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Prevalence Of Podiatric Changes In Patients Who Underwent Total Knee Replacement – A Cross-Sectional Study
Corresponding Author(s) : Arun Thachil
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 13 No. 1 (2025): 2025 Volume -13 - Issue 1
Abstract
Background: Knee osteoarthritis, a chronic condition prevalent among the elderly, often results in considerable pain and mobility challenges. In severe cases, it can cause misalignment of the entire lower limb, contributing to ankle joint deterioration over time. Despite extensive research on foot changes in chronic osteoarthritis patients, the impact of total knee replacement surgery on podiatric changes remains an underexplored area.
Methodology: A total of 135 chronic osteoarthritis knee patients who underwent total knee replacement were evaluated for podiatric changes using various measures. These included cadence in gait analysis, the Windlass test to assess for plantar fasciitis, measurement of inversion and eversion angles using a goniometer, and completion of the Foot and Ankle Disability Index questionnaire.
Result: The prevalence of podiatric changes in patients who underwent total knee replacement was statistically found using SPSS software (SPSS.20). The prevalence of cadence was analysed and found normal for 60% and low for 40% among the sample. The range of motion of ankle inversion and eversion was analysed and it found that no reduction in inversion and 0.7% reduced eversion. The analysis of the Foot and Ankle Disability Index (FADI) in patients after 6 months of Total knee replacement revealed that all samples exhibited normal scores. The prevalence of plantar fasciitis was analysed, and only 1.5% were positive for the windlass test.
Conclusion: The study revealed that after total knee replacement surgery, a significant portion of subjects experienced a decrease in cadence, while the majority maintained a normal cadence. In terms of the windlass test for plantar fasciitis, only a small change was observed post-surgery, with most subjects continuing to show a negative result, and a very small percentage testing positive. Additionally, there were only minor differences noted in foot inversion and eversion movements, as well as in the Foot and Ankle Disability Index.
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- Daman Kumar Jha, Prangthong Unprasert, Bavornrit Chuckpaiwong. The Prevalence and correlation of Foot Deformity in Primary Osteoarthritis of the Knee. The Thai Journal of Orthopaedic Surgery (JRCOST). Vol. 45No. 3- 4 (2021): JulyOctober.
- Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914-8. doi: 10.1002/art.1780300811. PMID: 3632732.
- Hart HF, Birmingham TB, Primeau CA, Pinto R, Leitch K, Giffin JR. Associations Between Cadence and Knee Loading in Patients with Knee Osteoarthritis. Res (Hoboken).2021 Nov;73(11):1667-1671. doi: 10.1002/acr.24400. Epub 2021 Sep 24. PMID:32741097.
- Miladi S, Bouzid S, Fazaa A, Boussaa H, Makhlouf Y, Souabni L, Ouenniche K, Kassab S, Chekili S, Ben Abdelghani K, Laatar A. Is there an association between plantar fasciitis and knee osteoarthritis? Musculoskeletal Care. 2023 May 22. doi:10.1002/msc.1784. Epub ahead of print. PMID: 37212781.
- Paterson KL, Hinman RS, Hunter DJ, Wrigley TV, Bennell KL. Impact of concurrent foot pain on health and functional status in people with knee osteoarthritis: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2015 Jul;67(7): 989-95.doi:10.1002/acr.22537. PMID: 25581254; PMCID: PMC4482794.
- Dominick J. Casciato, Natalie A. Builes, Luis A Rodrigues Anaya et al. Association between total knee arthroplasty and subtalar joint changes: A cadaver study. 2019VOL:07. Issue: Spring epub Month 2019: www.msrj.org.
- De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003 Mar;24(3): 251-5.doi: 10.1177/107110070302400309. PMID: 12793489.
- Hale SA, Hertel J. Reliability and Sensitivity of the Foot and Ankle Disability Index in Subjects with Chronic Ankle Instability. J Athl Train. 2005 Mar;40(1):35-40. PMID:15902322; PMCID: PMC1088343.
- De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003 Mar;24(3):251-5. doi: 10.1177/107110070302400309. PMID: 12793489.
- Martin, R., Burdett, R. and Irrgang, J. Development of the Foot and Ankle Disability Index (FADI). (1999) Journal of Orthopaedic & Sports Physical Therapy, 29, A32-A33.
- Hwang J, Jung MC. Age and sex differences in range of motion and motion patterns. Int J Occup Saf Ergon. 2015;21(2):173-186. doi:10.1080/10803548.2015.1029301.
- Ruba Musaid et al, June 2024. Assessment of foot deformities in patient with knee osteoarthritis. DOI:10.22153/kej.2024.09.001.
- Pazit Levinger, Hylton B Menz et al. Changes in foot posture and function following total knee replacement surgery.
- Benjamin K Buchanam et al: 2024. National Library of Medicine. Plantar Fasciitis.
- Benedict W Stansfield et al:2012. What is ‘Cadence’ and why do we need an unambiguous definition? DOI:10.1016/j.jsams.2012.11.225.
- Catrine Tudor-Locke et al:2020. Walking cadence (steps/min) and intensity in 41 to 60-year-old adults: the CADENCE-adults study.
