Lateral wedges with and without custom arch support for people with medial knee osteoarthritis and pronated feet: an exploratory randomized crossover study The Effects of Various Kinds of Lateral Wedge Insoles on Performance of Individuals with Knee Joint Osteoarthritis Immediate efficacy of laterally wedged insoles with arch support on walking in persons with bilateral medial knee osteoarthritis. Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis. Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis The effects of different elevations of laterally wedged insoles with subtalar strapping on medial compartment osteoarthritis of the knee. Lateral wedges in knee osteoarthritis: what are their immediate clinical and biomechanical effects and can these predict a three-month clinical outcome? Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis. A 2-year follow-up of a study to compare the efficacy of lateral wedged insoles with subtalar strapping and in-shoe lateral wedged insoles in patients with varus deformity osteoarthritis of the knee. Effect of a novel insole on the subtalar joint of patients with medial compartment osteoarthritis of the knee. Clinical effects of lateral wedge arch support insoles in knee osteoarthritis Comparison of the efficacy of laterally wedged insoles and bespoke unloader knee orthoses in treating medial compartment knee osteoarthritis How Effective are Lateral Wedge Orthotics in Treating Medial Compartment Osteoarthritis of the Knee? A Systematic Review of the Recent Literature A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. A six-month followup of a randomized trial comparing the efficacy of a lateral-wedge insole with subtalar strapping and an in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis. A two-year prospective randomized controlled study.
Background Pronated 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 . Methods Twenty-six people with pronated feet and symptomatic medial knee OA participated in a r and omized 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 . Results Twenty-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 . Conclusions Addition of custom arch support to a st and ard 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 registration Clinical trials.gov identifier : NCT02234895 Background : Knee joint osteoarthritis ( OA ) is one of the most incapacitating diseases affecting older population , which is associated with pain and functional limitation . Various kinds of conservative treatment have been used to decrease knee pain and to improve the quality of life of the subjects suffering from this disease . There are discrepancies in the clinical effects reported for the use of lateral wedge insole in spite of being used as one of the first conservative mechanical treatments for patients with medial compartments of knee OA . Methods : A total of 36 subjects with medial knee compartment OA were recruited in this research project . Subjects were r and omized into two groups to receive 3- and 7-mm lateral wedge insoles based on the date of birth of the participants . Some parameters such as severity of knee pain , Tibiofemoral angle ( TFA ) , severity of OA , and quality of life were selected in this research project . Results : The use of both 3-mm and 7-mm lateral wedge insole improves the quality of life and decreases knee joint pain . However , the effect of 7 mm lateral wedge insole was more than that of 3 mm . Conclusion : Using lateral wedge insole is a simple , inexpensive therapy for decreasing pain and improving quality of life ; however , most research must be carried out to find the effects of lateral wedge on severity of knee joint OA and aligning TFA OBJECTIVE To investigate the immediate efficacy of laterally wedged insoles with arch support ( LWAS ) on gait in persons with bilateral medial knee osteoarthritis ( OA ) . DESIGN A prospect i ve case-control intervention study . SETTING A gait laboratory with a 6-camera motion analysis system and 2 forceplates . PARTICIPANTS Fifteen women with bilateral medial knee OA and 15 healthy control subjects ( N=30 ) . INTERVENTIONS LWAS . MAIN OUTCOME MEASURES Subjective knee pain and objective biomechanical indices , namely , joint angles and moments in the frontal plane , frontal plane ground reaction force and lever arm , as well as medial/lateral center of mass and center of pressure during gait . RESULTS When wearing the LWAS , knee pain during gait in persons with medial knee OA decreased ( P=.01 ) . Peak internal knee abductor moments were also reduced ( P<.001 ) with increasing foot progression angles , laterally shifted center of pressure , and a shortened frontal plane lever arm ( all P<.05 ) . However , ankle invertor moments were increased ( P<.05 ) when wearing the LWAS . CONCLUSIONS Although peak internal knee abductor moment and knee pain were immediately reduced during gait when wearing the LWAS , increased ankle invertor moments were found , suggesting that the LWAS should be used with caution . Strengthening and monitoring the condition of the ankle invertor muscles may be necessary if the LWAS is used as an intervention for persons with bilateral medial knee OA OBJECTIVE To determine the effects of lateral wedged insoles on knee kinetics and kinematics during walking , according to radiographic severity of medial compartment knee osteoarthritis ( OA ) . DESIGN A prospect i ve case control study of patients with medial compartment OA of the knee . SETTING Gait analysis laboratory in a university hospital . PARTICIPANTS Forty-six medial compartment knees with OA of 23 patients with bilateral disease and 38 knees of 19 age-matched healthy subjects as controls . