Lateral Wedge Insoles Research Articles

The use of lateral wedge insoles delays osteoarthritis progression and improves clinical outcomes in medial meniscus posterior root repair.

The purpose of this retrospective study was to evaluate the efficacy of using a lateral wedge insole (LWI) during the first 3 months after medial meniscus posterior root (MMPR) repair. Overall, 179 patients were categorized into LWI use (LWI group, 90 patients) and nonuse (control group, 89 patients) groups. Patients in the LWI group were instructed to wear an LWI from the initiation of load bearing up to 3 months postoperatively. Medial meniscus extrusion (MME) was evaluated preoperatively and 1 year postoperatively, Kellgren-Lawrence (KL) grade and clinical scores were evaluated preoperatively and 2 years postoperatively, and second-look arthroscopic meniscal healing scores were evaluated at 1 year postoperatively. The proportion of patients with KL grade progression at 2 years postoperatively was significantly lower in the LWI group than in the control group (23.3% vs. 39.3%; p = 0.024). Change in the MME at 1 year postoperatively was significantly smaller in the LWI group than in the control group (1.1 ± 1.2 vs. 1.6 ± 1.4 mm; p = 0.042). The Lysholm score (p = 0.003) and Knee Injury and Osteoarthritis Outcome Scores-sport and recreation function (p = 0.027) at 2 years postoperatively were significantly superior in the LWI group than in the control group. The arthroscopic meniscal healing score after 1 year was not significantly different between the LWI and control groups (total score, 7.6 ± 1.1 vs. 7.4 ± 1.3 points; p = 0.732). The anteroposterior width of the repaired posterior root at 1 year second-look evaluation was significantly broader in the LWI group than in the control group (7.7 ± 1.6 vs. 6.9 ± 1.6 mm; p = 0.001). The use of LWI is an effective way to delay postoperative osteoarthritis progression and improve clinical outcomes after MMPR repair. Level III.

Effect of lateral wedge length on knee adduction moment reduction mechanics during gait.

Lateral wedge insole (LWI) wear is a well-known conservative treatment for patients with knee osteoarthritis and is expected to decrease knee joint loading. Although the effect of LWI length on knee adduction moment (KAM) has been investigated, the biomechanical mechanism has not been fully investigated. Twelve healthy young subjects walked in the laboratory with and without 2 different lengths of LWIs. Three-dimensional motion analysis was performed to calculate the first and second peaks and impulses of the KAM during the stance phase. In addition, the knee-ground reaction force lever arm (KLA) and center of pressure (COP), ankle eversion moment, and ankle eversion angle were calculated. The first peak of KAM was lower, COP was displaced outward, and KLA was shorter with both LWIs attached. On the other hand, the second peak of KAM was lower with longer LWIs, COP was displaced outward, and KLA was shorter. The KAM impulse was significantly smaller in the condition with longer LWI than in the other conditions with smaller ankle eversion motion; longer LWI induced COP to the lateral side through the stance phase and kept KLA short, thus reducing the KAM impulse.

Effect of lateral wedge insole on medial meniscus extrusion and its association with knee osteoarthritis progression.

Medial meniscus extrusion (MME) is associated with knee osteoarthritis (OA) progression because of increased loading stress in the medial compartment of the knee. Using a lateral wedge insole (LWI) decreases loading stress and immediately reduces MME. To investigate whether the wearing duration of LWI affects the midterm response to MME and is associated with knee OA progression. Cohort study. Twenty-three patients with knee OA who were conservatively treated with LWI were classified according to the duration of the LWI wear per day: less than 5 h (short-duration group) or over 5 h (long-duration group). MME was evaluated in the single-leg standing position by ultrasound. Knee OA progression and limb alignment were evaluated radiographically. These evaluations were performed thrice: at the initial office visit as a baseline without LWI (time 0), with LWI (LWI-time 0), and 1 year after intervention with LWI (LWI-1 year). In both groups, the MMEs at LWI time 0 were significantly decreased compared with those at time 0. In the long-duration group, this reduction in MME was maintained 1 year after the intervention compared with time 0 (time 0: 3.9 ± 0.9, LWI-1 year: 2.6 ± 1.1), but this improvement was not observed in the short-duration group (time 0: 3.8 ± 1.7, LWI-1 year: 3.6 ± 1.7). In addition, three of four patients demonstrated OA progression, and varus alignment had significantly progressed compared with that at time 0 in the short-duration group. However, the long-duration group showed OA progression only in one patient and maintained limb alignment. The duration of wearing LWI affects the midterm reduction of MME and knee OA progression while maintaining limb alignment.

