Combined effects of knee brace, laterally wedged insoles, and toe-out gait on knee adduction moment and fall risk in moderate medial knee osteoarthritis patients

Abstract

There is a synergistic effect of toe-out when combined with knee brace and laterally wedged insole concurrently in second peak knee adduction moment reduction but with a greater degree of fall risk. Simultaneous use of conservative treatments also decreases comfort level. Clinical relevance Patients with mild and moderate knee osteoarthritis are usually prescribed conservative treatment techniques. This study will provide an insight whether or not a combination of these techniques have a synergistic effect in reducing knee joint load.

Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta‐analysis

“…In KOA groups, four studies reported a BMI mean of 18.5–24.9 kg/m 2 (normal weight) [ 20 , 28 , 43 , 56 ]; 19 studies reported participants’ mean BMI of 25–29.9 kg/m 2 (overweight) [ 22 , 23 , 27 , 30 , 31 , 33 – 35 , 38 – 42 , 44 , 45 , 49 , 52 , 53 , 55 ]; eight studies reported the mean BMI of 30–34.9 kg/m 2 (grade I obese) [ 18 , 21 , 24 – 26 , 32 , 37 , 48 ]; and one study reported a mean BMI ≥35 kg/m 2 [ 51 ] (grade II obese). Seven studies did not report the mean BMI of their participants [ 19 , 29 , 36 , 46 , 47 , 50 , 54 ]. In control groups, four studies reported a BMI mean of 18.5–24.9 kg/m 2 (normal weight) [ 20 , 44 , 45 , 56 ]; 12 studies reported participants’ mean BMI of 25–29.9 kg/m 2 (overweight) [ 18 , 21 , 22 , 25 , 31 , 37 – 41 , 48 , 51 ] and six studies did not report the mean BMI of their control participants [ 19 , 29 , 46 , 47 , 50 , 54 ].…”

“…The percentages of STROBE criterion met ranged from 42% [ 19 ] to 84% [ 43 ]. Ten studies were categorized as high-quality studies [ 21 , 25 , 27 , 35 , 42 – 44 , 47 , 53 , 55 ], while 29 studies scored less than 65% in relation to the applicable criteria on the STROBE checklist, and were therefore classified as low-quality studies [ 18 – 20 , 22 – 24 , 26 , 28 – 34 , 36 – 41 , 45 , 46 , 48 , 49 , 51 , 52 , 54 , 56 ].…”

“…Among the common criterion not met included methods for addressing potential bias, with six meeting this criterion [ 26 , 27 , 35 , 36 , 43 , 47 ]; study generalizability and external validity, with 11 meeting this criterion [ 27 , 33 – 35 , 42 – 44 , 46 , 47 , 55 , 56 ]; and sample size calculations provided, with 12 meeting this criterion [ 22 , 24 , 25 , 30 , 36 , 42 , 44 , 46 , 47 , 52 – 54 ].…”

“…Twenty-four studies included measures of participants taken while barefoot [ 18 – 21 , 23 , 27 – 29 , 32 , 36 – 41 , 43 , 44 , 46 – 49 , 51 , 54 , 55 ], while 14 were in shod conditions [ 22 , 24 – 26 , 30 , 31 , 33 , 34 , 42 , 45 , 50 , 52 , 53 , 56 ] (Tables 4 , 5 and 6 ). The majority of the studies ( n = 24) used a three-dimensional (3D) motion analysis system and force platforms [ 19 – 28 , 30 , 31 , 33 , 34 , 36 , 37 , 39 , 40 , 44 , 48 , 49 , 52 – 54 ], whereas the rest ( n = 14) used other measurement instruments including pressure plates [ 41 ], plantar pressure insoles [ 56 ], the Biodex system [ 42 ], static footprint [ 38 ], foot scanners [ 50 ], digital callipers [ 29 ], a dynamometer force system [ 45 ], a biothesiometer [ 51 ], and objective visual and manual measurements including foot posture index (FPI) [ 18 , 47 , 53 , 55 ], goniometer [ 46 ], and lateral talometatarsal angle [ 32 ].…”

“…A wide range of foot characteristics and mechanics were reported in the included studies. The most common foot-related outcomes investigated and reported were foot progression angle (FPA) or toe-out degree ( n = 12) [ 22 , 23 , 27 , 33 , 34 , 36 , 37 , 44 , 48 , 49 , 52 , 54 ], and peak rearfoot eversion angle ( n = 7) [ 21 , 24 – 26 , 30 , 40 , 42 ]. Other outcome measures included the prevalence of pes planus among participants with KOA measured with reference to the medial arch index and the lateral talometatarsal angle [ 18 , 32 ], and foot pronation measured by foot posture index (FPI) [ 18 , 38 ].…”