Effects of Disease Severity on Response to Lateral Wedged Shoe Insole for Medial Compartment Knee Osteoarthritis

Shimada, Seiichiro; Kobayashi, Shigeru; Wada, Makoto; Uchida, Kenzo; Sasaki, Shinichi; Kawahara, Hideo; Yayama, Takafumi; Kitade, Ippei; Kamei, Kenta; Kubota, Masafumi; Baba, H.

doi:10.1016/j.apmr.2006.08.018

Cited by 97 publications

(80 citation statements)

References 29 publications

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“…This supports the hypothesis that possible strategies to reduce the incidence of OA from knee malalignment could include orthotic footwear (31) or the deliberate adaption of a toe-out foot alignment during gait (19,20). Knee adduction moments can be modified by orthoses (32)(33)(34), variable-stiffness shoes (35), leg braces (36), and reduced walking velocity (37). Knee malalignment may be associated with alterations in foot angle in early adult life (38).…”

Section: Discussionsupporting

confidence: 54%

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

McWilliams¹,

Doherty²,

Maciewicz³

et al. 2010

Arthritis Care & Research

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Objective. To determine whether self-reported early adult life malalignment of knees or feet are risk factors for knee or hip osteoarthritis (OA). Methods. Participants in the Genetics of Osteoarthritis and Lifestyle case-control database were sent a questionnaire (n ‫؍‬ 3,022) containing line-drawing instruments for self-reported knee and foot alignment at ages 20 -29 years. Respondents were categorized as having straight, valgus, or varus knee, and straight, toe-in, or toe-out feet. Radiographic criteria were used to define current isolated knee or hip OA, combined knee and hip OA, or non-OA controls. Odds ratios (ORs), adjusted ORs, and 95% confidence intervals (95% CIs) were calculated and logistic regression was performed. Results. The response rate was 72%; 87.5% of responders (n ‫؍‬ 1,901) completed the alignment questions. Increased risk of isolated knee OA occurred with early adult varus (adjusted OR 5.16, 95% CI 2.87-9.41) and valgus knees (adjusted OR 3.16, 95% CI 1.04 -9.64). The positive association between knee OA and toe-in foot was explained by varus knee. There was an increased risk of combined knee/hip OA from varus (adjusted OR 4.52, 95% CI 2.39 -8.53) and valgus knees (adjusted OR 3.07, 95% CI 0.99 -9.54). Varus knee was associated with risk of medial tibiofemoral OA, whereas valgus knee was associated with risk of lateral tibiofemoral and lateral patellofemoral OA. Toe-out foot was associated with reduced medial patellofemoral OA. For knee OA, a multiplicative interaction analysis between occupational risks and varus/valgus yielded an OR int of 3.20 (95% CI 1.08 -9.49). Conclusion. Constitutional alignment of the leg in terms of varus or valgus knee or foot rotation may be a significant factor in determining development and distribution of knee but not hip OA.

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Section: Discussionsupporting

confidence: 54%

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

McWilliams¹,

Doherty²,

Maciewicz³

et al. 2010

Arthritis Care & Research

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“…Half of the patients had radiographic evidence of moderate knee OA. A study by Shimada and colleagues [25] reported that insoles have the greatest effect on knee adduction moment in early to mild OA (Kellgren and Lawrence Grade I-II). Our subgroup analysis showed no difference in effect sizes between the mild and moderate OA groups.…”

Section: Discussionmentioning

confidence: 99%

“…In knee OA of the medial compartment, symptom reduction and functional improvement have been reported in patients fitted with a valgus unloader knee brace [11] or a laterally wedged insole [2,14,25]. Recently, a placebo-controlled trial found a valgus knee brace to be more effective than a neutral brace [11].…”

Section: Introductionmentioning

confidence: 99%

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

Duivenvoorden¹,

Raaij

Horemans³

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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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.

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“…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).…”

mentioning

confidence: 99%

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

Arnold

Wong

Jones

et al. 2016

Arthritis Care & Research

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Objective. Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there has been no definitive consensus on this topic. The aim of this systematic review and meta-analysis was to establish the within-subject effects of lateral wedge insoles on knee joint load in people with medial knee OA during walking. Methods. Six databases were searched from inception until February 13, 2015. Included studies reported on the immediate biomechanical effects of lateral wedge insoles during walking in people with medial knee OA. Primary outcomes of interest relating to the biomechanical risk of disease progression were the first and second peak external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI). Eligible studies were pooled using random-effects metaanalysis.Results. Eighteen studies were included with a total of 534 participants. Lateral wedge insoles resulted in a small but statistically significant reduction in the first peak EKAM (standardized mean difference [SMD] 20.19; 95% confidence interval [95% CI] 20.23, 20.15) and second peak EKAM (SMD 20.25; 95% CI 20.32, 20.19) with a low level of heterogeneity (I 2 5 5% and 30%, respectively). There was a favorable but small reduction in the KAAI with lateral wedge insoles (SMD 20.14; 95% CI 20.21, 20.07, I 2 5 31%). Risk of methodologic bias scores (quality index) ranged from 8 to 13 out of 16. Conclusion. Lateral wedge insoles cause small reductions in the EKAM and KAAI during walking in people with medial knee OA. Current evidence demonstrates that lateral wedge insoles appear ineffective at attenuating structural changes in people with medial knee OA as a whole and may be better suited to targeted use in biomechanical phenotypes associated with larger reductions in knee load.

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Effects of Disease Severity on Response to Lateral Wedged Shoe Insole for Medial Compartment Knee Osteoarthritis

Abstract: The kinetic and kinematic effects of wearing of lateral wedged insoles were significant in Kellgren-Lawrence grades I and II knee OA. The results support the recommendation of use of lateral wedged insoles for patients with early and mild knee OA.

Cited by 97 publications

References 29 publications

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

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

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

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