The Effects of Foot Orthoses and Knee Orthoses on Gait Pattern and Muscular Activation of Patients with Medial Compartment Knee Osteoarthritis
Date Issued
2011
Date
2011
Author(s)
Lin, Chun-Te
Abstract
Abstract:
Objective: The purpose of this study was to determine the possible biomechanical mechanisms resulting in effectiveness of the lateral wedge foot orthoses and valgus knee orthoses for patients with medial compartment knee osteoarthritis. And sEMG data were also investigated to clarify subtle muscle activation pattern in patients. A multi-segment model was developed to investigate kinematic and kinetic changes that contribute to knee osteoarthritis. To provide comprehensive information included joint mechanics, muscle activation pattern and proprioception of the patients among orthotics interventions.
Design and setting: All participants were separated into two groups depending on symptoms and physical examinations. Fifteen elders with medial compartment knee OA (7 males and 8 females) and fifteen matched controls (3 males and 12 females) were recruited in this research to collect the kinetic, kinematic and surface EMG data to analyze the biomechanical alterations in different orthotic conditions. The Orthotic group was tested the effects of 4° and 8° lateral wedges and valgus knee orthosis during the gait cycle. Symptoms, functional assessment and proprioception test were also assessed in the gait laboratory.
Main outcome measurement: (1) Gait parameters: stride length, width, gait speed, gait cycle time (2) Kinematics variables: peak knee flexion angle and excursion; static knee valgus angle and knee valgus excursion (3) Kinetics variables: ankle, knee and hip joint moment, COP deviation (∆COP) (4) Muscle activation pattern: % of the MVIC, co-contraction index (CI)
Results: the average age of Knee OA group was 67.5 years (±7.2) and the mean BMI was 24.7 ±3.4. The average age of the subjects in age-matched group was 63.3 years (±3.5) and the mean BMI was 23.4 ± 1.9. The OA knee group showed (1) significant lower walking speed, lower cadence, and longer stride time were found while compared to the control group. And there was a statistically significant difference between the KO and the shoes-only condition in proprioception test. (2) The OA group revealed significant smaller peak knee flexion angle during swing phase and knee flexion excursion during stance phase compared to the controls. The KO condition also revealed smaller peak knee flexion angle during swing phase and smaller flexion excursion during stance phase. (3) The significant differences were found in knee adduction and hip extension moment. The peak knee adduction moment decreased 14.7 % in the W4 condition, 24.4 % in the W8 and 17.1 % in the KO condition. (4) The OA group generally had larger values in lateral co-contraction index (VLLH and VLLG) than medial side significantly.
Conclusion: When the kinematics and kinetics data as well as muscle activities in patients with knee OA were assessed in this study, the results showed that they can benefit from orthotic interventions. With the use of lateral wedge orthoses or valgus knee orthoses, patients can improve joint mechanical environment and provide appropriate protection to those who suffer from medial compartment knee OA. The results support the hypotheses and indicate orthoses as a non-surgical, low-risk and less expensive treatments for patients. There are still unanticipated effects and problems among orthotic treatments needed to solve. And the long-term effects of the orthoses await further study.
Subjects
lateral wedge FO
valgus KO
medial compartment knee OA
joint kinematics
joint kinetics
co-contraction activation pattern
Type
thesis
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