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Effectiveness of medial-wedge insole treatment for valgus knee osteoarthritis
Abstract
To assess the efficacy of medial-wedge insoles in valgus knee osteoarthritis (OA).
Thirty consecutive women with valgus-deformity knee OA > or = 8 degrees were randomized into 2 groups: medial insole (insoles with 8-mm medial elevation at the rearfoot [n = 16]) and neutral insole (similar insole without elevation [n = 14]). Both groups also wore ankle supports. A blinded examiner assessed pain on movement, at rest, and at night with a visual analog scale (VAS), the Lequesne index, and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Femorotibial, talocalcaneal, and talar tilt angles were evaluated at baseline and after 8 weeks of insole use.
Significant reductions in the medial insole group were observed for pain on movement (mean +/- SD VAS pre- and postintervention 8.1 +/- 1.5 versus 4.2 +/- 2.4; P = 0.001), at rest (5.1 +/- 2.3 versus 2.7 +/- 2.4; P = 0.002), and at night (6.1 +/- 2.7 versus 3.1 +/- 2.1; P = 0.001). In addition, a decrease in Lequesne (14.7 +/- 3.4 versus 9.6 +/- 3.8; P = 0.001) and WOMAC scores (74.1 +/- 14.2 versus 56.1 +/- 14.9; P = 0.001) was observed for the medial insole group. In the neutral insole group, a significant reduction was observed only for night pain (mean +/- SD VAS pre- and postintervention 5.8 +/- 2.4 versus 4.6 +/- 2.4; P = 0.019). An increase in femorotibial angle (169.0 +/- 3.4 versus 170.8 +/- 3.7; P = 0.001) occurred only in the medial insole group. Moreover, the difference in measured femorotibial angles pre- and postintervention was 1.84 +/- 1.42 versus -0.18 +/- 0.67 (P < 0.001) for the medial and neutral insole groups.
The use of medial-wedge insoles was highly effective in reducing pain at rest and on movement and promoted a functional improvement of valgus knee OA.
... So it may transfer load from medial to lateral knee joints during weight-bearing. Many studies [20][21][22] have documented wedge insole can effectively relieve pain, improve knee function, and improve the femorotibial angle. Nevertheless, some literatures [23] suggest that it cannot significantly improve the pain and function of KOA. ...
... This left 37 articles assessed after reading whole article for eligibility. Of these, 8 met the inclusion criteria [20][21][22][23][28][29][30][31] (see Table 1). The examined intervention in this review was a lateral wedge insole. ...
... A total of 4 different outcome variables were identified in this review. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Indexes that were reported in 4 studies [21,23,29,30] included the WOMAC pain (4 studies) [21,23,29,30], WOMAC stiffness (3/4 studies) [21,23,30], and WOMAC function (3/4 studies) [21,23,30]; pain was reported in 5 studies [20,23,28,29,31]; Lequesne index was reported in 3 studies [20,22,29]; and FTA was report in 2 studies [20,22]. According to the different intervention time of the wedge insole, Toda et al. [22] divided the treatment components into three subgroups compared with the flat insole. ...
Background
Using the lateral wedge insole is a conservative management strategy for knee osteoarthritis. The theoretical basis for this intervention is to correct femorotibial angle, thereby reducing pain and optimising function.
Objective
This systematic review evaluates the evidence on the effectiveness of wedge insole compared with flat insole for the treatment of knee osteoarthritis.
Methods
A systematic review was performed, searching published (MEDLINE, EMBASE, CNKI, Cochrane Library, and Web of Science) and unpublished literature from their inception to April 2018. Randomized controlled trials (RCTs) that compared the use of wedge insole with a flat insole were included. Risk of bias and clinical relevance were assessed, and outcomes were analysed through meta-analysis.
Result
From a total of 413 citations, 8 studies adhered to the a priori eligibility criteria. The WOMAC pain was shown to be statistically nonsignificant change with the use of wedge insole (SMD=0.07), and low heterogeneity (I²=22%) and a 95% CI that crossed zero (95% CI: −0.09 to 0.24). The 5 independent trials were not significant in improving pain score (SMD = −0.02, 95% CI: −0.19 to 0.16). This review also revealed no significance in improving Lequesne index (SMD = −0.27, 95% CI: −0.72 to 0.19). The meta-analysis from the 2 independent trials was significant in improving femorotibial angle (SMD = −0.41, 95% CI: −0.73 to -0.09). In conclusion, this meta-analysis suggested that lateral wedge insoles can improve femorotibial angle but are of no benefit with pain and functions in knee osteoarthritis.
... A total of 30 studies met inclusion criteria: seven on TENS, 6-12 six on NMES, 13-18 13 on insoles, [19][20][21][22][23][24][25][26][27][28][29][30][31] and four on bracing. [32][33][34][35] The summary characteristics of each study are displayed in Table I. ...
... 40,41 However, inconsistent results were found when examining their effect on pain, 42 although some studies have reported an improvement. 19,28,29 A RCT of 30 patients compared the use of medial-wedge insoles with neutral insoles. After eight weeks, the medial-wedge insoles had achieved significant reductions in VAS for pain on movement, at rest, and at night with the medial-wedge compared with the neutral insole (8 vs 4, p = 0.001; 5 vs 3, p = 0.002; and 6 vs 3 points, p = 0.001). ...
... After eight weeks, the medial-wedge insoles had achieved significant reductions in VAS for pain on movement, at rest, and at night with the medial-wedge compared with the neutral insole (8 vs 4, p = 0.001; 5 vs 3, p = 0.002; and 6 vs 3 points, p = 0.001). 28 Knee braces help protect, stabilise and off-load the joint. There are five main types of brace: prophylactic, which protect the knee from injuries; functional, which give support for the injured knee; rehabilitative, which limit harmful movement during healing after injury or surgery; patellafemoral, which helps the patella move smoothly; and the joint off-loader. ...
The purpose of this study was to evaluate the effect of various non-operative modalities of treatment (transcutaneous electrical nerve stimulation (TENS); neuromuscular electrical stimulation (NMES); insoles and bracing) on the pain of osteoarthritis (OA) of the knee.
We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify the therapeutic options which are commonly adopted for the management of osteoarthritis (OA) of the knee.
The outcome measurement tools used in the different studies were the visual analogue scale and The Western Ontario and McMaster Universities Arthritis Index pain index: all pain scores were converted to a 100-point scale.
A total of 30 studies met our inclusion criteria: 13 on insoles, seven on TENS, six on NMES, and four on bracing. The standardised mean difference (SMD) in pain after treatment with TENS was 1.796, which represented a significant reduction in pain. The significant overall effect estimate for NMES on pain was similar to that of TENS, with a SMD of 1.924. The overall effect estimate of insoles on pain was a SMD of 0.992. The overall effect of bracing showed a significant reduction in pain of 1.34.
Overall, all four non-operative modalities of treatment were found to have a significant effect on the reduction of pain in OA of the knee.
This study shows that non-operative physical modalities of treatment are of benefit when treating OA of the knee. However, much of the literature reviewed evaluates studies with follow-up of less than six months: future work should aim to evaluate patients with longer follow-up.
Cite this article: Bone Joint J 2016;98-B(1 Suppl A):89–94.
... For example, Bennel et al. [15] used shoes with soles of variable stiffness and showed that it can significantly reduce the knee joint load. Rodrigues et [16] showed that a medial insole provides a clinically meaningful decrease in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Other studies have incorporated comfortable off-the-shelf shoes or various shoes designed specifically for individuals with OA. ...
... The study limitations include a small sample size, although this might not have affected the power of our results, as shown by the large effect sizes presented in Table 2, and also, previous literature concerning footwear efficacy present similar sample sizes [16,18]. Additionally, this sample size exceeds the calculated sample side reported in Section 2.4. ...
One of the recommendations for individuals with knee osteoarthritis (OA) is the use of specific footwear, such as sturdy or cushioned shoes. However, the long-term use effects of using cushioned shoes on the pain and spatiotemporal gait parameters in individuals with knee OA are yet to be reported. We therefore aimed to compare the efficacy of cushioned sport footwear versus sham shoes on motor functions, pain and gait characteristics of individuals with knee OA who used the shoes for 3 months. In a double-blinded study, we provided 26 individuals with knee OA with cushioned sport shoes and 12 individuals with knee OA with similar sport shoes without cushioning for 3 months. The gait analysis, the timed up and go (TUG) test and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were conducted and the pain levels were measured at the baseline, 1 month, and 3 months after the baseline. We found that the cushioned shoes reduce the amount of pain (based on WOMAC) in the affected knee and increase functionality in the research group, but not in the control group. Gait velocity and cadence were increased in both groups. Gait spatiotemporal parameters and their symmetry were unaffected during the intervention. We conclude that the use of cushioned shoes should be recommended to individuals with knee OA for alleviating pain.
... A small study of 30 women with symptomatic radiographic lateral knee OA and bilateral knee valgus deformity found that wearing medially wedged insoles (which have similar biomechanical effects on lateral TF joint loads to motion control shoes 17 ) for 3-6 hours/day resulted in greater improvements in pain and other symptoms over 8 weeks compared with wearing flat insoles. 18 Consequently, further research assessing the effects of motion control footwear in people with lateral knee OA is warranted to help inform footwear recommendations in international OA clinical guidelines and to guide clinical practice for this important but under-researched OA subgroup. ...
... Although no previous clinical trial has investigated the effects of footwear in people with lateral knee OA, our findings are not consistent with the only other similar trial conducted, which evaluated shoe insoles over 8 weeks. In a previous RCT with a smaller sample size than ours (n=30), medially wedged insoles, but not flat neutral insoles, significantly reduced knee pain with movement (mean (SD) baseline and 8-week values for medial wedges: from 8.1 (1.5) to 4.2 (2.4); flat insoles: from 6.9 (2.6) to 6.4 (2.7)) and at rest (medial wedges: from 5.1 (2.3) to 2.7 (2.4); flat insoles: from 3.3 (2.2) to 3.1 (2.5)) in women with lateral knee OA. 18 However, the average betweengroup differences were not reported in that study and thus it is possible that no significant between-group differences were observed. Although adherence rates were not Open access reported in that study, the different outcomes may also be due to the lower proportion of participants being classified as adherent wearing motion control shoes (56%) compared with neutral walking shoes (86%) in our study. ...
Objectives:
To determine if motion control walking shoes are superior to neutral walking shoes in reducing knee pain on walking in people with lateral knee osteoarthritis (OA).
Design:
Participant-blinded and assessor-blinded, comparative effectiveness, superiority randomised controlled trial.
Setting:
Melbourne, Australia.
Participants:
People with symptomatic radiographic lateral tibiofemoral OA from the community and our volunteer database.
Intervention:
Participants were randomised to receive either motion control or neutral shoes and advised to wear them >6 hours/day over 6 months.
Primary and secondary outcome measures:
The primary outcome was change in average knee pain on walking over the previous week (11-point Numeric Rating Scale (NRS), 0-10) at 6 months. The secondary outcomes included other measures of knee pain, physical function, quality of life, participant-perceived change in pain and function, and physical activity.
Results:
We planned to recruit 110 participants (55 per arm) but ceased recruitment at 40 (n=18 motion control shoes, n=22 neutral shoes) due to COVID-19-related impacts. All 40 participants completed 6-month outcomes. There was no evidence that motion control shoes were superior to neutral shoes for the primary outcome of pain (mean between-group difference 0.4 NRS units, 95% CI -1.0 to 1.7) nor for any secondary outcome. The number of participants experiencing any adverse events was similar between groups (motion control shoes: n=5, 28%; neutral shoes: n=4, 18.2%) and were minor.
Conclusions:
Motion control shoes were not superior to neutral shoes in improving knee pain on walking in symptomatic radiographic lateral tibiofemoral joint OA. Further research is needed to identify effective treatments in this important but under-researched knee OA subgroup.
Trial registration number:
ACTRN12618001864213.
... Of these, 830 were excluded after title or abstract screening. Finally, 15 studies from 13 RCTs (11,12,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) were eligible for data extraction and metaanalysis after retrieving 101 fulllength manus cripts. A schematic illustration of the selection criteria for the included studies is shown in Fig. 1. www.medicaljournals.se/jrm ...
