Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study.
OBJECTIVE
To examine the feasibility of a 10-week gait modification program in people with medial tibiofemoral knee osteoarthritis (OA), and to assess changes in clinical and biomechanical outcomes.


METHODS
Fifteen people with medial knee OA completed 10 weeks of gait modification focusing on increasing toe-out angle during stance 10° compared to their self-selected angle measured at baseline. In addition to adherence and performance difficulty outcomes, knee joint symptoms (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and total score, numerical rating scale (NRS) of pain), and knee joint loading during gait (late stance peak knee adduction moment (KAM)) were assessed.


RESULTS
Participants were able to perform the toe-out gait modification program with minimal to moderate difficulty, and exhibited significant increases in self-selected toe-out angle during walking (P < 0.001). Joint discomfort was reported by five participants (33%) in the hip or knee joints, though none lasted longer than 2 weeks. Participants reported statistically significant reductions in WOMAC pain (P = 0.02), NRS pain (P < 0.001), WOMAC total score (P = 0.02), and late stance KAM (P = 0.04).


CONCLUSIONS
These preliminary findings suggest that toe-out gait modification is feasible in people with medial compartment knee OA. Preliminary changes in clinical and biomechanical outcomes provide the impetus for conducting larger scale studies of gait modification in people with knee OA to confirm these findings.
Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada. Electronic address: michael.hunt@ubc.ca.
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Hunt
Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada. Electronic address: takacs@alumni.ubc.ca.
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Takacs
D000368:Aged; D001696:Biomechanical Phenomena / Q000502:physiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology* / Q000628:therapy*; D010146:Pain / Q000534:rehabilitation; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D014034:Toes / Q000502:physiology*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
Gait modification; Knee; Knee adduction moment; Osteoarthritis