title: The Association of Forefoot Varus Deformity with Patellofemoral Cartilage Damage in Older Adult Cadavers.
abstract: Forefoot alignment may contribute to patellofemoral joint (PFJ) osteoarthritis (OA) via its influence on the closed chain kinematics of the lower limb. The purpose of this cadaveric study was to investigate the relationship between forefoot varus and ipsilateral cartilage damage in the medial and lateral PFJ. Forefoot alignment measurements were obtained from the feet of 25 cadavers (n = 50). Cartilage damage in the medial and lateral PFJ of each knee was scored using the Outerbridge scale. The relative odds of medial and lateral PFJ cartilage damage in limbs with forefoot varus and valgus were determined using logistic regression. The relationship between increasing varus alignment and increasing odds of medial and lateral PFJ cartilage damage was assessed. Of the 51% of limbs with forefoot varus, 91.3% had medial, and 78.3% had lateral PFJ cartilage damage, compared with 54.6% and 68.2% of those with forefoot valgus. The former also had 3.0 times (95% CI 1.2, 7.7) the odds of medial PFJ damage; no association was found with lateral damage (OR 1.4, 95% CI 0.7, 3.0). Feet in the highest tertile of varus alignment had 3.9 times (95% CI 10, 15.3, P = 0.058) the odds of medial PFJ damage as those in the lowest tertile. The results of this study suggest a relationship between forefoot varus and medial PFJ cartilage damage in older adults. As forefoot varus may be modified with foot orthoses, these findings indicate a potential role for orthoses in the treatment of medial PFJ OA. Anat Rec, 300:1032-1038, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Integrative Physiology and Pathobiology Division of Medical Education, Tufts University School of Medicine, Boston, Massachusetts, 02111.|Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, 02186.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lufler
authors.affiliation: Department of Physical Therapy Movement and Rehabilitation Science Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, 02115.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Stefanik
authors.affiliation: Department of Medicine, Division of Rheumatology, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, 02118.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Niu
authors.affiliation: Department of Integrative Physiology and Pathobiology Division of Medical Education, Tufts University School of Medicine, Boston, Massachusetts, 02111.
authors.forename: F Kip
authors.initials: FK
authors.lastname: Sawyer
authors.affiliation: Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, 02186.|Department of Cell Biology Neurobiology and Anatomy Medical College of Wisconsin, Milwaukee, Wisconsin, 53226.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Hoagland
authors.affiliation: Department of Physical Therapy, Massachusetts General Hospital (MGH) Institute of Health Professions, Boston, Massachusetts, 02129.
authors.forename: K Douglas
authors.initials: KD
authors.lastname: Gross
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002358:Cartilage, Articular / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000209:etiology*; D057071:Patellofemoral Joint / Q000473:pathology*; D000070558:Talipes / Q000150:complications* / Q000473:pathology
keywords: forefoot varus; knee osteoarthritis; patellofemoral cartilage