... The mean age of subjects was > 60 years except for one study (28); the majority of studies included more females than males. Two RCTs were performed in Chinese Taipei (12,25), 2 in Japan (30,31), 3 in USA (20,21,24), 2 in Brazil (23,27), and 1 in each of Australia (22), Iran (28), France (26), and Canada (11). Most studies investigated differences between the effects of lateral wedge and flat control insoles, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were documented in 11 studies. ...
Objective:
Recent clinical evidence supports that orthopaedic insoles, especially lateral-wedge insoles, can significantly benefit patients with knee osteoarthritis. The aim of this study is to explore the effects of orthopaedic insoles in patients with knee osteoarthritis.
Methods:
Randomized controlled trials evaluating the effects of orthopaedic insoles on patients with knee osteoarthritis, published up to 16 February 2021, were reviewed and outcomes quantitatively summarized.
Results:
A total of 15 studies from 13 randomized controlled trials that involved 1,086 participants were included in this study. All the included studies exhibited a moderate bias risk and were of acceptable quality. The pooled mean difference of pain determined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was -1.05 (p < 0.01, 95% confidence interval (95% CI) -2.31-0.20) with a high heterogeneity (I2 = 73%). In the sensitivity analysis, the overall incidence was -0.19 (p= 0.73, 95% CI= -0.83-0.44) with an accepted heterogeneity (I2 = 0%). No difference was observed between the Asian and Caucasian groups (p= 0.26). No significant difference was found in the pain score, Lequesne index or functional improvements.
Conclusion:
Meta-analysis revealed that orthopaedic insoles do not provide relief of pain or improve functionality in patients with knee osteoarthritis.
... Thirteen studies [12][13][14][15][16][17][18][19][20][21][22][23][24] evaluated the effect of insoles on the treatment of medial compartment knee osteoarthritis (varus deformity). Only one study 25) evaluated lateral compartment knee osteoarthritis (valgus deformity). The interventions for medial compartment osteoarthritis were lateralwedged insoles with inclination angles of 5 degrees, 6 degrees, 8.5 degrees, 11.2 degrees and 16.8 degrees. ...
... The KOOS was developed as an extension of the WOMAC in subjects with knee injury and osteoarthritis. Six studies 12,13,18,20,24,25) used pain scales such as the Visual Analog Scale (VAS) or the Numerical Rating Scale (NRS). The NRS was an 11-point scale for patient self-reporting of pain. ...
Recently, many people are using insoles. They are used for structural and positional imbalance such as foot deformities. However, evidence of their effect remains unclear. The aim of this review is to investigate the scientific evidence on the effect of various insoles. A comprehensive review of the English-language scientific literature was carried out covering the period from April 1980 to January 2013 of MEDLINE, CINAHL and EMBASE databases, to search for articles relating to insoles for the prevention and treatment of lower extremity injuries. When data were available for stratification, we extracted information concerning patients with knee osteoarthritis (15 studies), Diabetes mellitus (3 studies) and other diseases (12 studies), comparisons of different insoles (10 studies), and sports injuries (6 studies). An improvement effect on alignment was found in femorotibial alignment; and it was suggested that such alignment is effective for knee osteoarthritis (OA). The insole has an effect on preventing the progression of the transformation of the foot part of patients with diabetes; and, as a result, it is thought of as an effective therapy for patients with diabetes. This review provides evidence for the beneficial effect of insoles in the treatment of some musculoskeletal disorders. However, some trials were compromised by poor methodology. Likewise, it is necessary to determine the effect of shoes, in addition to insoles, and to investigate their effect in the future.
... While this would suggest the need for soles of mid-range stiffness levels, the difficulty lies in accommodating competing patient needs. For instance, Rodrigues et al (2008) reported that use of a medial wedge helps to minimize symptoms associated with lateral knee osteoarthritis (OA) [18], whereas Fang et al (2006) reported similar findings with use of a lateral wedge on medial knee OA [19]. Understandably, the use of a medial or lateral wedge loads the foot in greater supination, or pronation, respectively. ...
... While this would suggest the need for soles of mid-range stiffness levels, the difficulty lies in accommodating competing patient needs. For instance, Rodrigues et al (2008) reported that use of a medial wedge helps to minimize symptoms associated with lateral knee osteoarthritis (OA) [18], whereas Fang et al (2006) reported similar findings with use of a lateral wedge on medial knee OA [19]. Understandably, the use of a medial or lateral wedge loads the foot in greater supination, or pronation, respectively. ...
The United States older adult population is expected to double within the next 15 years. A growing percentage present with multiple co-morbidities that require competing footwear accommodations. Yet, attributed to footwear mass manufacturing methods, older adults often must rely on the use foot orthotics to conservatively manage lower limb ailments. However, orthotics addresses only problems at the foot, and may further limit space within a shoe. Thus, footwear manufacturers are encouraged to develop personalized solutions that can address problems at the foot, knee, and a hip. Ergonomic standards that account for individualized anthropometrics, ground reaction forces, and balance should be developed. Accordingly, a paradigm shift in footwear manufacturing methods appears necessary, and is promoted.
... -women aged 60 to 80 years; -OA diagnosed according the American College of Rheumatology (Altman et al., 1986) criteria; -radiographic evidence of medial femorotibial OA classified as Kellgren-Lawrence (Kellgren and Lawrence, 1957) grade 2 or 3; -knee pain between 3 and 8 on a visual analog scale; -body mass index b35 kg/m 2 (Shakoor and Block, 2006); -ability to walk independently without an assistive device for at least 6 hours a day; -absence of asymptomatic OA of both knees (the patient had to had symptomatic OA in at least one knee) -absence of diagnosed hip and/or ankle OA, rheumatoid arthritis, or systemic inflammatory arthritis; -absence of rigid hallux (Rodrigues et al., 2008); -absence of arthroplasty and/or lower limb orthoses or indication of lower limb arthroplasty throughout the intervention period; -absence of knee instability (verified by clinical examination to assess the collateral and cruciate ligaments); -absence of diagnosed dementia or inability to give consistent information (Hunt et al., 2006); -absence of diagnosed neurological disease (Hunt et al., 2006); -no history of surgical procedure on knee, ankle, or hip, and no muscle injury in the last 6 months; -no leg length discrepancy greater than 1 cm; -no knee intra-articular steroid or hyaluronic acid 3 and 6 months, respectively, before inclusion in the study (Rodrigues et al., 2008); -currently not using the Moleca® or similar shoes for more than 25 hours/week; -no physical therapy or acupuncture treatment throughout the intervention period. ...
... -women aged 60 to 80 years; -OA diagnosed according the American College of Rheumatology (Altman et al., 1986) criteria; -radiographic evidence of medial femorotibial OA classified as Kellgren-Lawrence (Kellgren and Lawrence, 1957) grade 2 or 3; -knee pain between 3 and 8 on a visual analog scale; -body mass index b35 kg/m 2 (Shakoor and Block, 2006); -ability to walk independently without an assistive device for at least 6 hours a day; -absence of asymptomatic OA of both knees (the patient had to had symptomatic OA in at least one knee) -absence of diagnosed hip and/or ankle OA, rheumatoid arthritis, or systemic inflammatory arthritis; -absence of rigid hallux (Rodrigues et al., 2008); -absence of arthroplasty and/or lower limb orthoses or indication of lower limb arthroplasty throughout the intervention period; -absence of knee instability (verified by clinical examination to assess the collateral and cruciate ligaments); -absence of diagnosed dementia or inability to give consistent information (Hunt et al., 2006); -absence of diagnosed neurological disease (Hunt et al., 2006); -no history of surgical procedure on knee, ankle, or hip, and no muscle injury in the last 6 months; -no leg length discrepancy greater than 1 cm; -no knee intra-articular steroid or hyaluronic acid 3 and 6 months, respectively, before inclusion in the study (Rodrigues et al., 2008); -currently not using the Moleca® or similar shoes for more than 25 hours/week; -no physical therapy or acupuncture treatment throughout the intervention period. ...
Efforts have been made to retard the progressive debilitating pain and joint dysfunction in patients with knee osteoarthritis. We aimed to evaluate the therapeutic effect of a low-cost minimalist footwear on pain, function, clinical and gait-biomechanical aspects of elderly women with knee osteoarthritis.
Throughout a randomized, parallel and controlled clinical trial, fifty-six patients with medial knee osteoarthritis were randomly allocated to an intervention (n=28) or control group (n=28), and assessed at baseline and after three and six months. The intervention involved wearing Moleca(®) footwear for at least 6h/day, 7days/week, over 6months. The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index was the primary outcome. The secondary outcomes were the other subscales, Lequesne score, distance walked in 6 min, knee oedema and effusion, knee adduction moment and paracetamol intake. Intention-to-treat analysis was performed using two-way casewise ANOVA (< .05) and Cohen's d coefficient.
Intervention group showed improvement in pain (effect size: 1.41, p<.001), function (effect size: 1.22, p=.001), stiffness (effect size: 0.76, p=.001), Lequesne score (effect size: 1.07, p<.001), and reduction by 21.8% in the knee adduction moment impulse (p=.017) during gait wearing Moleca(®). The analgesic intake was lower in the intervention group.
The long-term use of Moleca(®) footwear relieves pain, improves self-reported function, reduces the knee loading while wearing Moleca(®), refrains the increase of analgesic intake in elderly women with knee osteoarthritis and can be considered as a conservative mechanical treatment option. ClinicalTrials.gov (NCT01342458).
Copyright © 2015 Elsevier Ltd. All rights reserved.
... Biomechanical insoles have been used in the context of orthopedic problems for decades, often as a standalone treatment or in addition to medication and/or active therapy, depending on foot [1][2][3][4], knee [5,6], hip [7,8], and back indications [5]. Insoles are part of both cause and symptom management. ...
This pilot study aimed to investigate the use of sensorimotor insoles in pain reduction, different orthopedic indications, and the wearing duration effects on the development of pain. Three hundred and forty patients were asked about their pain perception using a visual analog scale (VAS) in a pre-post analysis. Three main intervention durations were defined: VAS_post: up to 3 months, 3 to 6 months, and more than 6 months. The results show significant differences for the within-subject factor "time of measurement", as well as for the between-subject factor indication (p < 0.001) and worn duration (p < 0.001). No interaction was found between indication and time of measurements (model A) or between worn duration and time of measurements (model B). The results of this pilot study must be cautiously and critically interpreted, but may support the hypothesis that sensorimotor insoles could be a helpful tool for subjective pain reduction. The missing control group and the lack of confounding variables such as methodological weaknesses, natural healing processes, and complementary therapies must be taken into account. Based on these experiences and findings, a RCT and systematic review will follow.
... gie mittels Einlagen deutliche Schmerzverbesserungen und Verminderungen der Fußdrücke in den betroffenen Bereichen294 . Die Einlagen wurden durch ihr formbares Material (Plastazote®) mehrfach an die Fußdrücke und -form der292 Die Autoren untersuchten 4 verschiedene Konzepte in einem Cross-over-Design: Maßgefertigte Einlagen, vorgefertigte Einlagen und beide Einlagenformen jeweils mit und ohne einer40 mm starken Abrollhilfe, die an der Schuhsohle im Bereich der Metatarsalia angebracht wurde. Die maßgefertigten Einlagen (keine Materialangabe) waren nach Gipsabdrücken hergestellt und mit einer Fersenerhöhung von 25 mm, einer Längsgewölbeabstützung und einem Metatarsalpad proximal der Metatarsophalangealgelenke versehen. ...
