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The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis
  1. Alison Chang
  1. Northwestern University, United States
    1. Debra Hurwitz
    1. Rush Medical Center, United States
      1. Dorothy Dunlop
      1. Northwestern University, United States
        1. Jing Song
        1. Northwestern University, United States
          1. September Cahue
          1. Northwestern University, United States
            1. Karen Hayes
            1. Northwestern University, United States
              1. Leena Sharma (l-sharma{at}
              1. Northwestern University, United States


                A greater knee adduction moment increases risk of medial tibiofemoral OA progression. Greater toe-out during gait shifts the ground reaction force vector closer to knee center, reducing the adduction moment. We tested whether greater toe-out is associated with lower likelihood of medial OA progression.

                Baseline assessments included: kinematic/kinetic gait parameters using an optoelectronic camera system, force platform, and inverse dynamics to calculate 3-D external knee moments; toe-out angle (formed by line connecting heel strike and toe-off plantar surface centers of pressure and forward progression line; knee pain; full-limb alignment. Knee x-rays (semi-flexed) were obtained, baseline and 18 months, with progression as medial joint space grade worsening. With logistic regression, ORs for progression/5%X toe-out were estimated.

                In the 56 (59% women, mean age 66.6, BMI 29), baseline toe-out angle was less in knees with than without progression [difference -4.4, 95% CI (-8.5, - 0.3)]. Greater toe-out was associated with reduced likelihood of progression [OR 0.60, 95% CI (0.37, 0.98)]. Adjusting for age, gender, BMI, pain severity, disease severity, OR was 0.62, 95% CI (0.36, 1.06). Adjusting for adduction moment (second peak), OR was 0.72, 95% CI (0.40, 1.28).

                OA 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.

                • gait
                • knee
                • osteoarthritis
                • progression

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