Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis

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: Randomized 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.

Download Full-text

Effect of real-time biofeedback on peak knee adduction moment in patients with medial knee osteoarthritis: Is direct feedback effective?

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2017.07.004 ◽

2018 ◽

Vol 57 ◽

pp. 150-158 ◽

Cited By ~ 12

Author(s):

Rosie E. Richards ◽

Josien C. van den Noort ◽

Martin van der Esch ◽

Marjolein J. Booij ◽

Jaap Harlaar

Keyword(s):

Knee Osteoarthritis ◽

Real Time ◽

Knee Adduction Moment ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Peak Knee ◽

Direct Feedback

Download Full-text

Effect of Laterally Wedged Foot Orthoses on Rearfoot and Hip Mechanics in Patients with Medial Knee Osteoarthritis

Prosthetics and Orthotics International ◽

10.1080/03093640802613237 ◽

2009 ◽

Vol 33 (2) ◽

pp. 107-116 ◽

Cited By ~ 42

Author(s):

Robert J. Butler ◽

Joaquin A. Barrios ◽

Todd Royer ◽

Irene S. Davis

Keyword(s):

Knee Osteoarthritis ◽

Three Dimensional ◽

Frontal Plane ◽

Knee Adduction Moment ◽

Orthotic Devices ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Peak Knee ◽

Wedge Condition ◽

Foot Orthotic

The purpose of this study was to examine the effects of laterally wedged foot orthotic devices, used to treat knee osteoarthritis, on frontal plane mechanics at the rearfoot and hip during walking. Thirty individuals with diagnosed medial knee osteoarthritis were recruited for this study. Three dimensional kinematics and kinetics were recorded as the subjects walked in the laboratory at an intentional walking speed. Peak eversion, eversion excursion and peak eversion moment were increased while the peak knee adduction moment was reduced in the laterally wedged orthotic condition compared to the no wedge condition. In contrast, no changes were observed in the variables of interest at the hip. There was no significant relationship between the change in the peak frontal plane moment at the rearfoot and change in the peak frontal plane moment at the knee or hip as a result of the lateral wedge. Laterally wedged foot orthotic devices, used to treat knee osteoarthritis, do not influence hip mechanics. However, they do result in increased rearfoot eversion and inversion moment. Therefore, a full medical screen of the foot should occur before laterally wedged foot orthotic devices are prescribed as a treatment for knee osteoarthritis.

Download Full-text

The 2- and 8-week effects of decompressive brace use in people with medial compartment knee osteoarthritis

Prosthetics and Orthotics International ◽

10.1177/0309364615589537 ◽

2015 ◽

Vol 40 (4) ◽

pp. 447-453 ◽

Cited By ~ 9

Author(s):

Eric M Lamberg ◽

Robert Streb ◽

Marc Werner ◽

Ian Kremenic ◽

James Penna

Keyword(s):

Knee Osteoarthritis ◽

Repeated Measures ◽

Knee Adduction Moment ◽

Knee Brace ◽

Knee Motion ◽

Noninvasive Treatment ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Peak Knee ◽

Second Peak

Background: Knee osteoarthritis is a prevalent disease. Unloading the affected compartment using a brace is a treatment option. Objectives: To determine whether a decompressive knee brace alters loading in medial knee osteoarthritis following 2 and 8 weeks of use. Study design: Within subjects; pre- and post-testing. Methods: A total of 15 individuals with medial knee osteoarthritis attended four sessions: baseline, fitting, 2 weeks after fitting (post), and 8 weeks after fitting (final). A gait analysis was performed at baseline (without knee brace), post and final. Knee adduction impulse, first and second peak knee adduction moment, knee motion, and walking velocity were calculated. Participants also recorded hours and steps taken while wearing the brace. Results: On average, the brace was worn for more than 6 h/day. Through use of repeated-measures analysis of variance, it was determined that the knee adduction impulse and second peak knee adduction moment were reduced ( p < 0.05) at post and final compared to baseline (36% and 34% reduction in knee adduction impulse, 26% reduction in second peak knee adduction moment for post and final, respectively). Furthermore, participants walked faster with increased knee motion during stance. Conclusion: The studied decompressive brace was effective in reducing potentially detrimental forces at the knee—knee adduction impulse and second peak knee adduction moment during the stance phase of gait. Clinical relevance The data from this study suggest that use of a medial unloading brace can reduce potentially detrimental adduction moments at the knee. Clinicians should use this evidence to advocate for use of this noninvasive treatment for people presenting with medial knee osteoarthritis.

