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

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.

scholarly journals The relationship between urinary C-Telopeptide fragments of type II collagen, knee joint load, pain, and physical function in individuals with medial knee osteoarthritis

2020 ◽  
Author(s):  
Luiz Fernando Approbato Selistre ◽  
Glaucia Helena Gonçalves ◽  
Fernando Augusto Vasilceac ◽  
Paula Regina Mendes da Silva Serrão ◽  
Theresa Helissa Nakagawa ◽  
...  
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Physical Function ◽  
Type Ii Collagen ◽  
Type Ii ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Knee Joint Load ◽  
Joint Load ◽  
The Relationship

scholarly journals Alignment, body mass and their interaction on dynamic knee joint load in patients with knee osteoarthritis

2010 ◽  
Vol 18 (7) ◽  
pp. 888-893 ◽  
Author(s):  
R.F. Moyer ◽  
T.B. Birmingham ◽  
B.M. Chesworth ◽  
C.O. Kean ◽  
J.R. Giffin
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Body Mass ◽  
Knee Joint Load ◽  
Joint Load

scholarly journals An exploration of changes in plantar pressure distributions during walking with standalone and supported lateral wedge insole designs

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Calvin T. F. Tse ◽  
Michael B. Ryan ◽  
Jason Dien ◽  
Alex Scott ◽  
Michael A. Hunt
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Pressure Distribution ◽  
Contact Area ◽  
Plantar Pressure ◽  
Load Distribution ◽  
Plantar Pressure Distribution ◽  
Arch Support ◽  
Knee Joint Load ◽  
Joint Load

Abstract Background Lateral wedge insoles (LWI), standalone or with medial arch support (supported-LWI), have been thoroughly investigated for their effects on modifying gait biomechanics for people with knee osteoarthritis. However, plantar pressure distribution between these insole types has not been investigated and could provide insight towards insole prescription with concomitant foot symptoms taken into consideration. Methods In a sample of healthy individuals (n = 40), in-shoe plantar pressure was measured during walking with LWI, with or without medial arch support (variable- and uniform-stiffness designs), and a flat control insole condition. Pressure data from the plantar surface of the foot were divided into seven regions: medial/lateral rearfoot, midfoot, medial/central/lateral forefoot, hallux. Plantar pressure outcomes assessed were the medial-lateral pressure index (MLPI) for the whole foot, and the peak pressure, pressure-time integral (PTI), and contact area in each plantar region. Comfort in each insole condition was rated as a change relative to the flat control insole condition. Repeated-measures analyses of variance were calculated to compare the plantar pressure outcomes between insole conditions. Results Regionally, medial rearfoot and forefoot pressure were reduced by all wedged insoles, with the variable-stiffness supported-wedge showing greater reductions than the standalone wedge. Lateral rearfoot and forefoot pressure were reduced by both supported-LWI, but unchanged by the standalone wedge. In the midfoot, the standalone wedge maintained pressure but reduced regional contact area, while both supported-LWI increased midfoot pressure and contact area. All LWI increased the MLPI, indicating a lateral shift in plantar pressure distribution throughout the weightbearing phase of gait. Comfort ratings were not significantly different between insole conditions. Conclusions Regional differences in plantar pressure may help determine an appropriate lateral wedge insole variation to avoid exacerbation of concomitant foot symptoms by minimizing pressure in symptomatic regions. Lateral shifts in plantar pressure distribution were observed in all laterally wedged conditions, including one supported-LWI that was previously shown to be biomechanically ineffective for modifying knee joint load distribution. Thus, shifts in foot centre of pressure may not be a primary mechanism by which LWI can modify knee joint load distribution for people with knee osteoarthritis.

scholarly journals Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles

2012 ◽  
Vol 64 (10) ◽  
pp. 1545-1553 ◽  
Author(s):  
Milena Simic ◽  
Michael A. Hunt ◽  
Kim L. Bennell ◽  
Rana S. Hinman ◽  
Tim V. Wrigley
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Knee Joint Load ◽  
Gait Modification ◽  
Joint Load

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

2018 ◽  
Vol 43 (2) ◽  
pp. 148-157 ◽  
Author(s):  
Saad Jawaid Khan ◽  
Soobia Saad Khan ◽  
Juliana Usman ◽  
Abdul Halim Mokhtar ◽  
Noor Azuan Abu Osman
Keyword(s):  
Knee Osteoarthritis ◽  
Fall Risk ◽  
Comfort Level ◽  
Knee Adduction Moment ◽  
Knee Brace ◽  
Dynamic Setting ◽  
Peak Knee ◽  
Knee Joint Load ◽  
Joint Load ◽  
Second Peak

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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