Biomechanical response of lower limb joints to lateral wedge insoles

Lateral wedge insole (LWI) is a frequently recommended treatment option for early and midterm stages of medial knee osteoarthritis. However, studies of its effects on the lower limb joints are incomplete and imperfect. The main purpose of this study was to quantitatively analyze the response of intervention of LWI on lower-limb joint kinematics, ground reaction forces (GRFs), and centre of pressure (COP). Gait analysis of 16 healthy subjects was conducted. Three-dimensional motion data and force plate measurements were collected in the control (barefoot) and experimental conditions (wearing a pair of assigned shoes with 0, 7, and 10 mm LWIs). Results showed that the peak knee flexion angle was increased by 3.43°, 3.09°, and 3.27° with 0, 7, and 10 mm LWIs, respectively (p < 0.01). The ankle peak dorsiflexion angle was significantly decreased by 3.79°, 2.19°, and 1.66° with 0, 7, and 10 mm LWIs, respectively (p = 0.02). The internal rotation angle was increased by 2.78°, 3.76°, and 4.58° with 0, 7, and 10 mm LWIs, respectively (p < 0.01). The forefoot with LWIs showed highly significantly smaller inversion, eversion, and adduction angles (all p < 0.01). The 1st peak of the vertical GRF (p = 0.016) also increased significantly by a maximum of 0.06 body weight (BW) with LWIs. These results indicated that biomechanical changes and limitations of lateral wedges insole should be analyzed in more detail, possibly leading to new guidelines for the design and application.

Osteoarthritic Tibiofemoral Joint Contact Characteristics During Weightbearing With Arch-Supported and Standalone Lateral Wedge Insoles.

Imbalanced joint load distribution across the tibiofemoral surface is a risk factor for osteoarthritic changes to this joint. Lateral wedge insoles, with and without arch support, are a form of biomechanical intervention that can redistribute tibiofemoral joint load, as estimated by external measures of knee load. The objective of this study was to examine the effect of these insoles on the internal joint contact characteristics of osteoarthritic knees during weightbearing. Fifteen adults with tibiofemoral osteoarthritis underwent magnetic resonance imaging of the affected knee, while standing under 3 insole conditions: flat control, lateral wedge alone, and lateral wedge with arch support. Images were processed, and the surface area and centroid location of joint contact were quantified separately for the medial and lateral tibiofemoral compartments. Medial contact surface area was increased with the 2 lateral wedge conditions compared with the control (P ≤ .012). A more anterior contact centroid was observed in the medial compartment in the lateral wedge with arch support compared with the lateral wedge alone (P = .009). Significant changes in lateral compartment joint contact outcomes were not observed. These findings represent early insights into how loading at the tibiofemoral interface may be altered by lateral wedge insoles as a potential intervention for knee osteoarthritis.

Effect of Hind- and Fore-Foot Eversion on Positional and Rotational Displacement of the Knee in Standing Posture.

