Effects of a novel foot–ankle orthosis in the non-operative treatment of unicompartmental knee osteoarthritis

Abstract

IntroductionUnloader braces are non-surgical treatment options for patients with unicompartmental knee osteoarthritis (OA). However, many patients do not adhere to brace treatment because of complications related to discomfort and poor fit. An alternative to knee bracing is an ankle–foot orthosis (AFO) with a lever arm that presses the lower leg into valgus or varus. The aim of this study is to evaluate the clinical benefits of this AFO for patients with unicompartmental knee OA.Materials and methodsTwenty-three patients with knee OA were enrolled in this observational study. The primary clinical outcome measure was the Western Ontario and McMasters Universities Arthritis Index (WOMAC) total score. Secondary outcome measures included WOMAC subscores, visual analogue pain scale, activity restriction and complication rate. Clinical scores were collected at start and 3, 6, 9, and 12 months after enrollment. Statistical evaluation was performed using the Student’s t test.ResultsOf the patients enrolled, 83 % suffered from medial compartment OA. Most patients had Grade II OA according to the Kellgren and Lawrence classification. WOMAC total score, both subscores and visual analogue pain scale were significantly improved over time. Patients also noted a reduction in restrictions to activities of daily living and sport-related activities while using the AFO. No patients discontinued orthosis use because of adverse effects. Two types of complications were noted: discomfort or light pressure sores around the ankle (7 patients), and wear and tear of the shoe in which the AFO was worn (14 patients).ConclusionsThis observational study suggests that this AFO is effective at significantly reducing pain and stiffness as well as improving the physical function of patients with mild to moderate unicompartmental osteoarthritis of the knee.

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

“…So far, only a few and partly controversial results have been obtained on ankle-foot orthoses in the context of knee osteoarthritis. Studies by Petersen et al 21 and Menger et al 22 reported positive influences on pain and functional outcomes., On the contrary, the study by Sliepen et al 23 described a clinically relevant deterioration of the same measures after a six-week intervention with an ankle-foot orthosis. Our results complement this spectrum: Health-related quality of life was improved by the ankle-foot orthosis and even by the lateral wedge insole despite the only marginal biomechanical effects of the latter.…”

Varus Knee Limits Pain Relief Effects of Laterally Wedged Insoles and Ankle-Foot Orthoses in Medial Knee Osteoarthritis

“…As far as the authors are aware, there are no comparable results on AFO and limb alignment in the scientific literature. The clinical results of this investigation, however, allow the hypothesis that the positive clinical results described above with pain reduction and functional improvement may be improved by careful patient selection (16,17).…”

“…with knee osteoarthritis (14)(15)(16)(17). Nevertheless, not all patients within these cohorts benefited from AFO treatment.…”

Osteoarthritis of the Knee in Middle-age Athletes: Many Measures are Practiced, but Lack Sound Scientific Evidence

“…The LWIs are the most widely used to decrease the weight bearing load on the medial compartment of the knee. This type of insoles could be useful in patients with medial OA of the knee, aiming to slow down the progression of the OA process 57,58. Moreover, soft lateral wedge arch support insoles, compared with rigid ones, improve the symptoms of patients both in daily and in sports activities such as running 59…”