Download Full-text

Personalization improves the biomechanical efficacy of foot progression angle modifications in individuals with medial knee osteoarthritis

10.1101/2020.12.15.20248220 ◽

2020 ◽

Author(s):

Scott D Uhlrich ◽

Julie A Kolesar ◽

Łukasz Kidziński ◽

Melissa A Boswell ◽

Amy Silder ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Center Of Pressure ◽

Knee Adduction Moment ◽

Abduction Angle ◽

Valgus Knee ◽

Lasso Regression ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Foot Progression Angle ◽

Peak Knee

Abstract Objectives The goal of this study was to evaluate the importance of personalization when selecting foot progression angle modifications that aim to reduce the peak knee adduction moment in individuals with medial knee osteoarthritis. Design One hundred seven individuals with medial knee osteoarthritis walked on an instrumented treadmill with biofeedback instructing them to toe-in and toe-out by 5° and 10° relative to their self-selected foot progression angle. We selected individuals’ personalized foot progression angle as the modification that maximally reduced their larger knee adduction moment peak. Additionally, we used lasso regression to identify which secondary changes in kinematics made a 10° toe-in gait modification more effective at reducing the first knee adduction moment peak. Results Sixty-six percent of individuals reduced their larger knee adduction moment peak by at least 5% with a personalized foot progression angle modification, which is more than (p<0.001) the 54% and 23% of individuals who reduced it with a uniformly-assigned 10° toe-in or toe-out modification, respectively. When toeing-in, greater reductions in the first knee adduction moment peak were related to an increased frontal-plane tibia angle (knee more medial than ankle), a more valgus knee abduction angle, reduced contralateral pelvic drop, and a more medialized center of pressure in the foot reference frame. Conclusions Personalization increases the proportion of individuals with medial knee osteoarthritis who may benefit from modification of their foot progression angle.

Download Full-text

Peak knee adduction moment and impulse are not related to changes in self-reported pain or physical function over 12 months in individuals with medial knee osteoarthritis

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2012.02.111 ◽

2012 ◽

Vol 20 ◽

pp. S101-S102

Author(s):

C.O. Kean ◽

K.L. Bennell ◽

K. Bowles ◽

R.S. Hinman

Keyword(s):

Knee Osteoarthritis ◽

Physical Function ◽

Knee Adduction Moment ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Peak Knee

Download Full-text

Bone marrow lesions are related to dynamic knee loading in medial knee osteoarthritis

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.118182 ◽

2009 ◽

Vol 69 (6) ◽

pp. 1151-1154 ◽

Cited By ~ 64

Author(s):

Kim L Bennell ◽

Mark W Creaby ◽

Tim V Wrigley ◽

Kelly-Ann Bowles ◽

Rana S Hinman ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Mechanical Loading ◽

Knee Adduction Moment ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Knee Loading ◽

Independent Variable ◽

Tibiofemoral Osteoarthritis ◽

The Relationship ◽

External Knee Adduction Moment

ObjectivesTo evaluate the relationship between mechanical loading, as indicated by the external knee adduction moment (KAM) during walking, and BML on MRI in people with medial knee osteoarthritis.MethodsMeasures were taken in 91 individuals with medial knee osteoarthritis. Logistic regression analyses were performed with the presence/absence of medial tibial or medial femoral BML as the outcome and either peak KAM or KAM impulse as the independent variable. Analyses were also adjusted for age, gender, body mass index, alignment and walking speed.ResultsIn adjusted analyses, peak KAM was significantly related to medial tibial (OR 2.3; 95%CI 1.07 to 4.7), but not medial femoral (OR 1.85; 95%CI 0.93 to 3.7) BML. KAM impulse was significantly related to both medial tibial (OR 9.4; 95%CI 1.53 to 57.2) and medial femoral (OR 14.4; 95%CI 2.3 to 89.8) BML.ConclusionsThe findings support the hypothesis that greater mechanical loading of the medial compartment plays a role in the pathogenesis of BML in medial tibiofemoral osteoarthritis.

Download Full-text

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

Clinical Rehabilitation ◽

10.1177/0269215521993636 ◽

2021 ◽

pp. 026921552199363

Author(s):

Martin Schwarze ◽

Leonie P Bartsch ◽

Julia Block ◽

Merkur Alimusaj ◽

Ayham Jaber ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Controlled Trial ◽

Oxford Knee Score ◽

Knee Adduction Moment ◽

Osteoarthritis Of The Knee ◽

Knee Score ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Patient Reported ◽

Angular Impulse

Objective: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. Design: Single-centre, block-randomized, cross-over controlled trial. Setting: Outpatient clinic. Subjects: About 39 patients with symptomatic medial knee osteoarthritis. Interventions: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. Main measures: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire – Osteoarthritis and knee pain. Results: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% ( P < 0.001). The LWI reduced both maxima by 6% ( P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% ( P < 0.001) and 5% ( P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI ( P = 0.001, P = 0.004). Conclusions: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.

Download Full-text