Introduction / Background: In the period of evidence-based medicine orthopedic insoles and orthoses require evidence of efficacy as every other form of medical therapy. Providing such evidence is in the best interest of patients as well as funders in the health care systems. This review of literature has the objective to present the current state of evidence for a prescription of insoles and foot orthoses for different indications, to identify therapies which have not been proved effective yet with scientifically qualitative and quantitative evidence and to identify promising and relevant concepts of orthoses and insoles for further clinical trials. Material and Methods: A structured research of literature was conducted in two medical databases (PubMed and Cochrane); after screening all results and applying exclusion criteria it revealed 277 clinical trials, reviews and meta-analyses as well as further scientific studies covering more than 20 different areas of indication. Before completion of this review an update was conducted. Results: In general, the number and quality of the available articles concerning orthopedic in-soles and foot orthoses presents as low and poor, especially when considering their widespread use. Ailments like diabetic foot syndrome or rheumatoid arthritis can be treated with insoles and orthoses, at least as an adjuvant therapy. For the frequently discussed unicompartimental osteoarthritis of the knee there are certain hints of efficacy for a concept of elevating the insoles’ rims, however the data situation is insufficient. Beyond that there are single trials for many indications which claim to prove efficacy, yet the number of trials and quality of designs often prevents generating scientific evidence. Superiority of customized insults over off-the-shelf insoles has not been proved yet either. Discussion / Conclusion: At large, there is a current lack of high-quality clinical trials with sufficient follow-up intervals and population sizes which are necessary to conduct for creating a base of evidence for the future.
... A subject-specific insole has total contact characteristic that provides more appropriate pressure distribution and thereby reducing the pain. Also custom insoles can be modified considering some kind of deformities such as varus/valgus, and, in this way, such insoles can improve the posture by supporting the foot in a neutral position [9,10]. Moreover, complaints such as hip, knee and lower back pains caused by poor foot function could be reduced using custom made insoles restoring the abnormal foot function. ...
In this study, a biomechanical application of three dimensional (3D) printing method was implemented to produce a subject-specific insole. It was aimed to design and manufacture a customized total-contact insole operating a free mobile application that enables to create 3D scans of an object and a 3D printer device in this application. First, two dimensional pictures of a subject's foot sole was taken from various angles and these photos were uploaded to the server of the software which use photogrammetry technology to create a 3D model out of multiple pictures taken by the user. Next, 3D scanning data was transferred to a CAD software and the model was modified to represent the geometrical properties of the subject's foot most appropriately. Then, the model as an STL format imported to a 3D printer device. Finally, the model of subject-specific insole was printed and examined by placing into the shoe of the subject. It was shown with sequential processes that a subject-foot geometry based insole could be designed and manufactured benefitting from new facilities of technological advances with a low level of cost. Furthermore, the use of custom made biomechanical instruments, which make easy to carry out daily tasks, could likely be increased by utilizing educational and practical applications regarding 3D scanning and printing technologies.
... In relation to the musculoskeletal conditions, only studies on the intervention of feet and knee joints were founded, no article on the influence of insoles on the hip joint appeared in the search. Rodrigues et al. (2008), on the review ofknee osteoarthritis (KOA), verified that the EVA insole with medial wedge of 8 mm, in the rearfoot, improved the function and decreased pain at rest and during functional activities even prescribing the thickness of the edge elevation in a generic way. An interesting aspect of this study is that the researchers used orthoses in new shoes. ...
The objective of this review was to identify the main types of insoles described in the literature that are used to treat musculoskeletal alterations of lower limbs and to analyze the existence of previous evaluation for the prescription of these insoles. To this end, two researchers, independently and blindly, searched the PubMed, SciELO, Bireme, MEDLINE, Lilacs, PEDro, Cochrane Library and Web of Science databases between June and July of 2018, from the free combination of the following descriptors: insoles, foot orthoses, foot, orthoses, musculoskeletal diseases and clinical trial. We included randomized or non-randomized clinical trials in which at least one intervention group used insoles and individuals with some type of musculoskeletal disorder had been sampled. Of the 227 documents identified in date bases, 20 were included in this review. In general, it is suggested to carry out more studies with more precise methods and that include evaluation before the prescription. This is a systematic review of clinical trials registered in PROSPERO (International Prospective Register of Systematic Reviews) under the protocol no. CRD42018099534e.
... In patients with medial compartment OA, lateral-wedged insoles reduced KAM and KAM impulse, compared to those without insoles [119]. Application of medial-wedge insoles on knee OA patients with valgus-deformity has demonstrated an effective reduction in in knee pain and improvement in functionality [120]. ...
Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients’ quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA.
The translational potential of this article
Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.
... There is indirect RCT evidence supporting potential clinical improvements in people with lateral TF OA wearing motion-control footwear. A small RCT compared 30 women with lateral TF OA and bilateral knee valgus deformity wearing either medially wedged or neutral orthoses for 3-6 h/day for 8 weeks [28]. Compared to the neutral insoles group, the medially-wedged orthoses group showed greater improvements in pain with movement over 8 weeks, measured using a visual analogue scale (VAS; medially-wedged insoles: − 49% vs neutral insoles: − 6%, between group change P = 0.001), and in the Western Ontario McMasters University Osteoarthritis Index (WOMAC) total score (− 25% vs 3%, P = 0.001). ...
Background:
Structural features of lateral tibiofemoral (TF) joint osteoarthritis (OA) occur in up to half of all people with knee OA, and co-existing lateral TF OA is associated with worse knee pain in people with mixed compartmental knee OA. Clinical guidelines for management of knee OA advocate advice about appropriate footwear, yet there is no research evaluating which types of footwear are best for managing pain associated with lateral TF OA. Biomechanical evidence suggests that "motion-control" footwear, which possess midsoles that are stiffer medially compared to laterally, may shift load away from the lateral compartment of the knee and thus may reduce knee pain associated with lateral TF OA. The primary aim of this study is to compare the effects of motion-control shoes to neutral shoes on knee pain in people with predominantly lateral TF OA.
Methods:
This will be an assessor- and participant-blinded, two-arm, comparative effectiveness randomized controlled trial (RCT) conducted in Melbourne, Australia. We will recruit a minimum of 92 people with painful lateral TF OA from the community. Participants will be randomly allocated to receive either motion-control shoes or neutral shoes and will be instructed to wear their allocated shoes for a minimum of 6 h per day for 6 months. The primary outcome is change in self-reported knee pain on walking, measured using a numerical rating scale, assessed at baseline and 6 months. Secondary outcomes include other measures of knee pain, physical function, quality of life, participant-perceived change in pain and function, and physical activity levels.
Discussion:
This study will compare the efficacy of motion-control shoes to neutral shoes for people with painful lateral TF OA. Findings will be the first to provide evidence of the effects of footwear on knee pain in this important subgroup of people with knee OA and allow clinicians to provide accurate advice about the most appropriate footwear for managing pain associated with lateral TF OA.
Trial registration:
This trial has been prospectively registered by the Australian New Zealand Clinical Trials Registry on 15/11/2018 (reference: ACTRN12618001864213).
... All participants were initially examined by the investigator with regard to the inclusion and exclusion criteria, and if found to be appropriate, the participants were included in the study. The sample size was calculated at 15 patients in each group, considering the a ¼ 0.05, b ¼ 0.2 and the probable significant mean difference of 24 mm for patients perceived pain as reported by Rodrigues et al. [27] using the following formula: ...
Purpose: This study aimed to compare the effectiveness of physiotherapy with uphill walking versus physiotherapy alone on the disability of patients with knee osteoarthritis.
Methods: This study was a randomized clinical trial carried out on 30 patients (5 males and 25 females) with moderate knee osteoarthritis aged between 40 and 65 years. They were assigned to the intervention and control groups. Both groups received 10-session routine physiotherapy, and the intervention group received an 8-degree treadmill walking at a speed of 1.1m/s for 30 minutes in each session. The participants’ disability was measured before, immediately after, and 20 days after the 10-session treatment by the Persian version of Knee injury and Osteoarthritis Outcome Score (KOOS). The data were analyzed through the repeated measures analysis of variance in SPSS V. 22. The significant level was set at 0.05.
Results: Statistical analysis showed significant improvements in the activity of daily living (P≤0.01) and quality of life (P
... All participants were initially examined by the investigator with regard to the inclusion and exclusion criteria, and if found to be appropriate, the participants were included in the study. The sample size was calculated at 15 patients in each group, considering the a ¼ 0.05, b ¼ 0.2 and the probable significant mean difference of 24 mm for patients perceived pain as reported by Rodrigues et al. [27] using the following formula: ...
Purpose: This study aims to compare the effectiveness of uphill walking and physical therapy versus physical therapy alone on knee pain, excursion ranges, stride length, and walking speed in individuals with knee osteoarthritis.
Methods: In this randomized clinical trial, 30 patients with knee osteoarthritis participated. Both control and intervention groups received 10-session physical therapy. Moreover, the intervention group received an 8-degree treadmill walking at a speed of 1.1 m/s for 30 min in each session. Outcome measures, including pain, excursion ranges, stride length, and walking speed, were measured at baseline, post-treatment, and a 20-day follow-up.
Results: Significant improvements in stride length and walking speed were observed just in the intervention group from baseline to post-treatment (p ≤ 0.001) and from baseline to follow-up (p ≤ 0.001). Furthermore, significant improvement in excursion ranges was observed just in the intervention group from baseline to follow-up (p < 0.05).
Conclusions: This study revealed that the addition of uphill walking to physical therapy results in stride length and walking speed improvements and that it also has persistent effects on knee ranges, stride length, and walking speed as compared with physical therapy alone.
This clinical trial was registered at irct.ir (study ID: IRCT20171115034920N1).
• Implications for Rehabilitation
• Stretching exercises are recommended to correct knee flexion contracture and uphill treadmill walking is a form of functional stretching.
• This study shows 10 sessions of combined uphill treadmill walking and physical therapy provided superior improvements in stride length and walking speed at 10-session or 20-day follow-up, and active and passive excursion ranges at 20-day follow-up compared with physical therapy alone.
• Physical therapist may consider uphill treadmill walking when designing a physical therapy for patients with knee osteoarthritis to promote the results of the rehabilitation programs.
... However, some studies reached a weak relationship between controlling the motion of pronated foot and reducing the rate of injury [56]. Medial posting has also been effective for lateral knee osteoarthritis and patellofemoral pain syndrome by reducing the lateral knee loading and pain [57,58], which could be confirmed by our meta-analysis findings. ...
Objective:
Foot orthoses (FOs) are popular treatment to alleviate several abnormalities of lower extremity. FO designs might alter lower extremity biomechanics differently, but the association is not yet known. This review aimed to evaluate how different FO designs, namely FO with medial posting, lateral posting, arch support, or arch & heel support, change lower limb kinematics and kinetics during walking.
Literature survey:
Electronic database search were conducted from inception to March 2019, and 25 papers passed the inclusion criteria. Two independent reviewers checked the quality using a modified Downs and Black checklist (73.7±5.5%) and a biomechanical quality checklist (71.4±17.1%). Effect sizes for differences between with- and without- FO walking were calculated, and meta-analysis was performed whenever at least two studies reported the same variable.
Results:
Medial posting reduced peak ankle eversion moment. Lateral posting brought about higher peak ankle dorsiflexion and peak ankle eversion for kinematics, as well as higher peak ankle abduction moment, lower peak knee adduction moment, and higher peak mediolateral ground reaction force (GRF) for kinetics. FOs with either arch support or arch & heel support tended to decrease vertical ground reaction force, but it was not significant.
Conclusion:
The findings of this review reveal that medial or lateral posting work efficiently to change foot and knee kinematics and kinetics. However, the impact force is just slightly decreased by arch-supported and heel supported FOs. Due to the small number of available studies, and heterogeneity in meta-analysis findings, further research with more standardized biomechanical approach are required.
... [9,10] Also, Some clinical trials have demonstrated the role of wedge insole in the treatment of knee osteoarthritis. [11][12][13] However, according to the study conducted by Bennell et al, it cannot significantly improve the symptoms of knee osteoarthritis. [14] In addition, some systematic review and meta-analyses, which is a higher level of evidence-based research, have drawn different conclusions. ...
Background:
Functional limitations and pain are common presenting complaints for people suffering from knee osteoarthritis. Wedge insole can be sued for treatment of knee osteoarthritis. Hence, we conducted a systematic review and meta-analysis to explicit the efficacy of wedge insole in the treatment of knee osteoarthritis.
Methods:
A systematic literature search for studies will be performed in MEDLINE, Embase, the Chinese National Knowledge Infrastructure Database (CNKI), Cochrane Library, Web of Science. The methodological quality of the included studies using the risk bias assessment tool of Cochrane. Funnel plot will be used to assess the reporting bias. And the level of evidence for results are assessed by the GRADE method. Statistical analysis is conducted with Revman 5.3.
