The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis

Alison Hsin-I Chang, Debra Hurwitz, Dorothy D Dunlop, Jing Song, September Cahue, Karen Hayes, Leena Sharma*

*Corresponding author for this work

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Background: A greater knee adduction moment increases risk of medial tibiofemoral osteoarthritis (OA) progression. Greater toe-out during gait shifts the ground reaction force vector closer to the centre of the knee, reducing the adduction moment. The present study was designed to test whether greater toe-out is associated with lower likelihood of medial OA progression. Methods: Baseline assessments included: kinematic/kinetic gait parameters using an optoelectronic camera system, force platform and inverse dynamics to calculate three-dimensional external knee moments; toe-out angle (formed by the line connecting heel strike and toe-off plantar surface centres of pressure and the forward progression line; knee pain; and full-limb alignment. Knee x-rays (semi-flexed) were obtained at baseline and at 18 months, with progression noted as medial joint space grade worsening. With logistic regression, odds ratios (ORs) for progression/5° toe-out were estimated. Results: In the 56 subjects (59% women, mean age 66.6 years, body mass index (BMI) 29), baseline toe-out angle was less in knees with than without progression (difference -4.4, 95% CI -8.5 to -0.3). Greater toe-out was associated with reduced likelihood of progression (OR 0.60, 95% CI 0.37 to 0.98). Adjusting for age, gender, BMI, pain severity and disease severity, the OR was 0.62, 95% CI 0.36 to 1.06. Adjusting for adduction moment (second peak), the OR was 0.72, 95% CI 0.40 to 1.28. Conclusions: Osteoarthritic knees that progressed had less toeing-out than knees without progression. Greater toe-out was associated with a lower likelihood of progression. Adjustment for covariates did not alter the OR, although the 95% CI included 1. Further adjustment for adduction moment did alter the OR, consistent with the possibility that a mechanism of the effect may be via lowering of the adduction moment.

Original languageEnglish (US)
Pages (from-to)1271-1275
Number of pages5
JournalAnnals of the Rheumatic Diseases
Volume66
Issue number10
DOIs
StatePublished - Oct 1 2007

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Toes
Gait
Osteoarthritis
Optoelectronic devices
Logistics
Knee
Kinematics
Cameras
Hallux
X rays
Kinetics
Odds Ratio
Body Mass Index
Pain
Heel
Biomechanical Phenomena
Extremities
Joints
Logistic Models
X-Rays

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

@article{4314fb6437cb4dd9852a9a4998813c21,
title = "The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis",
abstract = "Background: A greater knee adduction moment increases risk of medial tibiofemoral osteoarthritis (OA) progression. Greater toe-out during gait shifts the ground reaction force vector closer to the centre of the knee, reducing the adduction moment. The present study was designed to test whether greater toe-out is associated with lower likelihood of medial OA progression. Methods: Baseline assessments included: kinematic/kinetic gait parameters using an optoelectronic camera system, force platform and inverse dynamics to calculate three-dimensional external knee moments; toe-out angle (formed by the line connecting heel strike and toe-off plantar surface centres of pressure and the forward progression line; knee pain; and full-limb alignment. Knee x-rays (semi-flexed) were obtained at baseline and at 18 months, with progression noted as medial joint space grade worsening. With logistic regression, odds ratios (ORs) for progression/5° toe-out were estimated. Results: In the 56 subjects (59{\%} women, mean age 66.6 years, body mass index (BMI) 29), baseline toe-out angle was less in knees with than without progression (difference -4.4, 95{\%} CI -8.5 to -0.3). Greater toe-out was associated with reduced likelihood of progression (OR 0.60, 95{\%} CI 0.37 to 0.98). Adjusting for age, gender, BMI, pain severity and disease severity, the OR was 0.62, 95{\%} CI 0.36 to 1.06. Adjusting for adduction moment (second peak), the OR was 0.72, 95{\%} CI 0.40 to 1.28. Conclusions: Osteoarthritic knees that progressed had less toeing-out than knees without progression. Greater toe-out was associated with a lower likelihood of progression. Adjustment for covariates did not alter the OR, although the 95{\%} CI included 1. Further adjustment for adduction moment did alter the OR, consistent with the possibility that a mechanism of the effect may be via lowering of the adduction moment.",
author = "Chang, {Alison Hsin-I} and Debra Hurwitz and Dunlop, {Dorothy D} and Jing Song and September Cahue and Karen Hayes and Leena Sharma",
year = "2007",
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pages = "1271--1275",
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The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis. / Chang, Alison Hsin-I; Hurwitz, Debra; Dunlop, Dorothy D; Song, Jing; Cahue, September; Hayes, Karen; Sharma, Leena.

