Toe-in and Toe-Out Walking Patterns and Lateral Wedge Insoles: A Musculoskeletal Simulation and Probabilistic Modelling Assessment of Medial Tibiofemoral Cartilage Mechanics

Abstract

This study examined lateral wedge insoles and altered foot progression angles on medial tibiofemoral loading and long-term cartilage failure risk. Fifteen healthy male participants walked under four conditions: neutral gait, lateral wedge insoles, toe-in and toe-out gait. Three-dimensional kinematics were captured using an eight-camera system, and ground reaction forces were measured via a piezoelectric force plate. Musculoskeletal simulation analysis quantified tibiofemoral compressive forces, cartilage stresses, strains, and whole-body metabolic power. Probabilistic modelling was employed to estimate the probability of cartilage failure. Comparisons across the four gait conditions employed linear mixed-effects models with repeated measures. Peak compressive forces, stresses and strains were significantly larger in the neutral (force = 2.68 BW, stress = 2.61 MPa & strain = 0.22), compared to toe-in (force = 2.51 BW, stress 2.47 MPa & strain = 0.21) and toe-out (force = 2.43 BW, stress 2.40 MPa & strain = 0.21) conditions. Medial tibiofemoral cartilage failure probability was also significantly larger in the neutral condition (14.04%) compared to toe-in (10.66%) and toe-out (7.89%) conditions. Whole-body metabolic power was also significantly greater in the toe-out (9.74 W/kg) condition compared to neutral (9.32 W/kg) and lateral insoles (9.36 W/kg). The findings suggest that toe-in or toe-out walking may reduce medial tibiofemoral osteoarthritis risk. However, the greater metabolic demand of toe-out walking may limit its long-term feasibility and practicality as a preventive intervention.