Balance is essential for mobility and performing activities of daily living. People with knee osteoarthritis display impairment in knee joint proprioception. Thus, the aim of this study was to evaluate balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis. Sixty subjects aged between 50 and 70 years volunteered in this study. They were categorized into three groups which were healthy (n = 20), mild (n = 20) and moderate (n = 20) bilateral knee osteoarthritis groups. Dynamic and static balance and risk of fall were assessed using Biodex Stability System. In addition, Timed Up and Go test was used as a clinical test for balance. Results of this study illustrated that there were significant differences in balance (dynamic and static) and risk of fall between three groups. In addition, the main (most significant) difference was found to be between healthy group and moderate group. Furthermore, on clinical scoring of balance, the “Timed Up and Go” test, all three groups showed significant difference. In conclusion, bilateral knee osteoarthritis impaired the balance and increased the risk of fall, particularly in people with moderate knee osteoarthritis.

ObjectiveDetermine whether impairments in lower limb muscle strength exist in individuals with chronic ankle instability (CAI) compared with uninjured controls.DesignSystematic review with meta-analysis.Data sourceA comprehensive search of PubMed, Cochrane, CINAHL, Web of Science and EMBASE electronic databases from inception to 10 February 2019.Eligibility criteria for selecting studiesCross-sectional and case–control studies were included if they objectively measured lower limb muscle strength in individuals with CAI compared with controls. Risk of bias and quality of included studies were assessed. Data of included studies were extracted, and meta-analysis was conducted where appropriate.Results12 397 unique studies were identified, of which 20 were included and 16 were eligible for meta-analysis. Reviewed studies clearly described the aim/hypothesis and main outcome measure, but most lacked sample size calculation and assessor blinding. Meta-analyses showed individuals with CAI had lower eccentric and concentric evertor strength (30 and 120°/s; Nm; standardised mean difference (SMD) between −0.73 and −0.95), eccentric invertor strength (60 and 120°/s; both Nm and Nm/kg; SMD between −0.61 and −1.37), concentric invertor strength (60 and 120°/s; Nm; SMD=−0.7) and concentric knee extensor strength (SMD=−0.64) compared with control participants. Ankle eccentric dorsiflexor strength was not different between groups. Although pooling was not possible, data from three separate studies indicated that hip flexor, abductor and external rotator strength, but not hip adductor and extensor strength, was lower in individuals with CAI than in control participants.ConclusionIndividuals with CAI have ankle inversion and eversion strength deficits. Our data also point to differences between individuals with CAI and controls in hip and knee strength. These elements of the kinetic chain should be evaluated by clinicians who rehabilitate individuals with CAI.PROSPERO registration numberCRD42016037759.

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The knee adduction moment represents the medial knee joint load, and greater value is associated with higher load. In people with knee osteoarthritis, it is important to apply proper treatment with the least side effects to reduce knee adduction moment and, consequently, reduce medial knee joint load. This reduction may slow the progression of knee osteoarthritis. The research team performed a literature search of electronic databases. The search keywords were as follows: knee osteoarthritis, knee adduction moment, exercise program, exercise therapy, gait retraining, gait modification and knee joint loading. In total, 12 studies were selected, according to the selection criteria. Findings from previous studies illustrated that exercise and gait retraining programs could alter knee adduction moment in people with knee osteoarthritis. These treatments are noninvasive and nonpharmacological which so far have no or few side effects, as well as being low cost. The results of this review revealed that gait retraining programs were helpful in reducing the knee adduction moment. In contrast, not all the exercise programs were beneficial in reducing knee adduction moment. Future studies are needed to indicate best clinical exercise and gait retraining programs, which are most effective in reducing knee adduction moment in people with knee osteoarthritis.

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Feet displacement is recognized to be an important element in standing and is also linked to postural instability in elderly people with diabetes. This study investigates standing balance in diabetic patients in four asymmetric feet displacements. Quiet standing balance was investigated using the Biodex Balance System in 18 diabetic patients and compared with 18 control elderly subjects. The four standing conditions, namely, comfortable feet position, preferred feet position with a stance width of 17 cm and 15° angle between the medial borders, feet side by side, and heel side by side with a 30° angle between medial edges of feet were evaluated (i.e. eyes opened, eyes closed). The overall stability was calculated by measuring anterior-posterior and medial-lateral indices in standing conditions. Differences among feet positions were compared using an analysis of variance and the independent t-test. The diabetic patients were unstable in the medial-lateral direction when standing with feet side by side versus heel side by side with a 30° angle between medial edges of feet (p = 0.012 and 0.011, respectively), while in controls the anterior-posterior stability scores between standing in preferred foot position with stance width of 17 cm and 15° angle between the medial borders versus feet side by side, and heel side by side with a 30° angle between medial edges of feet versus preferred foot position with stance width of 17 cm and 15° angle between the medial borders had significant difference (p < 0.05). The anterior-posterior stability scores of diabetic subjects with feet side by side versus comfortable foot position (p = 0.047) and heel side by side with a 30° angle between medial edges of feet versus comfortable foot position (p = 0.016) when they closed their eyes during the test had significant difference. Results confirmed that diabetic patients have greater instability in the medial-lateral direction when the base of support reduces and visual clue has an important role in standing balance.

Knee osteoarthritis is a common cause of disability which influences the quality of life. It is associated with impaired knee joint proprioception, which affects postural stability. Postural stability is critical for mobility and physical activities. Different types of treatment including nonsurgical and surgical are used for knee osteoarthritis. Hyaluronic acid injection is a nonsurgical popular treatment used worldwide. The aim of this study was to demonstrate the effect of hyaluronic acid injections on postural stability in individuals with bilateral knee osteoarthritis. Fifty patients aged between 50 and 70 years with mild and moderate bilateral knee osteoarthritis participated in our study. They were categorized into treatment (n = 25) and control (n = 25) groups. The treatment group received five weekly hyaluronic acid injections for both knees, whereas the control group did not receive any treatment. Postural stability and fall risk were assessed using the Biodex Stability System and clinical “Timed Up and Go” test. All the participants completed the study. The treatment group showed significant decrease in postural stability and fall risk scores after five hyaluronic acid injections. In contrast, the control group showed significant increase. This study illustrated that five intra-articular hyaluronic acid injections could significantly improve postural stability and fall risk in bilateral knee osteoarthritis patients. This trial is registered with: NCT02063373.

As the orthotic treatment is a time-consuming method that needs the close collaboration of patient and treatment team, it is possible that clinicians predict the probable result of treatment and efficiency of orthotic treatment. Thus, a clinician can abandon orthotic treatment and refer the patient for an operation.