The objective of this work was to conduct a proof of concept study utilizing auditory feedback from a pressure-detecting shoe insole to shift plantar pressure medially in order to reduce the knee adduction moment (KAM). When compared with normal walking, 32 healthy subjects significantly reduced their peak KAM using feedback (p < 0.001). When compared with medial thrust gait, an established gait modification, walking with pressure-based feedback was equally effective at reducing the peak KAM, yet it successfully mitigated other potentially detrimental gait measures such as the peak knee flexion moment (KFM), knee internal rotation moment (KIrM), and a reduction in speed.

References

References
1.
Brault
,
M. W.
,
Hootman
,
J. M.
,
Helmick
,
C. G.
,
Theis
,
K. A.
, and
Armour
,
B. S.
,
2009
, “
Prevalence and Most Common Causes of Disability Among Adults—United States, 2005
,”
Morb. Mortal. Wkly. Rep.
,
58
, pp.
421
426
.
2.
Ahlbäck
,
S.
,
1968
, “
Osteoarthrosis of the Knee. A Radiographic Investigation
,”
Acta Radiol. Diagn. (Stockh)
,
277
(
Suppl.
), pp.
7
72
.
3.
Schipplein
,
O. D.
, and
Andriacchi
,
T. P.
,
1991
, “
Interaction Between Active and Passive Knee Stabilizers During Level Walking
,”
J. Orthop. Res.
,
9
(
1
), pp.
113
119
.
4.
Kutzner
,
I.
,
Trepczynski
,
A.
,
Heller
,
M. O.
, and
Bergmann
,
G.
,
2013
, “
Knee Adduction Moment and Medial Contact Force—Facts About Their Correlation During Gait
,”
PLoS ONE
,
8
(
12
), p.
e81036
.
5.
Mündermann
,
A.
,
Asay
,
J. L.
,
Mündermann
,
L.
, and
Andriacchi
,
T. P.
,
2008
, “
Implications of Increased Medio-Lateral Trunk Sway for Ambulatory Mechanics
,”
J. Biomech.
,
41
(
1
), pp.
165
170
.
6.
Shull
,
P. B.
,
Silder
,
A.
,
Shultz
,
R.
,
Dragoo
,
J. L.
,
Besier
,
T. F.
,
Delp
,
S. L.
, and
Cutkosky
,
M. R.
,
2013
, “
Six-Week Gait Retraining Program Reduces Knee Adduction Moment, Reduces Pain, and Improves Function for Individuals With Medial Compartment Knee Osteoarthritis
,”
J. Orthop. Res.
,
31
(
7
), pp.
1020
1025
.
7.
Chang
,
A.
,
Hurwitz
,
D.
,
Dunlop
,
D.
,
Song
,
J.
,
Cahue
,
S.
,
Hayes
,
K.
, and
Sharma
,
L.
,
2007
, “
The Relationship Between Toe-Out Angle During Gait and Progression of Medial Tibiofemoral Osteoarthritis
,”
Ann. Rheum. Dis.
,
66
(
10
), pp.
1271
1275
.
8.
Fregly
,
B. J.
,
Reinbolt
,
J. A.
,
Rooney
,
K. L.
,
Mitchell
,
K. H.
, and
Chmielewski
,
T. L.
,
2007
, “
Design of Patient-Specific Gait Modifications for Knee Osteoarthritis Rehabilitation
,”
IEEE Trans. Biomed. Eng.
,
54
(
9
), pp.
1687
1695
.
9.
Schache
,
A. G.
,
Fregly
,
B. J.
,
Crossley
,
K. M.
,
Hinman
,
R. S.
, and
Pandy
,
M. G.
,
2008
, “
The Effect of Gait Modification on the External Knee Adduction Moment is Reference Frame Dependent
,”
Clin. Biomech.
,
23
(
5
), pp.
601
608
.
10.
Walter
,
J. P.
,
D'Lima
,
D. D.
,
Colwell
,
C. W.
, Jr.
, and
Fregly
,
B. J.
,
2010
, “
Decreased Knee Adduction Moment Does Not Guarantee Decreased Medial Contact Force During Gait
,”
J. Orthop. Res.
,
28
(
10
), pp.
1348
1354
.
11.
Gerbrands
,
T. A.
,
Pisters
,
M. F.
, and
Vanwanseele
,
B.
,
2014
, “
Individual Selection of Gait Retraining Strategies is Essential to Optimally Reduce Medial Knee Load During Gait
,”
Clin. Biomech.
