Effect of specific gait modifications on medial knee loading, metabolic cost and perception of task difficulty

The metabolic cost and cognitive demand of altering natural gait have not been well studied. The purpose of this investigation was to assess three modified patterns - toe out, ipsilateral trunk lean and a medial weight shift at the foot - on the basis of 1) medial knee joint load reduction, 2) metabolic cost of performance and 3) subject perception of task difficulty.12 healthy individuals underwent 3 dimensional motion analysis and metabolic testing to assess the gait mechanics and energy expenditure of natural gait and the three experimental gait patterns, performed to a self-selected moderate degree. Walking speed was controlled. Perceived workload was assessed using the NASA Task Load Index.Trunk lean significantly reduced first peak knee adduction moment (↓32%, P0.001) as well as KAM impulse (↓35%, P0.001), but was costly in terms of energy expenditure (↑11%, P0.001) and perceived workload (↑1178%, P0.001). A moderate toe-out pattern significantly reduced the second peak knee adduction moment (↓32%, P0.001) and KAM impulse (↓14%, P=0.026), but had no effect on the first peak. Conversely, toe-out was least demanding in terms of additional energy expenditure (↑2%, P=0.001) and perceived workload (↑314%, P=0.001). Medial shift did not reduce knee adduction moment.The prioritization of joint load reduction versus additional metabolic and cognitive demands could play a substantial role in the clinical decision making process of selecting a modified gait pattern.