Control of knee coronal plane moment via modulation of center of pressure: a prospective gait analysis study.

OBJECTIVES Footwear-generated biomechanical manipulations (e.g., wedge insoles) have been shown to reduce the magnitude of adduction moment about the knee. The theory behind wedged insoles is that a more laterally shifted location of the center of pressure reduces the distance between the ground reaction force and the center of the knee joint, thereby reducing adduction moment during gait. However, the relationship between the center of pressure and the knee adduction moment has not been studied previously. The aim of this study was to examine the association between the location of the center of pressure and the relative magnitude of the knee adduction moment during gait in healthy men. METHODS A novel foot-worn biomechanical device which allows controlled manipulation of the center of pressure location was utilized. Twelve healthy men underwent successive gait analysis testing in a controlled setting and with the device set to convey three different para-sagittal locations of the center of pressure: neutral, medial offset and lateral offset. RESULTS The knee adduction moment during the stance phase significantly correlated with the shift of the center of pressure from the functional neutral sagittal axis in the coronal plane (i.e., from medial to lateral). The moment was reduced with the lateral sagittal axis configuration and augmented with the medial sagittal axis configuration. CONCLUSIONS The study results confirm the hypothesis of a direct correlation between the coronal location of the center of pressure and the magnitude of the knee adduction moment.

[1]  M P Kadaba,et al.  Measurement of lower extremity kinematics during level walking , 1990, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[2]  D. Winter.  Kinematic and kinetic patterns in human gait: Variability and compensating effects , 1984 .

[3]  K. Yasuda,et al.  Clinical evaluation of the treatment of osteoarthritic knees using a newly designed wedged insole. , 1987, Clinical orthopaedics and related research.

[4]  P. Costigan,et al.  Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis. , 2002, Clinical biomechanics.

[5]  M. Morris,et al.  The effect of the knee adduction moment on tibial cartilage volume and bone size in healthy women. , 2003, Rheumatology.

[6]  Darren J. Stefanyshyn,et al.  Knee Angular Impulse as a Predictor of Patellofemoral Pain in Runners , 2006, The American journal of sports medicine.

[7]  J C Goh,et al.  Gait analysis study on patients with varus osteoarthrosis of the knee. , 1993, Clinical orthopaedics and related research.

[8]  T. Andriacchi.  Dynamics of knee malalignment. , 1994, The Orthopedic clinics of North America.

[9]  W Waugh,et al.  The distribution of load across the knee. A comparison of static and dynamic measurements. , 1980, The Journal of bone and joint surgery. British volume.

[10]  T. Andriacchi,et al.  Dynamic knee loads during gait predict proximal tibial bone distribution. , 1998, Journal of biomechanics.

[11]  Laura E Thorp,et al.  Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. , 2006, Arthritis and rheumatism.

[12]  T. Andriacchi,et al.  A relationship between gait and clinical changes following high tibial osteotomy. , 1985, The Journal of bone and joint surgery. American volume.

[13]  W. Kakihana,et al.  Changes of Joint Moments in the Gait of Normal Subjects Wearing Laterally Wedged Insoles , 2004, American journal of physical medicine & rehabilitation.

[14]  M. Wada,et al.  Relationships among bone mineral densities, static alignment and dynamic load in patients with medial compartment knee osteoarthritis. , 2001, Rheumatology.

[15]  T. Andriacchi,et al.  The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[16]  W. Kakihana,et al.  Effects of laterally wedged insoles on knee and subtalar joint moments. , 2005, Archives of physical medicine and rehabilitation.

[17]  J. Hoffman,et al.  American Journal of Physical Medicine and Rehabilitation , 2007 .

[18]  Effect of shoe modifications on center of pressure and in-shoe plantar pressures. , 1999, American journal of physical medicine & rehabilitation.

[19]  M. Wada,et al.  Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis. , 2006, Archives of physical medicine and rehabilitation.

[20]  J. Block,et al.  Bone mineral density in the proximal tibia varies as a function of static alignment and knee adduction angular momentum in individuals with medial knee osteoarthritis. , 2006, Bone.

[21]  Richard R Neptune,et al.  Biomechanics and muscle coordination of human walking. Part I: introduction to concepts, power transfer, dynamics and simulations. , 2002, Gait & posture.

[22]  K. Ogata,et al.  The effect of wedged insoles on the thrust of osteoarthritic knees , 1997, International Orthopaedics.

[23]  K. Yasuda,et al.  The mechanics of treatment of the osteoarthritic knee with a wedged insole. , 1987, Clinical orthopaedics and related research.

[24]  S. Crenshaw,et al.  Effects of Lateral-Wedged Insoles on Kinetics at the Knee , 2000, Clinical orthopaedics and related research.

[25]  W. Godwin.  Article in Press , 2000 .

[26]  T. Andriacchi,et al.  Interaction between active and passive knee stabilizers during level walking , 1991, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.