Comparing laterally wedged insoles and unloader knee orthoses in medial compartment knee osteoarthritis

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. 

Maximum knee range of motion was increased by both interventions although it was 3 degrees less when wearing the knee orthosis.

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.
Methods
Volunteer subjects with medial compartment knee OA (n = 24, mean age 59.29 ± 2.23 years) were randomly 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
This study demonstrated that the use of either laterally wedged inlays or knee unloader orthoses both improve knee pain and ROM and increase speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee in subjects with symptomatic medial compartment knee OA.

In comparing both interventions, no significant differences in pain, adduction moment, speed of walking and step length were noted. The inlay condition was more effective in increasing knee ROM. In improving pain, knee ROM, adduction moment, speed of walking and step length, lateral wedges also showed that they were a suitable alternative to knee unloader orthoses for conservative treatment of the medial compartment knee osteoarthritis patients.

The results of this study support the theory that both valgus bracing and laterally wedged inlays can significantly reduce medial compartment loads, which is consistent with patient reports regarding pain improvement with the use of both orthoses. It would be interesting to determine the effect of wearing both orthoses in combination on the same lower limb to see if the positive effects of both interventions would be compounded.

Comparison of the efficacy of laterally wedged insoles and bespoke unloader knee orthoses in treating medial compartment knee osteoarthritis, Arazpour M, Bani MA, Maleki M, Ghomshe FT, Kashani RV, Hutchins SW. Prosthet Orthot Int. 2013 Feb;37(1):50-7. doi: 10.1177/0309364612447094. Epub 2012 Aug 3.

Also see
Can A Custom Knee Brace Help Me? in Cornerstone Physiotherapy
Rotational mechanics: Bracing’s next frontier in Lower Extremity Review

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