Lateral Wedge Insoles Research Articles

Hindfoot Flexibility Influences the Biomechanical Effects of Laterally Wedged Insoles and Ankle-Foot Orthoses in Medial Knee Osteoarthritis

ObjectiveTo investigate the relationship of frontal plane ankle mobility with the effects of an ankle-foot orthosis (AFO) and a laterally wedged insole (LWI) on knee adduction moment (KAM) in the treatment of medial knee osteoarthritis. DesignRandomized, nonblinded crossover trial. SettingOutpatient clinic of university hospital. ParticipantsReferred sample of 20 patients (N=20) with medial knee osteoarthritis stage 1-3 (Kellgren and Lawrence), aged 56.4±6.5 years; 58 patients were assessed, 21 were included, and 1 was a dropout. There were 14 healthy reference participants without knee osteoarthritis (convenience sample) who were matched by age. InterventionsPatients received AFO and LWI for 6 weeks each with gait analysis after each 6-week intervention. Patients underwent additional barefoot gait analysis, walking on even ground and on a cross slope of 5° lateral elevation and standing on inclinations of 0°, 5°, 10°, and 20°. Main Outcome MeasuresSpearman correlation between the immediate change in first peak of KAM with each aid and the change in hindfoot varus on the cross slope relative to level ground. ResultsThe KAM reduction with AFO correlated significantly with hindfoot varus reaction to the cross slope during walking: the greater the hindfoot valgization on the cross slope, the greater the KAM reduction with AFO (Spearman ρ=0.53, P=.02).The KAM reduction with LWI correlated moderately negatively with the change in hindfoot varus: the greater the hindfoot valgization on the cross slope, the smaller the KAM reduction with LWI (r=−0.31 P=.18). ConclusionsLWI may be suitable for patients with limited to normal frontal plane ankle mobility. Patients with greater frontal plane ankle mobility benefit most from frontal plane ankle bridging with AFO. Studies with larger samples are necessary.

Physical therapy and orthopaedic equipment-induced reduction in the biomechanical risk factors related to knee osteoarthritis: a systematic review and Bayesian network meta-analysis of randomised controlled trials

ObjectiveAre physical therapy or orthopaedic equipment efficacious in reducing the biomechanical risk factors in people with tibiofemoral osteoarthritis (OA)? Is there a better therapeutic intervention than others to improve these...

A comparison of the biomechanical and clinical effects of a biaxial ankle-foot orthosis and lateral wedge insole in individuals with medial knee osteoarthritis

Purpose This study aimed to compare a biaxial ankle-foot orthosis (AFO) with a lateral wedge insole in terms of the biomechanical and clinical outcomes in individuals with knee osteoarthritis. Materials and methods A cross-over randomized design was used where 31 individuals (25 females and six males, mean age of 52.19 ± 4.12 years) with knee osteoarthritis wore each intervention for two weeks with two weeks washout period. Three-dimensional kinematic and kinetic data and clinical outcomes were collected to evaluate the effects of each intervention on knee adduction moment (KAM), pain, stiffness, and function. Results Both orthoses significantly improved pain by 17 and 22%, function by 11 and 14%, the first peak KAM by 15.7 and 19.2%, the second peak KAM by 10.4 and 16.7%, and KAM impulse by 14.8 and 22.2%, respectively. However, the biaxial AFO significantly reduced the KAM and improved function compared to the lateral wedge insole (p < 0.01). Conclusions The results of this study have shown that both orthoses have a potential role in the conservative management of medial knee osteoarthritis. The biaxial AFO proved statistically better at improving function and KAM; though these differences do not seem to be clinically significant. IMPLICATION FOR REHABILITATION Orthotic interventions have been reported to be effective in the management of medial knee osteoarthritis. Lateral wedge insole and biaxial ankle-foot orthosis (AFO) are effective in the improvement of pain, function, and knee adduction moment (KAM) in people with medial knee osteoarthritis. The biaxial AFO, compared with lateral wedge insole, contributes to statistically more improvement of function and KAM. However, these differences do not seem to be clinically significant.

