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... minimise the influence of footwear, all subjects wore the same type of standard shoe (ECCO Zen) which provided a baseline dataset for the footwear conditions. Two conditions were assessed, a control condition (with a neutral flat insert) and a lateral wedge insole. The lat- eral wedge insoles (Fig. 1) are off-the-shelf insoles made from a com- fortable and flexible material (SureStep-Control™, with a medium density Shore A 70, SalfordInsole, Nuneaton, UK). The insoles (SalfordInsole, Nuneaton, UK) were full length lateral wedge insoles constructed with a medial arch, with a 5° lateral wedge used in previous studies (Forghany et al., ...
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Objective
The primary objective was t...
Citations
... Moreover, a published report showed that every one-unit increase in EKAM is associated with a 6.46 times increase in the risk of progression of medial compartment knee osteoarthritis (OA) [6]. Terefore, reducing the EKAM has become the objective of gait modifcation in an attempt not only to reduce the medial knee loading but also to attempt in arresting disease progression [7]. In addition to EKAM, the knee adduction angular impulse (KAAI) has also been reported as a predictor of knee loading in the medial compartment [8,9]. ...
Backward walking (BW) has been recommended as a rehabilitation intervention to prevent, manage, or improve diseases. However, previous studies showed that BW significantly increased the first vertical ground reaction force (GRF) during gait, which might lead to higher loading at the knee. Published reports have not examined the effects of BW on medial compartment knee loading. The objective of this study was to investigate the effects of BW on external knee adduction moment (EKAM). Twenty-seven healthy adults participated in the present study. A sixteen-camera three-dimensional VICON gait analysis system, with two force platforms, was used to collect the EKAM, KAAI, and other biomechanical data during BW and forward walking (FW). The first ( P < 0.001 ) and second ( P < 0.001 ) EKAM peaks and KAAI ( P = 0.02 ) were significantly decreased during BW when compared with FW. The BW significantly decreased the lever arm length at the first EKAM peak ( P = 0.02 ) when compared with FW. In conclusion, BW was found to be a useful strategy for reducing the medial compartment knee loading even though the first peak ground reaction force was significantly increased.
... All 24 included studies were published in English. We identified two articles from Canada (Moisan et al., 2019;Moyer et al., 2017), four from the United States of America (Carcia et al., 2006a;Hertel et al., 2005;Jenkins et al., 2011;Yu et al., 2007), four from China (Ho et al., 2019;Lam et al., 2019;Lam et al., 2021;Wang et al., 2020), one from Denmark (Rathleff et al., 2016), two from Iran (Arastoo et al., 2014;Esfandiari et al., 2020), one from Italy (Caravaggi et al., 2016), two from Belgium (Dingenen et al., 2015a;Dingenen et al., 2015b), five from the United Kingdom (Alshawabka et al., 2014;Bonifácio et al., 2018;Burston et al., 2018;Lack et al., 2014a;Lack et al., 2014b), two from Australia Tan et al., 2020) and one from Thailand (Nouman et al., 2017). ...
... Sample sizes ranged from 8 to 42 participants, for a total of 546 participants and mean age ranged from 20 to 58 years. Thirteen studies included healthy participants (Arastoo et al., 2014;Bonifácio et al., 2018;Burston et al., 2018;Carcia et al., 2006b;Dingenen et al., 2015a;Hertel et al., 2005;Ho et al., 2019;Jenkins et al., 2011;Lack et al., 2014a;Lam et al., 2019;Lam et al., 2021;Wang et al., 2020), two included participants with chronic ankle instability (Dingenen et al., 2015b;Moisan et al., 2019), four with patellofemoral pain (Burston et al., 2018;Hart et al., 2020;Lack et al., 2014b;Rathleff et al., 2016), three with medial knee osteoarthritis (Alshawabka et al., 2014;Esfandiari et al., 2020;Moyer et al., 2017), one with patellofemoral osteoarthritis (Tan et al., 2020), one with diabetes and neuropathy (Nouman et al., 2017) and one with an unknown musculoskeletal status (Caravaggi et al., 2016). ...
... Among the included studies, the following functional tasks were studied: step-down (n = 3) (Bonifácio et al., 2018;Burston et al., 2018;Hertel et al., 2005), step up (n = 3) (Lack et al., 2014a;Lack et al., 2014b), stair ambulation (n = 6) (Alshawabka et al., 2014;Caravaggi et al., 2016;Hart et al., 2020;Moyer et al., 2017;Nouman et al., 2017;Tan et al., 2020), unilateral drop jump landing (n = 5) (Carcia et al., 2006b;Jenkins et al., 2011;Lam et al., 2021;Moisan et al., 2019;Wang et al., 2020), jump (n = 6) (Arastoo et al., 2014;Carcia et al., 2006a;Hertel et al., 2005;Ho et al., 2019;Moisan et al., 2019;Rathleff et al., 2016), single-leg squat (n = 2) (Hertel et al., 2005;Rathleff et al., 2016), weightlifting (n = 1) (Caravaggi et al., 2016), basketball specific tasks (n = 1) , transition from double to single leg stance (n = 2) (Dingenen et al., 2015a;Dingenen et al., 2015b) and gait initiation (n = 1) (Esfandiari et al., 2020). ...
