The Foot-Knee Arthrokinetic Relationship



Foot-Knee Arthrokinetic Relationship

Traditional methods of treating knee-specific injuries involve addressing the symptoms of the problem rather than the cause, which in most cases, is the result of weak biomechanical functioning of the feet.

The structure of the knee functions as a one-way hinge which separates the upper and lower leg, limiting its ability to adapt to uneven forces, unlike the foot. 

A study by Levinger et al. observed a reduction in medial joint loading in people suffering from knee osteoarthritis who walk with greater foot pronation.

This was determined to be a consequence of increased rearfoot eversion, rearfoot internal rotation and forefoot inversion; all associated with reduced knee adduction moments during the stance phase of gait.

These findings need to be kept at the forefront of designing any load-modifying interventions for people with knee osteoarthritis, as they clearly demonstrate the importance of considering the foot-knee dynamic in this process. 

Knee function in the sagittal, coronal and transverse planes is almost directly affected by excessive pronation.

Hyperpronation is not a disorder, but the trigger that leads to the unequal distribution of force in the foot, altering the musculoskeletal system and arthrokinematics of the body.

With abnormal pronation, there is an excessive internal rotation of the ipsilateral tibia, consequentially leading to an excessive internal rotation of the ipsilateral femur as well.
 

This counter-rotation of the femur and tibia causes an increase in the Q angle.

The foot and ankle complex is seen to dorsiflex and abduct, causing the knee and subsequently the hip to flex, adduct and rotate internally.

The result of this compensatory abnormality is an ipsilateral pelvic tilt.

Prolonged exposure to the resultant excessive forces created by the ineffectiveness of the foot function combined with the aberrant tracking of the knee, can produce chronic inflammation and joint degeneration, which manifests in the form of patellofemoral pain.

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References:

  1. Pazit Levinger, Hylton B Menz, Adam D Morrow, John R Bartlett, Julian A Feller and Neil R Bergman (2013) Relationship between foot function and medial knee joint loading in people with medial compartment knee osteoarthritis. Journal of Foot and Ankle Research: August 2013, Vol. 6, No.33

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