Results:
This systematic review and meta-analysis will provide a synthesis of evidences for wedge insole on knee osteoarthritis.
Conclusion:
The conclusion of this study will provide recommendations to assess effectiveness of exercise on knee osteoarthritis, which may further guide clinical practice.
Prospero registration number:
CRD42018096804.
... Brazilian rheumatologists have also published on nonpharmacologic treatment of rheumatic diseases including patient support [63]. Particularly, two articles demonstrating the benefit of insoles and canes, respectively, for OA patients achieved major impact [64,65]. Also, a lot of work was done in adapting questionnaires on pain, incapacitation and quality of life evaluation, disease and treatment knowledge which are crucial to provide adequate instruments to conduct clinical protocols. ...
Despite resilient inequities, Brazil has seen progressive improvement in health care in the last 25 years. Infectious diseases rendered place to chronic non-communicable diseases as a major cause of death. Existence of traditional schools of medicine and training services in rheumatology helped form a reasonable number of specialists, though irregular distribution due to the economic issues favoring their clustering in major cities. The Brazilian Society of Rheumatology provides continued medical education, helps training rheumatologists, family physicians and other health professionals and has worked to publish national recommendations for the diagnosis and treatment of major rheumatic diseases. Access to medications and health care facilities is provided for most patients, free of direct charge, including biologics. Specialized services for autoimmune and rare diseases, including pediatric rheumatology and autoinflammatory diseases, have improved, particularly in developed centers of the southern best developed parts of the country. A major unmet need is the lack of access to non-pharmacological treatment modalities. In this article, we will summarize some of the strengths and points that need improvement to enhance access to the rheumatological health care in Brazil.
... In addition, it might also be speculated whether potential postoperative compartment-unloading tactics would be beneficial for the outcome of APM. Compartment unloading can be achieved with knee braces [3,6,7,10,16,19,21] and wedge insoles [6,16,17,24,27]. These studies tested the unloading effects in patients with unicompartmental knee osteoarthritis with or without frontal plane knee malalignment. ...
Purpose:
To investigate whether temporary postoperative compartment-unloading therapy after arthroscopic partial meniscectomy (APM)-with either knee braces or wedge insoles-leads to superior clinical outcome as compared to controls. This difference in clinical outcome was tested in the form of two knee scores, physical activity and general health outcome over the first postoperative year.
Methods:
Sixty-three patients who underwent arthroscopic partial meniscectomy (APM) were randomized to one of the following three groups: 12 weeks postoperative knee compartment-unloading therapy with either a knee brace (brace group) or wedge insoles (insole group) or no specific postoperative therapy (control group). Patient-reported outcome was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC Score), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the MARX score (physical activity) and the SF-12 (general health).
Results:
Sixty-three patients were available for analysis. Except for the SF-12 mental score, all other scores showed significant improvement over time. With regard to the hypotheses proposed, no significant group * time interactions were observed for any of the outcome parameters. This means that the group (i.e. the type of postoperative treatment) was not related to the degree of improvement of any of the scores.
Conclusions:
It was concluded that 12 weeks of compartment-unloading therapy-with either a knee brace or wedge insoles-is ineffective with regard to clinical outcome after APM. This applies to the knee score outcome, physical activity and general health outcome over the first year following APM.
Level of evidence:
Randomized controlled trial, Level I.
... Also heel wedges are used to promote inversion (turning inward) or eversion (turning outward). It is reported in the literature that lateral wedges could be beneficial for treatment of pain and improving the quality of life for the patients suffering from knee joint osteoarthritis (Rafiaee and Karimi, 2012;Rodrigues et al., 2008). It was also reported that wedges could reduce postural sway during quiet standing with and without visual feedback (Ganesan et al., 2014). ...
Standing on wedges changes the position in the ankle joints and affects postural stability in the medial-lateral direction. The objective of the study was to investigate the role of wedges and external lateral perturbations on anticipatory (APA) and compensatory postural adjustments (CPA). Ten healthy young participants were exposed to perturbations applied to the lateral part of their right shoulder when standing on a planar surface, on a medial or lateral wedge. Bilateral electromyographic activity of dorsal and ventral postural muscles and the center of pressure (COP) displacement were recorded and analyzed during the APA and CPA phases. When exposed to the lateral perturbation, reciprocal activation of shank muscles was seen on the side of the perturbation while co-contraction of shank muscles was seen on the contralateral side during the APA and CPA phases. Standing on a wedge was associated with decreased magnitudes of co-contraction and reciprocal activation of shank muscles. The COP displacements were smaller in the APA phase and larger in the CPA phase while standing on wedges compared to standing on the planar surface. The outcome of the study provides a basis for future investigations of incorporating wedges in balance re-training paradigms for the elderly or individuals with neurological impairment.
... Las ortesis plantares constituyen un elemento terapéutico ampliamente utilizado para intentar corregir esta desalineación de los segmentos que conforman el miembro inferior 2,3,5-8, [11][12][13][14][15][16] . Su uso se basa en el control de la movilidad subtalar tanto a nivel del rango articular como a nivel de la velocidad del movimiento 5 . ...
... Biomechanical factors should be taken into account in the management of osteoarthritis. For example, correction of malalignment using a wedge insole has been reported to be highly effective in relieving pain and function in valgus knee osteoarthritis [63]. Similarly, use of a medial collagen meniscus implant in patients with meniscus injuries was shown to improve pain, activity, and radiological outcomes over 10 years compared with patients with partial medial meniscectomy [64]. ...
Osteoarthritis (OA), a disease affecting different patient phenotypes, appears as an optimal candidate for personalized healthcare. The aim of the discussions of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group was to explore the value of markers of different sources in defining different phenotypes of patients with OA. The ESCEO organized a series of meetings to explore the possibility of identifying patients who would most benefit from treatment for OA, on the basis of recent data and expert opinion. In the first meeting, patient phenotypes were identified according to the number of affected joints, biomechanical factors, and the presence of lesions in the subchondral bone. In the second meeting, summarized in the present article, the working group explored other markers involved in OA. Profiles of patients may be defined according to their level of pain, functional limitation, and presence of coexistent chronic conditions including frailty status. A considerable amount of data suggests that magnetic resonance imaging may also assist in delineating different phenotypes of patients with OA. Among multiple biochemical biomarkers identified, none is sufficiently validated and recognized to identify patients who should be treated. Considerable efforts are also being made to identify genetic and epigenetic factors involved in OA, but results are still limited. The many potential biomarkers that could be used as potential stratifiers are promising, but more research is needed to characterize and qualify the existing biomarkers and to identify new candidates.
... Biomechanical factors should be taken into account in the management of osteoarthritis. For example, correction of malalignment using a wedge insole has been reported to be highly effective in relieving pain and function in valgus knee osteoarthritis [63]. Similarly, use of a medial collagen meniscus implant in patients with meniscus injuries was shown to improve pain, activity, and radiological outcomes over 10 years compared with patients with partial medial meniscectomy [64]. ...
Osteoarthritis is a syndrome affecting a variety of patient profiles. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the European Union Geriatric Medicine Society working meeting explored the possibility of identifying different patient profiles in osteoarthritis. The risk factors for the development of osteoarthritis include systemic factors (e.g., age, sex, obesity, genetics, race, and bone density) and local biomechanical factors (e.g., obesity, sport, joint injury, and muscle weakness); most also predict disease progression, particularly joint injury, malalignment, and synovitis/effusion. The characterization of patient profiles should help to better orientate research, facilitate trial design, and define which patients are the most likely to benefit from treatment. There are a number of profile candidates. Generalized, polyarticular osteoarthritis and local, monoarticular osteoarthritis appear to be two different profiles; the former is a feature of osteoarthritis co-morbid with inflammation or the metabolic syndrome, while the latter is more typical of post-trauma osteoarthritis, especially in cases with severe malalignment. Other biomechanical factors may also define profiles, such as joint malalignment, loss of meniscal function, and ligament injury. Early- and late-stage osteoarthritis appear as separate profiles, notably in terms of treatment response. Finally, there is evidence that there are two separate profiles related to lesions in the subchondral bone, which may determine benefit from bone-active treatments. Decisions on appropriate therapy should be made considering clinical presentation, underlying pathophysiology, and stage of disease. Identification of patient profiles may lead to more personalized healthcare, with more targeted treatment for osteoarthritis.
... 11,24 Likewise, medial wedge insoles have shown benefits for patients with lateral compartment knee osteoarthritis. 25 However, despite recommendations in several guidelines, 26 neither the present study nor some long-term studies in the literature found any clinical benefit. 17,18,23,27 To the best of our knowledge, our study is the first clinical trial on lateral wedge insoles in a South American population. ...
CONTEXT AND OBJECTIVE:
Optimal management of knee osteoarthritis requires a combination of pharmacological and non-pharmacological methods. The use of lateral wedge insoles to treat medial knee osteoarthritis is recommended, but there is still controversy about its efficacy. The purpose of this study was to ascertain whether the use of lateral wedge insoles can diminish pain and improve function in patients with medial knee osteoarthritis.
DESIGN AND SETTING:
Prospective randomized trial conducted in a tertiary-level hospital.
METHODS:
We prospectively enrolled 58 patients with medial knee osteoarthritis and randomized them to use either a lateral wedge insole with subtalar strapping (Group W), or a neutral insole with subtalar strapping (Group N - control). All the patients were instructed to use the insole for five to ten hours per day. A visual analogue pain scale, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Lequesne questionnaire were applied at baseline and at weeks 2, 8 and 24.
RESULTS:
At weeks 8 and 24, both groups showed lower scores for WOMAC (P = 0,023 and P = 0,012 respectively). There were no statistically significant differences between the groups regarding the visual analogue pain scale, WOMAC or Lequesne results at any time evaluated.
CONCLUSION:
The use of a lateral wedge insole with subtalar strapping improved the patients' symptoms and function but was not superior to placebo insoles.
... They may reduce pathologically enhanced moments about the knee, thereby reducing load on the diseased joint compart- ment. 40,41 However, shoe wedges revealed no effect on hip kinetics or kinematics in knee OA patients 42 and healthy subjects. 12 In contrast, the present study revealed significant impact on hip joint kinetics and kinematics with medio-lateral COP manipulation. ...
Footwear-generated biomechanical manipulation of lower-limb joints has been shown to influence lower-limb biomechanics. Numerous studies report the influence of such interventions on the knee, however little is known about the influence of these interventions on the hip. The present study analyzed kinetic and kinematic changes about the hip of 12 healthy young males who underwent biomechanical manipulation utilizing the APOS biomechanical device (APOS–Medical and Sports Technologies Ltd., Herzliya, Israel) allowing controlled foot center of pressure manipulation. Subjects underwent gait testing in four para-sagittal device configurations: Medial, lateral, neutral, and regular shoes. In the medial configuration, subjects demonstrated no change in step width (i.e., distance between right and left foot center of pressure), however inter-malleolar distance significantly increased. Likewise with the medial setting, greater hip abduction was recorded, while hip adduction moment and joint reaction force decreased significantly. We speculate that subjects adopt a modified gait pattern aimed to maintain constant base of support. As a result, hip abductor muscle moment arm increases and adduction moment and joint reaction force decreases. To the best of our knowledge this is the first study to show this relationship. These results contribute to the understanding of lower-limb biomechanics and warrant further investigation. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
... reductions in back, 13 knee arthritis, 14 and foot pain 15 in nonobese individuals. Because reduced physical activity and functional levels associated with obesity may be associated with orthopedic conditions, 16 foot orthoses have been recommended within the conservative care for people with obesity. ...
