The knee adduction moment (KAM) is widely used as a surrogate measure of medial knee loading and is a primary target of gait modification. Toe-in and toe-out modifications of the foot progression angle are commonly assumed to reduce KAM peaks by displacing the center of pressure (COP), but this mechanism has not been firmly established. This study therefore aimed to clarify the mechanism underlying KAM reduction during these modifications. Healthy adults walked under normal, toe-out, and toe-in conditions. KAM, the moment arm of the ground reaction force (GRF), GRF magnitude, GRF angle, and COP were analyzed at the first and second KAM peaks. Toe-in and toe-out walking predominantly reduced the first and second KAM peaks, respectively. The moment arm was the primary determinant of both peaks (R2 > 0.90). Contrary to conventional assumptions, the reduction in moment arm depended largely on changes in GRF angle, whereas the contribution of COP was minimal or even opposed the change in moment arm. These findings provide a mechanistic basis for foot progression modification strategies and should help improve their clinical effectiveness.