We investigated the effects of hindfoot and forefoot eversion on the knee's positional and rotational displacement, plantar pressure, and foot discomfort in a standing posture, beyond the traditional focus on external knee adduction moments (EKAM) in lateral wedge insoles. Twenty-six healthy participants underwent hindfoot eversion from 0 to 10 degrees in 2-degree increments, and forefoot eversion from 0 degrees to the hindfoot eversion angle in 2-degree increments in a standing posture. At each eversion angle, the knee's medial displacement, EKAM's moment arm decrease, plantar pressure changes, and foot discomfort were obtained and compared across varying angles. Both hindfoot-only and entire-foot eversion led to significant medial knee displacement and the EKAM's moment arm decrease, with more pronounced effects in entire-foot eversion. At each hindfoot eversion angle, increasing forefoot eversion resulted in significant medial knee displacement and EKAM's moment arm decrease. Lower leg rotations were not significantly affected in hindfoot-only eversion but displayed significant medial tilting and internal rotation in entire-foot eversion at specific combinations. Varying eversion angles significantly influenced the forefoot pressure, with heel pressure remaining unaffected. Notably, the lateral forefoot pressure increased significantly as the forefoot eversion angle increased, particularly at higher hindfoot eversion angles. Foot discomfort increased significantly with higher eversion angles, particularly in entire-foot eversion, and also increased significantly as the forefoot eversion angle increased at higher hindfoot eversion angles. Insole configurations incorporating 6-10 degrees of hindfoot eversion and 40-60% forefoot eversion of the hindfoot angle may offer optimized biomechanical support for knee osteoarthritis patients.

Effects of gait modifications on tissue-level knee mechanics in individuals with medial tibiofemoral osteoarthritis: A proof-of-concept study towards personalized interventions.

Gait modification is a common nonsurgical approach to alter the mediolateral distribution of knee contact forces, intending to decelerate or postpone the progression of mechanically induced knee osteoarthritis (KOA). Nevertheless, the success rate of these approaches is controversial, with no studies conducted to assess alterations in tissue-level knee mechanics governing cartilage degradation response in KOA patients undertaking gait modifications. Thus, here we investigated the effect of different conventional gait conditions and modifications on tissue-level knee mechanics previously suggested as indicators of collagen network damage, cell death, and loss of proteoglycans in knee cartilage. Five participants with medial KOA were recruited and musculoskeletal finite element analyses were conducted to estimate subject-specific tissue mechanics of knee cartilages during two gait conditions (i.e., barefoot and shod) and six gait modifications (i.e., 0°, 5°, and 10° lateral wedge insoles, toe-in, toe-out, and wide stance). Based on our results, the optimal gait modification varied across the participants. Overall, toe-in, toe-out, and wide stance showed the greatest reduction in tissue mechanics within medial tibial and femoral cartilages. Gait modifications could effectually alter maximum principal stress (~20 ± 7%) and shear strain (~9 ± 4%) within the medial tibial cartilage. Nevertheless, lateral wedge insoles did not reduce joint- and tissue-level mechanics considerably. Significance: This proof-of-concept study emphasizes the importance of the personalized design of gait modifications to account for biomechanical risk factors associated with cartilage degradation.

The influence of lateral wedged insoles on performance and ankle joint biomechanics of lateral movements

The influence of lateral wedged insoles on performance and ankle joint biomechanics of lateral movements

The Relationship Between the Effects of Lateral Wedge Insoles and Kinematic Chain Dynamics Between the Hindfoot and Lower Leg in Patients With Osteoarthritis of the Knee.

Purpose We aim to determine whether kinematic chain dynamics of the hindfoot and lower leg are involved in the effect of a lateral wedge insole (LWI) on reducing lateral thrust among patients with medial compartment knee osteoarthritis (KOA). Participants and methods Eight patients with knee osteoarthritis were included in the study. Evaluation of the kinematic chain and gait analysis was performed using an inertial measurement unit (IMU). The dynamics of the kinematic chain were calculated as linear regression coefficients of the external rotation angle of the lower leg relative to the inversion angle of the hindfoot during repeated inversion and eversion of the foot in the standing position (kinematic chain ratio (KCR)). Walk tests were performed under four conditions: barefoot (BF), neutral insole (NI) with an incline of 0 degrees, and LWI with an incline of approximately 5 and 10 degrees (5LWI and 10LWI, respectively). Results The mean (± standard deviation (SD)) KCR was 1.4 ± 0.5. The KCR was significantly correlated with the change in 5LWI lateral thrust acceleration relative to BF (r = 0.74). A significant correlation was also observed between changes in the hindfoot evolution angle and lower leg internal rotation angle with a 10LWI with respect to BF and NI, and changes in lateral thrust acceleration. Conclusion The results of this study suggest that the kinematic chain is involved in the effects of an LWI in patients with knee osteoarthritis.