Individuals with obesity have reduced activity levels and increased incidence of knee arthritis and pes planus. Foot orthoses can affect lower-limb alignment to reduce pain in nonobese individuals. Evidence to support using foot orthoses for obese people, although often recommended, remains lacking. This pilot study determined the feasibility of prescribing foot orthoses for obese people; effect sizes for calculation of future sample sizes; and relationships among foot orthoses use, physical activity, and functional level. This repeated-measures study included nine people with obesity (body mass index [BMI] ≥ 30 kg/m2) prescribed with semicustom foot orthoses using arch classifications derived from arch index values. Self-reported data collected at baseline and 1 year were used to determine relationships among foot orthoses use, physical activity, and functional levels. Eight of nine subjects adhered to the foot orthoses prescription. Rate of foot orthoses use and physical activity level as self-reported on the Physical Activity Level (PAL) scale significantly increased, whereas functional level did not. Effect sizes ranged from large for PAL to small for the Lower Extremity Functional Scale (LEFS). Changes in ability to walk a mile were strongly associated with changes in rate of foot orthoses use and reductions in BMI. Larger studies to determine the effect of physical activity and foot orthoses use in obese people are warranted.
Abstract:
Objectives: Knee Osteoarthritis (OA) is a leading cause of disability in older adults. In current study, the effects of three types of orthoses on pain reduction were evaluated in OA patients in Iran.
Methods & Materials: In this prospective clinical trial, thirty-six patients consisting of 11 men and 25 women with age (Mean±SD) of 54.56±2.82 years and diagnosis of mild to moderate knee OA included. Patients were assigned to three groups of neoprene sleeve, unloader knee brace, and insole with lateral heel wedge each with twelve members. Their pain evaluated using visual analog scale before orthotic treatment and again six months after orthotic treatment. The results of each group compared together using paired t statistics.
Results: There was a significant difference in knee pain in all three groups before and after orthotic treatment (P<0.05). Percent of pain reduction was 40.909%, 40.186% and 32.493% in neoprene sleeve, unloader knee brace, and insole with lateral heel wedge, respectively.
Conclusion: It seems that neoprene sleeve by keeping the knee joint temperature, decreases pain. In group with unloader knee brace, probably the brace alters thigh and calf alignments during walking and causes pain reduction. In insole with lateral heel wedge group, it seems that insole by altering the orientation of calcaneus to valgus, reduces pain. Future studies with more participants and with consideration of longer follow-up in addition to measure knee and calcaneus displacements are recommended.
Keywords: Orthoses, Pain, Knee Osteoarthritis, Knee Alignment
During locomotion, the foot–ankle system plays an important role for forward progression of the body. The center of pressure (COP) is regarded as the point of the ground reaction force (GRF) vector acting on the foot surface during the stance phase. COP movement trajectory and velocity reflect the stance phase forward progression of the foot segment and the ankle joint motion characteristics. This study aimed to investigate different levels of footwear insole stiffness on COP forward velocity, GRF and ankle joint angles during walking stance phase. Two healthy subjects (one female, one male; age 26.5 6.4 years, height 168.5 2.1 cm, weight 64.9 5.4 kg) participated in this study. Subjects were asked to walk along a 10 m walkway at two different speeds: self–selected normal (SSN) and self–selected fast (SSF). Within each walking speed, subjects were required to walk under two different insole stiffness conditions: (1) normal shoe insole (NSI) from the testing shoe (Nike Free RN Flyknit 2017) used in this study; (2) 1.6 mm thick carbon fiber insole (CFI) fitted within the testing shoe. Stiffer insole (CFI) significantly decreased peak ankle internal rotation angle (p = 0.001) and sagittal plane angle ROM (p = 0.022); additionally, CFI significantly increased peak ankle eversion angle compared to the NSI condition (p = 0.028). In conclusion, increasing footwear insole stiffness would alter stance phase ankle joint motion at SSF walking speed. Additionally, stiffer insoles may tend to decrease COP peak velocity at the initial heel strike and the terminal stance phase. Future research should investigate the combined effects of various insole properties on lower extremity system kinematic and kinetic patterns in various locomotion activities.
As palmilhas são órteses indicadas como tratamento adjuvante de várias patologias com o objetivo de acomodar deformidades, aliviar áreas de sobrecarga, proporcionar conforto e aliviar a dor nos pés. Existem evidências de que auxiliam no alívio de dor nos pés, não sendo definida sua eficácia em melhorar a distribuição da pressão na superfície plantar ou prevenir deformidades. Discute-se neste artigo a participação do médico na prescrição de palmilhas e algumas de suas principais indicações.
Osteoartrite (OA) é considerada a doença musculoesquelética mais comum em todo o mundo, acometendo 20% da população mundial; tem evolução lenta, podendo levar à rigidez articular, deformidade progressiva e perda de função, afetando a qualidade de vida do indivíduo. A prevalência da OA é alta, no entanto, sua incidência é baixa antes dos 40 anos e aumenta com a idade; cerca de 30% dos indivíduos com 65 anos ou mais apresentam evidências radiológicas de OA de joelho, mesmo sem presença de sinais e sintomas; cerca de 80% dos indivíduos com mais de 75 anos apresentam alguma evidência de OA. Sua distribuição é muito parecida em ambos os gêneros, mas com maior prevalência na mulher acima dos 50 anos. Estatísticas preveem que, nos próximos 20 anos, o número de indivíduos afetados pela doença nos Estados Unidos poderá aumentar de aproximadamente 43 milhões para 60 milhões, aumentando os gastos com doenças crônicas em mais de 25%. No Brasil, estima-se que 4% da população apresente OA; as articulações mais acometidas pela OA são: joelho, mãos e coluna. O tratamento da OA deve ser realizado de maneira ideal por uma equipe multidisciplinar formada por reumatologista, ortopedista, fisioterapeuta, terapeuta ocupacional, educador físico, nutricionista e psicólogo. Dessa forma, cada profissional em sua especialidade pode contribuir para o tratamento. Apesar dos sinais e sintomas parecidos, com o tempo cada paciente estará em uma fase específica da doença e deve-se, portanto, levar em consideração cada particularidade, propondo-se um tratamento individualizado. Apesar do tratamento individualizado, os objetivos são semelhantes e normalmente envolvem o alívio da dor, a prevenção e/ou manutenção das deformidades e disfunções e a melhora da qualidade de vida e capacidade funcional.
1 Zusammenfassung 1.1 Hintergrund Aufgrund mangelnder Evidenz für die Wirksamkeit orthopädischer Einlagen wird zur Sicherung von deren Kostenübernahme durch die Krankenkassen in Zukunft die Durchführung methodisch verbesserter klinischer Studien notwendig sein. In der vorgelegten Arbeit werden die bisher verwendeten Methoden zur Bewertung des Nutzens von orthopädischen Einlagen zusammengestellt und analysiert. Darüber hinaus werden neue, bisher noch nicht verwendete Methoden aufgezeigt. Ziel ist die Identifizierung geeigneter Untersuchungsmethoden für zukünftige Studien, welche sich wissenschaftlich mit dem Effekt von orthopädischen Maßeinlagen befassen. 1.2 Methoden In den frei zugänglichen Datenbanken „PubMed“ und „Cochrane Library“ wurde in einer systematischen Literaturrecherche mit den Suchstrategien [„insoles“], [„foot AND orthoses“] und [„foot AND orthotics“] nach aussagekräftigen Publikationen zur Wirksamkeit von orthopädischen Maßeinlagen gesucht. Aus den Studien, welche die Aufnahmekriterien erfüllten, wurden die verwendeten Untersuchungsmethoden quantitativ gelistet und mit Hilfe beschreibender Sekundärliteratur qualitativ analysiert. Weitere, nicht in den eingeschlossenen Studien verwendete Verfahren, wurden unter anderem durch Expertenbefragungen identifiziert und ebenfalls bezüglich ihrer Eignung zur Generierung von Evidenz für die Wirksamkeit von Einlagen bewertet. 1.3 Ergebnisse Die Untersuchungsmethoden aus 212 Studien wurden analysiert. Dabei wurden 49 verschiedene Scores und Skalen in 114 Studien sowie neun Gruppen apparativer Methoden in 108 Studien verwendet. In 30 weiteren Studien wurden 2 verschiedene klinische Untersuchungsparameter angewandt. In 11 Studien erfolgten Prüfungen zur physischen Aktivität. 1.4 Schlussfolgerung Für bestimmte Fragestellungen (beispielsweise der positive Einfluss der Veränderung dynamischer Parameter, wie z.B. dem EKAM durch Einlagen auf den Krankheitsverlauf) scheint das aktuelle Repertoire an Methoden nicht ausreichend, sodass bisher nicht in Studien eingesetzte Techniken eingebunden, bzw. neue Techniken entwickelt werden müssen. Des Weiteren bedürfen insbesondere apparative Methoden und die damit gemessenen Parameter einer wesentlich eingehenderen Evaluation. Skalen und Scores als alleiniges Werkzeug sind wenig geeignet, jedoch als Ergänzung zu den apparativen Methoden sehr wertvoll
Studies have shown the short- and long-term effects of wearing minimalist footwear in reducing knee loads in patients with knee osteoarthritis (OA). This study aimed to investigate the mechanisms underpinning the reduction in external knee adduction moment (EKAM) in older adult women who wore this type of footwear through a randomized controlled trial. Fifty-six participants with medial compartment knee OA were equally allocated to either an intervention group (IG) that wore minimalist footwear (Moleca®) or to a control group (CG) that continued regular clinical treatment for OA for six months. The influence of lower limb joint kinematics and joint frontal moments, center of pressure displacement, and foot progression angle in predicting the reduction of EKAM were assessed after a six-month intervention. Surprisingly, none of the seven independent variables predicted the first peak EKAM in the multiple regression model for the IG. For the CG, the increase of one unit in the first peak of the hip adduction moment resulted in a 1.01 units increase in the first peak EKAM. Additionally, a one-unit reduction in the ankle eversion angle resulted in an increase of 0.16 units in the percent change in the first peak EKAM. Thus, wearing the Moleca® shoe for six months helped the participants keep a natural gait pattern without increasing the hip moment or the ankle inversion angle compared to the women who did not wear the Moleca® footwear.
ClinicalTrials.gov (NCT01342458)
Background
High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality.
Objectives
The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries.
Study Design
Systematic review.
Methods
Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall’s W) were calculated.
Results
Domain scores indicate that many guidelines have not sufficiently addressed stakeholder involvement (average score: 55%), applicability (20%) and editorial independence (33%) in the development process. Inter-rater agreement for assessors indicated ‘good’ agreement for clinical practice guidelines from Finland, Norway and Sweden ( W = 0.653, p < 0.001; W = 0.512, p = 0.003 and W = 0.532, p = 0.002, respectively) and ‘strong’ agreement for the clinical practice guideline from Denmark ( W = 0.800, p < 0.001).
Conclusion
Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation.
Clinical relevance
The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.
Footwear devices that shift foot center of pressure (COP), thereby impacting lower-limb biomechanics to produce clinical benefit, have been studied regarding degenerative diseases of knee and hip joints, exhibiting evidence of clinical success. Ability to purposefully affect trunk biomechanics has not been investigated for this type of footwear. Fifteen healthy young male subjects underwent gait and electromyography analysis using a biomechanical device that shifts COP via moveable convex elements attached to the shoe sole. Analyses were performed in three COP configurations for pairwise comparison: (1) neutral (control) (2) laterally deviated, and (3) medially deviated. Sagittal and frontal-plane pelvis and spine kinematics, external oblique activity, and frontal and transverse-plane lumbar moments were affected by medio-lateral COP shift. Transverse-plane trunk kinematics, activity of the lumbar longissimus, latissimus dorsi, rectus abdominus, and quadratus lumborum, and sagittal-plane lumbar moment, were not significantly impacted. Two linear mixed effects models assessed predictive impact of (I) COP location, and (II) trunk kinematics and neuromuscular activity, on the significant lumbar moment parameters. The COP was a significant predictor of all modeled frontal and transverse-plane lumbar moment parameters, while pelvic and spine rotation, and lumbar longissimus activity were significant predictors of one frontal-plane lumbar moment parameter. Model results suggest that, although trunk biomechanics and muscle activity were altered by COP shift, COP offset influences lumbar kinetics directly, or via lower-limb changes not assessed in this study, but not by means of alteration of trunk kinematics or muscle activity. Further study may reveal implications in treatment of low back pain.
Background
Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world’s population need a prosthesis or orthosis.
Objective
The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions.
Methods
Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis.
Results
A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible.
Conclusions
At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness.
