Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Association of frontal plane knee alignment with foot posture in patients with medial knee osteoarthritis

Authors: Hiroshi Ohi, Hirotaka Iijima, Tomoki Aoyama, Eishi Kaneda, Kazuko Ohi, Kaoru Abe

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Login to get access

Abstract

Background

To examine the association of radiographic frontal plane knee alignment with three-dimensional foot posture in patients with medial knee osteoarthritis (OA).

Methods

Participants in orthopedic clinics with Kellgren/Lawrence (K/L) grade ≥1 (88 patients and 88 knees; age, 61–91 years; 65.9% female) were enrolled. An anteroposterior radiographic view was used to assess the anatomical axis angle (AAA) after subtracting a sex-specific correction factor. The three-dimensional foot posture was also evaluated.

Results

Multiple regression analyses showed that increased corrected AAA (i.e., valgus direction) was independently associated with a decrease in the hallux valgus angle (regression coefficient: −0.40 per degree, 95% confidence interval [CI]: −0.72, −0.09; P = 0.013) and increase in the pronation angle of the calcaneus relative to floor (regression coefficient: 0.33 per degree, 95% CI: 0.10, 0.56; P = 0.005) adjusted for age, sex, and body mass index. The relationship between the corrected AAA and hallux valgus angle strengthened (regression coefficient: −0.60 per degree, 95% CI: −1.08, −0.13; P = 0.014) in varus-aligned knees examined separately (63 knees). The other foot postures (navicular height, navicular height/foot length, and rearfoot angle) were not significantly associated with corrected AAA.