Knee osteoarthritis treatment

Introduction. Osteoarthritis is the most common form of arthritis which affects millions of people worldwide and represents the leading cause of disability among the elderly. There is a substantial number of guidelines available for the treatment of knee osteoarthritis. The primary aim of this paper is to explore the distinctions and similarities between knee osteoarthritis treatment guidelines. The treatment is divided into core treatment and additional steps. Core treatment of knee osteoarthritis involves education of the patient, weight loss in the case of overweight patients and establishing an exercise program. First step of additional treatment of knee osteoarthritis consists of non-pharmacological (application of orthoses, lateral wedge insoles, assistive walking devices, therapeutic modalities, manual therapy, aquatic exercise, Tai chi) and pharmacological therapy (topical nonsteroidal anti-inflammatory drugs, topical capsaicin, paracetamol). Second step of additional treatment of knee osteoarthritis - pharmacological therapy should be considered if the first step didn?t show any significant results. It involves the use of oral nonsteroidal antiinflammatory drugs, intra-articular corticosteroid injections and viscosupplementation. Third step of additional treatment of knee osteoarthritis - last resort pharmacological therapy Pain occurring in knee osteoarthritis. can be partially caused by central sensitization. Because of that, use of duloxetine and tramadol may be considered. Fourth step of additional treatment of knee osteoarthritis-end stage treatment of knee osteoarthritis is reserved for the most severe patients. It includes total knee replacement surgery, and if it is not possible, treatment with strong opioids could be considered. Conclusion There are many possibilities in treatment of knee osteoarthritis. Unfortunately, there is often a lack of concordance between different guidelines. In these circumstances, treatment plans should be personalized, while comprehending potential risks and benefits.

Pressure Properties of Three Different Types of Prefabricated Insoles Related to Plantar Pressure in Asymptomatic Men.

In clinical fields, many types of insoles are used to not only realign movement patterns, but also treat pressure-related foot diseases. However, the characteristics of and plantar pressure in each type of insole are still unclear. Therefore, the aim of this study was to validate the plantar pressure-relieving effect of three representative types of insoles (metatarsal padding insole [MPI], lateral heel wedge insole [LHI], and arch support insole [ASI]) in asymptomatic men. A total of 35 feet of 35 asymptomatic men with a mean age of 23.4 ± 2.0 years were included. Pedobarographic data were evaluated by dividing the foot into eight designated regions to compare the three types of insoles. Peak plantar pressure (PPP) and pressure time integral (PTI) were assessed using the Pedar-X system. A repeated measures analysis of variance was used for statistical analyses. In the hallux region, there was no statistically significant difference. MPI showed highest pressure in the 2nd-5th toe and midfoot region, but lowest in the central and lateral forefoot regions. Meanwhile, ASI showed highest pressure in the medial forefoot region but lowest in the lateral heel region. Lastly, pressure in the lateral heel region was highest in LHI. Overall, results of PTI were similar to those of PPP. This study demonstrated that the three types of insole each could reduce and redistribute pressure of specific part of the foot to help select an appropriate insole for each purpose.

Influence of using knee sleeve and lateral wedge insole on knee loading among healthy individuals during stair negotiation