Orthoses for osteoarthritis represent splints, taping, sleeves, unloading knee braces and insoles. This review of the effectiveness of these orthoses involved a search for articles published up to 2015 in MEDLINE via PubMed, with a focus on Osteoarthritis Research Society International, American College of Rheumatology and European League Against Rheumatology international recommendations. Evidence for splinting effectiveness in patients with thumb-base osteoarthritis is now provided. Splints for thumb-base osteoarthritis decrease pain and functional disability. Weaker evidence was found for knee bracing, including taping, sleeves and unloading braces. Low rate of observance and safety results should be considered before using current unloading knee braces for knee osteoarthritis. For insoles, data remain controversial. Orthoses for interphalangeal or hip osteoarthritis have not been investigated in a randomized trial. Regardless, if indicated in daily clinical practice, bracing must be checked by a healthcare professional to insure the suitability of the device. Patients using bracing must be educated. Patient education should include knowledge of the aims and modalities of the treatment as well as knowledge of potential side effects. Patients should be encouraged to contact the therapist if adjustment is needed, with poor tolerance or with questions about the device.
This chapter reports on a systematic review of the literature of crenobalneotherapy in the management of knee OA. Crenobalneotherapy is defined as the spectrum of techniques based on mineral or tap water and its derivatives, as used in a medical context. We searched Medline using the following keywords: "spa therapy", "mud", "radon", "balneotherapy", and "hydrotherapy" in combination with "OA", "arthrosis", and "gonarthrosis". We also reviewed the reference lists of articles retrieved by the Medline search. All studies that compared crenobalneotherapy to any other intervention or to no intervention were selected, and a checklist was used to assess their internal validity, external validity and the quality of the statistical analysis. We analyzed separately some components of crenobalneotherapy and comparators and four types of outcome criteria (pain, function, stiffness and quality of life). We calculated standardized response mean. There is middle level evidence that "multiple mineral interventions" that combine two or more components of crenobalneotherapy are superior to no treatment, high level evidence that its combination with home exercises is superior to home exercises alone and low level evidence that it is superior to short wave. There is high level but conflicting evidence that water exercise is superior to no treatment. There is a high level of evidence that water exercise is similar to land based exercise (but the studies noted that it is better tolerated). There is middle level evidence that massage is superior to no treatment. There is low level and conflicting evidence that bathing in mineral water is superior to or similar to bathing in tap water and that mineral mud and bathing in mineral water is superior to hot water. The only study evaluating heat (heat sleeve vs regular sleeve) found no differences but was a pilot study with insufficient sample size. Crenobalneotherapy seems to improve, pain, function, stiffness and quality of life in lower limb OA. As a whole treatment, its efficacy has a high level of evidence but efficacy of each component has middle level (massage) and sometimes high but conflicting level of evidence (exercise in water). There is low level evidence that chemical composition of water has a clinical relevant effect. More studies with higher methodology quality and sufficient sample size are needed in these fields.
Individuals with obesity have reduced activity levels and increased incidence of knee arthritis and pes planus. Foot orthoses can affect lower-limb alignment to reduce pain in nonobese individuals. Evidence to support using foot orthoses for obese people, although often recommended, remains lacking. This pilot study determined the feasibility of prescribing foot orthoses for obese people; effect sizes for calculation of future sample sizes; and relationships among foot orthoses use, physical activity, and functional level. This repeated-measures study included nine people with obesity (body mass index [BMI] Q 30 kg/m2) prescribed with semicustom foot orthoses using arch classifications derived from arch index values. Self-reported data collected at baseline and 1 yearwere used to determine relationships among foot orthoses use, physical activity, and functional levels. Eight of nine subjects adhered to the foot orthoses prescription. Rate of foot orthoses use and physical activity level as self-reported on the Physical Activity Level (PAL) scale significantly increased, whereas functional level did not. Effect sizes ranged from large for PAL to small for the Lower Extremity Functional Scale (LEFS). Changes in ability to walk a mile were strongly associated with changes in rate of foot orthoses use and reductions in BMI. Larger studies to determine the effect of physical activity and foot orthoses use in obese people are warranted.
Non-pharmacological approaches are highly recommended for osteoarthritis (OA) treatment to reduce pain and improve function and quality of life. Based on international recommendations for the management of OA, we summarize herein the non-pharmacological treatments that may exhibit some analgesic effects in knee and hip OA. Studies on analgesic non-pharmacological approaches in OA include exercise, patient education, orthoses, acupuncture, physical agents and balneotherapy. Even though many of the published studies have methodological issues, it can be concluded that some of these approaches demonstrate analgesic effects with fewer side effects compared with pharmacological treatments. More evidence is available for knee OA than for hip OA for most of the nonpharmacological treatments. In all cases, these approaches should be individualised to each patient and can be combined together as well as combined with pharmacological management.
ZUSAMMENFASSUNG
Obwohl in vielen Richtlinien zur Therapie von Gonarthrosen als Therapieoption erwähnt, ist die Evidenz der Wirksamkeit von lateral erhöhten Schuheinlagen bei Gonarthrosebeschwerden besten Falls widersprüchlich.Eine Literatursuche zu den Effekten der lateralen Fußranderhöhung bei Patienten mit medial betonter Gonarthrose fand 9 Leitlinien, 7 Reviews, 20 biomechanische und 20 klinische Arbeiten. Vergleichende Studien zwischen Einlagenversorgung und Bewegungstherapie wurden nicht gefunden. Die biomechanischen Folge der lateralen Fußerhöhung ist eine Veränderungen der Größe des Adduktionsmomentes am Kniegelenk in Richtung Varusstellung. Die Beeinflussung von Schmerz und Behinderungsgrad sind nur gering bis mäßig gradig. Die vorhandenen Daten erlauben es nicht, eine Empfehlung für oder gegen den Einsatz von lateral erhöhten Schuheinlagen zur Therapie der Varusgonarthrose abzugeben
ABSTRACT
Many guidelines for conservative management of knee osteoarthritis mention wedged insoles as treatment option, but the evidence of efficacy of this intervention remains controversial. A literature search on the efficacy of laterally wedged insoles as therapy for patients with medial osteoarthritis of the knee revealed 9 guidelines 7 reviews, 20 biomechancal and 20 clinical studies. Comparative studies between application of orthoses
and exercise therapy have not been detected. Raising the lateral side of the foot is biomechanically followed by a change of the external adduction moment of the knee. The effects on the level of pain or disabilty are small to moderate. Based on the existing literature, no recommendations can be given for or against the use of laterally wedged insoles as a treatment option for medial osteoarthritis of the knee.
To compare foot posture in people with and without medial compartment knee osteoarthritis (OA), and to assess association between its abnormalities and medial compartment knee OA.
We compared the foot posture of patients with clinically and radiographically-confirmed medial compartment knee OA and asymptomatic healthy controls using the foot posture index (FPI), navicular height, and the medial arch.
We included 100 patients and 80 asymptomatic controls. The mean age of patients was 59 ± 7 (44-76) years and 48 ± 9 (28-60) years in the control (p=0.06). Patients group have more pronated foot for FPI (1.50 ± 2.68 vs 0.72 ± 2.63; p=0.05), more flat foot (42% vs 22%; p=0.03), and less pes cavus than the control group (58% vs 77%; p=0.004). However, there was no significant difference between the groups in the navicular height (3.90 ± 0.85 cm vs 4.00 ± 0.76 cm; p=0.41). In multivariate statistical analysis, after adjusting for age and body mass index, pronated foot in FPI (OR=1.22, 95%IC= [1.06-1.40], p=0.005), and pes cavus (OR=0.32, 95%IC= [0.11-0.93], p=0.03) had a significant correlation with the knee osteoarthritis.
Pronated foot posture and flat foot are significantly associated with medial compartment knee osteoarthritis.
Adhesive capsulitis is a condition wherein the shoulder capsule of the glenohumeral joint becomes inflamed and stiff along with adhesion formation. Mobilisation techniques and soft tissue manipulations are important interventions in the management. Both, soft tissue manipulation and joint mobilisation are proven to be effective in treatment of adhesive capsulitis in the past. However logical thinking warranted the need to study the effects of prior use of soft tissue mobilisation of the periarticular structures, which primarily get affected in adhesive capsulitis, followed by joint mobilisation techniques around the glenohumeral joint. Thus our study compared the efficacy of treatment strategies to improve the extensibility of soft tissues i.e; Myofascial release Armpull technique and Maitland's joint mobilization technique in patients with adhesive capsulitis.
Hintergrund
Valgisierende Orthesen stellen eine kostengünstige Alternative in der Behandlung der medialen Gonarthrose dar. Sie helfen zum einen in der präoperativen Diagnostik als Entscheidungshilfe, ob ein Patient aller Voraussicht nach von einer valgisierenden Osteotomie des Tibiakopfes profitiert. Darüber hinaus ist ein direkter klinischer Nutzen in Form einer Schmerzlinderung und Besserung der Kniegelenkfunktion in einigen Arbeiten gezeigt worden.
Diskussion
Die genauen Wirkungsmechanismen werden kontrovers diskutiert. Es wird eine Verringerung der mechanischen Last im medialen Kompartiment des Kniegelenks durch Verringerung des Varus, sowie eine Reduktion des gesteigerten Muskeltonus angenommen.
Schlussfolgerung
Ein langfristiger Nutzen der entlastenden Kniegelenkorthesen ist jedoch umstritten, da zum einen der degenerative Gelenkverschleiß fortschreitet, zum anderen aufgrund des oft fehlenden Tragekomforts der Orthesen die Bereitschaft zum Tragen der Orthese mit der Zeit abnimmt.
The objective of this study was to evaluate the effects of lateral and medial wedges on postural sway. Twenty healthy volunteers (mean age range of 28.45±3.34) participated in the study. They stood barefoot with eyes open or closed on each of the three surfaces: 10° lateral wedges, 10° medial wedges, and no wedges. Force platform data were collected and the mean and root mean square (RMS) distance, range, and velocity and the mean frequency of the center of pressure (COP) were calculated in the anterior-posterior (AP) and medial-lateral (ML) directions. Standing on both lateral and medial wedges was associated with improved postural stability seen through the decreased mean and RMS distance of COP displacement in ML direction. The results of this study suggest that standing on either lateral or medial wedges might enhance postural control in standing.
The stabilizing effect of external support (taping and nine different ankle braces) was tested in a total of 220 functionally unstable ankles. A standard surface EMG controlled stress Roentgen test protocol was used, measuring talar tilt (TT) without support and with tape bandage or brace. Different levels of TT restraining by external support could be identified. Tape bandage and two braces had a highly significant influence on the talar tilt. The mean TT without support was decreased by using from 13.4 degrees to 4.9 degrees, by using one brace to 4.8 degrees and by using another brace to 5.9 degrees. These two braces are effective for protection during functional treatment. A classification into three grades of effectiveness is proposed. It is concluded that the stabilizing influence offered by bandages and braces should be measured before using the external support as a treatment device for acute ankle sprain and as a reliable protection against sprain injuries in daily living and sports.
Lateral-wedged insoles have been shown to help clinically alleviate pain associated with medial compartment osteoarthritis, This study analyzed the effects of lateral-wedged insoles on the gait and medial knee compartment load of 17 healthy subjects. Three-dimensional gait analysis was performed for each subject with and without wearing a 5 degrees lateral-wedged insole, Subjects walked at a constant velocity for both conditions. A motion analysis system and force plate were used to calculate temporal and spatial parameters, joint angles, moments, and powers. An analytical model was developed to estimate medial compartment loads at the knee for each subject during both conditions. Results were compared with a Student's paired t test, There were no significant differences in temporal and spatial parameters, joint angles at the hip, knee, and ankle, or kinetics at the hip and ankle. However, the external varus moment and estimated medial compartment load at the knee were reduced significantly with the addition of the lateral-wedged insole, These results suggest that the pain relief and improvement in function reported by patients with osteoarthritis while using lateral-wedged insoles may be achieved by a reduction in external varus moment and medial compartment load.
e studied the complications after open-wedge osteotomy by hemicallotasis in 308 consecutive patients, most of whom had osteoarthritis of the knee. The participating surgeons, who worked at 17 hospitals, used their discretion in selecting patients, operating techniques and external fixators. The general complications included 11 cases of deep-vein thrombosis (4%), six of nonunion (2%) and one of septic arthritis of the knee. There were technical complications in 13 patients (4%). In 157 patients (51%) pin-site infections were recorded; of these, 96% were minor and responded to wound toilet and antibiotic treatment. A total of 18 revision procedures was carried out.