In: Annals of the Rheumatic Diseases, Vol. 66, No. 10, 01.10.2007, p. 1271-1275.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis

AU - Chang, Alison Hsin-I

AU - Hurwitz, Debra

AU - Dunlop, Dorothy D

AU - Song, Jing

AU - Cahue, September

AU - Hayes, Karen

AU - Sharma, Leena

PY - 2007/10/1

Y1 - 2007/10/1

N2 - Background: A greater knee adduction moment increases risk of medial tibiofemoral osteoarthritis (OA) progression. Greater toe-out during gait shifts the ground reaction force vector closer to the centre of the knee, reducing the adduction moment. The present study was designed to test whether greater toe-out is associated with lower likelihood of medial OA progression. Methods: Baseline assessments included: kinematic/kinetic gait parameters using an optoelectronic camera system, force platform and inverse dynamics to calculate three-dimensional external knee moments; toe-out angle (formed by the line connecting heel strike and toe-off plantar surface centres of pressure and the forward progression line; knee pain; and full-limb alignment. Knee x-rays (semi-flexed) were obtained at baseline and at 18 months, with progression noted as medial joint space grade worsening. With logistic regression, odds ratios (ORs) for progression/5° toe-out were estimated. Results: In the 56 subjects (59% women, mean age 66.6 years, body mass index (BMI) 29), baseline toe-out angle was less in knees with than without progression (difference -4.4, 95% CI -8.5 to -0.3). Greater toe-out was associated with reduced likelihood of progression (OR 0.60, 95% CI 0.37 to 0.98). Adjusting for age, gender, BMI, pain severity and disease severity, the OR was 0.62, 95% CI 0.36 to 1.06. Adjusting for adduction moment (second peak), the OR was 0.72, 95% CI 0.40 to 1.28. Conclusions: Osteoarthritic knees that progressed had less toeing-out than knees without progression. Greater toe-out was associated with a lower likelihood of progression. Adjustment for covariates did not alter the OR, although the 95% CI included 1. Further adjustment for adduction moment did alter the OR, consistent with the possibility that a mechanism of the effect may be via lowering of the adduction moment.

AB - Background: A greater knee adduction moment increases risk of medial tibiofemoral osteoarthritis (OA) progression. Greater toe-out during gait shifts the ground reaction force vector closer to the centre of the knee, reducing the adduction moment. The present study was designed to test whether greater toe-out is associated with lower likelihood of medial OA progression. Methods: Baseline assessments included: kinematic/kinetic gait parameters using an optoelectronic camera system, force platform and inverse dynamics to calculate three-dimensional external knee moments; toe-out angle (formed by the line connecting heel strike and toe-off plantar surface centres of pressure and the forward progression line; knee pain; and full-limb alignment. Knee x-rays (semi-flexed) were obtained at baseline and at 18 months, with progression noted as medial joint space grade worsening. With logistic regression, odds ratios (ORs) for progression/5° toe-out were estimated. Results: In the 56 subjects (59% women, mean age 66.6 years, body mass index (BMI) 29), baseline toe-out angle was less in knees with than without progression (difference -4.4, 95% CI -8.5 to -0.3). Greater toe-out was associated with reduced likelihood of progression (OR 0.60, 95% CI 0.37 to 0.98). Adjusting for age, gender, BMI, pain severity and disease severity, the OR was 0.62, 95% CI 0.36 to 1.06. Adjusting for adduction moment (second peak), the OR was 0.72, 95% CI 0.40 to 1.28. Conclusions: Osteoarthritic knees that progressed had less toeing-out than knees without progression. Greater toe-out was associated with a lower likelihood of progression. Adjustment for covariates did not alter the OR, although the 95% CI included 1. Further adjustment for adduction moment did alter the OR, consistent with the possibility that a mechanism of the effect may be via lowering of the adduction moment.

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