Clinical and biomechanical changes following a 4-month toe-out gait modification program for people with medial knee osteoarthritis: a randomized controlled trial.
Study Goal
To compare changes in knee pain, function, and loading between a progressive walking program with or without toe-out gait modification in people with medial tibiofemoral knee osteoarthritis.
Results Summary
Both groups showed improvements in self-reported pain and function, but only the toe-out group demonstrated significant biomechanical improvements in foot progression angle and knee joint loading. No between-group differences were found in knee pain, function, or timed stair climb.
Population
Individuals with medial tibiofemoral knee osteoarthritis.
Effective Dosage
Progressive walking program (specific dosage not detailed).
Duration
4 months.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
4-month progressive walking program with toe-out gait modification | no change | knee pain | people with medial tibiofemoral knee osteoarthritis | - | no between-group differences | #1 |
4-month progressive walking program with toe-out gait modification | no change | function | people with medial tibiofemoral knee osteoarthritis | - | no between-group differences | #2 |
4-month progressive walking program with toe-out gait modification | no change | timed stair climb | people with medial tibiofemoral knee osteoarthritis | - | no between-group differences | #3 |
4-month progressive walking program with toe-out gait modification | decrease | foot progression angle | people with medial tibiofemoral knee osteoarthritis | mean difference = -9.04° | exhibited significantly greater changes | #4 |
4-month progressive walking program with toe-out gait modification | decrease | late stance knee adduction moment (KAM) | people with medial tibiofemoral knee osteoarthritis | mean difference = -0.26 %BW*ht | exhibited significantly greater changes | #5 |
4-month progressive walking program with toe-out gait modification | decrease | KAM impulse | people with medial tibiofemoral knee osteoarthritis | mean difference = -0.06 %BW*ht*s | exhibited significantly greater changes | #6 |
4-month progressive walking program with toe-out gait modification | decrease | foot progression angle | people with medial tibiofemoral knee osteoarthritis | mean difference = -6.78° | greater changes | #7 |
4-month progressive walking program with toe-out gait modification | neutral | - | people with medial tibiofemoral knee osteoarthritis | - | experienced biomechanical improvements | #8 |
4-month progressive walking program without toe-out gait modification | increase | self-reported pain | people with medial tibiofemoral knee osteoarthritis | - | experienced improvements | #9 |
4-month progressive walking program without toe-out gait modification | increase | function | people with medial tibiofemoral knee osteoarthritis | - | experienced improvements | #10 |
OBJECTIVE: To compare changes in knee pain, function, and loading following a 4-month progressive walking program with or without toe-out gait modification in people with medial tibiofemoral knee osteoarthritis. DESIGN: Individuals with medial knee osteoarthritis were randomized to a 4-month program to increase walking activity with (toe-out) or without (progressive walking) concomitant toe-out gait modification. The walking program was similar between the two groups, except that the gait modification group was trained to walk with 15° more toe-out. Primary outcomes included: knee joint pain (WOMAC), foot progression angles and knee joint loading during gait (knee adduction moment (KAM)). Secondary outcomes included WOMAC function, timed stair climb, and knee flexion moments during gait. RESULTS: Seventy-nine participants (40 in toe-out group, 39 in progressive walking group) were recruited. Intention-to-treat analysis showed no between-group differences in knee pain, function, or timed stair climb. However, the toe-out group exhibited significantly greater changes in foot progression angle (mean difference = -9.04° (indicating more toe-out), 95% CI: -11.22°, -6.86°; P < 0.001), late stance KAM (mean difference = -0.26 %BW*ht, 95% CI: -0.39 %BW*ht, -0.12 %BW*ht, P < 0.001) and KAM impulse (-0.06 %BW*ht*s, 95% CI: -0.11 %BW*ht*s, -0.01 %BW*ht*s; P = 0.031) compared to the progressive walking group at follow-up. The only between-group difference that remained at a 1-month retention assessment was foot progression angle, with greater changes in the toe-out group (mean difference = -6.78°, 95% CI: -8.82°, -4.75°; P < 0.001). CONCLUSIONS: Though both groups experienced improvements in self-reported pain and function, only the toe-out group experienced biomechanical improvements. TRIALS REGISTRY NUMBER: NCT02019108.