Clinical and biomechanical changes following a 4-month toe-out gait modification program for people with medial knee osteoarthritis: a randomized controlled trial

Objective: To compare changes in knee pain, function, and loading following a 4-month progressive walking program with or without toe-out gait modification in people with medial tibiofemoral knee osteoarthritis. Design: Individuals with medial knee osteoarthritis were randomized to a 4-month program to increase walking activity with (toe-out) or without (progressive walking) concomitant toe-out gait modification. The walking program was similar between the two groups, except that the gait modification group was trained to walk with 15 degrees more toe-out. Primary outcomes included: knee joint pain (WOMAC), foot progression angles and knee joint loading during gait (knee adduction moment (KAM)). Secondary outcomes included WOMAC function, timed stair climb, and knee flexion moments during gait. Results: Seventy-nine participants (40 in toe-out group, 39 in progressive walking group) were recruited. Intention-to-treat analysis showed no between-group differences in knee pain, function, or timed stair climb. However, the toe-out group exhibited significantly greater changes in foot progression angle (mean difference=-9.04 degrees (indicating more toe-out), 95% CI: -11.22 degrees, -6.86 degrees; P < 0.001), late stance KAM (mean difference=-0.26 % BW*ht, 95% CI: -0.39 % BW*ht, -0.12 % BW*ht, P < 0.001) and KAM impulse (-0.06 % BW*ht*s, 95% CI: -0.11 % BW*ht*s, -0.01 % BW*ht*s; P < 0.031) compared to the progressive walking group at follow-up. The only between-group difference that remained at a 1-month retention assessment was foot progression angle, with greater changes in the toe-out group (mean difference=-6.78 degrees, 95% CI: -8.82 degrees, -4.75 degrees; P < 0.001). Conclusions: Though both groups experienced improvements in self-reported pain and function, only the toe-out group experienced biomechanical improvements. Trials registry number: NCT02019108. (c) 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.