Introduction: Foot posture plays a crucial role in musculoskeletal health by influencing the dynamic function and alignment of the lower limbs. Alterations in foot biomechanics, such as flatfoot, have been linked to the development and progression of medial compartment knee osteoarthritis (OA). Pedography, a non-invasive technique to assess foot posture, provides detailed visualization of footprints and may serve as an effective screening tool for early identification and management of foot malalignment using orthotics.

Materials and Methods: This case-control study assessed pedographicparameters (Arch index and Arch angle) and radiographic parameters (calcaneal pitch angle and cuboid abduction angle) in 45 patients with clinically and radiologically confirmed medial knee OA and 33 age-matched healthy controls from the Dehradun district. Additional radiographic angles measured included Meary’sangle, talo-calcaneal angle, and talo-navicular coverage angle. The correlation between pedographicand radiographic parameters was analyzed, along with demographic factors such as BMI, age, and gender.

Results: Significant differences were found in both pedographic and radiographic measurements between individuals with and without knee OA. Pronated foot posture (elevated Arch index and reduced Arch angle) was more prevalent in the OA group. The cuboid abduction angle (CAA) and calcaneal pitch angle (CPA) also showed significant associations with OA status (p = 0.000 and 0.035, respectively). BMI was significantly associated with OA presence.

Conclusions: Pronated flatfoot was more common in individuals with medial knee OA, suggesting a biomechanical link. Pedographicassessment offers a useful, radiation-free alternative for early screening and prevention strategies, especially in rural settings where radiographic resources are limited.

Keywords: Arch index, Calcaneal pitch, Foot health, BMI, Foot alignment