Invitation letters were issued to all patients ( n = 146) diagnosed in August 2019 as having knee osteoarthritis according to the American College of Rheumatology Clinical Criteria.
Patients were recruited from the orthopedic clinic of a well-known orthopaedic hospital in Chongqing, China. This study hypothesized that not only the presence of flatfoot but also the severity of flatfoot is associated with the stated knee symptoms. This study aimed to systematically assess the correlation between the severity of flatfoot and the symptoms of knee OA, including knee degeneration, lower limb alignment, knee pain, stiffness, and function. Thus, assessing the relationship between the characteristics of the knee and foot can help with accurate diagnosis and with devising a suitable correction plan. In addition to knee pain and degeneration ( 8), knee malalignment ( 9), stiffness, and dysfunction ( 10) are also key factors for physicians when diagnosing knee OA. The association between the severity of flatfoot and knee OA is still unclear. Despite the known biomechanical link between flatfoot and mechanical stress in the knee, previous studies only considered the relationship between the presence of flatfoot and knee pain or knee degeneration ( 3, 5, 7). Studies have shown that knee pain in flatfooted people with knee OA can be relieved by taking steps to correct the flatfoot ( 6). People with flatfoot often complain of knee pain ( 4) and suffer knee degeneration ( 5). Due to this interdependent relationship, abnormal foot posture can lead to some knee pathologies, such as knee OA. The motion of the foot and knee are coupled in a closed kinematic chain during weight-bearing activities, which can cause excessive knee rotation in people with flatfoot ( 3). The foot plays an important role in sculpting the pattern of postural alignment throughout the lower extremity, absorbing ground reaction forces, and maintaining normal joint motion ( 2). Abnormal mechanical loading of lower limbs has been reported to be associated with symptoms of knee OA ( 1). Knee osteoarthritis (OA) is a debilitating joint disease that results in structural damage to articular cartilage and bone.
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