Lateral wedges with and without custom arch support for people with medial knee osteoarthritis and pronated feet: an exploratory randomized crossover study

Abstract

BackgroundPronated foot posture is associated with many clinical and biomechanical outcomes unique to medial compartment knee osteoarthritis (OA). Though shoe-worn insole treatment, including lateral wedges, is commonly studied in this patient population, their effects on the specific subgroup of people with medial knee OA and concomitant pronated feet are unknown. The purpose of this study was to evaluate whether lateral wedge insoles with custom arch support are more beneficial than lateral wedge insoles alone for knee and foot symptoms in people with medial tibiofemoral knee osteoarthritis (OA) and pronated feet.MethodsTwenty-six people with pronated feet and symptomatic medial knee OA participated in a randomized crossover study comparing five degree lateral wedge foot insoles with and without custom foot arch support. Each intervention was worn for two months, separated by a two-month washout period of no insoles wear. Main outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function subscales, the revised short-form Foot Function Index (FFI-R) pain and stiffness subscales, and the timed stair climb test. Regression modeling was conducted to examine treatment, period, and interaction effects.ResultsTwenty-two participants completed the study, and no carryover or interaction effects were observed for any outcome. Significant treatment effects were observed for the timed stair climb, with greater improvements seen with the lateral wedges with arch support. Within-condition significant improvements were observed for WOMAC pain and physical function, as well as FFI-R pain and stiffness with lateral wedges with arch support use. More adverse effects were reported with the lateral wedges alone, while more people preferred the lateral wedges with arch support overall.ConclusionsAddition of custom arch support to a standard lateral wedge insole may improve foot and knee symptoms in people with knee OA and concomitant pronated feet. These preliminary findings suggest further research evaluating the role of shoe-worn insoles for treatment of this specific sub-group of people with knee OA is warranted.Trial registrationClinicaltrials.gov identifier: NCT02234895.

The effect of a lateral wedge insole and a subtalar strap on gait parameters in knee osteoarthritis

“…Mean±SD of external knee adduction moment at early, mid, and late stance in 3 conditions: without insole, lateral wedge insole, and lateral wedge insole and a subtalar strap (n =17). 5 support ended to a protracted controversy (7,13,14,31). The possible explanations could be related to the variation among the sample of the studies or the interventions used in the studies.…”

“…Therefore, fixing the talus movement with a subtalar strap may increase the valgus angulation of the talus and augment the femorotibial angle change (11,12). Moreover, the effect of LWI can be increased if it is joined with the foot comfort, which is associated with concomitant use of longitudinal arch support (13,14). Although the augmented effect of LWI and a subtalar strap have been shown by reducing EKAM in KOA, the impact of using LWI with an arch support and a subtalar strap in reduction of EKAM has not yet been known (11,12).…”

Does footwear affect articular cartilage volume change after a prolonged run?

“…In the experimental shoes, the midsole was stiffer (ie, firmer) on foot‐ground contact because of the addition of the plastic tubes. Secondly, the medially posted shoe (Condition 2) could result in less eversion during the support period, while the laterally posted shoe (Condition 3) may result in greater eversion …”

Characteristics of frontal plane lower limb movement during walking in patients with knee osteoarthritis of varying severity

“…In contrast, several problems related to the foot, such as flatfoot and pronated foot, have been reported in KOA. 13,14 The change in the shape of the foot in KOA may cause pain, restriction of the daily activities, and damage to the articular cartilage. [14][15][16] Since the movement of the foot has a close relationship with the tibia, the effect on the knee joint is marked, 17 and it is reported that the pronated moment of the subtalar joint during walking simulation increases due to the varus deformity of the knee joint.…”