Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis

Parkes, Matthew; Maricar, Nasimah; Lunt, Mark; LaValley, Michael P.; Jones, Richard; Segal, Neil A.; Takahashi-Narita, Kayoko; Felson, David T.

doi:10.1001/jama.2013.243229

Cited by 96 publications

(85 citation statements)

References 46 publications

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“…However, the size of effects on pain and function varies, depending on the type of control intervention that is used. Differences in effect sizes based on RCT designs are consistent with a recent meta-analysis of lateral heel wedges for medial knee osteoarthritis (8), and largely influences the conclusions that can be drawn from such meta-analyses. Clinical trial designs that compare valgus bracing to standard care without a control orthosis emphasize external validity and might be considered more clinically relevant, regardless of the potential mechanisms at work (including placebo effects).…”

Section: Discussionsupporting

confidence: 61%

“…If so, conventional descriptors for effect sizes (37) suggest moderate improvements in both pain and function with valgus bracing, although the relatively large 95% CIs around those point estimates indicate that considerable uncertainty remains (Figure 2). Additionally, when translated into the difference between groups for improvements in WOMAC pain and function scores (8,38), the upper ends of the 95% CIs include values that would likely be considered clinically important (5 of a maximum 20 for pain, and 16 of a maximum 68 for function).…”

Section: Discussionmentioning

confidence: 99%

“…Previously reported SDs from a typical knee osteoarthritis population were then used to also translate the SMD into a difference between groups in the change score for the WOMAC pain and function subdomains (8,38).…”

Section: Moyer Et Almentioning

confidence: 99%

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Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Moyer

Birmingham

Bryant

et al. 2015

Arthritis Care & Research

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Objective. To evaluate the effects of valgus knee bracing on pain and function, and compliance and complications, in patients with medial knee osteoarthritis (OA). Methods. A meta-analysis of randomized controlled trials that compared changes in patient-reported pain and/or function in patients with medial knee OA was performed. Seven databases were searched from their inception to January 2014. Two reviewers independently determined study eligibility, rated risk of bias, and extracted data. Pooled estimates and 95% confidence intervals (95% CIs) for standardized mean differences (SMDs) for the improvement in pain (and function) were calculated. Event rates (proportions) were calculated for studies that reported complications.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Moyer

Birmingham

Bryant

et al. 2015

Arthritis Care & Research

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“…Internationally, some guidelines issue a conditional recommendation (16,17), while others do not recommend use of lateral wedge insoles on the basis of equivocal evidence of any benefit on pain or knee function (18). A recent meta-analysis demonstrated an effect of lateral wedge insoles on pain outcomes below the minimally clinical important difference for OA (19). However, to our knowledge, there remains no comprehensive meta-analysis of their effect on biomechanical risk factors for knee OA progression, such as knee load.…”

Section: Introductionmentioning

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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“…Recently, a placebo-controlled trial found a valgus knee brace to be more effective than a neutral brace [11]. Other studies concluded that a laterally wedged insole may be no more effective than the neutral equivalent [2,20] and that a neutral insole can reduce the load of the medial compartment [9,14]. However, a Cochrane review rated the evidence as ''low quality'' that both the valgus knee brace and laterally wedged insole have benefits in the treatment of symptomatic medial knee OA [7].…”

Section: Introductionmentioning

confidence: 99%

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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Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis

Cited by 96 publications

References 46 publications

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

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

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

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