The effect of different types of insoles or shoe modifications on medial loading of the knee in persons with medial knee osteoarthritis: a randomised trial.

Richard K Jones,Matthew J Parkes,Graham J Chapman,David T Felson,Laura Forsythe

doi:10.1002/jor.22947

Abstract

ABSTRACTMany conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walking in individuals with medial knee OA. Seventy individuals with medial knee OA underwent three‐dimensional walking gait analysis in five conditions (barefoot, control shoe, typical wedge, supported wedge, and mobility shoe) with pain and comfort recorded concurrently. The change in EKAM, KAAI, external knee flexion moment, pain, and comfort were assessed using multiple linear regressions and pairwise comparisons. Compared with the control shoe, lateral wedge insoles and barefoot walking significantly reduced early stance EKAM and KAAI. The mobility shoe showed no effect. A significant reduction in latter stance EKAM was seen in the lateral wedge insoles compared to the other conditions, with only the barefoot condition reducing the external knee flexion moment. However, the mobility shoe showed significant immediate knee pain reduction and improved comfort scores. Different lateral wedge insoles show comparable reductions in medial knee loading and in our study, the mobility shoe did not affect medial loading. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 33:1646–1654, 2015.

Highlights

Knee osteoarthritis (OA) is the most common form of OA and is the leading cause of pain and disability in older adults.[1]
We have demonstrated in a previous paper the effects on early stance peak external knee adduction moment (EKAM) and external knee flexion moment of these two different types of lateral wedge insole.[18]
We found that barefoot walking had the greatest effect on early stance peak EKAM, lowering it by À7.6% (p < 0.001 vs. control shoe)

Summary

Introduction

Knee osteoarthritis (OA) is the most common form of OA and is the leading cause of pain and disability in older adults.[1]. In this study we chose to investigate a full length lateral wedge insole (typical) as these have been found to be better than heel only wedges[21] and one with a medial arch support (supported), as this was previously found to be better functionally for the foot and ankle and more comfortable.[22] We have demonstrated in a previous paper the effects on early stance peak EKAM and external knee flexion moment of these two different types of lateral wedge insole.[18] In addition, other footwear based approaches to lowering medial load have been proposed One such shoe treatment which aims to mimic barefoot walking during gait,[16] which is perceived as the best walking style for reducing medial loading, has been developed and recommended as efficacious for medial knee OA. These shoes have not been directly compared with traditional lateral wedge insoles in terms of their effects on medial knee load

Objectives

Results

Conclusion