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES We measured the peak external adduction moment at the knee during the stance phase of gait and the first acceleration peak after heel strike at the lateral side of the femoral condyles .  Kellgren and Lawrence grading system was used for radiographic assessment of OA severity . RESULTS The mean value of peak external adduction moment of the knee was higher in OA knees than the control . Application of lateral wedged insoles significantly reduced the peak external adduction moment in Kellgren-Lawrence grade s I and II knee OA patients . The first acceleration peak value after heel strike in these patients was relatively high compared with the control . Application of lateral wedged insoles significantly reduced the first acceleration peak in Kellgren-Lawrence grade s I and II knee OA patients . CONCLUSIONS The kinetic and kinematic effects of wearing of lateral wedged insoles were significant in Kellgren-Lawrence grade s I and II knee OA . The results support the recommendation of use of lateral wedged insoles for patients with early and mild knee OA Background : There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment , improves comfort , and reduces knee pain during the late stance phase of gait . Objectives : To verify if such effects occur in participants with medial knee osteoarthritis . Study design : R and omized single-blinded study . Methods : Gait analysis was performed on 18 patients affected by medial knee osteoarthritis . Pain and comfort scores , frontal plane kinematics and kinetics of ankle , knee , and hip were compared in four conditions : without foot orthosis , with foot orthoses , with medial arch support , and with foot orthoses with medial arch support and lateral wedge insoles with 6 ° and 10 ° inclination . Results : Lower-extremity gait kinetics were characterized by a significant decrease , greater than 6 % , in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001 ; effect size = 0.6 ) . No significant difference in knee adduction moment was observed between laterally wedged insole conditions . In contrast , a significant increase of 7 % in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001 ; effect size = 0.3 ) . No difference was found in comfort or pain ratings between conditions . Conclusion : Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included . Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis ( KOA ) . We also found evidence that medial arch support may increase knee loading , which could potentially be detrimental in KOA patients OBJECTIVE To assess the radiographic and symptomatic effects of treating patients with medial compartment osteoarthritis ( OA ) of the knee with laterally wedged insoles with subtalar strapping of varying elevations . DESIGN Prospect i ve quasi-experimental evaluation . SETTING Outpatient clinic in Japan . PARTICIPANTS Sixty-two women out patients with knee OA who were r and omized into 3 groups according to their birth date s and wedge elevation . INTERVENTIONS Participants wore laterally wedged insoles with subtalar strapping with elevations of 8 , 12 , or 16 mm for 2 weeks . MAIN OUTCOME MEASURES St and ing radiographs were used to analyze the femorotibial angle for each subject , both with and without their respective unilateral insoles . The remission scores of the Lequesne index of severity for knee OA were compared among the 3 groups at the conclusion . Participants were asked to report adverse effects on use of the insoles . RESULTS The 16-mm group ( n=21 ) showed a significantly greater valgus correction of the femorotibial angle than the 8-mm group ( n=20 ) ( P=.013 ) . The remission score was significantly improved in the 12-mm group ( n=21 ) compared with the 16-mm group ( P=.029 ) . Adverse effects were more common in the 16-mm group ( 9/21 , 42.8 % ) than in the 12-mm ( 3/21 , 14.3 % ) or 8-mm ( 2/20 , 10 % ) groups . CONCLUSIONS The degree of change in femorotibial angle with the insole with subtalar strapping was affected by the tilt of the lateral wedge . For constant routine use , the 8- or 12-mm elevation wedged insoles with subtalar strapping may be more comfortable and effective than the 16-mm elevation wedge OBJECTIVE To