Plantar pressure analysis in total knee arthroplasty: current evidence and clinical applications

Total knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis (OA). However, a substantial proportion of patients continue to experience suboptimal functional recovery and remain dissatisfied after surgery. As an objective, non-invasive biomechanical assessment tool, plantar pressure analysis enables the quantification of dynamic changes in foot–ground interaction after correction of lower limb alignment, thereby providing a unique distal endpoint perspective for evaluating postoperative outcomes following TKA. This narrative review summarizes the current evidence regarding the application of plantar pressure analysis before and after TKA. Article based on a PubMed/MEDLINE search up to May 2026. Available studies have demonstrated that individuals with varus knee OA exhibit a characteristic lateralized plantar pressure distribution pattern. Following TKA, plantar pressure distribution in most patients gradually normalizes toward a pattern comparable to that observed in healthy individuals, although persistent abnormalities may remain in some cases. Furthermore, plantar pressure parameters may demonstrate only partial concordance with radiographic measures of lower limb alignment and patient-reported functional outcome scores. Differences in postoperative plantar pressure recovery have also been reported among different surgical techniques. Overall, plantar pressure analysis has the potential to serve as a valuable complementary tool for postoperative functional assessment and rehabilitation planning following TKA.