Decreasing the ambulatory knee adduction moment without increasing the knee flexion moment individually through modifications in footprint parameters: A feasibility study for a dual kinetic change in healthy subjects

Gait retraining is gaining in interest to reduce loading associated to knee osteoarthritis (OA) progression. So far, interventions focused on reducing the peak knee adduction moment (pKAM) and it remains unclear if this can be done individually without increasing the peak knee flexion moment (pKFM). Additionally, while modifying foot progression angle (FPA) and step width (SW) is common, little is known about modifications in stride length (SL). This study aimed at characterizing the feasibility of a dual kinetic change, consisting in reducing the pKAM by at least 10% without increasing the pKFM. It also aimed to evaluate the added value of SL modifications in achieving the dual kinetic change. Gait trials with modifications in FPA, SW and SL were recorded for 11 young healthy subjects in a laboratory equipped with an augmented-reality system displaying instruction footprints on the floor. All participants achieved the dual kinetic change with at least one of the modifications. Seven participants achieved it with FPA modification, three with SW modification, and seven with SL modification. In conclusion, this study showed that it is feasible to achieve the dual kinetic change individually through subject-specific modifications in footprint parameters, suggesting that, in the future, gait retraining could aim for more specific kinetic changes than simply pKAM reductions. Modifying SL allowed achieving the dual kinetic change, stressing out the value of this parameter for gait retraining, in addition to FPA and SW. Finally, an augmented-reality approach was introduced to help footprint parameter modifications in the framework of knee OA. (C) 2020 The Author(s). Published by Elsevier Ltd