Knee osteoarthritis (OA) is a leading cause of disability in older persons. Few risk factors for disease progression or functional decline have been identified. Hip-knee-ankle alignment influences load distribution at the knee; varus and valgus alignment increase medial and lateral load, respectively.
To test the hypotheses that (1) varus alignment increases risk of medial knee OA progression during the subsequent 18 months, (2) valgus alignment increases risk of subsequent lateral knee OA progression, (3) greater severity of malalignment is associated with greater subsequent loss of joint space, and (4) greater burden of malalignment is associated with greater subsequent decline in physical function.
Prospective longitudinal cohort study conducted March 1997 to March 2000 at an academic medical center in Chicago, Ill.
A total of 237 persons recruited from the community with primary knee OA, defined by presence of definite tibiofemoral osteophytes and at least some difficulty with knee-requiring activity; 230 (97%) completed the study.
Progression of OA, defined as a 1-grade increase in severity of joint space narrowing on semiflexed, fluoroscopically confirmed knee radiographs; change in narrowest joint space width; and change in physical function between baseline and 18 months, compared by knee alignment at baseline.
Varus alignment at baseline was associated with a 4-fold increase in the odds of medial progression, adjusting for age, sex, and body mass index (adjusted odds ratio [OR], 4.09; 95% confidence interval [CI], 2.20-7.62). Valgus alignment at baseline was associated with a nearly 5-fold increase in the odds of lateral progression (adjusted OR, 4.89; 95% CI, 2.13-11.20). Severity of varus correlated with greater medial joint space loss during the subsequent 18 months (R = 0.52; 95% CI, 0.40-0.62 in dominant knees), and severity of valgus correlated with greater subsequent lateral joint space loss (R = 0.35; 95% CI, 0.21-0.47 in dominant knees). Having alignment of more than 5 degrees (in either direction) in both knees at baseline was associated with significantly greater functional deterioration during the 18 months than having alignment of 5 degrees or less in both knees, after adjusting for age, sex, body mass index, and pain.
This is, to our knowledge, the first demonstration that in primary knee OA varus alignment increases risk of medial OA progression, that valgus alignment increases risk of lateral OA progression, that burden of malalignment predicts decline in physical function, and that these effects can be detected after as little as 18 months of observation.
For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or paraarticular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
Sixty-two patients with early medial compartment osteoarthritis of the knee were treated with lateral heel wedges and followed for from 7 years and 5 months to 12 years. Those who were treated with heel wedges and analgesics showed a significantly greater improvement in pain score than those treated with analgesics only, but not in the walking ability score at the second follow up. The lateral heel wedge had no effect on the progress of the radiographic changes. The lateral heel wedge is useful for patients with early medical compartment osteoarthritis provided it is used with an understanding of the indications and its limitations.
The index for hip disease (ISH) was established, validated and appraised as a new assessment test for the trial of new drugs as well as for long-term follow-up of patients, and to help with future indications for surgery. The ISH deals with pain, maximum walking distance, and some activities of daily living. Inter-observer reproducibility is good (mean deviation 0.55 points; p less than 0.05). In a short-term, double-blind crossover trial, the ISH, judged according to its power to distinguish between the active drug period and the placebo period, appears as one of the best assessment tests. In the long term, total hip prosthesis is most often justified when the ISH score reaches 10-12 points. The index of severity for knee disease (ISK) was validated and appraised by the same statistical methods. Its value in non-steroidal anti-inflammatory drug (NSAID) or analgesic trials is lower than the value of the ISH. However, its use is still justified for that purpose, and for long-term follow-up of osteoarthritis of the knee.
For the purpose of investigating the clinical efficacy of a newly designed wedged insole, 149 patients with medial osteoarthritis of the knee were followed from one year to five years and five months. A rating system for pain, walking ability, and both were used for evaluation of the clinical results. Comparing two groups consisting of 107 patients with early radiographic stages (Stage I or II), 67 patients (Group I) treated with both a wedged insole and anodyne (Indomethacin 600 mg/day) showed a significantly greater improvement than 40 patients (Group II) treated with anodyne alone. Analyzing the therapeutic efficacy of the wedged insole according to the radiographic stage, the prescription of a wedged insole was significantly more effective for patients with mild osteoarthritis (Stages I, II, and III), and ineffective for those with advanced osteoarthritis (Stage IV). The wedged insole, designed on the basis of an established hypothesis, represents an excellent means of conservative treatment for early medial osteoarthritis of the knee.
For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a known medical condition or event (secondary). Clinical criteria for the classification of idiopathic OA of the knee were developed through a multicenter study group. Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred or para-articular pain. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classification trees, or algorithms.
The mechanism of the static effects of the wedged insole for the medial osteoarthritic knee was studied in ten women. They stood with one leg on the wedged sole board, and the change of the position of the line through the center of gravity, the femorotibial angle, the tibiocalcaneal angle, and the spatial position of the whole lower limb were investigated using load transducers and roentgenograms. When the subjects stood on the wedged sole board, the line through the center of gravity and femorotibial angle did not change. The change in the spatial positions of the lower limb (p less than 0.02), i.e., the mechanical axis of the lower limb near an upright position, and the change of the calcaneus to valgus direction in the subtalar joint (p less than 0.01) were observed. These changes were considered from two-dimensional analysis to reduce the excessive loading on the medial joint surface and the excessive tensile force of the lateral side. The wedged insole thus proved effective for the conservative treatment of the medial compartment osteoarthritic knee.
Valgus deformities at the knee can be successfully corrected with V-shaped supracondylar osteotomy. The advantages of this relatively simple technique are low morbidity, good stability with early weight-bearing, no need for internal fixation, and ability to adjust alignment with postoperative cast. Healing is relatively rapid (two months), and the range of motion returns (two months after cast removal) to preoperative values. This technique proved useful for deformities in both young and old patients with osteoarthritis. This is a preliminary report of the surgical technique, postoperative management, and short-term results of a prospectively evaluated series of 14 consecutive cases.
Joint loading at the knee for subjects with angular deformity of the joint has been determined by dynamic (normal-walking) and static (one-legged-stance) analysis. Sixteen subjects who exhibited varus, valgus, or flexion deformity of the knee were examined using a force-platform cinephotographic technique. Comparisons were made with three normal subjects. Normal individuals showed three characteristic load-peaks corresponding to hamstrings, quadriceps, and gastroecnemius muscle contraction. Loading profiles from subjects with knee deformity did not show these peaks; in general, the magnitude of joint force was less in subjects with deformity than in normal subjects. Our results do not support the concept that there is a direct relationship between angulation, magnitude of load, and the location of load within the knee (center of pressure). Although a general tendency for increased magnitude of total load was observed with increased angulation of the joint in all planes, the relationship was not clearly predictable. The center of pressure was found to vary throughout the stance phase of the gait cycle and was not directly related to the magnitude of angulation of the joint. For example, the center of pressure was located in the medial part of the knee for some subjects with valgus angulation. These findings suggest that individuals can modify force transmission by adopting compensatory mechanisms that result in unloading of the knee. Fators such as pain in the joint, walking speed, and deformity are believed to contribute to unloading of the joint. The results indicate that it is easier to compensate for a valgus than for a varus deformity, since knees with varus deformity showed a more predictable loading pattern (location of the center of pressure) than did knees with valgus deformity.
The clinical assessment of outcome in osteoarthritis (OA) clinical trials is highly dependent on the use of valid, reliable, and responsive measurement techniques. Despite several decades of clinical studies, and a half-century of development in clinical metrology, we still lack international standards of measurement for OA trials. There have, nevertheless, been several very encouraging developments. In particular, the Osteoarthritis Research Society and the 5th WHO/ILAR Task Force have discussed issues of standardization. The Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne Index have been proposed as important outcome measures. Finally, data have recently been published on observer variability, variance estimation, and sample size determination for OA trials.
The authors discuss the use of lateral heel wedges in the treatment of medial osteoarthritis of the knee in 121 knees in 85 patients. Follow-up was an average of 12 months after the insertion of the wedge. Patients' roentgenograms were graded according to the Ahlback classification, and various improvements were noted. Overall, 38% of patients improved to a Hospital for Special Surgery pain score of 25 or 30, which corresponds to an excellent result from total knee arthroplasty. Fifty percent of patients improved to a pain score of 20 or higher, which corresponds to a good result from total knee arthroplasty. The patients with milder osteoarthritis received greater pain relief. However, even patients with complete loss of joint space and bony erosion showed some improvement. It appears that the use of lateral wedges has a place in the conservative treatment of medial osteoarthritis.
We describe a method of quantifying the lateral/medial thrust of the knee which occurs in the early phase of walking. We have used this method to evaluate the effects of wedged insoles on the lateral and medial thrust for normal knees and knees with unicompartment osteoarthritis (OA). A laterally elevated (valgus) insole decreased the lateral thrust of both normal and osteoarthritic knees. A medially elevated (varus) insole increased the lateral thrust. In 50 symptomatic knees with medial compartment OA, decreasing the lateral thrust with a valgus insole reduced pain on walking in 27. Patients whose pain was reduced by valgus insoles tended to have earlier OA and to have a significantly greater reduction in the lateral thrust than in the 23 remaining unaffected knees. A varus insole was effective in decreasing the medial thrust and reducing pain in all ten knees with lateral compartment OA. We recommend the use of valgus insoles for patients with painful early medial compartment OA and the use of varus insoles for lateral compartment OA.
Based on our clinical experience and an anatomical study, we examined the conditions under which injury to the popliteal artery, tibial nerve or peroneal nerve and its branches may occur during high tibial osteotomy. In 250 high tibial osteotomies performed in our department, we observed the following intraoperative complications. (1) The popliteal artery was severed in 1 patient and repaired by the same surgical team using a microsurgical technique. (2) A tibial nerve paresis also occurred in 1 patient. (3) In 3 patients, temporary palsy of the anterior tibialis muscle was documented. (4) In 4 other patients, palsy of the extensor hallucis longus occurred. To investigate the causes of these complications in the popliteal artery, tibial nerve and branches of the peroneal nerve, we dissected the neurovascular structures surrounding the area of the osteotomy in 10 cadaveric knees and performed a high tibial osteotomy in another 13 cadaveric knees. We concluded the following. (1) The popliteal artery and tibial nerve are protected, at the level of the osteotomy, behind the popliteus and tibialis posterior muscles. Damage can occur only by placing the Hohman retractor behind the muscles. The insertion of the muscles is very close to the periosteum and can be separated only with a scalpel. (2) The tibialis anterior muscle is innervated by a group of branches arising from the deep branch of the peroneal nerve. In two-thirds of the dissected knees, we found a main branch close to the periosteum, which can be damaged by dividing the muscle improperly or due to improper placement and pressure of the Hohman retractor. This may explain the partially reversible muscle palsy. (3) The extensor hallucis longus is also innervated by 2-3 thin branches, arising from the deep branch of the peroneal nerve, but in 25% of the specimens, only one large branch was found. This branch is placed under tension by manipulating the distal tibia forward. Thus, it may be damaged by the Hohman retractor during distal screw fixation, tensioned by hyperextension or directly injured during midshaft fibular osteotomy.
Lateral-wedged insoles have been shown to help clinically alleviate pain associated with medial compartment osteoarthritis. This study analyzed the effects of lateral-wedged insoles on the gait and medial knee compartment load of 17 healthy subjects. Three-dimensional gait analysis was performed for each subject with and without wearing a 5 degrees lateral-wedged insole. Subjects walked at a constant velocity for both conditions. A motion analysis system and force plate were used to calculate temporal and spatial parameters, joint angles, moments, and powers. An analytical model was developed to estimate medial compartment loads at the knee for each subject during both conditions. Results were compared with a Student's paired t test. There were no significant differences in temporal and spatial parameters, joint angles at the hip, knee, and ankle, or kinetics at the hip and ankle. However, the external varus moment and estimated medial compartment load at the knee were reduced significantly with the addition of the lateral-wedged insole. These results suggest that the pain relief and improvement in function reported by patients with osteoarthritis while using lateral-wedged insoles may be achieved by a reduction in external varus moment and medial compartment load.