Effects of footwear modification along with physiotherapy on activity of daily living (ADLS) in patients with medial knee osteoarthritis

Background: the management of osteoarthritis (OA) of the knee with biomechanical therapies claimed that application of orthotic devices is another crucial component of a rehabilitation program. Several footwear modifications are used to lessen medial knee loading (MKL), which helps to reduce pain and other symptoms. Objective: to compare the effects of lateral heel wedge insole alone and in combination with medial arch support on ADLs in patient with medial knee OA. Methodology: A randomized clinical trial was conducted on n=60 patients with medial knee OA were randomly allocated in to group A, received lateral heel wedge insole (LHWI) along with medial arch support (MAS) and group B only adjusted with LHWI. Nonprobability convenient sampling technique was used to collect the data on the knee injury and osteoarthritis outcomes score (KOOS) was used as outcome measures. The outcome measures were assessed at the baseline, and after 8 and 16 weeks. Results: The results of independent t-test showed that group A which received LHWI along with MAS showed more significant improvement (p&lt;0.05) in pain, ADLs, sports activity on KOOS questionnaire at each level of assessment than group B which only received the LHWI. But KOOS quality of life scores only showed significant improvement after 8 weeks of intervention in group A while after 16th weeks no significant difference (p=0.09) was observed. Conclusion: the lateral wedge insoles with medial arch support combined with conventional physical therapy protocol is more effective to improve activities of daily living (ADLS) in patients having medial knee osteoarthritis. Keywords: Footwear, osteoarthritis, lateral heel wedge insoles, KOOS, ADLs.

The effect of gait modification on the response of medial meniscus extrusion during gait in patients with knee osteoarthritis

BackgroundAn increase in medial meniscus extrusion during weight-bearing conditions is associated with the progression of medial knee osteoarthritis (OA). Toe-out gait modification has been known to reduce the knee adduction moment (KAM); however, its effect on reducing the increase in medial meniscus extrusion in patients with knee OA remains unclear. Research questionTo (1) evaluate the effect of toe-out gait on the increase in medial meniscus extrusion and the KAM in patients with medial knee OA and (2) investigate the synergetic effect of lateral wedge insoles in combination with toe-out gait in determining the most effective intervention for reducing medial meniscus extrusion during gait. MethodsTwenty-five patients with medial knee OA were enrolled in this study. Participants walked under four conditions: normal gait, toe-out gait, normal gait with lateral wedge insoles, and toe-out gait with lateral wedge insoles. Medial meniscus extrusion and KAM peaks during gait were measured using ultrasound and a three-dimensional motion analysis system in each condition. These parameters were compared among the four conditions using repeated measures analysis of variance. ResultsThe increase in medial meniscus extrusion and the second KAM peak were significantly lower in all interventions compared with those observed during normal gait. However, there was no significant difference among the interventions. SignificanceThis study suggested that toe-out gait reduces the increase in medial meniscus extrusion and is associated with the reduction of the second KAM peak. However, no synergistic effect of lateral wedge insoles and toe-out gait was observed.

Evaluation of the Effect of Knee Unloader Orthoses, Lateral Wedge Insoles, and Ankle Foot Orthoses on Pain, Function, and Knee Adduction Moment in Subjects with Medial Compartment Knee Osteoarthritis: A Literature Review