BackgroundFor individuals with knee osteoarthritis (OA), stair negotiation is a challenging task and the first task during which they report pain due to the high knee loading required. The use of lateral wedge insole (LWI) has been found to reduce loading in patients with OA but not to reduce pain, whereas the use of knee sleeve has been shown to result in good pain reduction. Understanding the effect of combining LWI and knee sleeve use on healthy individuals before testing on individuals with knee OA is an important step. Research questionThe current study aimed to evaluate the effect of combining the use of LWI and knee sleeve and compare the results with the application of each treatment separately and with the control condition. MethodsThis randomised cross-over study included 17 healthy participants who underwent 3D gait analysis. Participants performed ascending and descending stair activities with the following four treatment conditions: five-degree LWI, off-the-shelf knee sleeve, both LWI and knee sleeve and control condition. External knee adduction moment (EKAM) and knee frontal plane range of motion (ROM) were evaluated as primary outcomes. Repeated measure ANOVA or the Friedman test was selected based on meeting the assumption followed by multiple pairwise comparisons with Bonferroni correction. ResultsIn general, the use of LWI reduced the first peak EKAM significantly (p < 0.001) compared to the control condition in stir ascending (12% reduction) but not in stair descending (p > 0.05). Interestingly, knee sleeve use did not result in any reduction in the first peak EKAM compared to the control or any other condition. However, knee sleeve use led to a significant reduction in the knee frontal plane ROM during stair descending. The combined treatment was not superior to the LWI use when compared to control in the EKAM reduction. SignificanceCombined knee sleeve and LWI use was not superior to LWI use alone in reducing the knee loading, but it may be beneficial for individuals with knee OA since it helped in reduction of the knee frontal plane ROM during stair descending. Importantly, the effect of LWI use or any other treatment must be investigated for each different activity, and the results found in one activity must not be generalised across other activities.

Effect of lateral wedged insole shoe in knee osteoarthritis: A 12 month randomized controlled trial

Introduction: Knee osteoarthritis (OA) is a chronic degenerative musculoskeletal condition that imposes a major healthcare burden due to considerable pain, disability and loss of quality of life especially among the older adults. Most knee OA researchers have focused on tertiary management strategies i.e pain relief with effective drug therapies (Non steroidal anti inflammatory drugs, chondroitin supplements etc). However, long-term use of NSAIDS have significant side effects and are expensive. With the exception of knee joint arthroplasty, typically reserved for end-stage disease, there is no definitive cure for osteoarthritis. Accordingly, there is an urgent need for conservative treatment modalities, that not only alleviate painful symptoms of OA, but also reduce the progression of the degenerative pathology over time. Patients with knee OA usually show major involvement in only one compartment; medial tibiofemoral compartment being more common than the lateral compartment. The lateral wedge shoe insole is an orthotic device, which is hypothesized to reduce the moment arm of the ground reaction force vector relative to the knee joint center during walking. They are an inexpensive and feasible treatment modality, that has shown to reduce medial knee load. Materials and Methods: 80 patients with bilateral medial compartment osteoarthritis of knee were included in the present study. They were randomly divided into two groups ; Group A (n = 40) included patients who were given lateral wedged insole shoes and Group B (n = 40) included those who were given normal flat soled shoes. All patients who fulfilled the inclusion and exclusion criteria were recruited for the study. The present study was carried between January 2020 to January 2021 in Krishna Institute Of Medical Sciences, “Deemed to be University” Karad. Severity of pain using WOMAC score, FTA using plain knee radiograph in AP view and frequency of intake of NSAIDS were calculated at the start of study, thereafter at each follow up every 2 months up to 12 months. Results: At the initial 2nd month follow up group A patients showed significant reduction in severity pain scale (66.74+/-19.44) as compared to group B (72.78+/-17.04), but neither of group A or group B showed any significant change in remaining variable characters (p>0.005). At the end of 12 months follow up assessment, Group A patients showed a marked reduction in severity of pain (average 46.8+/-16.24) as compared to Group B (mean 59.26+/-18.74). Patients in Group A showed significant decrease in the frequency of intake of NSAIDS for pain relief as compared to patients in Group B (p

Comparing Two Orthoses for Managing Medial Knee Osteoarthritis: Lateral Wedge with Subtalar Strap While Barefoot Versus Lateral Wedged Insole Fitted Within Sandal.