Conclusions

Radiographic frontal plane knee alignment was associated with hallux valgus angle and calcaneus angle relative to the floor in patients with medial knee OA, particularly in varus-aligned knees. These results indicate a connection between altered frontal knee alignment and foot posture, which may be helpful in understanding the pathogenesis of altered foot posture observed in patients with knee OA.
Literature
1.
Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, Kelly-Hayes M, Wolf PA, Kreger BE, Kannel WB. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994;84(3):351–8.CrossRefPubMedPubMedCentral
2.
Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91–7.CrossRefPubMedPubMedCentral
3.
Hunter DJ, Sharma L, Skaife T. Alignment and osteoarthritis of the knee. J Bone Joint Surg Am. 2009;91 Suppl 1:85–9.CrossRefPubMed
4.
Sharma L. The role of varus and valgus alignment in knee osteoarthritis. Arthritis Rheum. 2007;56(4):1044–7.CrossRefPubMed
5.
Felson DT, Niu J, Gross KD, Englund M, Sharma L, Cooke TD, Guermazi A, Roemer FW, Segal N, Goggins JM, et al. Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Rheum. 2013;65(2):355–62.CrossRefPubMedPubMedCentral
6.
Levinger P, Menz HB, Fotoohabadi MR, Feller JA, Bartlett JR, Bergman NR. Foot posture in people with medial compartment knee osteoarthritis. J Foot Ankle Res. 2010;3:29.CrossRefPubMedPubMedCentral
7.
Reilly K, Barker K, Shamley D, Newman M, Oskrochi GR, Sandall S. The role of foot and ankle assessment of patients with lower limb osteoarthritis. Physiotherapy. 2009;95(3):164–9.CrossRefPubMed
8.
Anne Reilly K, Louise Barker K, Shamley D, Sandall S. Influence of foot characteristics on the site of lower limb osteoarthritis. Foot Ankle Int. 2006;27(3):206–11.CrossRefPubMed
9.
Golightly YM, Hannan MT, Dufour AB, Renner JB, Jordan JM. Factors associated with hallux valgus in a community-based cross-sectional study of adults with and without osteoarthritis. Arthritis Care Res (Hoboken). 2015;67(6):791–8.CrossRef
10.
Gross KD, Felson DT, Niu J, Hunter DJ, Guermazi A, Roemer FW, Dufour AB, Gensure RH, Hannan MT. Association of flat feet with knee pain and cartilage damage in older adults. Arthritis Care Res (Hoboken). 2011;63(7):937–44.CrossRef
11.
Roddy E, Zhang W, Doherty M. Prevalence and associations of hallux valgus in a primary care population. Arthritis Rheum. 2008;59(6):857–62.CrossRefPubMed
12.
Guler H, Karazincir S, Turhanoglu AD, Sahin G, Balci A, Ozer C. Effect of coexisting foot deformity on disability in women with knee osteoarthritis. J Am Podiatr Med Assoc. 2009;99(1):23–7.CrossRefPubMed
13.
Paterson KL, Hinman RS, Hunter DJ, Wrigley TV, Bennell KL. Impact of concurrent foot pain on health and functional status in people with knee osteoarthritis: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2015;67(7):989–95.CrossRef
14.
Paterson KL, Kasza J, Hunter DJ, Hinman RS, Menz HB, Peat G, Bennell KL. The relationship between foot and ankle symptoms and risk of developing knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage. 2017;25(5):639–46.CrossRefPubMed
15.
Gates LS, Bowen CJ, Sanchez-Santos MT, Delmestri A, Arden NK. Do foot & ankle assessments assist the explanation of 1 year knee arthroplasty outcomes? Osteoarthritis Cartilage. 2017;25(6):892–8.CrossRefPubMed
16.
Souza TR, Pinto RZ, Trede RG, Kirkwood RN, Fonseca ST. Temporal couplings between rearfoot-shank complex and hip joint during walking. Clin Biomech (Bristol, Avon). 2010;25(7):745–8.CrossRef
17.
Lafortune MA, Cavanagh PR, Sommer 3rd HJ, Kalenak A. Foot inversion-eversion and knee kinematics during walking. J Orthop Res. 1994;12(3):412–20.CrossRefPubMed
18.
Van Gheluwe B, Kirby KA, Hagman F. Effects of simulated genu valgum and genu varum on ground reaction forces and subtalar joint function during gait. J Am Podiatr Med Assoc. 2005;95(6):531–41.CrossRefPubMed
19.
Mullaji A, Shetty GM. Persistent hindfoot valgus causes lateral deviation of weightbearing axis after total knee arthroplasty. Clin Orthop Relat Res. 2011;469(4):1154–60.CrossRefPubMed
20.
Norton AA, Callaghan JJ, Amendola A, Phisitkul P, Wongsak S, Liu SS, Fruehling-Wall C. Correlation of knee and hindfoot deformities in advanced knee OA: compensatory hindfoot alignment and where it occurs. Clin Orthop Relat Res. 2015;473(1):166–74.CrossRefPubMed
21.
Hara Y, Ikoma K, Arai Y, Ohashi S, Maki M, Kubo T. Alteration of hindfoot alignment after total knee arthroplasty using a novel hindfoot alignment view. J Arthroplasty. 2015;30(1):126–9.CrossRefPubMed
22.
