Influence of wide-stance gait, foot progression modification and lateral trunk lean on knee contact forces in healthy adults: A musculoskeletal modelling-based study

Objective

To evaluate the effects of wide-stance, toe-in, and lateral trunk lean gait modifications on knee joint contact forces (KCF) in healthy participants through motion capture and musculoskeletal modelling.

Methods

Twenty healthy participants completed walking trials under four gait conditions: natural walking, wide stance, toe-in, and lateral trunk lean. Walking biomechanics were recorded using an 8-camera motion capture system, synchronised with four ground reaction force plates. Kinematic and kinetic data were used to calculate right-limb KCF during early and late stance using an OpenSim-based musculoskeletal model. Within-subject differences in KCF across the four walking conditions were evaluated using a linear mixed model, accounting for speed as a covariate.

Results

Only medial-lateral forces were affected by condition during early stance, with wide-stance (p < 0.001, Cohen’s d=-0.91) and toe-in (p < 0.001, Cohen’s d=-1.28) gaits reducing medial KCF compared to natural gait, and toe-in exhibiting lower medial forces than lateral trunk lean (p < 0.001, Cohen’s d=-0.91). In late stance, both medial-lateral and vertical forces were condition dependent, with wide-stance (p < 0.001, Cohen’s d=-0.79) and toe-in (p < 0.001, Cohen’s d=-1.68) gaits continuing to reduce medial forces compared to natural gait. Toe-in gait further decreased medial forces relative to both wide-stance (p < 0.001, Cohen’s d=-0.90) and lateral trunk lean (p < 0.001, Cohen’s d=-1.39), while also lowering vertical forces in comparison to natural walking (p < 0.001, Cohen’s d=-0.90) and lateral trunk lean (p < 0.001, Cohen’s d=-0.77).

Conclusion

Gait retraining is an achievable intervention to immediately modify KCF in healthy adults, with toe-in gait demonstrating the most lateralisation of force amongst the walking conditions observed.