The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis
The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis
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DOI：
10.1136/ard.2006.062927
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发表时间：
2007-10-01
影响因子：
27.4
通讯作者：
Sharma, Leena
中科院分区：
文献类型：
--
作者：
Chang, Alison;Hurwitz, Debra;Sharma, Leena
背景：膝关节内收力矩越大，内侧胫股骨关节炎（OA）进展的风险越大。步态中更大的脚趾外移使地面反作用力矢量更接近膝盖中心，从而减少内收力矩。本研究的目的是测试是否更大的脚趾出与内侧OA progression.Methods较低的可能性：基线评估包括：运动学/动力学步态参数使用光电摄像系统，力平台和逆动力学计算三维外部膝关节力矩;前束角（由连接足跟着地和前束足底表面压力中心的线和向前进展线形成）;膝关节疼痛;和四肢对齐。在基线和18个月时获得膝关节X线片（半屈曲），进展记录为内侧关节间隙等级恶化。结果：在56例受试者中（59%为女性，平均年龄66.6岁，体重指数（BMI）29），基线脚趾出角小于膝关节与没有进展（差异-4.4，95%CI-8.5-0.3）。脚趾外翻较大与进展可能性降低相关（OR 0.60，95% CI 0.37 - 0.98）。调整年龄、性别、BMI、疼痛严重程度和疾病严重程度后，OR为0.62，95%CI为0.36 - 1.06。校正内收力矩（第二峰值）后，OR为0.72，95%CI为0.40 ~ 1.28。结论：进展性骨关节炎膝关节的前趾外翻程度低于未进展膝关节。脚趾向外越大，进展的可能性越低。协变量调整未改变OR，尽管95% CI包括1。对内收力矩的进一步调整确实改变了OR，这与影响机制可能是通过降低内收力矩的可能性一致。
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 degrees 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.