Using foot orthoses for managing medial knee osteoarthritis (MKOA) is common, although its effectiveness is in debate. Most orthoses are placed inside the shoe as a lateral wedged insole. Thus, most studies in this area have focused on the effect of insoles used with shoes. This study compared the effects of a lateral wedge with subtalar strap (combined insole) used while barefoot and lateral wedged insole fitted within sandal on pain, function and external knee adduction moment (EKAM) in patients with MKOA to consider which orthotic treatment is better. In this quasi-experimental pretest-posttest study, 29 participants with medial knee osteoarthritis were divided into two groups: (1) combined insole (n = 15) and (2) sandal (n = 14) groups. We recorded their gait while walking with and without orthoses using a motion analysis system. We evaluated their pain and performance with visual analog scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, 30s chair stand, and Timed Up and Go functional tests. The pain and performance evaluations were repeated after one month. The pain immediately decreased after walking with both orthoses (p < 0.001). There was no significant difference in EKAM results between the two orthoses. Pain and performance improved in both groups after a one month using the orthoses (p < 0.01). Both types of orthoses have similar effect and lead to better performance and less pain after 1 month.

Effect of Lateral Wedge Insole on Pain and Function in Medial Compartment Osteoarthritis Knee- An Evidence Based Study

Background: Osteoarthritis is the second most common rheumatologic problem &amp; nearly 80% of population shows OA among the patient who claimed for knee pain and limitation in movement, out of which approximately 25% cannot perform their major daily activities of life.(WHO 2019)As per recent study, prevalence of knee OA in India is 28.7% with medial compartment more involved than lateral. Purpose: To study the evidences regarding effect of lateral wedge insole patient with medial compartment osteoarthritis of knee on pain and function. Methodology: The study was conducted according to Preferred Reporting Items for systematic reviews and meta-analysis guidelines. Evidences selected since year 2005-February 2019 from PubMed, Google Scholar, Physiotherapy Evidence Database(PEDro), ResearchGate, ScienceDirect, Wiley’s online library and The Cochrane library. Key words used were: Lateral wedge insole, knee osteoarthritis, Pain and Function.Analysis was done using 2 scales: PEDro scale and Centre for Evidence-Based Medicine Levels of Evidence Scale. Total 200 articles were found, out of which 23 articles were relevant and from those 16 articles were included in the study and other articles were excluded as per eligibility criteria. Results: 13 studies were shown that lateral wedge insole is effective treatment for reducing pain and improving function.(Level of evidence-1a,1b,2b) 3 studies were showed that lateral wedge insole have none or same effect as other conservative treatment in knee osteoarthritis. (Level of evidence-1a,1b,2b). Conclusion: Based on the evidences taken from search engines: PubMed, Google Scholar, Physiotherapy Evidence Database(PEDro), ResearchGate, ScienceDirect, Wiley’s online library and The Cochrane library of year 2005-2019 and analysis of all concluded that, full length wedge insole is found to be an effective conservative treatment for reducing pain and improving function in medial compartment knee osteoarthritis. Keywords: Lateral wedge insole, knee osteoarthritis, pain and function.

Outcomes of patients with medial knee osteoarthritis in two types of orthotic interventions

Purpose: This study aimed to evaluate and compare the effects of Lateral wedge combined with medial-arch support and subtalar strap (combined insole) applied to the bare foot and lateral wedged insole fitted in sandals (Figure 1) on pain, function and knee adduction moment (EKAM) in patients with medial knee osteoarthritis (MKOA).

A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial

Objective: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. Design: Single-centre, block-randomized, cross-over controlled trial. Setting: Outpatient clinic. Subjects: About 39 patients with symptomatic medial knee osteoarthritis. Interventions: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. Main measures: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire – Osteoarthritis and knee pain. Results: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% (P < 0.001). The LWI reduced both maxima by 6% (P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% (P < 0.001) and 5% (P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI (P = 0.001, P = 0.004). Conclusions: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.

