A six-month followup of a randomized trial comparing the efficacy of a lateral-wedge insole with subtalar strapping and an in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee

Toda Orthopedic Rheumatology Clinic, Suita, Osaka, Japan.
Arthritis & Rheumatology (Impact Factor: 7.76). 10/2004; 50(10):3129-36. DOI: 10.1002/art.20569
Source: PubMed


To assess the effect of a lateral-wedge insole with elastic strapping of the subtalar joint on the femorotibial angle in patients with varus deformity of the knee.
The efficacy of a wedged insole with subtalar straps and that of a traditional wedged insole shoe insert were compared. Sixty-six female outpatients with knee osteoarthritis (OA) were randomized (according to birth date) to be treated with either the strapped or the traditional inserted insole. Standing radiographs with unilateral insole use were used to analyze the femorotibial angles for each patient. In both groups, the baseline and 6-month visual analog scale (VAS) scores for subjective knee pain and the Lequesne index scores for knee OA were compared.
The 61 patients who completed the 6-month study were evaluated. At baseline, there was no significant difference in the femorotibial angle (P = 0.66) and the VAS score (P = 0.75) between the 2 groups. At the 6-month assessment, the 29 subjects wearing the subtalar-strapped insole demonstrated a significantly decreased femorotibial angle (P < 0.0001) and significantly improved VAS scores (P = 0.001) and Lequesne index scores (P = 0.033) compared with their baseline assessments. These significant differences were not observed in the 32 subjects assigned to the traditional shoe-inserted wedged insole.
These results suggest that an insole with a subtalar strap maintained the valgus correction of the femorotibial angle in patients with varus knee OA for 6 months, indicating longer-term clinical improvement with the strapped insert compared with the traditional insert.

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    • "Lateral wedged insoles are suggested as a conservative management method for the individual with medial tibiofemoral osteoarthritis as they are very cheap, simple and safe. The clinical findings with lateral wedged insoles are inconsistent with authors (Barrios, Crenshaw, Royer, & Davis, 2009; Toda & Tsukimura, 2004) showing significant pain reductions, whereas others have demonstrated no difference in pain scores (Baker et al., 2007; Bennell et al., 2011; Pham et al., 2004), although the latter did demonstrate a reduced analgesia intake in their subjects. Lateral wedged insoles are designed to reduce the external knee adduction moment by altering the path of the centre of pressure laterally with respect to the defined knee centre or origin (Yasuda & Sasaki, 1987) and thus altering loading at the knee. "
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    ABSTRACT: Lateral wedged insoles are a common treatment in individuals with medial tibiofemoral osteoarthritis of the knee joint. One concern has been the potential for increased foot and ankle pain due to increased eversion. The purpose of this study was to assess the biomechanical effectiveness of a typical lateral wedged insole and a combined insole with a lateral wedge and off-the-shelf anti-pronatory device in shoes while walking. A cross-over randomized design was used where each insole was worn by fifteen healthy subjects while three-dimensional motion data were collected in three different conditions: (1) control condition (with standard shoes), (2) with an insole with a lateral wedge and additional off-the-shelf anti-pronatory support (supporting), and (3) with an insole with a lateral wedge with no additional support (unsupported) in the standard shoes. The unsupported insole significantly increased the amount of ankle/subtalar joint complex eversion than the other experimental conditions, with the supporting insole reducing the ankle/subtalar joint complex eversion, and was found to be more comfortable. Both the supporting and unsupported lateral wedged insoles significantly reduced knee loading (external knee adduction moment reduction 8.5% and 9.1%, respectively), the knee adduction angular impulse. This new design of lateral wedge may offer increased adherence in future osteoarthritis population studies while offering reductions in joint loading.
    Full-text · Article · Aug 2013 · Human movement science
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    • "Key Words: adult; knee osteoarthritis; pain; physical function INTRODUCTION Knee Osteoarthritis (OA) is estimated to be the most common causes of disability in old adults (Toda and Tsukimura, 2004). Patients with knee osteoarthritis suffer from progressive disability when walking, going up and down stairs (Chuang et al., 2007). "
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    ABSTRACT: ABSTRACT: Knee Osteoarthritis is estimated to be the most common causes of disability in older adults. Knee and hip osteoarthritis pain in older adults is very common and osteoarthritis is one of the most common causes of joint pain and physical, mental and social disability. There is no study in Iran to explore the forms of relationships among pain, demographic characteristics and physical function. Therefore, this study was undertaken to describe the relationship among pain, demographic characteristics and physical function in patients with knee Osteoarthritis Considering Iranian patients’ culture in daily activities. Eighty-one knee Osteoarthritis patients referring to Rheumatology clinic depended on Tabriz University of medical science participated in this study with convenience sampling method. Data was collected through the Western Ontario and McMaster Universities questionnaire, that ordered in three subscales which included pain (5 items), stiffness (2 items) and physical function (17 items). Data analyzed using SPSS software. The results of linear regression analysis indicate the relationship among physical function, pain, stiffness, and duration of disease were significant. From these results it can be concluded pain and joint stiffness are important factors that affect the ability to perform activities of daily living in patients with knee Osteoarthritis. Therefore, we suggest that patients become familiar with nonpharmacologic pain relief methods and muscle strengthening exercises to overcome disability from disease. Key Words: adult; knee osteoarthritis; pain; physical function
    Full-text · Article · Jan 2013 · International Journal of Sciences: Basic and Applied Research (IJSBAR)
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    • "wedged insoles that in both healthy and subjects with OA have had mixed results (Baker et al., 2007; Bennell et al., 2011; Fang et al., 2006; Kakihana et al., 2007; Kutzner et al., 2011; Toda and Tsukimura, 2004). The mechanism by which the external adduction moment is reduced in the VS shoe is not clear. "
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    ABSTRACT: A recently described variable-stiffness shoe has been shown to reduce the adduction moment and pain in patients with medial-compartment knee osteoarthritis. The mechanism associated with how this device modifies overall gait patterns to reduce the adduction moment is not well understood. Yet this information is important for applying load modifying intervention for the treatment of knee osteoarthritis. A principal component analysis (PCA) was used to test the hypothesis that there are differences in the frontal plane kinematics that are correlated with differences in the ground reaction forces (GRFs) and center of pressure (COP) for a variable-stiffness compared to a constant-stiffness control shoe. Eleven healthy adults were tested in a constant-stiffness control shoe and a variable-stiffness shoe while walking at self-selected speeds. The PCA was performed on trial vectors consisting of all kinematic, GRF and COP data. The projection of trial vectors onto the linear combination of four PCs showed there were significant differences between shoes. The interpretation of the PCs indicated an increase in the ankle eversion, knee abduction and adduction, decreases in the hip adduction and pelvic obliquity angles and reduced excursion of both the COP and peak medial-lateral GRFs for the variable-stiffness compared to the control shoe. The variable-stiffness shoe produced a unique dynamic change in the frontal plane motion of the ankle, hip and pelvis that contributed to changes in the GRF and COP and thus reduced the adduction moment at a critical instant during gait suggesting a different mechanism that was seen with fixed interventions (e.g. wedges).
    Full-text · Article · Apr 2012 · Journal of Biomechanics
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