Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
PM R. 2019 May;11(5):503-511. doi: 10.1016/j.pmrj.2018.08.388. Epub 2019 Apr 1.
Toe-in and toe-out walking are 2 strategies that have been shown to be effective in reducing the knee adduction moment in people with knee osteoarthritis. However, despite a positive biomechanical impact on the knee, altering foot rotation may impart unintended forces or joint positions on the ankle that could impact joint health. The kinematic and kinetic changes at the ankle during toe-in or toe-out walking have yet to be examined.
To examine ankle/rearfoot biomechanics during toe-in and toe-out walking in those with knee osteoarthritis.
Single-session repeated measures design to compare ankle biomechanics during walking with 4 different foot rotations.
University motion analysis laboratory.
A convenience sample (N = 15) of males and females with a diagnosis of medial knee osteoarthritis confirmed by radiographs.
Participants walked in 4 conditions guided by real-time biofeedback: (1) toe-in (+10°), (2) zero rotation (0°), (3) toe-out (-10°), and (4) toe-out (-20°). Ankle and rearfoot kinematics and kinetics were examined during barefoot over-ground walking.
Ankle joint angles, moments, moment impulses, and foot rotation.
Overall, toe-in compared to toe-out walking decreased (P = .03) peak rearfoot eversion (toe-in = -1.6°; 10° toe-out = -3.7°; 20° toe-out = -4.1°). Toe-in compared to toe-out walking also increased rearfoot inversion at initial contact (7.4° vs 3.1° at 10° toe-out and 1.9° at 20° toe-out; P < .001) and frontal plane rearfoot angle excursion (9.0° vs 6.8° at 10° toe-out and 6.0° at 20° toe-out; P < .006). Toe-in compared to all other conditions increased peak external ankle inversion moments (0.04 Nm/kg vs 0.02 Nm/kg at 0°, 0.02 Nm/kg at 10° toe-out, and 0.01 Nm/kg at 20° toe-out; P < .003).
Toe-in and toe-out walking require different ankle/rearfoot biomechanics, though no differences in discomfort were observed. Longer-term studies are required to properly assess these relationships in knee osteoarthritis populations.
IV.
内翻和外翻行走是两种已被证明可有效减少膝骨关节炎患者膝关节内收力矩的策略。然而，尽管对膝关节有积极的生物力学影响，但改变足部旋转可能会对踝关节施加意想不到的力或关节位置，从而影响关节健康。内翻或外翻行走时踝关节/后足的运动学和动力学变化尚未得到研究。
研究膝骨关节炎患者内翻和外翻行走时的踝关节/后足生物力学。
单次会话重复测量设计，比较 4 种不同足部旋转时行走时的踝关节生物力学。
大学运动分析实验室。
经 X 射线证实患有内侧膝骨关节炎的男性和女性的便利样本（N=15）。
参与者在实时生物反馈指导下以 4 种不同的条件行走：（1）内翻（+10°），（2）零旋转（0°），（3）外翻（-10°）和（4）外翻（-20°）。在赤脚地面行走时检查踝关节和后足运动学和动力学。
踝关节角度、力矩、力矩冲量和足部旋转。
总体而言，与外翻相比，内翻行走（P=0.03）降低了峰值后足外翻（内翻=-1.6°；10°外翻=-3.7°；20°外翻=-4.1°）。与外翻相比，内翻行走还增加了初始接触时的后足内翻（7.4°比 10°外翻时的 3.1°和 20°外翻时的 1.9°；P<0.001）和额状面后足角度偏移（9.0°比 10°外翻时的 6.8°和 20°外翻时的 6.0°；P<0.006）。与所有其他条件相比，内翻行走增加了峰值外踝关节内翻力矩（0.04 Nm/kg 比 0.02 Nm/kg 在 0°，0.02 Nm/kg 在 10°外翻，0.01 Nm/kg 在 20°外翻；P<0.003）。
内翻和外翻行走需要不同的踝关节/后足生物力学，但观察到的不适感没有差异。需要进行更长期的研究才能在膝骨关节炎人群中正确评估这些关系。
IV。