Levinger P, Menz HB, Morrow AD, Bartlett JR, Feller JA, Fotoohabadi MR, Bergman NR. Dynamic foot function changes following total knee replacement surgery. Knee. 2012;19(6):880–5.CrossRefPubMed
23.
Okamoto Y, Otsuki S, Jotoku T, Nakajima M, Neo M. Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity. Knee Surg Sports Traumatol Arthrosc. 2016. Epub ahead of print.
24.
Muraki S, Oka H, Akune T, Mabuchi A, En-yo Y, Yoshida M, Saika A, Suzuki T, Yoshida H, Ishibashi H, et al. Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts: the ROAD study. Osteoarthritis Cartilage. 2009;17(9):1137–43.CrossRefPubMed
25.
Kraus VB, Vail TP, Worrell T, McDaniel G. A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arthritis Rheum. 2005;52(6):1730–5.CrossRefPubMed
26.
Hinman RS, May RL, Crossley KM. Is there an alternative to the full-leg radiograph for determining knee joint alignment in osteoarthritis? Arthritis Rheum. 2006;55(2):306–13.CrossRefPubMed
27.
Iijima H, Ohi H, Isho T, Aoyama T, Fukutani N, Kaneda E, Ohi K, Abe K, Kuroki H, Matsuda S. Association of bilateral flat feet with knee pain and disability in patients with knee osteoarthritis: A cross-sectional study. J Orthop Res. 2017. Epub ahead of print.
28.
29.
Wise BL, Kritikos L, Lynch JA, Liu F, Parimi N, Tileston KL, Nevitt MC, Lane NE. Proximal femur shape differs between subjects with lateral and medial knee osteoarthritis and controls: the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2014;22(12):2067–73.CrossRefPubMedPubMedCentral
30.
Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage. 2007;15(Suppl A):A1–A56.CrossRefPubMed
31.
Muraki S, Akune T, En-Yo Y, Yoshida M, Suzuki T, Yoshida H, Ishibashi H, Tokimura F, Yamamoto S, Tanaka S, et al. Joint space narrowing, body mass index, and knee pain: the ROAD study (OAC1839R1). Osteoarthritis Cartilage. 2015;23(6):874–81.CrossRefPubMed
32.
Hart DJ, Spector TD. Kellgren & Lawrence grade 1 osteophytes in the knee--doubtful or definite? Osteoarthritis Cartilage. 2003;11(2):149–50.CrossRefPubMed
33.
Cibere J, Sayre EC, Guermazi A, Nicolaou S, Kopec JA, Esdaile JM, Thorne A, Singer J, Wong H. Natural history of cartilage damage and osteoarthritis progression on magnetic resonance imaging in a population-based cohort with knee pain. Osteoarthritis Cartilage. 2011;19(6):683–8.CrossRefPubMed
34.
Schiphof D, de Klerk BM, Kerkhof HJ, Hofman A, Koes BW, Boers M, Bierma-Zeinstra SM. Impact of different descriptions of the Kellgren and Lawrence classification criteria on the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2011;70(8):1422–7.CrossRefPubMed
35.
McDaniel G, Mitchell KL, Charles C, Kraus VB. A comparison of five approaches to measurement of anatomic knee alignment from radiographs. Osteoarthritis Cartilage. 2010;18(2):273–7.CrossRefPubMed
36.
Sheehy L, Felson D, Zhang Y, Niu J, Lam YM, Segal N, Lynch J, Cooke TD. Does measurement of the anatomic axis consistently predict hip-knee-ankle angle (HKA) for knee alignment studies in osteoarthritis? Analysis of long limb radiographs from the multicenter osteoarthritis (MOST) study. Osteoarthritis Cartilage. 2011;19(1):58–64.CrossRefPubMed
37.
Issa SN, Dunlop D, Chang A, Song J, Prasad PV, Guermazi A, Peterfy C, Cahue S, Marshall M, Kapoor D, et al. Full-limb and knee radiography assessments of varus-valgus alignment and their relationship to osteoarthritis disease features by magnetic resonance imaging. Arthritis Rheum. 2007;57(3):398–406.CrossRefPubMed
38.
Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P. Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthritis Cartilage. 1997;5(1):39–47.CrossRefPubMed
39.
Fujita H, Fukumoto S, Yoshida H, Wakasugi Y, Kano H. A 3D Foot Scanning System with a Sensor Head Guided around the Foot (Japanese Title: 単一の計測ヘッドで足の全体形状計測を行う三次元足型自動計測機). Trans Inst Syst Control Inf Eng. 2004;17:330–7.
40.
Nishimura A, Kato K, Fukuda A, Nakazora S, Yamada T, Uchida A, Sudo A. Prevalence of hallux valgus and risk factors among Japanese community dwellers. J Orthop Sci. 2014;19(2):257–62.CrossRefPubMed
41.
Root ML, Orien WP, Weed JH. Normal and abnormal function of the foot: Clinical Biomechanics. 1977.
42.
Zhang Y, Glynn RJ, Felson DT. Musculoskeletal disease research: should we analyze the joint or the person? J Rheumatol. 1996;23(7):1130–4.PubMed
43.
Matsumoto T, Hashimura M, Takayama K, Ishida K, Kawakami Y, Matsuzaki T, Nakano N, Matsushita T, Kuroda R, Kurosaka M. A radiographic analysis of alignment of the lower extremities--initiation and progression of varus-type knee osteoarthritis. Osteoarthritis Cartilage. 2015;23(2):217–23.CrossRefPubMed
44.