assess immediate effects of laterally wedged insoles on walking pain , external knee adduction moment , and static alignment , and whether these immediate effects together with age , body mass index , and disease severity predict clinical outcome after 3 months of wearing insoles in medial knee osteoarthritis . METHODS Forty volunteers ( mean age 64.7 years , 16 men ) were tested in r and om order with and without a pair of 5 degrees full-length lateral wedges . Immediate changes in static alignment were measured via radiographic mechanical axis and changes in adduction moment via 3-dimensional gait analysis . After 3 months of treatment with insoles , changes in pain and physical functioning were assessed via the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and patient-perceived global change scores . RESULTS Reductions in the adduction moment occurred with insoles ( first peak mean [ 95 % confidence intervals ( 95 % CI ) ] -0.22 [ -0.28 , -0.15 ] Nm/body weight x height % ) , accompanied by a reduction in walking pain of approximately 24 % ( mean [ 95 % CI ] -1.0 [ -4.0 , 2.0 ] ) . Insoles had no mean effect on static alignment . Mean improvement in WOMAC pain ( P = 0.004 ) and physical functioning ( mean [ 95 % CI ] -6 [ -11 , -1 ] ) was observed at 3 months , with 25 ( 69 % ) and 26 ( 72 % ) of 36 individuals reporting global improvement in pain and functioning , respectively . Regression analyses demonstrated that disease severity , baseline functioning , and magnitude of immediate change in walking pain and the first peak adduction moment with insoles were predictive of clinical outcome at 3 months . CONCLUSION Lateral wedges immediately reduced knee adduction moment and walking pain but had no effect on static alignment . Although some parameters predicted clinical outcome , these explained only one-third of the variance , suggesting that other unknown factors are also important Objective To assess the effect of lateral wedge insoles compared with flat control insoles on improving symptoms and slowing structural disease progression in medial knee osteoarthritis . Design R and omised controlled trial . Setting Community in Melbourne , Australia . Participants 200 people aged 50 or more with clinical and radiographic diagnosis of mild to moderately severe medial knee osteoarthritis . Interventions Full length 5 degree lateral wedged insoles or flat control insoles worn inside the shoes daily for 12 months . Main outcome measures Primary symptomatic outcome was change in overall knee pain ( past week ) measured on an 11 point numerical rating scale . Primary structural outcome was change in volume of medial tibial cartilage from magnetic resonance imaging scans . Secondary clinical outcomes included changes in measures of pain , function , stiffness , and health related quality of life . Secondary structural outcomes included progression of medial cartilage defects and bone marrow lesions . Results Between group differences did not differ significantly for the primary outcomes of change in overall pain ( −0.3 points , 95 % confidence intervals −1.0 to 0.3 ) and change in medial tibial cartilage volume ( −0.4 mm3 , 95 % confidence interval −15.4 to 14.6 ) , and confidence intervals did not include minimal clinical ly important differences . None of the changes in secondary outcomes showed differences between groups . Conclusion Lateral wedge insoles worn for 12 months provided no symptomatic or structural benefits compared with flat control insoles . Trial registration Australian New Zeal and Clinical Trials Registry ACTR12605000503628 and Clinical Trials.gov NCT00415259 OBJECTIVE Two lateral wedged insoles were compared : one with , and the other without , subtalar strapping . METHODS Twenty-one patients ( age 58 - 83 , mean 72 ) with medial knee osteoarthritis ( OA ) were enrolled . Thirty-seven knees in the patients were divided into three groups based on the Kellgren and Lawrence OA grading system ; grade s 2 ( cases=20 ) , 3 ( cases=11 ) , and 4 ( cases=6 ) . The subjects were tested during walking barefoot and during walking with a silicon rubber lateral wedged insole with elevation of 10 mm attached to a barefoot .  Gait analysis was performed on a 10 m walkway for each subject under three different walking conditions ; barefoot , wearing a conventional insole , and a subtalar strapping insole .  