Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis

Gardner, Jacob K.; Zhang, Songning; Liu, Hairui; Klipple, Gary; Stewart, Candice; Milner, Clare E.; Asif, Irfan M.

doi:10.1016/j.clinbiomech.2015.01.003

Cited by 20 publications

(28 citation statements)

References 33 publications

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“…In KOA groups, four studies reported a BMI mean of 18.5–24.9 kg/m 2 (normal weight) [ 20 , 28 , 43 , 56 ]; 19 studies reported participants’ mean BMI of 25–29.9 kg/m 2 (overweight) [ 22 , 23 , 27 , 30 , 31 , 33 – 35 , 38 – 42 , 44 , 45 , 49 , 52 , 53 , 55 ]; eight studies reported the mean BMI of 30–34.9 kg/m 2 (grade I obese) [ 18 , 21 , 24 – 26 , 32 , 37 , 48 ]; and one study reported a mean BMI ≥35 kg/m 2 [ 51 ] (grade II obese). Seven studies did not report the mean BMI of their participants [ 19 , 29 , 36 , 46 , 47 , 50 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies did not report the mean BMI of their participants [ 19 , 29 , 36 , 46 , 47 , 50 , 54 ]. In control groups, four studies reported a BMI mean of 18.5–24.9 kg/m 2 (normal weight) [ 20 , 44 , 45 , 56 ]; 12 studies reported participants’ mean BMI of 25–29.9 kg/m 2 (overweight) [ 18 , 21 , 22 , 25 , 31 , 37 – 41 , 48 , 51 ] and six studies did not report the mean BMI of their control participants [ 19 , 29 , 46 , 47 , 50 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

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Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta‐analysis

Almeheyawi

Riskowski

Barn

et al. 2021

Journal of Foot and Ankle Research

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Background Foot characteristics and mechanics are hypothesized to affect aetiology of several lower extremity musculoskeletal conditions, including knee osteoarthritis (KOA). The purpose of this systematic review was to identify the foot characteristics and mechanics of individuals with KOA. Methods Five databases were searched to identify relevant studies on foot characteristics and mechanics in people with KOA. Meta-analyses were performed where common measures were found across included studies. Included studies were evaluated for data reporting quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist. Results Thirty-nine studies were included in this systematic review. Two studies reported participants with KOA had statistically significantly (P < 0.05) more pronated foot postures than those without. Meta-analyses for foot progression angle (FPA) and peak rearfoot eversion angle found no difference between those with and without KOA (FPA mean difference:-1.50 [95% confidence interval − 4.20-1.21]; peak rearfoot eversion mean difference: 0.71 [1.55–2.97]). Conclusion A more pronated foot posture was noticed in those with KOA. However, it was not possible to establish a relationship between other foot characteristics or mechanics in people with KOA due to heterogeneity between the included study and limited number of studies with similar measurements. There is need for identifying common measurement techniques and reporting metrics when studying the foot in those with KOA.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta‐analysis

Almeheyawi

Riskowski

Barn

et al. 2021

Journal of Foot and Ankle Research

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“…12 For people with medial knee OA, rotating the shank to increase toe-in angle reduced peak knee adduction angles, with no impact on peak knee abduction moments. 36 Gardner et al 36 hypothesized that an alignment change with increased toe-in foot position would decrease the frontal plane moment arm of the pedal reaction force, which would decrease knee abduction moments. As competitive cyclists and people with knee OA differ in knee alignment, findings may be specific to these populations.…”

Section: Discussionmentioning

confidence: 99%

“…For participants with osteoarthritis (OA) with and without pain, decreased knee adduction angles of 2.7° and 3.2° were seen with wedges placed to increase the toe-in angle by 5° and 10°, respectively; yet no changes were seen in knee abduction moments and vertical pedal reaction forces increased. 36 Ankle eversion of 10° was found to decrease knee peak varus moments by 55% and peak internal axial moments by 53% and to increase activation ratio of the vastus medialis to vastus lateralis (r = -0.23). 12 Thus eversion of the foot may decrease risks for PFP.…”

Section: Methodology and Outcomes Measuredmentioning

confidence: 99%

“…24,30,36 Knee kinetics with or without assessment of other joints were main outcome measures in 12 studies with different measures examined, including joint power, [25][26][27] 32 Moments around the knee were primarily measured in the sagittal plane, but four studies also examined moments in the coronal plane. 12,24,30,36 Two studies measured muscle activity around the knee using electromyography (EMG), 12,35 and one study assessed pain. Cadence and Power Effects: Increasing cadence led to increased knee range of motion (ROM), 27 increased anterior and vertical pedal reaction forces, 30 and increased knee flexion moments.…”

Section: Methodology and Outcomes Measuredmentioning

confidence: 99%

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The Influence of Extrinsic Factors on Knee Biomechanics During Cycling: A Systematic Review of the Literature

Johnston

Baskins

Koppel

et al. 2017

Intl J Sports Phys Ther

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Background:The knee is susceptible to injury during cycling due to the repetitive nature of the activity while generating torque on the pedal. Knee pain is the most common overuse related injury reported by cyclists, and intrinsic and extrinsic factors can contribute to the development of knee pain.Purpose: Due to the potential for various knee injuries, this purpose of this systematic review of the literature was to determine the association between biomechanical factors and knee injury risk in cyclists. Study Design: Systematic review of the literatureMethods: Literature searches were performed using CINAHL, Ovid, PubMed, Scopus and SPORTDiscus. Quality of studies was assessed using the Downs and Black Scale for non-randomized trials.Results: Fourteen papers were identified that met inclusion and exclusion criteria. Only four studies included cyclists with knee pain. Studies were small with sample sizes ranging from 9-24 participants, and were of low to moderate quality. Biomechanical factors that may impact knee pain include cadence, power output, crank length, saddle fore/ aft position, saddle height, and foot position. Changing these factors may lead to differing effects for cyclists who experience knee pain based on specific anatomical location. Conclusion:Changes in cycling parameters or positioning on the bicycle can impact movement, forces, and muscle activity around the knee. While studies show differences across some of the extrinsic factors included in this review, there is a lack of direct association between parameters/positioning on the cycle and knee injury risk due to the limited studies examining cyclists with and without pain or injury. The results of this review can provide guidance to professionals treating cyclists with knee pain, but more research is needed. Level of Evidence: 3a

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Lower-limb joint reaction forces and moments during modified cycling in healthy controls and individuals with knee osteoarthritis

Thompson

Gardner

Zhang

et al. 2020

Clinical Biomechanics

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Effects of toe-in angles on knee biomechanics in cycling of patients with medial knee osteoarthritis

Cited by 20 publications

References 33 publications

Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta‐analysis

Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta‐analysis

The Influence of Extrinsic Factors on Knee Biomechanics During Cycling: A Systematic Review of the Literature

Lower-limb joint reaction forces and moments during modified cycling in healthy controls and individuals with knee osteoarthritis

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