A recent poster presentation that was published on Osteoarthritis and Cartilage in May of 2024 discussed foot positioning and its relationship to knee cartilage damage. Williams et al out of Standford University looked at Pes Planus foot type (flatfoot) and pronated ankle posture and hypothesized that medial foot center of pressure, ankle eversion, and tibial rotation are associated with tibiofemoral cartilage damage. "Twenty-four participants with knee MRI showing intact cartilage, lower limb radiographs, and gait assessments acquired 2 years. To further demonstrate pre-OA status, the uninjured limb MRIs were evaluated against MRIs of 13 healthy controls. An optoelectronic system and force plate was used to measure participants’ motion, maximum ankle eversion over stance (°), and external tibial rotation at heel strike (°) were calculated from 3 walking trials. Frontal-plane mechanical axis was determined from full-length standing-alignment radiographs of the lower limbs."1
The authors determined that foot and ankle posture is related to tibiofemoral cartilage composition in knees without clinical evidence of osteoarthritis. "Biomechanical models linking flat-footedness, ankle eversion, and internal tibial rotation suggest these factors couple to generate rotational stress across the TF joint. This observation is in line with a report relating greater flat-footedness to lower medial TF contact forces in healthy knees, and may represent evidence of an adaptation strategy similar to that adopted by individuals with knee OA. Among the many biomechanical factors contributing to knee OA, flat-footedness and ankle eversion are relatively accessible targets for potential therapeutic or preventative interventions."1
This idea that repositioning the foot under the leg is nothing new however having evidence to show the benefit of specific devices to Reposition the flat foot shows advantages for knee pain and reduction of osteoarthritis
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The correlation of foot and ankle posture to cartilage composition at the knee suggests that orthotics, braces, or shoe interventions to alter weight distribution at the foot and ankle appropriately could be utilized to benefit knee cartilage health. The key aspect of placing the foot under the leg is not accomplished by an over-the-counter orthotic in most situations and casting the foot or scanning the foot in a sub tailor joint neutral eliminates the overpronation of the foot and tibial rotation therefore reducing the stress of the knee.
If you're suffering from knee pain, early arthritis, flatfeet consider having Dr Martins look at your biomechanics and see if orthotics can 3D custom orthotics are the right choice for you
References
Ashley A. Williams, Jade He, Constance R. Chu. Osteoarthritis and Cartilage, 2024-04-01, Volume 32, Pages S143-S144, Copyright © 2024
Darryl Martins DPM
Board Certified Foot and Ankle Surgeon/ Podiatrist
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