Peak knee varus moment during gait was measured under each condition , and compared between the three conditions and between the OA grade s. RESULTS On the whole ( cases=37 ) , the peak varus moment was significantly reduced by wearing either of the insoles , compared to walking barefoot . The reduction was more obvious with the strapping insole ( -13 % , P<0.01 ) , compared with the conventional insole ( -8 % , P<0.05 ) . In moderate OA patients ( grade s 2 and 3 ) , the moments were significantly lower with the strapping insole , compared with the conventional insole ( P=0.0048 and 0.005 , respectively ) . However , no significant difference was detected in severe OA patients ( grade 4 ) between the two types of insoles ( P=0.4 ) . CONCLUSIONS Both lateral wedged insoles significantly reduced the peak medial compartment load during gait . The subtalar strapping insole had a greater effect than the conventional insole , particularly in patients with moderate medial knee OA OBJECTIVE This study was conducted in order to assess the effect of wearing a lateral wedged insole with a subtalar strap for 2 years in patients with osteoarthritis varus deformity of the knee ( knee OA ) . DESIGN The setting was an outpatient clinic . The efficacies of the strapped insole and a traditional shoe insert wedged insole ( the inserted insole ) , as a positive control , were compared at the baseline and after 2 years of treatment . R and omization was performed according to birth date . The 61 female out patients with knee OA who completed a prior 6-month study were asked to wear their respective insoles continuously as treatment during the course of the 2-year study . The femorotibial angle ( FTA ) was assessed by st and ing radiographs obtained while the subjects were barefoot and the Lequesne index of the knee OA at 2 years was compared with those at baseline in each insole group . RESULTS There were 61 patients in the original study , but 13 patients ( 21.3 % ) did not want to wear the insole continuously and five ( 8.2 % ) withdrew for other reasons . The 42 patients who completed the 2-year study were evaluated . At the 2-year assessment , participants wearing the subtalar strapped insole ( n=21 ) demonstrated significantly decreased FTA ( P=0.015 ) , and significantly improved Lequesne index ( P=0.031 ) in comparison with their baseline assessment s. These significant differences were not found in the group with the traditional shoe inserted wedged insole ( n=21 ) . CONCLUSION Only those participants using the subtalar strapped insole demonstrated significant change in the FTA in comparison with the baseline assessment s. If the insole with a subtalar strap maintains FTA for more than 2 years , it may restrict the progression of degenerative articular cartilage lesions of knee OA OBJECTIVE To assess the efficacy of a lateral wedge insole with elastic strapping of the subtalar joint for conservative treatment of osteoarthritis ( OA ) of the knee . METHODS The efficacy of a novel insole with elastic subtalar strapping and a traditional shoe insert wedge insole was compared . Ninety female out patients with OA of the knee were treated with wedge insoles for 8 weeks . R and omization was performed according to birth date . St and ing radiographs with unilateral insole use were used to analyze the femorotibial and talar tilt angles for each patient with and without their respective insole . Visual analog scale ( VAS ) score for subjective knee pain at the final assessment was compared with that at baseline in both groups . RESULTS Participants wearing the elastically strapped insole ( n = 46 ) had significantly decreased femorotibial angle ( p < 0.0001 ) and talar tilt angle ( p = 0.005 ) and significantly improved VAS pain score ( p = 0.045 ) in comparison with baseline assessment s. These significant differences were not found in the group with the inserted insole ( n = 44 ) . CONCLUSION The novel strapped insole leads to valgus angulation of the talus , result ing in correction of the femorotibial angle in patients with knee OA with varus deformity , and may have a therapeutic effect similar to that of high tibial osteotomy Abstract We compared the short-term efficacy of rigid versus soft lateral wedge arch support ( LWAS ) insoles for patients with knee osteoarthritis ( OA ) , as assessed using the International Classification of Functioning , Disability and Health ( ICF ) system , through a prospect i ve , double-blind , r and omized controlled trial . Participants who fulfilled the combined radiographic and clinical criteria for knee OA , as defined by the American College of Rheumatology , were r and omly prescribed 1  pair of rigid or soft LWAS insoles . Body functions and structures were evaluated according to Kellgren – Lawrence scores , the Foot Posture Index , Hospital Anxiety and Depression Scale scores , the pain – pressure threshold , postural stability , dynamic balance , and fall risk ; activities and participation were assessed according to 10-m fast speed walking , stair climbing and chair rising times , and Chronic Pain Grade question naire responses ; and knee OA-related health status was evaluated using the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) . Hospital Anxiety and Depression Scale scores , the pain – pressure threshold , physical activity , balance , Chronic Pain Grade question naire responses , and the KOOS were recorded before treatment and at 1- , 2- , and 3-month follow-ups . We enrolled 90 participants , 70 women and 20 men , with mean ages of 60.6 ± 