Biomechanical changes accompanying unilateral and bilateral use of laterally wedged insoles with medial arch supports in patients with medial knee osteoarthritis

Abdallah, Amira A. A.; Radwan, Ahmed

doi:10.1016/j.clinbiomech.2011.03.013

Cited by 35 publications

(55 citation statements)

References 52 publications

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“…Laterally wedged insoles reduce knee adduction moment temporarily, but the reduction of moment arm, and thus the valgus effect, is doubtful. Two small studies that compared the knee adduction moment data of neutral versus laterally wedged insoles show conflicting effects of the lateral wedge, but the differences were small in both studies [1,2].…”

Section: Discussionmentioning

confidence: 98%

Do Laterally Wedged Insoles or Valgus Braces Unload the Medial Compartment of the Knee in Patients With Osteoarthritis?

Duivenvoorden¹,

Raaij

Horemans³

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The results of conservative treatment of knee osteoarthritis (OA) are generally evaluated in epidemiological studies with clinical outcome measures as primary outcomes. Biomechanical evaluation of orthoses shows that there are potentially beneficial biomechanical changes to joint loading; however, evaluation in relation to clinical outcome measures in longitudinal studies is needed. Questions/purposes We asked (1) is there an immediate effect on gait in patients using a laterally wedged insole or valgus knee brace; (2) is there a late (6 weeks) effect; and (3) is there a difference between subgroups within each group with respect to patient compliance, body mass index, and OA status? Methods This was a secondary analysis of data from a previous randomized controlled trial of patients with early medial knee OA. A total of 91 patients were enrolled in that trial, and 73 (80%) completed it after 6 months. Of the enrolled patients, 80 (88%) met prespecified inclusion criteria for analysis in the present study. The patients were randomized to an insole or brace. Gait was analyzed with and without wearing the orthosis (insole or brace) at baseline and after 6 weeks. Measurements were taken of the knee adduction moment, ground reaction force, moment arm, walking speed, and toe-out angle. Data were analyzed with regression analyses based on an intention-to-treat principle. Results A mean reduction of 4% (± 10) (95% confidence interval [CI], À0.147 to À0.03, p = 0.003) of the peak knee adduction moment and 4% (± 13) (95% CI, À0.009 to À0.001, p = 0.01) of the moment arm at baseline was observed in the insole group when walking with an insole was compared with walking without an insole. A mean reduction of 1% (± 10) (95% CI, À0.002 to À0.001, p = 0.001) of the peak knee adduction moment and no reduction of the moment arm were measured after 6 weeks.

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Section: Discussionmentioning

confidence: 98%

Do Laterally Wedged Insoles or Valgus Braces Unload the Medial Compartment of the Knee in Patients With Osteoarthritis?

Duivenvoorden¹,

Raaij

Horemans³

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…All but 4 studies were withinsubjects repeated-measures designs, with the remaining being randomized trials (30)(31)(32)(33). Four studies reported the use of the ACR criteria (31,(34)(35)(36), with 10 stating cutoffs regarding the severity of knee pain (13,14,21,31,32,34,(36)(37)(38)(39), most commonly .3 of 10 on a visual analog scale (13,14,21,31,32,34,37). This definition varied across studies according to the activity, with pain recalled during walking (29,38), walking 2 blocks and/or climbing stairs (36), weight-bearing activities (37), and on most days of the past month (21,32,39).…”

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confidence: 99%

“…All studies included radiographic assessment of tibiofemoral OA. This was most commonly defined as Kellgren/Lawrence grade 2 and above (13,14,21,29,31,32,34,37,38,40). Presence of medial joint space narrowing greater than lateral (13,32, 29,32,33,35,36,38,39) and/or varus knee alignment (13,30, 36,40,41) were used to limit participants to those with medial tibiofemoral OA.…”

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confidence: 99%

“…The most common insole inclination angle was 5 degrees (13,21,29,32,33,36,38,39,43), with insole angles ranging from 4 (40) to 11 degrees (34). The presence of a concomitant medial arch support was common with 4 studies modifying generic insoles (14,31,37,43) and 3 used a bespoke design (29,33,38).…”

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confidence: 99%

“…Fourteen studies prescribed the same insole to all participants, with the remaining 4 using a customized amount based on comfort and/or pain level (14,31,35,37). A flat insole was the comparison condition in 4 studies (14,31,34,37), 7 studies used participants' own footwear (13,21,30,32,36,40,43), 5 studies used standardized footwear (29,33,35,39,42), 1 study used both a flat insole and participants' own footwear (39), and 1 study did not report the type of footwear (41). Walking speed was either controlled across conditions within a threshold of each participants' preferred speed (13,14,21,31,32,37), (43).…”

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confidence: 99%

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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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Association of bilateral flat feet with knee pain and disability in patients with knee osteoarthritis: A cross‐sectional study

Iijima

Ohi

Isho

et al. 2017

Journal Orthopaedic Research

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This cross-sectional study examined the relationship of flat feet with knee pain, disability, and physical performance in patients with knee osteoarthritis (OA). Orthopedic clinic participants (n = 95; age 61-91 years; 68.4% women) with Kellgren-Lawrence (K/L) grade ≥1 in the medial compartment underwent evaluation of navicular height and foot length for flat feet. Knee pain intensity, disability, and physical performance were evaluated using the Japanese Knee Osteoarthritis Measure, 10-m walk, timed up and go, and five-repetition chair stand tests. Of the 95 enrolled patients, 24 (25.3%) had bilateral flat feet, and significantly higher knee pain compared to patients with no flat feet (11.3 ± 8.23 points vs. 6.58 ± 6.37 points; p = 0.043). A ordinal logistic regression analysis showed that bilateral flat feet were significantly associated with increased knee pain (proportional odds ratio: 5.48, 95% confidence interval: 1.96, 15.3; p = 0.001) compared with no flat feet, adjusted for age, sex, body mass index, and tibiofemoral joint K/L grade, which is consistent across various different cutoffs of the definition of flat feet. Physical performance was similar between patients with and without bilateral flat feet. The presence of unilateral flat feet was not significantly associated with any outcome measures. These findings indicate that bilateral, but not unilateral, flat feet are associated with worse knee pain. A prospective study investigating a causal relationship between bilateral flat feet posture and knee pain as well as disability would be of particular interest to verify the potential adverse effect of altered foot posture. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2490-2498, 2017.

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Biomechanical changes accompanying unilateral and bilateral use of laterally wedged insoles with medial arch supports in patients with medial knee osteoarthritis

Cited by 35 publications

References 52 publications

Do Laterally Wedged Insoles or Valgus Braces Unload the Medial Compartment of the Knee in Patients With Osteoarthritis?

Do Laterally Wedged Insoles or Valgus Braces Unload the Medial Compartment of the Knee in Patients With Osteoarthritis?

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

Association of bilateral flat feet with knee pain and disability in patients with knee osteoarthritis: A cross‐sectional study

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