Background
Foot orthoses are among the most commonly used external supports to treat musculoskeletal disorders. It remains unclear how they change the biomechanics of the lower extremities during functional tasks. This systematic review aimed to determine the effects of foot orthoses on primary outcomes (i.e., kinematics, kinetics and electromyography of the lower extremities) in adults with and without musculoskeletal disorders during functional tasks.
Methods
A literature search was conducted for articles published from inception to June 2021 in Medline, CINAHL, SPORTDiscus, Cochrane libraries and PEDro electronic databases. Two investigators independently assessed the titles and abstracts of retrieved articles based on the inclusion criteria. Of the 5578 citations, 24 studies were included in the qualitative synthesis as they reported the effects of foot orthoses on the primary outcomes. Risk of bias of included studies was determined using the modified Downs and Black Quality Index.
Findings
During low impact tasks, foot orthoses decrease ankle inversion and increase midfoot plantar forces and pressure. During higher impact tasks, foot orthoses had little effects on electromyography and kinematics of the lower extremities but decreased ankle inversion moments.
Interpretation
Even though the effects of foot orthoses on the biomechanics of the lower extremities seem task-dependent, foot orthoses mainly affected the biomechanics of the distal segments during most tasks. However, few studies determined their effects on the biomechanics of the foot. It remains unclear to what extent foot orthoses features induce different biomechanical effects and if foot orthoses effects change for different populations.
... The researchers suggest that foot insoles with only lateral wedge would align the tibia and femur into a more upright position and thus reduce knee adduction moment. 30,31 Larger GRF is suggested to lead to higher knee loading, suggesting a higher risk of noncontact ACL injuries. 16,32 Our findings showed higher peak knee flexion angular velocity at peak posterior GRF in arch-support insoles compared with the flat insoles. ...
Background:
Anterior cruciate ligament injuries commonly occur during sports that involve sudden stops or direction changes. Although athletes often use arch-support insoles in competition and training, little is known about the effect of foot insoles on knee biomechanics and jump take-off performances.
Objective:
This study aimed to investigate the effects of arch-support insoles on knee kinematics and kinetics during the stop-braking phase and the subsequent jump take-off performances.
Study design:
That is a quasi-experimental study, repeated-measures design.
Methods:
Twenty male healthy recreational university basketball athletes performed stop-jump with maximum effort in both arch-support and flat insole conditions. Paired t-tests were performed on knee kinetics and kinematics and jump performance variables to determine whether there were significant differences between insole conditions.
Results:
Wearing arch-support insoles experienced larger ground reaction forces (GRFs), loading rates of peak vertical and posterior GRFs, peak knee adduction and rotation moments, and knee flexion angular velocity than the flat insoles (P < 0.05).
Conclusions:
The increased GRFs and knee loading in arch-support insoles are indicative of a higher risk of anterior cruciate ligament injuries. The findings could be insightful to the knee mechanics that are related to performance and injury potential during stop-jump maneuvers.
... A commonly adopted strategy is the utilization of lateral wedge insoles/ orthoses [12], whereby the centre of pressure is forced into a more lateral position; causing a reduction in the lever arm of the knee adduction moment [13]. Importantly lateral wedge insoles have been shown to attenuate the magnitude of the knee adduction moment during gait [14,15], stair ascent and descent [16]. ...
INTRODUCTION: The aim of the current investigation was to examine the effects of both lateral orthoses and toe-in/ toe-out foot progression angles on lower extremity joint loading during walking using a musculoskeletal simulation approach.
METHODS: The current investigation examined 15 healthy males, walking in six different conditions (neutral, lateral orthoses, toe-in, lateral toe-in, toe-out and lateral toe-out). Walking kinematics were collected using an eight-camera motion capture system, and kinetics via an embedded piezoelectric force plate. Lower extremity joint loading was explored using a musculoskeletal simulation approach.
RESULTS: This investigation showed that peak patellofemoral joint stress was greater in the neutral (3.96 KPa/BW) and lateral orthoses (4.20 KPa/BW) conditions compared to toe-in (3.33 KPa/BW), lateral toe-in (3.43 KPa/BW), toe-out (3.35 KPa/BW) and lateral toe-out (3.53 KPa/BW) and ankle joint impulse larger in the toe-in (1.65BW·s) and toe-out (1.62BW·s) foot progression angle modalities compared to neutral (1.51BW·s) and lateral orthoses (1.53BW·s). Furthermore, it was also shown that medial tibiofemoral impulse was statistically greater in the toe-in (1.20BW·s) and lateral toe-in (1.15BW·s) conditions compared to neutral (1.07BW·s), lateral orthoses (1.07BW·s), toe-out (1.09BW·s) and lateral toe-out (1.05BW·s).
CONCLUSIONS: Therefore, the current investigation provides evidence that altering the foot progression angle may attenuate the risk from patellofemoral disorders whilst simultaneously enhancing the risk from degenerative ankle pathologies. Similarly, adopting a toe-in foot progression angle may also increase the risk from medial tibiofemoral degeneration.
... Passive reflective markers with a diameter of 10 mm were placed on the skin according to the calibrated anatomical systems technique (CAST) protocol [21]: anterior superior iliac spine, posterior superior iliac spine, great trochanter, medial and lateral femoral epicondyle, medial and lateral malleolus, aspect of the Achilles tendon insertion on the calcaneus, dorsal margin of the first metatarsal head, dorsal aspect of the second metatarsal head, and dorsal margin of the fifth metatarsal head. Two force plates (AMTI BP400600, Advanced Mechanical Technology Inc., