Combined effects of knee brace, laterally wedged insoles, and toe-out gait on knee adduction moment and fall risk in moderate medial knee osteoarthritis patients

Background: Knee osteoarthritis is a major contributor to the global burden of disease. There is a need of reducing knee joint load and to improve balance and physical function among knee osteoarthritis patients. Objectives: To test the hypothesis that toe-out gait will reduce second peak knee adduction moment further and increase fall risk when combined with knee brace and laterally wedged insole in knee osteoarthritis patients. Study design: Single visit study with repeated measures. Methods: First and second peak knee adduction moments, fall risk and comfort level. First and second peak knee adduction moments were determined from three-dimensional gait analysis, completed under six randomized conditions: (1) natural, (2) knee brace, (3) knee brace + toe-out gait, (4) laterally wedged insole, (5) laterally wedged insole + toe-out gait, and (6) knee brace + laterally wedged insole + toe-out gait. Fall risk was assessed by Biodex Balance System using three randomized stability settings: (1) static, (2) moderate dynamic setting (FR12), and (3) high dynamic setting (FR8). Results: The reduction in first peak knee adduction moment and second peak knee adduction moment was greatest (7.16% and 25.55%, respectively) when toe-out gait combine with knee brace and laterally wedged insole. Significant increase in fall risk was observed with knee brace + laterally wedged insole + toe-out gait (42.85%) at FR12. Similar significant balance reductions were found at FR8 condition for knee brace + toe-out gait (35.71%), laterally wedged insole + toe-out gait (28.57%), and knee brace + laterally wedged insole + toe-out gait (50%) as compared to natural. However, knee brace decreased fall risk at FR12 by 28.57%. Conclusion: There is a synergistic effect of toe-out when combined with knee brace and laterally wedged insole concurrently in second peak knee adduction moment reduction but with a greater degree of fall risk. Simultaneous use of conservative treatments also decreases comfort level. Clinical relevance Patients with mild and moderate knee osteoarthritis are usually prescribed conservative treatment techniques. This study will provide an insight whether or not a combination of these techniques have a synergistic effect in reducing knee joint load.

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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.

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Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis

10.1101/2022.01.10.22268858 ◽

2022 ◽

Author(s):

Kirsten Seagers ◽

Scott D Uhlrich ◽

Julie A Kolesar ◽

Madeleine Berkson ◽

Janelle M Janeda ◽

...

Keyword(s):

Experimental Data ◽

Knee Osteoarthritis ◽

Musculoskeletal Modeling ◽

Knee Adduction Moment ◽

Foot Progression Angle ◽

Peak Knee ◽

Hip Abduction ◽

Surrogate Measure ◽

Surrogate Measures ◽

Second Peak

People with knee osteoarthritis who adopt a modified foot progression angle (FPA) during gait often benefit from a reduction in the knee adduction moment and knee pain. It is unknown, however, whether changes in the FPA increase hip moments, a surrogate measure of hip loading, which may increase the risk of hip pain or osteoarthritis. This study examined how altering the FPA affects hip moments. Individuals with knee osteoarthritis walked on an instrumented treadmill with their baseline gait, 10° toe-in gait, and 10° toe-out gait. A musculoskeletal modeling package was used to compute joint moments from the experimental data. Fifty participants were selected from a larger study who reduced their peak knee adduction moment with a modified FPA. In this group, participants reduced the first peak of the knee adduction moment by 7.6% with 10° toe-in gait and reduced the second peak by 11.0% with 10 ° toe-out gait. Modifying the FPA reduced the early-stance hip abduction moment, at the time of peak hip contact force, by 4.3% ± 1.3% for 10° toe-in gait (p=0.005) and by 4.6% ± 1.1% for 10° toe-out gait (p<0.001) without increasing the flexion and internal rotation moments (p>0.15). In summary, when adopting a FPA modification that reduced the knee adduction moment, participants did not increase surrogate measures of hip loading.

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The optimal degree of lateral wedge insoles for reducing knee joint load: a systematic review and meta-analysis

Archives of Physiotherapy ◽

10.1186/s40945-019-0068-1 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Vitor Ferreira ◽

Rita Simões ◽

Rui Soles Gonçalves ◽

Leandro Machado ◽

Paulo Roriz

Keyword(s):

Systematic Review ◽

Knee Joint ◽

Knee Osteoarthritis ◽

Meta Analysis ◽

Slight Reduction ◽

Biomechanical Parameters ◽

Knee Joint Load ◽

Joint Load ◽

Angular Impulse ◽

Second Peak

Abstract Background Lateral wedge insoles are traditionally used to reduce the adduction moment that crosses the knee during walking in people with medial knee osteoarthritis. However, the best degree to reduce knee joint load is not yet well established. Methods Electronic databases were searched from their inception until May 2017. Included studies reported on the immediate biomechanical effects of different degrees of lateral wedge insoles during walking in people with knee osteoarthritis. The main measures of interest relating to the biomechanics were the first and second peak of external knee adduction moment and knee adduction angular impulse. For the comparison of the biomechanical effects of different degrees of insoles, the studies were divided in three subgroups: insoles with a degree higher than 0° and equal to or lower than 5°; insoles higher than 5° and equal to or lower than 9°; and insoles higher than 9°. Eligible studies were pooled using random-effects meta-analysis. Results Fifteen studies with a total of 415 participants met all eligibility criteria and were included in the final review and meta-analysis. The overall effect suggests that lateral wedge insoles resulted in a statistically significant reduction in the first peak (standardized mean difference [SMD] –0.25; 95% confidence interval [CI] –0.36, − 0.13; P < 0.001), second peak (SMD –0.26 [95% CI –0.48, − 0.04]; P = 0.02) and knee adduction angular impulse (SMD –0.17 [95% CI –0.31, − 0.03]; P = 0.02). The test of subgroups found no statistically significant differences. Conclusion Systematic review and meta-analysis suggests that lateral wedge insoles cause an overall slight reduction in the biomechanical parameters. Higher degrees do not show higher reductions than lower degrees. Prior analysis of biomechanical parameters may be a valid option for selecting the optimal angle of wedge that best fits in knee osteoarthritis patients with the lowest possible degree.

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Knee Joint Load Reduction by using Lateral Wedge Insole in Different Body Mass Index Level Females

Asian Journal of Applied Sciences ◽

10.24203/ajas.v7i4.5882 ◽

2019 ◽

Vol 7 (4) ◽

Author(s):

Chitchanok Nutalaya ◽

Montakarn Chaikumarn

Keyword(s):

Body Mass Index ◽

Knee Joint ◽

Knee Osteoarthritis ◽

Body Mass ◽

Knee Adduction Moment ◽

Cross Sectional ◽

Significant Difference ◽

Knee Joint Load ◽

Joint Load ◽

External Knee Adduction Moment

Background: The higher body mass index is a risk factor that associated with onset and progression of knee osteoarthritis by increasing the knee adduction moment. Lateral wedge insoles are used for reducing the knee adduction moment which may prevent the occurrence of knee osteoarthritis in healthy population.Purpose: The purpose of this study was to assess the effectiveness of the lateral wedge insole among normal, overweight, obese I and obese II female while walking.Methods: A cross-sectional experimental design study was used to investigate 80 females who aged between 18 â€“ 40 years using 3-D Motion Analysis. The peak external knee adduction moment was collected in walking shoes and walking shoes with 5-degree lateral wedge insoles conditions. The significant difference was determined using Paired-T test (p = 0.05).Results: The peak external knee adduction moment was significantly decreased by the effect of shoes with lateral wedge insoles in normal, overweight and obese I (22.12%, 18.34% and 24.15%). However, it did not change in the obese II.Conclusion: The peak external knee adduction moment was decreased by the immediate effect of lateral wedge insoles. It may prevent the onset of knee osteoarthritis in normal, overweight, and obese I. Further study should investigate long term effect of lateral wedge insoles on the knee joint load and the effect of dose in higher body mass index.

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