10.8 and 63.1 ± 10.8 years in the rigid and soft LWAS insole groups , respectively . Repeated- measures analysis of covariance revealed significant time × group effect improvements in pain ( P = 0.008 for the KOOS ) , stair ascent time ( P = 0.003 ) , daily living function ( P = 0.003 for the KOOS ) , sports and recreation function ( P = 0.012 for the KOOS ) , and quality of life ( P = 0.021 for the KOOS ) in the soft LWAS insole group . Patients with knee OA  who used soft LWAS insoles for a short term showed more significant improvement than did those who used rigid LWAS insoles  in pain , physical activity , daily living function , sports and recreation function , and quality of life , which belong to the body functions and structures and the activities and participation components in the ICF scheme Background : Patients suffering from medial compartment knee osteoarthritis ( OA ) may be treated with unloader knee orthoses or laterally wedged insoles . Objectives : The aim of this study was to identify and compare the effects of them on the gait parameters and pain in these patients . Study Design : Quasi-experimental . Methods : Volunteer subjects with medial compartment knee OA ( n = 24 , mean age 59.29 ± 2.23 years ) were r and omly assigned to two separate groups and evaluated when wearing an unloader knee orthosis or insoles incorporating a 6 ° lateral wedge . Testing was performed at baseline and after six weeks of each orthosis use . A visual analog scale score was used to assess pain and gait analysis was utilized to determine gait parameters . Results : Both orthoses improved all parameters compared to the baseline condition ( p = 0.000 ) . However , no significant differences in pain ( p = 0.649 ) , adduction moment ( p = 0.205 ) , speed of walking ( p = 0 . 056 ) or step length ( p = 0.687 ) were demonstrated between them . The knee range of motion ( p = 0.000 ) were significantly different between the two interventions . Conclusion : Both orthoses reduced knee pain . Maximum knee range of motion was increased by both interventions although it was 3 degrees less when wearing the knee orthosis . Clinical relevance Both orthoses reduce pain and improve gait anomalies in medial compartment knee OA . Our results suggest a laterally wedged insole can be an alternative conservative approach to unloader knee orthosis for treating symptoms of medial compartment knee OA Lateral wedges were originally proposed to manage medial compartment osteoarthritis of the knee but recent review s suggest that lateral wedges do not affect disease progression . We performed a systematic review to analyse the recent literature and define how effective , if at all , lateral wedges are in the management of medial compartment osteoarthritis of the knee . The inclusion criteria were defined as any study published within the last decade , using a sample size of at least twenty patients , and investigating the effect of insoles or wedges on either unilateral or bilateral knee varus osteoarthritis . The st and ardised keyword term ‘ lateral*wedge*OR insole*OR orthotic * OR medial compartment OR varus OR osteoarthri * OR knee * ’ was used . We identified 10 studies that fitted our inclusion criteria . Although there is not enough evidence in the literature to prove that lateral wedge orthotics are an effective treatment for varus osteoarthritis of the knee  , there is some evidence to suggest that they do have some symptomatic effect .  Patients with early osteoarthritis and higher BMI may benefit to a greater extent than those with a greater extent of degenerative changes and lower BMI . The literature is unclear as to what the optimal duration for the use of lateral wedges is , but does support the prolonged use of the wedges as the benefits at one month are maintained at one year . Future studies should be r and omised controlled trials with a large sample size with long follow-up , and use objective clinical , biomechanical and radiological outcome measures OBJECTIVE In uncontrolled studies , a lateral-wedge insole has reduced knee pain in patients with medial knee osteoarthritis ( OA ) . The aim of this study was to test the efficacy of this simple , low-cost intervention for pain in patients with medial knee OA . METHODS We conducted a double-blind , r and omized , crossover trial design ed to detect a small effect of treatment . Participants were at least 50 years of age and had medial joint space narrowing on posteroanterior semiflexed radiographs and scores indicating moderate pain for 2 of the 5 items on the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain scale . Participants were r and omized to receive a 5 degrees lateral-wedge insole or a neutral insole for 6 weeks . Following a 4-week washout period , participants crossed over to the other treatment for 6 weeks . Knee pain , the primary outcome , was assessed by the WOMAC pain scale ( visual analog scale version ) . Secondary outcomes included the