ABSTRACT Introduction Osteoarthritis (OA) is a destructive joint disease and a major cause of pain in the elderly. The use of supportive orthoses including valgus knee brace, lateral wedged insole, and ankle-foot orthosis (AFO) is a common treatment for these people. The purpose of this review of the literature is to evaluate the effect of orthoses on pain, function, and adduction moment (AM) of individuals with medial knee OA. Method The search was conducted among articles published from 2010 to 2021 in bibliographic online databases including ISI Web of Science, PubMed, Scopus, and Google Scholar. The potential titles and abstracts were reviewed based on the study inclusion criteria. All randomized controlled trial (RCT) studies on the effectiveness of valgus knee brace, AFO, and lateral wedged insoles in subjects with medial knee OA were reviewed. The search terms were OA, medial knee osteoarthritis, medial joint arthritis, unloader knee brace, valgus knee brace, knee sleeve, lateral wedge insole, AFO, ankle-foot orthosis, function, pain, alignment, kinetic, kinematic, and AM. Result Forty-two articles were reviewed to determine the current research process. Thirteen studies evaluated the effect of lateral wedge insole on pain, function, and AM in subjects with medial compartment knee OA. Ten studies evaluated unloader knee braces. Nine studies evaluated unloader knee brace compared with lateral wedge insole, three studies evaluated AFO, and seven studies examined the combination of knee braces and lateral wedge insoles on pain, function, and AM. Conclusion All three orthoses in short-term follow-up reduced the AM in subjects with medial knee OA. Lateral wedge insoles did not support pain reduction in studies. The results of this study showed that knee braces may have a more lasting effect on the knee joint in the long run than lateral wedge insoles. Although the number of studies that evaluated the effect of AFOs on outcomes of subjects with knee OA is low, this intervention was found to be effective in relieving pain and reducing AM. Clinical Relevance In clinical studies, clinical relevance in patients with medial knee OA, orthoses effectively reduced external knee AM and pain sensation during daily activities. Thus, use of orthoses effectively supports conservative treatment in medial knee OA.

The Effect of Lateral Wedge Insole on Gait Variability Assessed Using Wearable Sensors in Patients with Medial Compartment Knee Osteoarthritis.

Lateral thrust seen in people with medial compartment knee osteoarthritis can cause dynamic knee instability and poor postural control during gait cycles. A lateral wedge insole can reduce the lateral thrust and may have a favorable effect on gait variability, which in turn may indicate gait instability improves. The aim of this study was to investigate the effect of lateral wedge insole on gait variability in knee osteoarthritis patients. We involved 15 symptomatic knee osteoarthritis patients who were provided with lateral wedge insole and 13 healthy asymptomatic volunteers as the control group. The gait variability was evaluated as the coefficient of variation of stride, stance, and swing duration based on acceleration monitoring using a wearable sensor. The lateral thrust was estimated as the lateral acceleration peak on the shank sensor. These measurements were performed without lateral wedge insole (baseline), immediately with lateral wedge insole (T0) at the initial office visit and one month after intervention (T1). Our data showed that the stance duration coefficient of variation and lateral thrust at T1 in the knee osteoarthritis group, were significantly decreased compared to the baseline values and these values were identical to those in the control group. The lateral wedge insole reduces dynamic knee instability and could improve gait variability in medial compartment knee osteoarthritis.

Clinically-accessible and laboratory-derived predictors of biomechanical response to standalone and supported lateral wedge insoles in people with knee osteoarthritis

BackgroundLateral wedge insoles (both standalone and those incorporating individualized arch support) have been frequently studied for the effects on knee joint loading and pain in people with knee osteoarthritis. It has been shown that many people who use these insoles do not obtain the intended biomechanical effect, and thus may not experience a clinical benefit. The ability to identify biomechanical responders to lateral wedge insoles before research or clinical intervention is an important objective for efficient resource use and optimizing patient outcomes. The purpose of our exploratory, hypothesis-generating study was to provide an initial assessment of variables that are associated with the biomechanical response to lateral wedge insoles in people with knee osteoarthritis.MethodsWe collected a number of demographic (age, sex, body mass index, foot posture), clinical (knee pain, foot pain, radiographic disease severity), and walking-related (speed, knee alignment, frontal plane subtalar movement, and foot rotation) outcomes from 53 individuals with painful, radiographically-confirmed knee osteoarthritis. The walking-related outcomes were obtained using equipment both from the research laboratory and the clinical setting. We used logistic regression to generate predictive models to determine candidate variables associated with a reduction in the knee adduction moment during walking – a surrogate for tibiofemoral load distribution, and a known biomechanical risk factor for osteoarthritis progression – with the use of standalone and arch-supported lateral wedge insoles. Three different response thresholds (2%, 6%, and 10% reductions in the knee adduction moment) were used.ResultsIn general, biomechanical responders were those who walked faster, were female, had less varus alignment, and had less severe radiographic severity. Findings were similar between the standalone and arch-supported lateral wedge insoles, as well as between models using the laboratory-derived or clinically-available measures of walking performance.ConclusionsOur hypothesis-generating study provides valuable information that will inform future research into the efficient and effective use of lateral wedge insoles in the conservative management of knee osteoarthritis.

