Abstract
Background Using the lateral wedge insole is a conservative management strategy for knee osteoarthritis. The theoretical basis for this intervention is to correct femorotibial angle, thereby reducing pain and optimising function. Objective This systematic review evaluates the evidence on the effectiveness of wedge insole compared with flat insole for the treatment of knee osteoarthritis. Methods A systematic review was performed, searching published (MEDLINE, EMBASE, CNKI, Cochrane Library, and Web of Science) and unpublished literature from their inception to April 2018. Randomized controlled trials (RCTs) that compared the use of wedge insole with a flat insole were included. Risk of bias and clinical relevance were assessed, and outcomes were analysed through meta-analysis. Result From a total of 413 citations, 8 studies adhered to the a priori eligibility criteria. The WOMAC pain was shown to be statistically nonsignificant change with the use of wedge insole (SMD=0.07), and low heterogeneity (I2=22%) and a 95% CI that crossed zero (95% CI: −0.09 to 0.24). The 5 independent trials were not significant in improving pain score (SMD = −0.02, 95% CI: −0.19 to 0.16). This review also revealed no significance in improving Lequesne index (SMD = −0.27, 95% CI: −0.72 to 0.19). The meta-analysis from the 2 independent trials was significant in improving femorotibial angle (SMD = −0.41, 95% CI: −0.73 to -0.09). In conclusion, this meta-analysis suggested that lateral wedge insoles can improve femorotibial angle but are of no benefit with pain and functions in knee osteoarthritis.
Highlights
Knee osteoarthritis (KOA), as the most common musculoskeletal disorders, is a degenerative articular joint disease which leads to erosion and degradation of the articular cartilage, formation of extended bone, and narrowing of the joint space [1, 2]
The objective of this article was to assess the efficacy of lateral wedge insole (LWI) treatments compared with flat insole (FI) for patients with KOA by assessing pain, function, and femorotibial angle (FTA) as a marker for mediolateral load shift, reported in randomized controlled trials (RCTs) that we can retrieve in line with the established criteria
Identification after searching the database, we identified articles: PubMed n=71 the Cochrane library n=71 Web of Science n=297 Embase and CNKI n=28 literature obtained through other source n=10
Summary
Using the lateral wedge insole is a conservative management strategy for knee osteoarthritis. This systematic review evaluates the evidence on the effectiveness of wedge insole compared with flat insole for the treatment of knee osteoarthritis. Randomized controlled trials (RCTs) that compared the use of wedge insole with a flat insole were included. The 5 independent trials were not significant in improving pain score (SMD = −0.02, 95% CI: −0.19 to 0.16). The meta-analysis from the 2 independent trials was significant in improving femorotibial angle (SMD = −0.41, 95% CI: −0.73 to -0.09). This meta-analysis suggested that lateral wedge insoles can improve femorotibial angle but are of no benefit with pain and functions in knee osteoarthritis
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