Self-reported knee and foot alignments in early adult life and risk of osteoarthritis




To determine whether self-reported early adult life malalignment of knees or feet are risk factors for knee or hip osteoarthritis (OA).


Participants in the Genetics of Osteoarthritis and Lifestyle case–control database were sent a questionnaire (n = 3,022) containing line-drawing instruments for self-reported knee and foot alignment at ages 20–29 years. Respondents were categorized as having straight, valgus, or varus knee, and straight, toe-in, or toe-out feet. Radiographic criteria were used to define current isolated knee or hip OA, combined knee and hip OA, or non-OA controls. Odds ratios (ORs), adjusted ORs, and 95% confidence intervals (95% CIs) were calculated and logistic regression was performed.


The response rate was 72%; 87.5% of responders (n = 1,901) completed the alignment questions. Increased risk of isolated knee OA occurred with early adult varus (adjusted OR 5.16, 95% CI 2.87–9.41) and valgus knees (adjusted OR 3.16, 95% CI 1.04–9.64). The positive association between knee OA and toe-in foot was explained by varus knee. There was an increased risk of combined knee/hip OA from varus (adjusted OR 4.52, 95% CI 2.39–8.53) and valgus knees (adjusted OR 3.07, 95% CI 0.99–9.54). Varus knee was associated with risk of medial tibiofemoral OA, whereas valgus knee was associated with risk of lateral tibiofemoral and lateral patellofemoral OA. Toe-out foot was associated with reduced medial patellofemoral OA. For knee OA, a multiplicative interaction analysis between occupational risks and varus/valgus yielded an ORint of 3.20 (95% CI 1.08–9.49).


Constitutional alignment of the leg in terms of varus or valgus knee or foot rotation may be a significant factor in determining development and distribution of knee but not hip OA.