Managing Genu Varum in Adolescents to Reduce Risks of Progression to Knee Osteoarthrosis

Introduction: Genu varum is not uncommon in adolescents. Managing the condition to reduce its progression may decrease the prevalence of incident knee osteoarthrosis in adulthood. The present review examines studies on risk factors contributing to the progression of genu varum and associated with the degeneration of the medial tibiofemoral joint. We proposed approaches to decrease the magnitude of genu varum and external knee adduction moment, to reduce the incidence of knee osteoarthrosis in the aged population. Methods and Materials: Literature searches were conducted in Pubmed, Embase, and Cochrane Systematic Reviews, using keywords individually and in combinations. We excluded papers on pathological genu varum, tibia vara, Blount disease, nutritional rickets, imaging, and surgery and included only articles on genu varum involving children and young adults. Reference lists of the included papers were also screened manually for additional references. Results and Discussion: Search results showed that many children with physiologic genu varum are deficient or insufficient in vitamin D. High-impact exercises in late children and adolescents promote genu varum. In contrast, therapeutic exercises reduce the magnitude of genu varum in young adults with postural bowlegs. Lateral wedge insoles decrease the external knee adduction moment. We proposed to check the serum vitamin D level of children and adolescents with genu varum. Growing children with genu varum should be advised to reduce the frequency of performing high-impact exercises. Adolescents with genu varum should strengthen the external hip rotators and use lateral wedged insoles.

Changes in the Kinematics of Midfoot and Rearfoot Joints with the Use of Lateral Wedge Insoles.

The lateral wedge insole (LWI) is a typical orthopedic treatment for medial knee osteoarthritis pain, chronic ankle instability, and peroneal tendon disorders. It is still unknown what the effects are in the most important joints of the foot when using LWIs as a treatment for knee and ankle pathologies. Objectives: The aim of this study was to determine the influence of LWIs on the position of the midfoot and rearfoot joints by measuring the changes using a tracking device. Methods: The study was carried out with a total of 69 subjects. Movement measurements for the midfoot were made on the navicular bone, and for the rearfoot on the calcaneus bone. The Polhemus system was used, with two motion sensors fixed to each bone. Subjects were compared by having them use LWIs versus being barefoot. Results: There were statistically significant differences in the varus movement when wearing a 4 mm LWI (1.23 ± 2.08°, p < 0.001) versus the barefoot condition (0.35 ± 0.95°), and in the plantarflexion movement when wearing a 4 mm LWI (3.02 ± 4.58°, p < 0.001) versus the barefoot condition (0.68 ± 1.34°), in the midfoot. There were also statistically significant differences in the valgus movement when wearing a 7 mm LWI (1.74 ± 2.61°, p < 0.001) versus the barefoot condition (0.40 ± 0.90°), and in the plantar flexion movement when wearing a 4 mm LWI (2.88 ± 4.31°, p < 0.001) versus the barefoot condition (0.35 ± 0.90°), in the rearfoot. Conclusions: In the navicular bone, a varus, an abduction, and plantar flexion movements were generated. In the calcaneus, a valgus, an adduction, and plantar flexion movements were generated with the use of LWIs.

Can Slight Variations to Lateral Wedge Insoles Induce Significant Biomechanical Changes in Patients with Knee Osteoarthritis?

Lateral wedge insoles are recommended in order to minimize the impacts of osteoarthritis of the knee. The amount of wedging required to induce a biomechanical response with clinical significance is still controversial. This study aimed to investigate the immediate biomechanical effects of different amounts of wedging in symptomatic medial knee OA. A 3D motion capture system and five force platforms were used to acquire walking kinematic and kinetic data along a 10 m walkway. Each participant was tested for six different lateral wedge insoles (0, 2, 4, 6, 8, and 10°) in a randomized order. Thirty-eight patients with medial osteoarthritis of the knee were recruited. The application of insoles resulted in an incremental reduction of the first peak of the external knee adduction moment under all experimental conditions in comparison with the control condition (0° insole). A significant increase (p &lt; 0.05) was observed in peak ankle eversion and in ankle eversion at the first peak of the external knee adduction moment with insoles higher than 8° and 6°, respectively. Slight variations to lateral wedge insoles, greater than 2°, appear to induce significant biomechanical changes in patients with knee osteoarthritis.

