Do Laterally Wedged Insoles or Valgus Braces Unload the Medial Compartment of the Knee in Patients With Osteoarthritis?

Abstract

Background The results of conservative treatment of knee osteoarthritis (OA) are generally evaluated in epidemiological studies with clinical outcome measures as primary outcomes. Biomechanical evaluation of orthoses shows that there are potentially beneficial biomechanical changes to joint loading; however, evaluation in relation to clinical outcome measures in longitudinal studies is needed. Questions/purposes We asked (1) is there an immediate effect on gait in patients using a laterally wedged insole or valgus knee brace; (2) is there a late (6 weeks) effect; and (3) is there a difference between subgroups within each group with respect to patient compliance, body mass index, and OA status? Methods This was a secondary analysis of data from a previous randomized controlled trial of patients with early medial knee OA. A total of 91 patients were enrolled in that trial, and 73 (80%) completed it after 6 months. Of the enrolled patients, 80 (88%) met prespecified inclusion criteria for analysis in the present study. The patients were randomized to an insole or brace. Gait was analyzed with and without wearing the orthosis (insole or brace) at baseline and after 6 weeks. Measurements were taken of the knee adduction moment, ground reaction force, moment arm, walking speed, and toe-out angle. Data were analyzed with regression analyses based on an intention-to-treat principle. Results A mean reduction of 4% (± 10) (95% confidence interval [CI], À0.147 to À0.03, p = 0.003) of the peak knee adduction moment and 4% (± 13) (95% CI, À0.009 to À0.001, p = 0.01) of the moment arm at baseline was observed in the insole group when walking with an insole was compared with walking without an insole. A mean reduction of 1% (± 10) (95% CI, À0.002 to À0.001, p = 0.001) of the peak knee adduction moment and no reduction of the moment arm were measured after 6 weeks.

The effects of shoe-worn insoles on gait biomechanics in people with knee osteoarthritis: a systematic review and meta-analysis

“…Biomechanical variables that were reported in more than 10 studies included the KAM (26/27 studies), gait speed (17/27 studies) and the frontal plane ankle moment (11/27 studies), while 21 different variables appeared in only one study. The number of different variables from a given study ranged from 114 to 30 15. Data are summarised in table 2 and Appendix 1, and summaries by intervention are listed below.…”

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

“…The 18 eligible studies included a total of 534 participants. All but 4 studies were withinsubjects repeated-measures designs, with the remaining being randomized trials (30)(31)(32)(33). Four studies reported the use of the ACR criteria (31,(34)(35)(36), with 10 stating cutoffs regarding the severity of knee pain (13,14,21,31,32,34,(36)(37)(38)(39), most commonly .3 of 10 on a visual analog scale (13,14,21,31,32,34,37).…”

“…Fourteen studies prescribed the same insole to all participants, with the remaining 4 using a customized amount based on comfort and/or pain level (14,31,35,37). A flat insole was the comparison condition in 4 studies (14,31,34,37), 7 studies used participants' own footwear (13,21,30,32,36,40,43), 5 studies used standardized footwear (29,33,35,39,42), 1 study used both a flat insole and participants' own footwear (39), and 1 study did not report the type of footwear (41). Walking speed was either controlled across conditions within a threshold of each participants' preferred speed (13,14,21,31,32,37), (43).…”

Video-analysis of the effect of different types of adapted shoes on knee adduction moment

“…Было также выдвинуто предположение, что снижение аддукционного момента может быть достигнуто за счет физической реабилитации и тренировки мышц, однако анализ проведенных исследований с участием 233 пациентов не нашел подтвержде-ния данной гипотезы [15]. Но значительные из-менения величины медиального момента были достигнуты за счет использования различных ор-топедических изделий [14,[16][17][18].…”

“…Например, ортопеды для исправления начального вальгусного искрив-ления голеностопного сустава используют кор-ректирующие стельки, благодаря которым может быть уменьшен аддукционный момент коленного сустава за счет коррекции переката центра масс стопы (рис. 1) [16,17].…”