Comparison of the Effects of 3-Point Valgus Knee Support and Lateral Wedge Insoles in Medial Compartment Knee Osteoarthritis

Abstract

BackgroundThere are many opinions and controversies regard the effect of lateral wedge insoles and valgus stress 3point knee braces in treatment of medial compartment knee osteoarthritis (OA). In this study we compared the effect of lateral wedge insoles and 3 point knee supports in treatment of medial compartment knee OA.MethodSixty patients (35-65 years), with knee pain and genu varum and moderate to severe medial compartment DJD were divided into three groups. The first group received a custom molded 3 point valgus stress knee support. Lateral wedge insoles were applied for the second group and the third group served as control. All groups were followed for 9 months according to pain severity, walking distance, and radiologic changes.ResultsPain reduced significantly in both lateral wedge and knee brace groups compared to control group with more significant reduction in the brace group. The walking distance was significantly longer only in the brace group. There was more pronounced effect of brace in patients with severe DJD in walking distance compared to moderate DJD, but not in severity of pain.ConclusionThree point valgus stress knee support had more significant effect on pain reduction, walking distance and also radiologic improvement of patients with moderate to severe medial compartment DJD compared to lateral wedge insoles and could even reverse radiologic findings.

Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis

“…In these studies, we used the insert without strapping condition because it was comparable with the other lateral wedge implementations. Regarding controls, 7 studies used a neutral (flat) control wedge, * 4 used no treatment (ie, an empty shoe), 8,27,36,39 and 1 used a subtalar strap as a control (the strap was also included in the active treatment). 40 Treatment duration ranged from 2 weeks to 2 years.…”

“…Three of the 12 studies involved the application of concomitant therapy alongside the treatment and the control. 8,27,36 Data from a total of 885 participants were extracted of whom 502 received lateral wedge treatment.…”

“… a Each item was regressed in a univariate fashion against effect size. b For this meta-regression, Toda et al 40 was excluded because it was neither a neutral wedge nor a no treatment control. c Four of the 12 trials either did not report wedge angulation or used various angles of wedge on different participants, and were therefore not included in this meta-regression. d The study by Sattari and Ashraf 8 did not report mean body mass index of the sample and was not included in this meta-regression. …”

“… d The study by Sattari and Ashraf 8 did not report mean body mass index of the sample and was not included in this meta-regression. …”

“…4–7 As a consequence of this medial unloading, painful knee symptoms should be reduced. However, studies examining knee pain following treatment have shown inconsistent findings, some suggesting a larger amount of pain decreases when using wedged insoles, 8–10 and others (including a recent randomized clinical trial [RCT] 11 ) suggesting that they produce little pain reduction compared with a control treatment.…”