Effects of toe-in/ out toe-in gait and lateral wedge orthoses on lower extremity joint kinetics; an exploration using musculoskeletal simulation and Bayesian contrasts.

Abstract

INTRODUCTION: The aim of the current investigation was to examine the effects of both lateral orthoses and toe-in/ toe-out foot progression angles on lower extremity joint loading during walking using a musculoskeletal simulation approach.
METHODS: The current investigation examined 15 healthy males, walking in six different conditions (neutral, lateral orthoses, toe-in, lateral toe-in, toe-out and lateral toe-out). Walking kinematics were collected using an eight-camera motion capture system, and kinetics via an embedded piezoelectric force plate. Lower extremity joint loading was explored using a musculoskeletal simulation approach.
RESULTS: This investigation showed that peak patellofemoral joint stress was greater in the neutral (3.96 KPa/BW) and lateral orthoses (4.20 KPa/BW) conditions compared to toe-in (3.33 KPa/BW), lateral toe-in (3.43 KPa/BW), toe-out (3.35 KPa/BW) and lateral toe-out (3.53 KPa/BW) and ankle joint impulse larger in the toe-in (1.65BW·s) and toe-out (1.62BW·s) foot progression angle modalities compared to neutral (1.51BW·s) and lateral orthoses (1.53BW·s). Furthermore, it was also shown that medial tibiofemoral impulse was statistically greater in the toe-in (1.20BW·s) and lateral toe-in (1.15BW·s) conditions compared to neutral (1.07BW·s), lateral orthoses (1.07BW·s), toe-out (1.09BW·s) and lateral toe-out (1.05BW·s).
CONCLUSIONS: Therefore, the current investigation provides evidence that altering the foot progression angle may attenuate the risk from patellofemoral disorders whilst simultaneously enhancing the risk from degenerative ankle pathologies. Similarly, adopting a toe-in foot progression angle may also increase the risk from medial tibiofemoral degeneration.