Dynamic response of medial meniscus extrusion to the lateral wedge insole is correlated with immediate pain reduction in knee osteoarthritis patients: real-time ultrasonographic study.

To investigate the effect of lateral wedge insole (LWI) on medial meniscus extrusion (MME) observed during dynamic evaluation with ultrasound and its correlation with the alteration in knee pain in patients with knee osteoarthritis (OA). This cohort study included 25 participants with knee OA. The medial meniscus was imaged during walking in video mode using ultrasonography. The degree of increase in MME (ΔMME) was calculated as the difference in the value of the maximum and minimum MME. The intensity of knee pain was evaluated immediately after the walking trial using the visual analogue scale (VAS). These measurements were performed with and without the LWI. The participants were categorised into the responder group, which was identified by the constant reduction in the VAS, and the non-responder group. MME, ΔMME, and knee pain during walking were significantly lower with the LWI than without the LWI (p < 0.01). The reduction in ΔMME with the LWI in the responder group was significantly higher than that in the non-responder group (p < 0.01). Our findings showed that MME and knee pain during walking decreased with LWI use, especially in patients whose reduction in knee pain was characterised by inhibition in the increase in MME observed during dynamic evaluation with ultrasound.

EFFECTIVENESS OF LATERAL WEDGE INSOLE ON KNEE OSTEOARTHRITIS OUTCOMES IN PAKISTANI POPULATION

Background: Osteoarthritis (OA) is a persistent joint disorder, which normally affects the weight bearing joints especially knee joint. Lateral wedge insole is one such approach suggested by professionals to manage the knee osteoarthritis. Objective: To determine the effectiveness of lateral wedge insoles on knee osteoarthritis outcomes in Pakistani population Design: A single-blinded, pretest-posttest comparison. Setting: District Headquarter (DHQ) Hospital, Bahawalnagar and National Institute of Rehabilitation Medicine (NIRM), for a time period of one month. Population: Patients with the age criteria of 40-70 years, and who had knee OA were included in the study. Methods: Participants were randomly divided in two groups; lateral wedge insoles (LWI) group (n=20), and conventional physical therapy (CPT) group (n=20). Pain, stiffness, activities of daily living, sports and recreational activities, and quality of life was assessed on Urdu version of Knee Injury and Osteoarthritis Outcome Score scale (KOOS) on every week till 4th week of intervention. Mixed ANOVA was used for interaction effect of between-subject factor (group) and within-subject factor (time) with-in group analysis and one way ANOVA for between group comparisons with their effect size (ɳp2). Results: Significant improvement with large effect size was observed in Symptoms and stiffness (p&lt;0.001, ɳp2=.329} , pain (p&lt;0.001, ɳp2=.559), functional activities (p&lt;0.001, ɳp2=.394), recreational activities (p&lt;0.001, ɳp2=.369) and quality of life (p&lt;0.001, ɳp2=.280). The CPT group showed more significant improvement (p&lt;0.001) in all domains of KOOS as compared to LWI group. Conclusion: Lateral wedge insoles (LWI) and conventional physical therapy (CPT) both have positive impact on knee osteoarthritis outcomes. But conventional physical therapy was more effective in improving functional independence. Clinical rehabilitation impact: This study provides the evidence on the use of LWI and CPT as alternative strategies to improving Knee OA outcome measures. Keywords: Knee osteoarthritis, functional independence, geriatric population, musculoskeletal physiotherapy, orthotics, quality of life, rehabilitation.

The Effect of Lateral Wedge Insole on Coordination and Coordination Variability in young Individuals with Varus Knee during Walking

The Effect of Lateral Wedge Insole on Coordination and Coordination Variability in young Individuals with Varus Knee during Walking