Wedge Insoles Research Articles

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<0.001, ɳp2=.329} , pain (p<0.001, ɳp2=.559), functional activities (p<0.001, ɳp2=.394), recreational activities (p<0.001, ɳp2=.369) and quality of life (p<0.001, ɳp2=.280). The CPT group showed more significant improvement (p<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

Efficacy of unloader knee orthosis and lateral wedge insole on static balance in medial knee osteoarthritis

Background Medial knee osteoarthritis can contribute to pain and stiffness, interfere with balance and limit functional activities of daily living. Unloader knee orthosis or lateral wedged insoles are current conservative approaches used to treat these conditions. The aim of this study was to identify and compare the effects of them on the balance parameters. Methods 66 subjects with mild to moderate medial knee osteoarthritis were randomly assigned to wear unloader knee brace or full-length 6° lateral wedge insole. Primary outcome balance parameters were stability %, path length and average velocity of center of pressure and mobility score which were investigated by HUMAC® Balance and Tilt system. Secondary outcome measures were knee function score using Knee Injury and Osteoarthritis Outcome Score scale. Assessment was performed at baseline and six months post orthotic intervention period. Findings Both orthoses improved all parameters compared to the baseline condition (p < 0.05). Unloader knee orthosis showed a significant improvement in all balance parameters compared to lateral wedged insoles (p < 0.001) except mobility scores (p = 0.527). Except activities of daily living (p = 0.752) and sports and recreational activities (p = 0.437), unloader knee orthosis had a greater effect on the pain (p = 0.002) and symptoms (p < 0.001) sub scales than lateral wedged insoles. However, quality of life sub-scale scores for insoles were more effective than the knee orthosis. Interpretation Unloader knee orthosis improved balance and knee function scores more than lateral wedged insole, though both orthoses produced significantly improved results compared to baseline assessment.

Effect of Physical Therapy Treatment in Knee Osteoarthritis with and without Wedge Insole: Randomized Controlled Trial

The purpose of this study was to determine the effects of physical therapy treatment in knee osteoarthritis with and without wedge support.Methods: This randomized controlled trail was conducted at Outpatient Department of Physical Therapy, Mayo Hospital, Lahore and Mid City Hospital, Lahore. Eighty patients with knee osteoarthritis were selected using a predefined inclusion and exclusion criteria and randomly allocated in two treatment groups; Group A (Routine physiotherapy treatment) and Group B (Routine physiotherapy with wedge insole). Outcome were recorded at the start and at the end of treatment at 3 weeks in terms of pain and disability as recorded on Numeric Pain Rating Scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) respectively. The collected data was entered and analyzed using SPSS v25 with p value < 0.05 as significant.Results: At the end of the third week, there was a statistically significant difference between the two treatment groups in terms of VAS (Mean Difference 1.55; p value 0.05) and WOMAC (Mean Difference 5.53; p value 0.0001). A statistically significant difference in before and after treatment VAS and WOMAC score was also noted within each group with p value <0.0001.Conclusion: In comparison to conventional physical therapy alone, adding wedge insoles to the routine physical therapy treatment of Knee Osteoarthritis results in better pain relief and function improvement.

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...

Effect of Physical Therapy Treatment in Knee Osteoarthritis with and without Wedge Insole: Randomized Controlled Trial

The purpose of this study was to determine the effects of physical therapy treatment in knee osteoarthritis with and without wedge support.Methods: This randomized controlled trail was conducted at Outpatient Department of Physical Therapy, Mayo Hospital, Lahore and Mid City Hospital, Lahore. Eighty patients with knee osteoarthritis were selected using a predefined inclusion and exclusion criteria and randomly allocated in two treatment groups; Group A (Routine physiotherapy treatment) and Group B (Routine physiotherapy with wedge insole). Outcome were recorded at the start and at the end of treatment at 3 weeks in terms of pain and disability as recorded on Numeric Pain Rating Scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) respectively. The collected data was entered and analyzed using SPSS v25 with p value < 0.05 as significant.Results: At the end of the third week, there was a statistically significant difference between the two treatment groups in terms of VAS (Mean Difference 1.55; p value 0.05) and WOMAC (Mean Difference 5.53; p value 0.0001). A statistically significant difference in before and after treatment VAS and WOMAC score was also noted within each group with p value <0.0001.Conclusion: In comparison to conventional physical therapy alone, adding wedge insoles to the routine physical therapy treatment of Knee Osteoarthritis results in better pain relief and function improvement.

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

Is there a dose-response of medial wedge insoles on lower limb biomechanics in people with pronated feet during walking and running?

Although the effects of medial wedge insoles on lower limb biomechanics have been investigated, information about the effects of different magnitudes of medial posting is still lacking. What are the dose-response effects of medial wedge insoles with postings varying between 0 °, 3 °, 6 °, and 9 ° of inclination on the lower limb biomechanics during walking and running in individuals with pronated feet? Sixteen participants with an FPI ≥ 6 were recruited. Four arch-supported insole conditions with varying degrees of medial heel wedge were tested (0°, 3°, 6°, and 9°). A 3D motion analysis system with force plates was used to obtain the kinetics and kinematics of walking and running at self-selected speeds. To compare the ankle, knee, and hip angles and moments among conditions, a time series analysis was performed using Statistical Parametric Mapping (SPM). A reduction in ankle eversion angle was observed during walking for all insoles. For running, the 6° and 9° insoles decreased the ankle eversion angle during early stance and increased this angle during the propulsive phase. A decrease in ankle eversion moment was observed in walking and running for 6° and 9° insoles. An increase in knee adduction moment occurred in walking and running for all insoles. For hip, the 6° and 9° insoles showed, during walking, a decrease in hip adduction angle and an increase in hip adduction and external rotation moments. For most variables, statistical differences were found for a greater period across the stance phase as the medial wedge increased, except for ankle eversion moment and hip external rotation moment during walking. The biomechanical effects over the time series for many of the parameters increased with the addition of insole inclination, showing a dose-response effect of medial wedge insoles on the lower limb biomechanics during walking and running in adults with excessive foot pronation.

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).

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.

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.

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.

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.