Ohi Hiroshi, Iijima Hirotaka, Fukutani Naoto, Aoyama Tomoki, Kaneda Eishi, Ohi Kazuko, Ito Hiromu, Matsuda Shuichi, Kaoru Abe
Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan; Ohi Manufacturing Co., Ltd., Kyoto, Japan.
Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Department of System Design Engineering, Keio University, Yokohama, Japan.
Gait Posture. 2018 Mar;61:269-275. doi: 10.1016/j.gaitpost.2018.01.020. Epub 2018 Mar 20.
The foot is speculated to play a role in knee joint kinematics. This exploratory cross-sectional study examined the association between static foot posture and the presence of varus thrust visualized during gait in patients with medial knee osteoarthritis (OA). Patients (n = 88 patients and 134 knees; age, 61-91 years; 68.2% female) with Kellgren/Lawrence (K/L) grade ≥1 in the medial compartment were included in this study and underwent gait observation for varus thrust. These patients' three-dimensional static foot posture while standing was evaluated and their tibiofemoral joint K/L grades and anatomical axis angles were also assessed as covariates. Knees with varus thrust (22 knees, 16.4%) on average had a 4° more inverted calcaneus relative to the floor than those without varus thrust (P < 0.001). A logistic regression analysis showed that an increased calcaneus inversion angle was significantly associated with higher odds of the presence of varus thrust with adjustments for age, sex, body mass index, K/L grade, and anatomical axis angle. The other predictors, such as navicular height, navicular height/foot length, and rearfoot angle relative to the lower leg, were not significantly associated with varus thrust. These results suggest that patients with varus thrust had a different static rearfoot posture as compared with those without varus thrust, a finding that may indicate an important role of static rearfoot posture in the pathogenesis of varus thrust. Furthermore, investigating the potential influence of foot posture on the efficacy of biomechanical interventions, such as lateral wedge insole use, on varus thrust would be of particular interest in the further studies.
据推测，足部在膝关节运动学中发挥着作用。这项探索性横断面研究调查了内侧膝关节骨关节炎（OA）患者静态足部姿势与步态中所见内翻推力之间的关联。本研究纳入了内侧间室Kellgren/Lawrence（K/L）分级≥1级的患者（n = 88例患者，134个膝关节；年龄61 - 91岁；68.2%为女性），并对其进行了内翻推力的步态观察。评估了这些患者站立时的三维静态足部姿势，并将其胫股关节K/L分级和解剖轴角度作为协变量进行评估。有内翻推力的膝关节（22个膝关节，16.4%）相对于地面平均比无内翻推力的膝关节跟骨内翻多4°（P < 0.001）。逻辑回归分析表明，在对年龄、性别、体重指数、K/L分级和解剖轴角度进行调整后，跟骨内翻角度增加与存在内翻推力的较高几率显著相关。其他预测因素，如舟骨高度、舟骨高度/足长以及相对于小腿的后足角度，与内翻推力无显著关联。这些结果表明，有内翻推力的患者与无内翻推力的患者相比，其静态后足姿势不同，这一发现可能表明静态后足姿势在内翻推力发病机制中起重要作用。此外，在进一步研究中，研究足部姿势对生物力学干预（如使用外侧楔形鞋垫）对内翻推力疗效的潜在影响将特别有意义。