Effects of tailored lateral wedge insoles on medial knee osteoarthritis based on biomechanical analysis: 12-week randomized controlled trial

Background: Lateral wedge insoles adjusted by biomechanical analysis may improve the condition of patients with medial knee osteoarthritis. Design: This is a prospective, randomized, controlled, single-blind clinical trial. Setting: The study was conducted in a biomechanics laboratory. Subjects: A total of 38 patients with medial knee osteoarthritis were allocated to either an experimental group (lateral wedge insoles) or a control group (neutral insoles). Interventions: Experimental group (n = 20) received an adjusted lateral wedge insole of 2, 4, 6, 8, or 10 degrees, after previous biomechanical analysis. Control group (n = 18) received a neutral insole (0 degrees). All patients used the insoles for 12 weeks. Main measures: Visual analogue scale, Knee Injury and Osteoarthritis Outcome Score questionnaire, biomechanical parameters: first and second peak of the external knee adduction moment and knee adduction angular impulse, and physical performance tests: 30-second sit-to-stand test, the 40-m fast-paced walk test, and the 12-step stair-climb test. Results: After 12 weeks, between-group differences did not differ significantly for pain intensity (−12.5 mm, (95% CI −29.4–4.4)), biomechanical parameters (p = 0.05), Knee Injury and Osteoarthritis Outcome Score, and physical performance tests, except on the Knee Injury and Osteoarthritis Outcome Score subscale other symptoms (p = 0.002; 13.8 points, (95% CI 5.6–22.0)). Conclusion: Tailored wedge insoles were no more effective at improving biomechanical or clinically meaningful outcomes than neutral insoles, except on symptoms. More participants from the experimental group reported they felt some improvement. However, these effects were minimal and without clinical significance.

The influence of design variations in footwear medial-lateral support on the running biomechanics of older female runners

Reports of greater incidence of knee pain and injury in older female runners compared with their younger counterparts may be associated with differences in lower limb biomechanics that influence knee joint loading. The aim of this study was to investigate footwear interventions aimed at influencing lower limb biomechanics in older female runners (&gt;45 years). Strategies for reducing peak rearfoot eversion and the external knee adductor moment were investigated, since both measures have been associated with knee joint injury. Twenty female runners (mean age 50.7 ± 5.6 years) performed 10 running trials in four footwear conditions: neutral running shoe (Control); neutral shoe with 4° medial heel wedge insole (Medial Wedge); neutral shoe with 4° lateral heel wedge insole (Lateral Wedge); and neutral shoe with combined insole with 5° lateral wedge and medial arch support (Combined Insole). Peak rearfoot eversion and knee external adductor moment were compared for the four conditions using RMANOVA and post-hoc Tukey tests ( p &lt; 0.05). Compared with the Control, peak rearfoot eversion was lower for the Combined Insole condition, with this value being lower than for all other insole conditions ( p &lt; 0.05). Compared with the Control, the peak knee external adductor moment was lower for the Lateral Wedge and the Combined Insole conditions ( p &lt; 0.05). These results support the use of a combined insole with lateral wedge and medial arch support for the reduction of peak rearfoot eversion and peak knee external adductor moment, variables that have been associated with increased risk of knee injury. If aiming to reduce knee external adductor moment alone, then the lateral wedge technology employed in this study provides an effective method for older female runners.

Immediate Effect of Valgus Knee Brace and Lateral Wedge Insole on Gait Parameters in Medial Compartment Osteoarthritis of Knee: A Cross-sectional Study