,
29
(
7
), pp.
828
834
.
12.
Barrios
,
J. A.
,
Crossley
,
K. M.
, and
Davis
,
I. S.
,
2010
, “
Gait Retraining to Reduce the Knee Adduction Moment Through Real-Time Visual Feedback of Dynamic Knee Alignment
,”
J. Biomech.
,
43
(
11
), pp.
2208
2213
.
13.
Simic
,
M.
,
Hunt
,
M. A.
,
Bennell
,
K. L.
,
Hinman
,
R. S.
, and
Wrigley
,
T. V.
,
2012
, “
Trunk Lean Gait Modification and Knee Joint Load in People With Medial Knee Osteoarthritis: The Effect of Varying Trunk Lean Angles
,”
Arthritis Care Res.
,
64
(
10
), pp.
1545
1553
.
14.
Cochrane
,
C. K.
,
Takacs
,
J.
, and
Hunt
,
M. A.
,
2014
, “
Biomechanical Mechanisms of Toe-Out Gait Performance in People With and Without Knee Osteoarthritis
,”
Clin. Biomech.
,
29
(
1
), pp.
83
86
.
15.
Simic
,
M.
,
Wrigley
,
T. V.
,
Hinman
,
R. S.
,
Hunt
,
M. A.
, and
Bennell
,
K. L.
,
2013
, “
Altering Foot Progression Angle in People With Medial Knee Osteoarthritis: The Effects of Varying Toe-In and Toe-Out Angles are Mediated by Pain and Malalignment
,”
Osteoarthritis Cartilage
,
21
(
9
), pp.
1272
1280
.
16.
Manal
,
K.
,
Gardinier
,
E.
,
Buchanan
,
T. S.
, and
Snyder-Mackler
,
L.
,
2015
, “
A More Informed Evaluation of Medial Compartment Loading: The Combined Use of the Knee Adduction and Flexor Moments
,”
Osteoarthritis Cartilage
,
23
(
7
), pp.
1107
1111
.
17.
Chehab
,
E. F.
,
Favre
,
J.
,
Erhart-Hledik
,
J. C.
, and
Andriacchi
,
T. P.
,
2014
, “
Baseline Knee Adduction and Flexion Moments During Walking are Both Associated With 5 Year Cartilage Changes in Patients With Medial Knee Osteoarthritis
,”
Osteoarthritis Cartilage
,
22
(
11
), pp.
1833
1839
.
18.
Studenski
,
S.
,
Perera
,
S.
,
Patel
,
K.
,
Rosano
,
C.
,
Faulkner
,
K.
,
Inzitari
,
M.
,
Brach
,
J.
,
Chandler
,
J.
,
Cawthon
,
P.
,
Connor
,
E. B.
,
Nevitt
,
M.
,
Visser
,
M.
,
Kritchevsky
,
S.
,
Badinelli
,
S.
,
Harris
,
T.
,
Newman
,
A. B.
,
Cauley
,
J.
,
Ferrucci
,
L.
, and
Guralnik
,
J.
,
2011
, “
Gait Speed and Survival in Older Adults
,”
J. Am. Med. Assoc.
,
305
(
1
), pp.
50
58
.
19.
Simic
,
M.
,
Hinman
,
R. S.
,
Wrigley
,
T. V.
,
Bennell
,
K. L.
, and
Hunt
,
M. A.
,
2011
, “
Gait Modification Strategies for Altering Medial Knee Joint Load: A Systematic Review
,”
Arthritis Care Res.
,
63
, pp.
405
426
.
20.
Levinger
,
P.
,
Menz
,
H. B.
,
Morrow
,
A. D.
,
Bartlett
,
J. R.
,
Feller
,
J. A.
, and
Bergman
,
N. R.
,
2013
, “
Relationship Between Foot Function and Medial Knee Joint Loading in People With Medial Compartment Knee Osteoarthritis
,”
J. Foot Ankle Res.
,
6
(
1
), p.
33
.
21.
Kerrigan
,
D. C.
,
Lelas
,
J. L.
,
Goggins
,
J.
,
Merriman
,
G. J.
,
Kaplan
,
R. J.
, and
Felson
,
D. T.
,
2002
, “
Effectiveness of a Lateral-Wedge Insole on Knee Varus Torque in Patients With Knee Osteoarthritis
,”
Arch. Phys. Med. Rehabil.
,
83
(
7
), pp.
889
893
.
22.
Hinman
,
R. S.
,
Bowles
,
K. A.
,
Payne
,
C.
