Change in intersegmental foot and ankle motion after a high tibial osteotomy in genu varum patients

High tibial osteotomy (HTO) is a well‐established treatment for medial compartment knee osteoarthritis (OA), which shifts the weight‐bearing axis from the medial to the lateral side of the knee. As the adjacent ankle joint may be directly affected by the change in biomechanics, this study aimed to evaluate the change in the intersegmental foot and ankle motion after HTO in patients with genu varum. The study included 24 patients who underwent HTO, and 48 older healthy participants as a control group. Segmental foot kinematics were evaluated using a 3D multisegment foot model, and gait data of temporal and spatial parameters were obtained. After HTO, normalized stride length significantly increased with a tendency for increases in gait speed. In hallux kinematics relative to the forefoot, the sagittal motions of both the patients and the control group were similar throughout the majority of the gait cycle. In forefoot kinematics relative to the hindfoot, the pre‐HTO state revealed significant pronation throughout the gait cycle, while the post‐HTO state showed a similar position and motion to the control group. In hindfoot kinematics relative to the tibia, coronal motions of the pre‐HTO state showed supination throughout the gait cycle, while supination during the stance phase decreased after HTO. Genu varum patients with medial compartment knee OA showed different gait parameters and intersegmental motion during gait when compared with age‐ and gender‐matched controls. The effect of HTO was demonstrated by the normalization of midfoot compensation in patients with genu varum. Genu varum patients with medial compartment knee OA showed different gait parameters and intersegmental motion during gait when compared with age‐ and gender‐matched controls. After high tibial osteotomy (HTO), normalized stride length significantly increased with a tendency for increases in gait speed. Before the operation, the midfoot segment compensated in a pronated position in order to acquire a plantigrade foot in a varus alignment of the knee. The effect of HTO was demonstrated by the normalization of midfoot compensation in patients with genu varum.