The knee adduction moment (KAM) is commonly used as a surrogate measure of medial compartment loading in individuals with medial knee osteoarthritis. This study investigated the effects of four gait modification strategies—toe-in, toeout, trunk lean, and knee thrust—on KAM peak and impulse using a within-subject design. Fourteen healthy adults performed normal walking and each modified gait condition. All gait modifications significantly reduced KAM peak compared to normal gait (p<0.05). However, a significant reduction in KAM impulse was observed only during the toe-out gait (p<0.01). Multiple regression analysis revealed that the moment arm accounted for 89–92% of the variance in KAM peak, while the combined effects of moment arm and stance time explained 87% of the variance in KAM impulse (p<0.001). The decrease in impulse during toe-out gait was primarily driven by a lower KAM peak without a significant increase in stance time. In contrast, for the other gait modifications, reductions in KAM peak were counterbalanced by prolonged stance time, resulting in no overall reduction in impulse. These findings suggest that both KAM peak and impulse should be considered when selecting gait modification strategies, with toe-out gait appearing to offer the most favorable biomechanical response in healthy adults.
The purpose of this study was to compare ankle joint loads (Linear and Angular Impulses) while descending the stairs and ramp. Ten young male subjects participated in this study. Stairs and ramp of identical slope (30 degrees) were custom-made to include force plates in the middle of pathways. Subjects descended the stairs and ramp at a comfortable speed and posture. The stance period was divided into three phases, weight acceptance (WA), single limb stance, and pre-swing. Three-directional impulses and their sum were derived from the reaction forces and moments at the ankle joint. Differences in impulse sums (Both Linear and Angular) between stairs and ramp were significant only in the early (WA) phase, whereas those of stairs were greater than the ramp. All subjects adopted forefoot strike strategy for the stairs and 80% of the subjects adopted rearfoot strike strategy for the ramp. An increase in the GRF and moment arm of the GRF at the ankle joint in case of forefoot strike may have contributed to the increase in the linear and angular impulse in the early phase of stair descent compared to ramp descent. The results are in agreement with the preference of ramp in the elderly.
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