, and
Bennell
,
K. L.
,
2008
, “
Effect of Length on Laterally-Wedged Insoles in Knee Osteoarthritis
,”
Arthritis Care Res.
,
59
(
1
), pp.
144
147
.
23.
Hinman
,
R. S.
,
Bowles
,
K. A.
,
Metcalf
,
B. B.
,
Wrigley
,
T. V.
, and
Bennell
,
K. L.
,
2012
, “
Lateral Wedge Insoles for Medial Knee Osteoarthritis: Effects on Lower Limb Frontal Plane Biomechanics
,”
Clin. Biomech.
,
27
(
1
), pp.
27
33
.
24.
Erhart
,
J. C.
,
Mündermann
,
A.
,
Elspas
,
B.
,
Giori
,
N. J.
, and
Andriacchi
,
T. P.
,
2010
, “
Changes in Knee Adduction Moment, Pain, and Functionality With a Variable-Stiffness Walking Shoe After 6 Months
,”
J. Orthop. Res.
,
28
(7), pp.
873
879
.
25.
Jenkyn
,
T. R.
,
Erhart
,
J. C.
, and
Andriacchi
,
T. P.
,
2011
, “
An Analysis of the Mechanisms for Reducing the Knee Adduction Moment During Walking Using a Variable Stiffness Shoe in Subjects With Knee Osteoarthritis
,”
J. Biomech.
,
44
(
7
), pp.
1271
1276
.
26.
Boyer
,
K. A.
,
Federolf
,
P.
,
Lin
,
C.
,
Nigg
,
B. M.
, and
Andriacchi
,
T. P.
,
2012
, “
Kinematic Adaptations to a Variable Stiffness Shoe: Mechanisms for Reducing Joint Loading
,”
J. Biomech.
,
45
(
9
), pp.
1619
1624
.
27.
Shakoor
,
N.
,
Lidtke
,
R. H.
,
Sengupta
,
M.
,
Fogg
,
L. F.
, and
Block
,
J. A.
,
2008
, “
Effects of Specialized Footwear on Joint Loads in Osteoarthritis of the Knee
,”
Arthritis Rheum.
,
59
(
9
), pp.
1214
1220
.
28.
Shakoor
,
N.
,
Lidtke
,
R. H.
,
Wimmer
,
M. A.
,
Mikolaitis
,
R. A.
,
Foucher
,
K. C.
,
Thorp
,
L. E.
,
Fogg
,
L. F.
, and
Block
,
J. A.
,
2013
, “
Improvement in Knee Loading After Use of Specialized Footwear for Knee Osteoarthritis
,”
Arthritis Rheum.
,
65
(
5
), pp.
1282
1289
.
29.
Ferrigno
,
C.
,
Thorp
,
L. E.
,
Shakoor
,
N.
, and
Wimmer
,
M. A.
,
2014
, “
Center of Plantar Pressure Can Predict Changes in Tibiofemoral Contact Load
,”
Osteoarthritis Cartilage
,
22
(
Suppl.
), pp.
S92
S93
.
30.
Ferrigno
,
C.
,
Wimmer
,
M. A.
,
Thorp
,
L. E.
,
Block
,
J. A.
,
Lidtke
,
R. H.
, and
Shakoor
,
N.
,
2015
, “
Medializing Foot Center of Pressure With Flexible Shoes is Associated With a Medial Knee Load Reduction in Knee Osteoarthritis
,”
Osteoarthritis Cartilage
,
23
(
Suppl. 2
), pp.
A98
A99
.
31.
Dowling
,
A. V.
,
Fisher
,
D. S.
, and
Andriacchi
,
T. P.
,
2010
, “
Gait Modification Via Verbal Instruction and an Active Feedback System to Reduce Peak Knee Adduction Moment
,”
ASME J. Biomech. Eng.
,
132
(
7
), p.
071007
.
32.
Schmidt
,
R. A.
, and
Lee
,
T.
,
2011
,
Motor Control and Learning: A Behavioral Emphasis
,
Human Kinetics
, Champaign, IL.
33.
Wheeler
,
J. W.
,
Shull
,
P. B.
, and
Besier
,
T. F.
,
2011
, “
Real-Time Knee Adduction Moment Feedback for Gait Retraining Through Visual and Tactile Displays
,”
ASME J. Biomech. Eng.
,
133
(
4
), p.
041007
.
34.