Introduction: Orthoses have been reported to improve function and symptom reduction in knee Osteoarthritis (OA) of the medial compartment. Biomechanical changes introduced instantly in the gait with the use of orthoses can be evaluated to understand their effectiveness. Aim: To determine and compare the immediate effect of valgus knee brace and Lateral Wedge Insole (LWI) on gait parameters in medial compartment OA knee patients. Materials and Methods: This was a cross-sectional study conducted in the Department of Physical Medicine and Rehabilitation at a tertiary centre from August 2018 to July 2019. A 56 patients of knee OA (Kellgren-Lawrence system grades 2 or 3) were assessed by instrumented gait analysis before and just after orthotic fitment. Gait parameters related to External Knee Adduction Moment (EKAM) (e.g., maximum Ground Reaction Force (mGRF), vertical Ground Reaction Forces (vGRF), Varus Angle (VA) were assessed via motion capture during walking, in all four conditions: barefoot (B), LWI, valgus Knee brace (KB), Combined (C) i.e., (LW+KB). Statistical analysis was done using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 24.0. To find the significant difference in given parameters, repeated measure Analysis of Variance (ANOVA) was applied taking p-value &lt;0.05. Results: A total of 56 patients (13 men, 43 women) mean age of 58.04±5.8 years and a mean Body Mass Index (BMI) of 27.4±3.5 kg/m2 were analysed. A 35 patients had OA grade 2 and 21 were classified as grade 3. No significant difference in mean vGRF and VA values was found among LW, KB and C (p=0.118) and (p=0.894) throughout the stance phase. The significant difference was in mean mGRF values during initial stance phase (0-20% of gait cycle) (p=0.036). Conclusion: The orthoses may not swiftly provide beneficial biomechanical changes in gait parameters of medial OA knee patients.

An exploration of changes in plantar pressure distributions during walking with standalone and supported lateral wedge insole designs

BackgroundLateral wedge insoles (LWI), standalone or with medial arch support (supported-LWI), have been thoroughly investigated for their effects on modifying gait biomechanics for people with knee osteoarthritis. However, plantar pressure distribution between these insole types has not been investigated and could provide insight towards insole prescription with concomitant foot symptoms taken into consideration.MethodsIn a sample of healthy individuals (n = 40), in-shoe plantar pressure was measured during walking with LWI, with or without medial arch support (variable- and uniform-stiffness designs), and a flat control insole condition. Pressure data from the plantar surface of the foot were divided into seven regions: medial/lateral rearfoot, midfoot, medial/central/lateral forefoot, hallux. Plantar pressure outcomes assessed were the medial-lateral pressure index (MLPI) for the whole foot, and the peak pressure, pressure-time integral (PTI), and contact area in each plantar region. Comfort in each insole condition was rated as a change relative to the flat control insole condition. Repeated-measures analyses of variance were calculated to compare the plantar pressure outcomes between insole conditions.ResultsRegionally, medial rearfoot and forefoot pressure were reduced by all wedged insoles, with the variable-stiffness supported-wedge showing greater reductions than the standalone wedge. Lateral rearfoot and forefoot pressure were reduced by both supported-LWI, but unchanged by the standalone wedge. In the midfoot, the standalone wedge maintained pressure but reduced regional contact area, while both supported-LWI increased midfoot pressure and contact area. All LWI increased the MLPI, indicating a lateral shift in plantar pressure distribution throughout the weightbearing phase of gait. Comfort ratings were not significantly different between insole conditions.ConclusionsRegional differences in plantar pressure may help determine an appropriate lateral wedge insole variation to avoid exacerbation of concomitant foot symptoms by minimizing pressure in symptomatic regions. Lateral shifts in plantar pressure distribution were observed in all laterally wedged conditions, including one supported-LWI that was previously shown to be biomechanically ineffective for modifying knee joint load distribution. Thus, shifts in foot centre of pressure may not be a primary mechanism by which LWI can modify knee joint load distribution for people with knee osteoarthritis.

Effects of orthopedic insoles on patients with knee osteoarthritis: A meta-analysis and systematic review.

