A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis

Erhart, Jennifer C.; Mündermann, Annegret; Elspas, Barbara; Giori, Nicholas J.; Andriacchi, Thomas P.

doi:10.1016/j.jbiomech.2008.06.016

Cited by 90 publications

(89 citation statements)

References 34 publications

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“…This supports the hypothesis that possible strategies to reduce the incidence of OA from knee malalignment could include orthotic footwear (31) or the deliberate adaption of a toe-out foot alignment during gait (19,20). Knee adduction moments can be modified by orthoses (32)(33)(34), variable-stiffness shoes (35), leg braces (36), and reduced walking velocity (37). Knee malalignment may be associated with alterations in foot angle in early adult life (38).…”

Section: Discussionsupporting

confidence: 53%

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

McWilliams¹,

Doherty²,

Maciewicz³

et al. 2010

Arthritis Care & Research

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Objective. To determine whether self-reported early adult life malalignment of knees or feet are risk factors for knee or hip osteoarthritis (OA). Methods. Participants in the Genetics of Osteoarthritis and Lifestyle case-control database were sent a questionnaire (n ‫؍‬ 3,022) containing line-drawing instruments for self-reported knee and foot alignment at ages 20 -29 years. Respondents were categorized as having straight, valgus, or varus knee, and straight, toe-in, or toe-out feet. Radiographic criteria were used to define current isolated knee or hip OA, combined knee and hip OA, or non-OA controls. Odds ratios (ORs), adjusted ORs, and 95% confidence intervals (95% CIs) were calculated and logistic regression was performed. Results. The response rate was 72%; 87.5% of responders (n ‫؍‬ 1,901) completed the alignment questions. Increased risk of isolated knee OA occurred with early adult varus (adjusted OR 5.16, 95% CI 2.87-9.41) and valgus knees (adjusted OR 3.16, 95% CI 1.04 -9.64). The positive association between knee OA and toe-in foot was explained by varus knee. There was an increased risk of combined knee/hip OA from varus (adjusted OR 4.52, 95% CI 2.39 -8.53) and valgus knees (adjusted OR 3.07, 95% CI 0.99 -9.54). Varus knee was associated with risk of medial tibiofemoral OA, whereas valgus knee was associated with risk of lateral tibiofemoral and lateral patellofemoral OA. Toe-out foot was associated with reduced medial patellofemoral OA. For knee OA, a multiplicative interaction analysis between occupational risks and varus/valgus yielded an OR int of 3.20 (95% CI 1.08 -9.49). Conclusion. Constitutional alignment of the leg in terms of varus or valgus knee or foot rotation may be a significant factor in determining development and distribution of knee but not hip OA.

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Section: Discussionsupporting

confidence: 53%

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

McWilliams¹,

Doherty²,

Maciewicz³

et al. 2010

Arthritis Care & Research

View full text Add to dashboard Cite

show abstract

“…A recent prospective randomized placebo controlled clinical trial found that pain was decrease by a clinically significant amount for patients wearing a variable stiffness shoe (Erhart et al, 2008;Erhart et al, 2010). This clinical benefit was attributed to the decrease in the external knee adduction moment, a change that has also been shown for a group of healthy subjects in this same shoe (Fisher et al, 2007).…”

Section: Introductionmentioning

confidence: 90%

Kinematic adaptations to a variable stiffness shoe: Mechanisms for reducing joint loading

Boyer

Federolf

Lin

et al. 2012

Journal of Biomechanics

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“…This allowed the type of footwear, which can itself independently alter knee biomechanics, to be controlled within studies. Studies testing "variables stiffness" shoes were not eligible as, although these devices work by the same mechanism, other design features may impact upon their effects, and it is unclear if shoe features could be held constant across testing conditions (22,23). Primary outcome variables of interest were specific due to their relevance to disease progression and included features of the external knee adduction moment; the first peak EKAM, second peak EKAM, and the area under the EKAM curve, the KAAI.…”

Section: Significance and Innovationsmentioning

confidence: 99%

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

Arnold

Wong

Jones

et al. 2016

Arthritis Care & Research

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Objective. Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there has been no definitive consensus on this topic. The aim of this systematic review and meta-analysis was to establish the within-subject effects of lateral wedge insoles on knee joint load in people with medial knee OA during walking. Methods. Six databases were searched from inception until February 13, 2015. Included studies reported on the immediate biomechanical effects of lateral wedge insoles during walking in people with medial knee OA. Primary outcomes of interest relating to the biomechanical risk of disease progression were the first and second peak external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI). Eligible studies were pooled using random-effects metaanalysis.Results. Eighteen studies were included with a total of 534 participants. Lateral wedge insoles resulted in a small but statistically significant reduction in the first peak EKAM (standardized mean difference [SMD] 20.19; 95% confidence interval [95% CI] 20.23, 20.15) and second peak EKAM (SMD 20.25; 95% CI 20.32, 20.19) with a low level of heterogeneity (I 2 5 5% and 30%, respectively). There was a favorable but small reduction in the KAAI with lateral wedge insoles (SMD 20.14; 95% CI 20.21, 20.07, I 2 5 31%). Risk of methodologic bias scores (quality index) ranged from 8 to 13 out of 16. Conclusion. Lateral wedge insoles cause small reductions in the EKAM and KAAI during walking in people with medial knee OA. Current evidence demonstrates that lateral wedge insoles appear ineffective at attenuating structural changes in people with medial knee OA as a whole and may be better suited to targeted use in biomechanical phenotypes associated with larger reductions in knee load.

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A variable-stiffness shoe lowers the knee adduction moment in subjects with symptoms of medial compartment knee osteoarthritis

Cited by 90 publications

References 34 publications

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

Self‐reported knee and foot alignments in early adult life and risk of osteoarthritis

Kinematic adaptations to a variable stiffness shoe: Mechanisms for reducing joint loading

Lateral Wedge Insoles for Reducing Biomechanical Risk Factors for Medial Knee Osteoarthritis Progression: A Systematic Review and Meta‐Analysis

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