Shull
,
P. B.
,
Lurie
,
K. L.
,
Cutkosky
,
M. R.
, and
Besier
,
T. F.
,
2011
, “
Training Multi-Parameter Gaits to Reduce the Knee Adduction Moment With Data-Driven Models and Haptic Feedback
,”
J. Biomech.
,
44
(
8
), pp.
1605
1609
.
35.
Fregly
,
B. J.
,
D'Lima
,
D. D.
, and
Colwell
,
C. W.
, Jr.
,
2009
, “
Effective Gait Patterns for Offloading the Medial Compartment of the Knee
,”
J. Orthop. Res.
,
27
(
8
), pp.
1016
1021
.
36.
Fregly
,
B. J.
,
Rooney
,
K. L.
, and
Reinbolt
,
J. A.
,
2005
, “
Predicted Gait Modifications to Reduce the Peak Knee Adduction Torque
,”
ISB
XXth Congress—ASB 29th Annual Meeting
, Cleveland, OH, July 30–Aug. 5, p.
283
.
37.
Kadaba
,
M. P.
,
Ramakrishnan
,
H. K.
, and
Wootten
,
M. E.
,
1990
, “
Measurement of Lower Extremity Kinematics During Level Walking
,”
J. Orthop. Res.
,
8
(
3
), pp.
383
392
.
38.
Andriacchi
,
T.
,
Natarajan
,
R.
, and
Hurwitz
,
D.
,
2005
,
Musculo-Skeletal Dynamic Locomotion and Clinical Applications
,
Lippincott
,
Philadelphia, PA
.
39.
Andriacchi
,
T.
, and
Strickland
,
A.
,
1985
, “
Gait Analysis as a Tool to Assess Joint Kinetics
,”
Biomechanics of Normal and Pathological Human Articulating Joints
,
E.
Berme
,
A.
Engin
, and
K. M.
,
Correia da Silva
, Eds.
Martiuns Nijhoff
,
Doordrecht
, p.
83
.
40.
McPoil
,
T. G.
,
Cornwall
,
M. W.
, and
Yamada
,
W.
,
1995
, “
A Comparison of Two In-Shoe Plantar Pressure Measurement Systems
,”
Lower Extremity
,
2
, pp.
95
103
.
41.
Putti
,
A. B.
,
Arnold
,
G. P.
,
Cochrane
,
L.
, and
Abboud
,
R. J.
,
2007
, “
The Pedar® In-Shoe System: Repeatability and Normal Pressure Values
,”
Gait Posture
,
25
(
3
), pp.
401
405
.
42.
Favre
,
J.
,
Erhart-Hledik
,
J. C.
, and
Andriacchi
,
T. P.
,
2014
, “
Age-Related Differences in Sagittal-Plane Knee Function at Heel-Strike of Walking are Increased in Osteoarthritic Patients
,”
Osteoarthritis Cartilage
,
22
(
3
), pp.
464
471
.
43.
Robbins
,
S. M. K.
, and
Maly
,
M. R.
,
2009
, “
The Effect of Gait Speed on the Knee Adduction Moment Depends on Waveform Summary Measures
,”
Gait Posture
,
30
(
4
), pp.
543
546
.
44.
Mündermann
,
A.
,
Dyrby
,
C. O.
,
Hurwitz
,
D. E.
,
Sharma
,
L.
, and
Andriacchi
,
T. P.
,
2004
, “
Potential Strategies to Reduce Medial Compartment Loading in Patients With Knee Osteoarthritis of Varying Severity: Reduced Walking Speed
,”
Arthritis Rheum.
,
50
(
4
), pp.
1172
1178
.
45.
Zeni
,
J. A.
, Jr.
, and
Higginson
,
J. S.
,
2009
, “
Differences in Gait Parameters Between Healthy Subjects and Persons With Moderate and Severe Knee Osteoarthritis: A Result of Altered Walking Speed?
Clin. Biomech.
,
24
(
4
), pp.
372
378
.
46.
Myer
,
G. D.
,
Ford
,
K. R.
,
Barber
,
K. D.
,
Foss
,
Goodman
,
A.
,
Ceasar
,
A.
,
Rauh
,
M. J.
,
Divine
,
J. G.
, and
Hewett
,
T. E.
,
2010
, “
The Incidence and Potential Pathomechanics of Patellofemoral Pain in Female Athletes
,”
Clin. Biomech.
,
25
(
7
), pp.
700
707
.
47.
Hewett
,
T. E.
,
Myer
,
G. D.
,
Ford
,
K. R.
,
Heidt
,
R. S.
, Jr.