ObjectiveRecent clinical evidence supports that orthopaedic insoles, especially lateral-wedge insoles, can significantly benefit patients with knee osteoarthritis. The aim of this study is to explore the effects of orthopaedic insoles in patients with knee osteoarthritis.MethodsRandomized controlled trials evaluating the effects of orthopaedic insoles on patients with knee osteoarthritis, published up to 16 February 2021, were reviewed and outcomes quantitatively summarized.ResultsA total of 15 studies from 13 randomized controlled trials that involved 1,086 participants were included in this study. All the included studies exhibited a moderate bias risk and were of acceptable quality. The pooled mean difference of pain determined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was –1.21 (p < 0.001, 95% confidence interval (95% CI) –2.61–0.18) with a high heterogeneity (I2 = 75%). In the sensitivity analysis, the overall incidence was –0.20 (p= 0.62, 95% CI= –0.87–0.46) with an accepted heterogeneity (I2 = 0%). No difference was observed between the Asian and Caucasian groups (p= 0.28). No significant difference was found in the pain score, Lequesne index or functional improvements.ConclusionMeta-analysis revealed that orthopaedic insoles do not provide relief of pain or improve functionality in patients with knee osteoarthritis.LAY ABSTRACTOsteoarthritis of the knee joint is a progressive degenerative disease, which is fairly common in older adults, and leads to major pain and disability. The development and progression of knee osteoarthritis is exacerbated by excessive load on the medial knee joint. Various forms of orthopaedic insoles, such as insoles that provide arch support, shock-absorbing insoles, and lateral-wedge insoles, are widely used by patients with knee osteoarthritis, and are claimed to provide comfort and better support during walking. However, this meta-analysis and systematic review of randomized controlled trials evaluating the effects of orthopaedic insoles on knee osteoarthritis patients found that orthopaedic insoles do not provide relief of pain or improve functionality in patients with knee osteoarthritis.

The correlation between osteoarthritis stage and the effect of the lateral wedge insole for 3 months on medial meniscus extrusion in the knee joint

BackgroundMedial meniscus extrusion (MME) leads to symptomatic knee osteoarthritis (OA) due to increased mechanical stress. MME increases with weight-bearing, and the difference in MME between non-weight-bearing and weight-bearing status (ΔMME) is a factor that causes greater MME. The lateral wedge insole (LWI) is an ideal approach for decreasing the amount of ΔMME associated with the reduction of medial loading stress in the early stage of knee OA. However, the effect of the LWI for 3 months on the ΔMME and its response to OA stage have not been elucidated. ObjectiveTo investigate the effects of the LWI for 3 months on MME and the ΔMME in each stage of OA. MethodsParticipants were divided into three groups: no intervention with the LWI (control group; n = 9) and intervention with the LWI in early OA (early OA group: Kellgren–Lawrence (K/L) stage = 2, n = 17) and late OA (late OA group: K/L stage > 2, n = 13). MME was evaluated using ultrasound, and the ΔMME was obtained as the difference in MME from non-weight-bearing and weight-bearing conditions. These measurements were performed at two time points: the initial office visit as a baseline and post-3 months. ResultsThe weight-bearing MME and ΔMME values post-3 months were significantly decreased compared with those at baseline in the early OA group but not in the control or late OA groups. ConclusionsThe use of the LWI for 3 months decreased weight-bearing MME and ΔMME values, and its effectiveness was more pronounced in the early stage of knee OA.

Gait initiation and lateral wedge insole for individuals with early knee osteoarthritis