- Kade L Peterson et al: 2015. Concurrent foot pain is common in people with knee osteoarthritis and impacts health and functional status: data from the Osteoarthritis Initiative. [PubMed].
- Krähenbühl N, Horn-Lang T, Hintermann B, Knupp M. The subtalar joint: A complex mechanism. EFORT Open Rev. 2017 Jul 6;2(7):309-316. doi:10.1302/20585241.2.160050. PMID: 28828179; PMCID: PMC5549175.
- Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, Carr A, Beard D. Knee replacement. Lancet. 2018 Nov 3;392(10158):1672-1682. doi: 10.1016/S01406736(18)32344-4. PMID: 30496082.
- Vaidya SV, Jogani AD, Pachore JA, Armstrong R, Vaidya CS. India Joining the World of Hip and Knee Registries: Present Status-A Leap Forward. Indian J Orthop. 2020 Sep 16;55(Suppl 1):46-55. doi: 10.1007/s43465-020-00251-y. PMID: 34122754; PMCID: PMC8149501.
References
Daman Kumar Jha, Prangthong Unprasert, Bavornrit Chuckpaiwong. The Prevalence and correlation of Foot Deformity in Primary Osteoarthritis of the Knee. The Thai Journal of Orthopaedic Surgery (JRCOST). Vol. 45No. 3- 4 (2021): JulyOctober.
Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914-8. doi: 10.1002/art.1780300811. PMID: 3632732.
Hart HF, Birmingham TB, Primeau CA, Pinto R, Leitch K, Giffin JR. Associations Between Cadence and Knee Loading in Patients with Knee Osteoarthritis. Res (Hoboken).2021 Nov;73(11):1667-1671. doi: 10.1002/acr.24400. Epub 2021 Sep 24. PMID:32741097.
Miladi S, Bouzid S, Fazaa A, Boussaa H, Makhlouf Y, Souabni L, Ouenniche K, Kassab S, Chekili S, Ben Abdelghani K, Laatar A. Is there an association between plantar fasciitis and knee osteoarthritis? Musculoskeletal Care. 2023 May 22. doi:10.1002/msc.1784. Epub ahead of print. PMID: 37212781.
Paterson KL, Hinman RS, Hunter DJ, Wrigley TV, Bennell KL. Impact of concurrent foot pain on health and functional status in people with knee osteoarthritis: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2015 Jul;67(7): 989-95.doi:10.1002/acr.22537. PMID: 25581254; PMCID: PMC4482794.
Dominick J. Casciato, Natalie A. Builes, Luis A Rodrigues Anaya et al. Association between total knee arthroplasty and subtalar joint changes: A cadaver study. 2019VOL:07. Issue: Spring epub Month 2019: www.msrj.org.
De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003 Mar;24(3): 251-5.doi: 10.1177/107110070302400309. PMID: 12793489.
Hale SA, Hertel J. Reliability and Sensitivity of the Foot and Ankle Disability Index in Subjects with Chronic Ankle Instability. J Athl Train. 2005 Mar;40(1):35-40. PMID:15902322; PMCID: PMC1088343.
De Garceau D, Dean D, Requejo SM, Thordarson DB. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003 Mar;24(3):251-5. doi: 10.1177/107110070302400309. PMID: 12793489.
Martin, R., Burdett, R. and Irrgang, J. Development of the Foot and Ankle Disability Index (FADI). (1999) Journal of Orthopaedic & Sports Physical Therapy, 29, A32-A33.
Hwang J, Jung MC. Age and sex differences in range of motion and motion patterns. Int J Occup Saf Ergon. 2015;21(2):173-186. doi:10.1080/10803548.2015.1029301.
Ruba Musaid et al, June 2024. Assessment of foot deformities in patient with knee osteoarthritis. DOI:10.22153/kej.2024.09.001.
Pazit Levinger, Hylton B Menz et al. Changes in foot posture and function following total knee replacement surgery.
Benjamin K Buchanam et al: 2024. National Library of Medicine. Plantar Fasciitis.
Benedict W Stansfield et al:2012. What is ‘Cadence’ and why do we need an unambiguous definition? DOI:10.1016/j.jsams.2012.11.225.
Catrine Tudor-Locke et al:2020. Walking cadence (steps/min) and intensity in 41 to 60-year-old adults: the CADENCE-adults study.
Kade L Peterson et al: 2015. Concurrent foot pain is common in people with knee osteoarthritis and impacts health and functional status: data from the Osteoarthritis Initiative. [PubMed].
Krähenbühl N, Horn-Lang T, Hintermann B, Knupp M. The subtalar joint: A complex mechanism. EFORT Open Rev. 2017 Jul 6;2(7):309-316. doi:10.1302/20585241.2.160050. PMID: 28828179; PMCID: PMC5549175.
Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, Carr A, Beard D. Knee replacement. Lancet. 2018 Nov 3;392(10158):1672-1682. doi: 10.1016/S01406736(18)32344-4. PMID: 30496082.
Vaidya SV, Jogani AD, Pachore JA, Armstrong R, Vaidya CS. India Joining the World of Hip and Knee Registries: Present Status-A Leap Forward. Indian J Orthop. 2020 Sep 16;55(Suppl 1):46-55. doi: 10.1007/s43465-020-00251-y. PMID: 34122754; PMCID: PMC8149501.