We studied the complications after open-wedge osteotomy by hemicallotasis in 308 consecutive patients, most of whom had osteoarthritis of the knee. The participating surgeons, who worked at 17 hospitals, used their discretion in selecting patients, operating techniques and external fixators. The general complications included 11 cases of deep-vein thrombosis (4%), six of nonunion (2%) and one of septic arthritis of the knee. There were technical complications in 13 patients (4%). In 157 patients (51%) pin-site infections were recorded; of these, 96% were minor and responded to wound toilet and antibiotic treatment. A total of 18 revision procedures was carried out.
Forty-eight knees in 44 patients who had a high tibial osteotomy performed for medial compartment osteoarthritis were reevaluated twice, once at 1 year after surgery and again at 10 to 15 years after the high tibial osteotomy, to determine the effects of high tibial osteotomy on progression of medial and lateral joint arthrosis. Radiologically, although arthrosis significantly increased in the medial and the lateral joint compartment, there was no significant difference in the degree of progression between the two compartments. There was a significant correlation between the progression of medial joint arthrosis evaluated at 10 years or more after surgery and the femorotibial angle measured at 1 year. There was no significant correlation between the progression of lateral joint arthrosis in 10 to 15 years and the femorotibial angle measured at 1 year. The average knee function score improved significantly from 59.1 +/- 5.5 points before surgery to 85.1 +/- 6.1 points at the 1-year followup. At the final followup, the clinical score (80.7 +/- 5.4) had deteriorated relative to the 1-year results but still was significantly better than the preoperative score. The current results indicate that the greater the surgical valgus correction, the slower the progression of medial joint arthrosis. Lateral joint arthrosis did not progress more quickly after high tibial osteotomy, even if an overcorrection was performed.
To assess the efficacy of a lateral wedge insole with elastic strapping of the subtalar joint for conservative treatment of osteoarthritis (OA) of the knee.
The efficacy of a novel insole with elastic subtalar strapping and a traditional shoe insert wedge insole was compared. Ninety female outpatients with OA of the knee were treated with wedge insoles for 8 weeks. Randomization was performed according to birth date. Standing radiographs with unilateral insole use were used to analyze the femorotibial and talar tilt angles for each patient with and without their respective insole. Visual analog scale (VAS) score for subjective knee pain at the final assessment was compared with that at baseline in both groups.
Participants wearing the elastically strapped insole (n = 46) had significantly decreased femorotibial angle (p < 0.0001) and talar tilt angle (p = 0.005) and significantly improved VAS pain score (p = 0.045) in comparison with baseline assessments. These significant differences were not found in the group with the inserted insole (n = 44).
The novel strapped insole leads to valgus angulation of the talus, resulting in correction of the femorotibial angle in patients with knee OA with varus deformity, and may have a therapeutic effect similar to that of high tibial osteotomy.
To test whether a lateral-wedged insole, inclined at 5 degrees or 10 degrees, significantly reduces knee varus torque during walking in patients with knee osteoarthritis compared with both using no insole and with wearing nonwedged control insoles of the same material and average thickness.
Patients with medial knee osteoarthritis were studied while they walked wearing their comfortable shoes (1) without an insole; (2) with a 5 degrees lateral wedge compared with a nonwedged, 3.175-mm (1/8-in) even-thickness control insole; and (3) with a 10 degrees lateral wedge compared with a nonwedged 6.35-mm ((1/4)-in) even-thickness control insole.
A gait laboratory with 3-dimensional motion analysis and force platform equipment.
Fifteen patients with clinical and radiographic osteoarthritis of the medial compartment of 1 knee.
Not applicable.
Peak external knee varus torques during the stance period of gait. Data regarding lower-extremity joint torques and motions were collected, and knee joint torques using the different insoles and wedges were compared by analysis of variance.
Although responses varied among individuals, as a group, both the 5 degrees and 10 degrees lateral-wedge insoles significantly reduced the knee varus torque during walking compared with walking with no insole and walking with nonwedged 3.175-mm and 6.35-mm control insoles. Compared with no insole, the 5 degrees wedge reduced the peak knee varus torque values by about 6% and the 10 degrees wedge reduced the peaks by about 8%. Although there were no significant differences in speed of walking between the conditions, the 10 degrees wedge and 6.35-mm control insoles were associated with varying degrees of discomfort.
Both wedge insoles are effective in reducing the varus torque during walking beyond what theoretically could be explained by a reduced walking speed or cushioning effect from the insole. These data imply that wedged insoles are biomechanically effective and should reduce loading of the medial compartment in persons with medial knee osteoarthritis. Although the effect of the 5 degrees wedge was smaller, it may be more comfortable than the 10 degrees wedge to wear inside one's own shoes.
To assess the radiographic and symptomatic effects of treating patients with medial compartment osteoarthritis (OA) of the knee with laterally wedged insoles with subtalar strapping of varying elevations.
Prospective quasi-experimental evaluation.
Outpatient clinic in Japan.
Sixty-two women outpatients with knee OA who were randomized into 3 groups according to their birth dates and wedge elevation.
Participants wore laterally wedged insoles with subtalar strapping with elevations of 8, 12, or 16 mm for 2 weeks.
Standing radiographs were used to analyze the femorotibial angle for each subject, both with and without their respective unilateral insoles. The remission scores of the Lequesne index of severity for knee OA were compared among the 3 groups at the conclusion. Participants were asked to report adverse effects on use of the insoles.
The 16-mm group (n=21) showed a significantly greater valgus correction of the femorotibial angle than the 8-mm group (n=20) (P=.013). The remission score was significantly improved in the 12-mm group (n=21) compared with the 16-mm group (P=.029). Adverse effects were more common in the 16-mm group (9/21, 42.8%) than in the 12-mm (3/21, 14.3%) or 8-mm (2/20, 10%) groups.
The degree of change in femorotibial angle with the insole with subtalar strapping was affected by the tilt of the lateral wedge. For constant routine use, the 8- or 12-mm elevation wedged insoles with subtalar strapping may be more comfortable and effective than the 16-mm elevation wedge.
To assess the optimal duration of daily wear for a laterally wedged insole with subtalar strapping in subjects with medial compartment osteoarthritis of the knee (knee OA).
The setting was an outpatient clinic. Eighty-one patients with knee OA were prospectively randomized according to birth date and to either 2 weeks of treatment with a lateral wedge with subtalar strapping for less than 5 h (the short group), 5-10 h (the medium group) or greater than 10 h (the long group) each day, or to treatment with a subtalar strapping band without lateral wedge (the placebo group). Standing radiographs were used to analyze the femorotibial angle for each subject, both with and without their respective orthotic device. The remission scores of Lequesne index were compared among the four groups at the conclusion.
The short (n=21), medium (n=20) and long (n=18) groups demonstrated a significant greater valgus correction of the femorotibial angle than the placebo group (n=22) (P<0.0001). The remission score was significantly improved in the medium group compared to the placebo (P=0.001) and long (P=0.001) groups.
An optimal duration of insole with subtalar strapping wear for patients with varus deformity knee OA may be between 5 and 10 h each day.
In earlier stages of knee osteoarthritis orthotic treatments with knee orthoses or modified footwear are often considered. Although the load reducing effects of knee orthoses have been well established, wearing modified footwear would be more comfortable for the patient and less encumbering. The effect of modified footwear on the frontal load of the knee is controversial. This article describes the effect of medial or lateral shoe wedges alone or together with two different types of ankle-stabilizing orthoses.
The effect on frontal knee loading was measured during standing and walking with medially and laterally placed wedges under the sole of the shoe. The wedges were also combined with two types of orthotic devices - an Ankle-Foot-Orthosis that was rigid in the frontal plane but allowed unrestricted sagittal plane motion and an ankle support that was semi-rigid in the frontal plane. Joint loading of 10 healthy persons (mean (standard deviation): age 34 (9) years, height 178 (4)cm, mass 73 (9)kg) was investigated by means of a special measuring device that accurately determines static loads (Lasar Posture) and with instrumented gait analysis (Vicon/Kistler).
Using a lateral wedge under the sole of the shoe (without orthotic support) showed no significant reduction in the mean maximal knee moment in the frontal plane. Adding an Ankle-Foot-Orthosis that is rigid in the frontal plane resulted in significant reduction in the maximal frontal moment from 0.54 Nm/kg to 0.38Nm/kg (p0.01). Using a medial wedge, without and with Ankle-Foot-Orthosis, produced a significant increase in the maximal frontal moment to 0.59 Nm/kg (p0.05) or 0.67 Nm/kg (p0.01), respectively.
These results suggest that the application of a sole wedge significantly influences frontal knee loading when used in combination with an Ankle-Foot-Orthosis that is rigid in the frontal plane.
Although knee malalignment is assumed to correlate with knee osteoarthritis (OA), it is still unknown whether malalignment precedes the development of OA or whether it is a result of OA. The aim of this study was to assess the relationship between malalignment and the development of knee OA as well as progression of knee OA.
A total of 1,501 participants in the Rotterdam study were randomly selected. Knee OA at baseline and at followup (mean followup 6.6 years) was scored according to the Kellgren/Lawrence (K/L) grading system. Alignment was measured by the femorotibial angle on radiographs at baseline. Multivariable logistic regression for repeated measurements was used to analyze the association of malalignment with the development and progression of OA.
Of 2,664 knees, 1,012 (38%) were considered to have normal alignment, 693 (26%) had varus alignment, and 959 (36%) had valgus alignment. A comparison of valgus alignment and normal alignment showed that valgus alignment was associated with a borderline significant increase in development of knee OA (odds ratio [OR] 1.54, 95% confidence interval [95% CI] 0.97-2.44), and varus alignment was associated with a 2-fold increased risk (OR 2.06, 95% CI 1.28-3.32). Stratification for body mass index showed that this increased risk was especially seen in overweight and obese individuals but not in non-overweight persons. The risk of OA progression was also significantly increased in the group with varus alignment compared with the group with normal alignment (OR 2.90, 95% CI 1.07-7.88).
An increasing degree of varus alignment is associated not only with progression of knee OA but also with development of knee OA. However, this association seems particularly applicable to overweight and obese persons.
In uncontrolled studies, a lateral-wedge insole has reduced knee pain in patients with medial knee osteoarthritis (OA). The aim of this study was to test the efficacy of this simple, low-cost intervention for pain in patients with medial knee OA.
We conducted a double-blind, randomized, crossover trial designed to detect a small effect of treatment. Participants were at least 50 years of age and had medial joint space narrowing on posteroanterior semiflexed radiographs and scores indicating moderate pain for 2 of the 5 items on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale. Participants were randomized to receive a 5 degrees lateral-wedge insole or a neutral insole for 6 weeks. Following a 4-week washout period, participants crossed over to the other treatment for 6 weeks. Knee pain, the primary outcome, was assessed by the WOMAC pain scale (visual analog scale version). Secondary outcomes included the WOMAC disability subscale, overall knee pain, 50-feet walk time, chair-stand time, and use of medications for knee pain.
Ninety patients were randomized. The mean difference in pain between the 2 treatments was 13.8 points on the WOMAC pain scale (95% confidence interval -3.9, 31.4 [P=0.13]). We observed similar small effects for the secondary outcomes.
The effect of treatment with a lateral-wedge insole for knee OA was neither statistically significant nor clinically important.
Biomechanical load of lateral wedged insole on knee and ankle joints: the effect of insole with fixation of ankle joint
- Y Kuroyanagi
- T Nagura
- H Matsumoto
- T Otani
- Y Suda
- K Harafujy
Kuroyanagi Y, Nagura T, Matsumoto H, Otani T, Suda Y,
Harafujy K, et al. Biomechanical load of lateral wedged insole
on knee and ankle joints: the effect of insole with fixation of
ankle joint. J Jpn Orthop Surg Assoc 2004;78:1597-8.
- Lawrence
- Harrington
Biomechanical load of lateral wedged insole on knee and ankle joints: the effect of insole with fixation of ankle joint
- Kuroyanagi Y