BackgroundPeople with knee osteoarthritis are at higher risk of postural deficits and locomotor adaptations which could be manifested in transient tasks like gait initiation. To better understand the effect of early knee osteoarthritis on gait initiation, we measured the gait initiation in two groups of early knee osteoarthritis and healthy age-matched controls and assessed the effect of lateral wedge insole in knee osteoarthritis group. MethodsTwenty-one individuals with early knee osteoarthritis, mean (SD) age = 53.1 (7.4, years), and 19 age- and sex-matched asymptomatic healthy individuals, mean (SD) age = 47.5 (11.2, years), participated. Centre of pressure trajectories were used to quantify the two phases of gait initiation in barefoot condition: anticipatory postural adjustment, and locomotor phase. The immediate and four-week effect of lateral wedge insole and shod condition were also compared for individuals in knee osteoarthritis group. FindingsLonger duration of anticipatory postural adjustment phase (P = 0.046), locomotor phase (P = 0.049), and total duration of gait initiation (P = 0.035) with lower length and velocity of the center of pressure trajectories in anticipatory postural adjustment phase (P = 0.002, and 0.008, respectively) were observed in knee osteoarthritis group compared to controls. Lateral wedge insole could increase the length and velocity of the centre of pressure in locomotor phase compared to barefoot condition (P = 0.001, and 0.002, respectively). InterpretationOur study outlined that people with early knee osteoarthritis adopt different gait initiation strategies mainly in postural preparation phase. The potential effect of lateral wedge insole was shown with better performance of the locomotor phase. Clinical trial registry numberIRCT2016060628310N1.

Influence of foot posture on immediate biomechanical responses during walking to variable-stiffness supported lateral wedge insole designs

BackgroundNovel designs of lateral wedge insoles with arch support can alter walking biomechanics as a conservative treatment option for knee osteoarthritis. However, variations in foot posture may influence individual responses to insole intervention and these effects are not yet known. Research questionHow does foot posture influence biomechanical responses to novel designs of lateral wedge insoles with arch support? MethodsThis exploratory biomechanical investigation categorized forty healthy volunteers (age 23–34) into pronated (n = 16), neutral (n = 15), and supinated (n = 9) foot posture groups based on the Foot Posture Index. Three-dimensional gait analysis was conducted during walking with six orthotic insole conditions: flat control, lateral wedge, uniform-stiffness arch support, variable-stiffness arch support, and lateral wedge + each arch support. Frontal plane knee and ankle/subtalar joint kinetic and kinematic outcomes were compared among insole conditions and foot posture groups using a repeated measures analysis of variance. ResultsThe lateral wedge alone and lateral wedge + variable-stiffness arch support were the only insole conditions effective at reducing the knee adduction moment. However, the lateral wedge + variable-stiffness arch support had a smaller increase in peak ankle/subtalar eversion moment than the lateral wedge alone. Supinated feet had smaller ankle/subtalar eversion excursion and moment impulse than neutral and pronated feet, across all insole conditions. SignificanceSupinated feet have less mobile ankle/subtalar joints than neutral and pronated feet and, as a result, may be less likely to respond to biomechanical intervention from orthotic insoles. Supported lateral wedge insoles incorporating an arch support design that is variable-stiffness may be better than uniform-stiffness since reductions in the knee adduction moment can be achieved while minimizing increases in the ankle/subtalar eversion moment.

Study of effectiveness of lateral wedge insole on medial compartment of osteoarthritis of knee treated with viscosupplementation

Context: Knee Osteoarthritis (OA) is a common disorder affecting the elderly population in the Asia-Pacific region. The goals of OA treatment include alleviation of pain and improvement of functional status. There is lack of consensuses regarding the management of knee OA. Aims: The main aim of this study is to evaluate any synergistic effect of adding lateral wedge insoles to viscosupplementation. Settings and Design: This is a randomized interventional study in which total 60 patients were selected from a tertiary care center and divided in two equal groups using computerized block randomization. Methods and Material: Group A got only VS while Group B got VS with LWI. Assessment was done at baseline and then after 2nd, 4th and 12thweeks after the intervention by using Visual Analogue Scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for function and Health Assessment Questionnaire (HAQ) for quality of life. Statistical Analysis Used: The data were entered in MS EXCEL spreadsheet and analysed by using Statistical Package for Social Sciences (SPSS) version 21.0. Results: In this study all the patients in both group showed statistically significant improvement in VAS, WOMAC and HAQ on all three follow-ups over the baseline assessment (P value