WOMAC disability subscale , overall knee pain , 50-feet walk time , chair-st and time , and use of medications for knee pain . RESULTS Ninety patients were r and omized . The mean difference in pain between the 2 treatments was 13.8 points on the WOMAC pain scale ( 95 % confidence interval -3.9 , 31.4 [ P=0.13 ] ) . We observed similar small effects for the secondary outcomes . CONCLUSION The effect of treatment with a lateral-wedge insole for knee OA was neither statistically significant nor clinical ly important OBJECTIVE To assess the effect of a lateral-wedge insole with elastic strapping of the subtalar joint on the femorotibial angle in patients with varus deformity of the knee . METHODS The efficacy of a wedged insole with subtalar straps and that of a traditional wedged insole shoe insert were compared . Sixty-six female out patients with knee osteoarthritis ( OA ) were r and omized ( according to birth date ) to be treated with either the strapped or the traditional inserted insole .  St and ing radiographs with unilateral insole use were used to analyze the femorotibial angles for each patient . In both groups , the baseline and 6-month visual analog scale ( VAS ) scores for subjective knee pain and the Lequesne index scores for knee OA were compared . RESULTS The 61 patients who completed the 6-month study were evaluated . At baseline , there was no significant difference in the femorotibial angle ( P = 0.66 ) and the VAS score ( P = 0.75 ) between the 2 groups . At the 6-month assessment , the 29 subjects wearing the subtalar-strapped insole demonstrated a significantly decreased femorotibial angle ( P < 0.0001 ) and significantly improved VAS scores ( P = 0.001 ) and Lequesne index scores ( P = 0.033 ) compared with their baseline assessment s. These significant differences were not observed in the 32 subjects assigned to the traditional shoe-inserted wedged insole . CONCLUSION These results suggest that an insole with a subtalar strap maintained the valgus correction of the femorotibial angle in patients with varus knee OA for 6 months , indicating longer-term clinical improvement with the strapped insert compared with the traditional insert OBJECTIVE To compare the clinical effects of laterally wedged insoles and neutrally wedged insoles ( used as control ) in patients with medial femoro-tibial knee osteoarthritis . METHODS STUDY DESIGN 24-month prospect i ve r and omized controlled study . PATIENTS Out patients with painful medial femoro-tibial knee osteoarthritis . OUTCOME MEASURES Patient 's overall assessment of disease activity ( 5 grade scale ) , WOMAC index subscales and concomitant treatments . STATISTICAL ANALYSIS Performed as an intention-to-treat analysis , with the last observation carried forward ( LOCF ) . Main symptomatic criterion : Improvement in the patient 's assessment of activity ( defined as a reduction of one grade or more at the end of the study as compared to baseline , and no intra-articular injection or lavage during the 6 months previous to the last visit ) . Secondary criteria for assessment : ( a ) Changes in the WOMAC subscales at month 24 , and ( b ) concomitant therapies ( analgesics , NSAIDs and intra-articular injections or lavages ) . Structural criterion : Joint space width ( JSW ) at the narrowest point . Non-compliance was defined as intermittent or lack of insole fitting at two consecutive visits . Compliance within groups was compared by using a life table analysis technique ( Log-Rank ) . RESULTS The baseline characteristics of the 156 recruited patients ( 41 males , 115 females , mean age 64.8 years ) were not different in the 2 treatment groups . At year 2 , there was no statistically significant difference between the 2 groups concerning the percentages of patients with improvement in both global assessment of disease activity and in WOMAC subscales ( pain , stiffness , function ) . The number of days with NSAIDs intake was lower in the group with laterally wedged insoles than in the neutrally wedged group ( 71+/-173 days vs. 127+/-193 days , P=0.003 , Mann-Whitney test ) . The mean joint space narrowing rate did not differ between the two groups : 0.21+/-0.59 mm/year in the laterally wedged group vs 0.12+/-0.32 mm/year in the neutrally wedged group . Compliance and tolerance were satisfactory . Compliance was different between the 2 groups at month 24 , with a greater frequency of patients who wore insoles permanently in the laterally wedged insole group than in the other group ( 85.8 % vs 71.9 % , P=0.023 ) . CONCLUSION This study failed to demonstrate a relevant symptomatic and /or structural effect of laterally-wedged insoles in medial femoro-tibial OA . However , the reduced NSAIDs intake and the better compliance in the treatment group are in favor of a beneficial effect of laterally-wedged insoles in medial femoro-tibial OA
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
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 .