehensive outcome measures including pain, function, and adverse effects before clinical implementation.
Key Findings
P Value: P < .05 for all significant comparisons
Effect Size: Not reported in abstract
Primary Outcome: Three-dimensional pelvic kinematics during different foot progression angle conditions
Nnt Or Sensitivity: Not applicable for kinematic study
Confidence Interval: Not reported
Clinical Application
Requires specialised gait analysis equipment and trained personnel for assessment; clinical implementation challenging Relevant to Australian physiotherapy and orthopaedic practice; aligns with RACGP osteoarthritis management guidelines emphasising conservative interventions, though specialised gait analysis may have limited PBS coverage Individuals with medial compartment knee osteoarthritis considering gait modification interventions
Abstract
BACKGROUND: Foot progression angle (FPA) modification trials during walking have been used to reduce knee adduction moments in medial compartment knee osteoarthritis. However, few studies have confirmed the impact of FPA modification as a clinical intervention on pelvic segment kinematics. METHODS: Kinematic pelvic data were obtained from 37 participants with medial knee osteoarthritis using a three-dimensional motion capture system under varying FPA walking conditions. A repeated-measures analysis of variance was conducted to assess the influence of each FPA condition on kinematic values. RESULTS: During maximal internal foot rotation gait trials, participants exhibited decreased depression, reduced external rotation, and increased internal rotation of the pelvis compared to the free walking condition (P < .05). In contrast, under the maximal external foot rotation condition, significantly less internal rotation and increased external rotation of the pelvis were observed compared to the free walking condition (P < .05). CONCLUSION: The findings of this study suggest that additional musculoskeletal dysfunctions and clinical implications, including back pain and pelvic instability, should be considered when implementing FPA modification gait in individuals with medial compartment knee osteoarthritis.
References
- 1.Kim, Y. (2026). Influence of alteration of foot progression angle on three-dimensional pelvic kinematics in individuals with knee osteoarthritis during walking: A randomized crossover study. Medicine, 105(15), e48344. https://doi.org/10.1097/MD.0000000000048344
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