,
Colosimo
,
A. J.
,
McLean
,
S. G.
,
Van Den Bogert
,
A. J.
,
Paterno
,
M. V.
, and
Succop
,
P.
,
2005
, “
Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study
,”
Am. J. Sports Med.
,
33
(
4
), pp.
492
501
.
48.
Kean
,
C. O.
,
Bennell
,
K. L.
,
Wrigley
,
T. V.
, and
Hinman
,
R. S.
,
2013
, “
Modified Walking Shoes for Knee Osteoarthritis: Mechanisms for Reductions in the Knee Adduction Moment
,”
J. Biomech.
,
46
(
12
), pp.
2060
2066
.
49.
Lynn
,
S. K.
,
Kajaks
,
T.
, and
Costigan
,
P. A.
,
2008
, “
The Effect of Internal and External Foot Rotation on the Adduction Moment and Lateral–Medial Shear Force at the Knee During Gait
,”
J. Sci. Med. Sport
,
11
(
5
), pp.
444
451
.
50.
Guo
,
M.
,
Axe
,
M. J.
, and
Manal
,
K.
,
2007
, “
The Influence of Foot Progression Angle on the Knee Adduction Moment During Walking and Stair Climbing in Pain Free Individuals With Knee Osteoarthritis
,”
Gait Posture
,
26
(
3
), pp.
436
441
.
51.
Hunt
,
M. A.
, and
Takacs
,
J.
,
2014
, “
Effects of a 10-Week Toe-Out Gait Modification Intervention in People With Medial Knee Osteoarthritis: A Pilot, Feasibility Study
,”
Osteoarthritis Cartilage
,
22
(
7
), pp.
904
911
.
52.
Rothman
,
M. D.
,
Leo-Summers
,
L.
, and
Gill
,
T. M.
,
2008
, “
Prognostic Significance of Potential Frailty Criteria
,”
J. Am. Geriatr. Soc.
,
56
(
12
), pp.
2211
2216
.
53.
Vermeulen
,
J.
,
Neyens
,
J. C.
,
Van Rossum
,
E.
,
Spreeuwenberg
,
M. D.
, and
De Witte
,
L. P.
,
2011
, “
Predicting ADL Disability in Community-Dwelling Elderly People Using Physical Frailty Indicators: A Systematic Review
,”
BMC Geriatr.
,
11
(
1
), p.
33
.
54.
Fried
,
L. P.
,
Tangen
,
C. M.
,
Walston
,
J.
,
Newman
,
A. B.
,
Hirsch
,
C.
,
Gottdiener
,
J.
,
Seeman
,
T.
,
Tracy
,
R.
,
Kop
,
W. J.
,
Burke
,
G.
, and
McBurnie
,
M. A.
,
2001
, “
Frailty in Older Adults: Evidence for a Phenotype
,”
J. Gerontol. Ser. A Biol. Sci. Med. Sci.
,
56
(
3
), pp.
M146
M156
.
55.
Russell
,
E. M.
,
Braun
,
B.
, and
Hamill
,
J.
,
2010
, “
Does Stride Length Influence Metabolic Cost and Biomechanical Risk Factors for Knee Osteoarthritis in Obese Women?
Clin. Biomech.
,
25
(
5
), pp.
438
443
.
56.
Caldwell
,
L. K.
,
Laubach
,
L. L.
, and
Barrios
,
J. A.
,
2013
, “
Effect of Specific Gait Modifications on Medial Knee Loading, Metabolic Cost and Perception of Task Difficulty
,”
Clin. Biomech.
,
28
(
6
), pp.
649
654
.
57.
Shull
,
P. B.
,
Shultz
,
R.
,
Silder
,
A.
,
Dragoo
,
J. L.
,
Besier
,
T. F.
,
Cutkosky
,
M. R.
, and
Delp
,
S. L.
,
2013
, “
Toe-in Gait Reduces the First Peak Knee Adduction Moment in Patients With Medial Compartment Knee Osteoarthritis
,”
J. Biomech.
,
46
(
1
), pp.
122
128
.
58.
Winstein
,
C. J.
,
1991
, “
Knowledge of Results and Motor Learning—Implications for Physical Therapy
,”
Phys. Ther.
,
71
, pp.
140
149
.
59.
Haibach
,
P.
,
Reid
,
G.
, and
Collier
,
D.
,
2011
,
Motor Learning and Development
,
Human Kinetics
, Champaign, IL.
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