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Assessment of fore-, mid-, and rear-foot alignment and their association with knee symptoms and function in patients with knee osteoarthritis

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Abstract

Objective

Hallux valgus, flatfoot, and rearfoot eversion are well-known major complications of knee osteoarthritis (OA). However, there is no consensus on the association between these foot malalignments and knee symptoms or function. Thus, this study aimed to examine the association between foot alignment and knee symptoms or function in patients with knee OA.

Methods

Female patients aged ≥ 50 years with symptomatic knee OA participated in this study. Knee symptoms and function were assessed using the Knee Society Scoring System (KSS). Hallux valgus, navicular/foot ratio, and leg heel alignment were used as the forefoot, midfoot, and rearfoot alignment indices, respectively. The navicular/foot ratio was defined as the ratio of the navicular height to the total foot length. We performed multiple linear regression analysis to examine the associations between foot alignment and knee symptoms or function.

Results

Seventy-eight participants participated our study. KSS symptom score was significantly associated with navicular/foot ratio (regression coefficient [β], −0.30; 95% confidence interval [CI], −109.2 to −20.5; P = 0.005), knee extensor strength (β, 0.32; 95% CI, 0.02 to 0.09; P = 0.004), and age (β, 0.24; 95% CI, 0.01 to 0.32; P = 0.036). KSS function score was not associated with foot alignments but with knee extensor strength (β, 0.40; 95% CI, 0.10 to 0.33; P = 0.001) and body mass index (β, −0.35; 95% CI, −2.82 to −0.66; P = 0.002).

Conclusions

Knee symptoms were significantly associated with midfoot alignment in patients with medial knee OA. This suggests that lower navicular height in patients with medial knee OA may relate with the alleviation of knee symptoms.

Key Points

• In patients with medial knee OA, midfoot alignment was significantly associated with knee symptoms in patients with medial knee OA; however, knee function was not associated with foot alignment.

• Lower navicular height in patients with medial knee OA may relate with the alleviation of knee symptoms.

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Data availability

Data are not available due to ethical restrictions.

Code availability

Not applicable.

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Acknowledgements

The authors thank Imada T, Iwaki K, and Sato S for their practical and technical assistance. The authors also thank all individuals who participated in this study.

Author information

Authors and Affiliations

  1. Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8570, Japan

    Kaede Nakazato, Masashi Taniguchi, Masahide Yagi, Yoshiki Motomura, Yoshihiro Fukumoto, Junya Saeki, Shogo Okada, Sayaka Okada & Noriaki Ichihashi

  2. Department of Orthopedic Surgery, Kobayashi Hospital, Kyoto, Japan

    Yoshiki Motomura & Masashi Kobayashi

  3. Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan

    Yoshihiro Fukumoto

  4. Kanemitsu Clinic, Kyoto, Japan

    Kyoseki Kanemitsu

Authors
  1. Kaede Nakazato
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Contributions

All authors have made substantial contributions to (1) the conception and design of the study, (2) critical revision for important intellectual content, and (3) final approval of the version to be submitted. The specific contributions of each author are as follows:

(1) Analysis and interpretation of data: Kaede Nakazato, Masashi Taniguchi, and Noriaki Ichihashi.

(2) Article drafting: Kaede Nakazato, Masashi Taniguchi, and Noriaki Ichihashi.

Corresponding author

Correspondence to Masashi Taniguchi.

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Ethics approval

All study procedures were approved by the Ethics Committee of the Kyoto University Graduate School of Medicine and were conducted in accordance with the principles of the Declaration of Helsinki.

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Written informed consent was obtained from all participants.

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Nakazato, K., Taniguchi, M., Yagi, M. et al. Assessment of fore-, mid-, and rear-foot alignment and their association with knee symptoms and function in patients with knee osteoarthritis. Clin Rheumatol 42, 511–517 (2023). https://doi.org/10.1007/s10067-022-06421-7

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