Inverted
posture
‘A Rearfoot
good fit?’
(calcaneus angle ≤−5°); normal calcaneus (−5°
< and≤5°); and inverted calcaneus (calcaneus
angle >5°). Throughout the manuscript,
“inversion/eversion” indicates posture on a
single frontal plane, which is a part of triplane
motion “supination/ pronation”.
143 patients were
initially recruited
Excluded (n=75)
üLoss of follow up for
non-specific reasons
Covariates
Data on age, sex, and height were self-
reported by patients. Patients wearing clothes
without shoes were weighed on a scale. Body
mass index (BMI) was calculated by dividing
the weight by height squared. Radiographic
medial TFOA severity and anatomical axis angle
(AAA) with sex-specific correction [31] were
assessed in the anteroposterior short view in
the weight-bearing position. The intra-rater
reliability was excellent for evaluating the TFOA
K/L grade (Kappa: 0.80) and measuring the
AAA (intra-class correlation coefficient [ICC]:
0.98). Varus thrust was evaluated according
to previously described methods [32, 33]. Two
physical therapists judged the presence of
lateral movement of the tibial tuberosity relative
to hip and ankle. This resulted in an increase
in varus alignment during initial contact with
the mid-stance of the stance phase with self-
selected speed. We have previously reported
good interrater reliability (Kappa: 0.73) for
evaluating varus thrust assessment [32, 33]. A
trained physical therapist passively measured
the flexion and extension range of motion (ROM)
of the affected knee joint through standard
goniometric procedures according to previously
validated methods [34].
Statistical analyses
To minimize any bias produced by similarities
between the knees of the same patient, only
(n=41)
üMissing data (n=34)
Knee with K/L grade ≥ 2 in
the medial compartment: n=68
Coexisting any Isolated TFOA*
PFOA* (n=38 knees) (n=30 knees)
Figure 2: Flowchart showing the inclusion of participants
in the study. *Presence of PFOA was defined as knee
with K/L grade 2 in skyline view or osteophytes 1 in
lateral view [21] based on baseline radiography. If clinical
symptoms worsened within the 12-month follow-up,
participants underwent repeat radiography that is used
for evaluation of the PFOA presence.
one knee per patient was analyzed, which
was designated as the “index knee.” The index
knee was defined as the more painful knee in
the present or past. Descriptive statistics were
calculated as mean and standard deviation
(SD) for continuous variables and as proportion
for dichotomous/categorical variables. We
performed univariate analysis using Student’s
t-test for parametric continuous variables and
Fisher’s exact test for dichotomous/categorical
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