Uritani D, Fukumoto T, Matsumoto D, Shima M. Associations between toe grip strength and hallux valgus, toe curl ability, and foot arch height in Japanese adults aged 20 to 79 years: a cross-sectional study. J Foot Ankle Res. 2015;8:18.CrossRefPubMedPubMedCentral
45.
Ozguclu E, Kilic E, Kaymak B. A knee osteoarthritis connected with hallux valgus-related pes planus. J Biomech. 2008;41(16):3523–4.CrossRefPubMed
46.
47.
Coughlin MJ, Thompson FM. The high price of high-fashion footwear. Instr Course Lect. 1995;44:371–7.PubMed
48.
Torkki M, Malmivaara A, Seitsalo S, Hoikka V, Laippala P, Paavolainen P. Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA. 2001;285(19):2474–80.CrossRefPubMed
49.
Lidtke RH, Muehleman C, Kwasny M, Block JA. Foot center of pressure and medial knee osteoarthritis. J Am Podiatr Med Assoc. 2010;100(3):178–84.CrossRefPubMed
50.
Saito I, Okada K, Nishi T, Wakasa M, Saito A, Sugawara K, Takahashi Y, Kinoshita K. Foot pressure pattern and its correlation with knee range of motion limitations for individuals with medial knee osteoarthritis. Arch Phys Med Rehabil. 2013;94(12):2502–8.CrossRefPubMed
51.
Otsuki T, Nawata K, Okuno M. Quantitative evaluation of gait pattern in patients with osteoarthrosis of the knee before and after total knee arthroplasty. Gait analysis using a pressure measuring system. J Orthop Sci. 1999;4(2):99–105.CrossRefPubMed
52.
Shih KS, Chien HL, Lu TW, Chang CF, Kuo CC. Gait changes in individuals with bilateral hallux valgus reduce first metatarsophalangeal loading but increase knee abductor moments. Gait Posture. 2014;40(1):38–42.CrossRefPubMed
53.
Voronov ML, Pinzur MS, Havey RM, Carandang G, Gil JA, Hopkinson WJ. The relationship between knee arthroplasty and foot loading. Foot Ankle Spec. 2012;5(1):17–22.CrossRefPubMed
54.
Riegger-Krugh C, Keysor JJ. Skeletal malalignments of the lower quarter: correlated and compensatory motions and postures. J Orthop Sports Phys Ther. 1996;23(2):164–70.CrossRefPubMed
55.
Takenaka T, Ikoma K, Ohashi S, Arai Y, Hara Y, Ueshima K, Sawada K, Shirai T, Fujiwara H, Kubo T. Hindfoot alignment at one year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016;24(8):2442–6.CrossRefPubMed
56.
Abourazzak F, Kadi N, Azzouzi H, Lazrak F, Najdi A, Nejjari C, Harzy T. A Positive Association Between Foot Posture Index and Medial Compartment Knee Osteoarthritis in Moroccan People. Open Rheumatol J. 2014;8:96.CrossRef
57.
Buchanan KR, Davis I. The relationship between forefoot, midfoot, and rearfoot static alignment in pain-free individuals. J Orthop Sports Phys Ther. 2005;35(9):559–66.CrossRefPubMed
58.
Arangio GA, Phillippy DC, Xiao D, Gu WK, Salathe EP. Subtalar pronation--relationship to the medial longitudinal arch loading in the normal foot. Foot Ankle Int. 2000;21(3):216–20.CrossRefPubMed
59.
Mahiquez MY, Wilder FV, Stephens HM. Positive hindfoot valgus and osteoarthritis of the first metatarsophalangeal joint. Foot Ankle Int. 2006;27(12):1055–9.CrossRefPubMed
60.
Nix SE, Vicenzino BT, Collins NJ, Smith MD. Characteristics of foot structure and footwear associated with hallux valgus: a systematic review. Osteoarthritis Cartilage. 2012;20(10):1059–74.CrossRefPubMed
61.
Wilder FV, Barrett JP, Farina EJ. The association of radiographic foot osteoarthritis and radiographic osteoarthritis at other sites. Osteoarthritis Cartilage. 2005;13(3):211–5.CrossRefPubMed
62.
Arnold J, Mackintosh S, Jones S, Thewlis D. Altered dynamic foot kinematics in people with medial knee osteoarthritis during walking: a cross-sectional study. Knee. 2014;21(6):1101–6.CrossRefPubMed
Metadata
Title
Association of frontal plane knee alignment with foot posture in patients with medial knee osteoarthritis
Authors
Hiroshi Ohi
Hirotaka Iijima
Tomoki Aoyama
Eishi Kaneda
Kazuko Ohi
Kaoru Abe
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1588-z

Other articles of this Issue 1/2017

BMC Musculoskeletal Disorders 1/2017 Go to the issue

Research article

Psychological risk and protective factors for disability in chronic low back pain – a longitudinal analysis in primary care

Correction

Correction to: effects of dietary gelatin hydrolysates on bone mineral density in magnesium-deficient rats

Case report

Sonication contribution to identifying prosthetic joint infection with Ralstonia pickettii: a case report and review of the literature

Research article

Micro-structural bone changes in early rheumatoid arthritis persist over 1-year despite use of disease modifying anti-rheumatic drug therapy

Research article

With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction

Research article

Physical therapists and importance of work participation in patients with musculoskeletal disorders: a focus group study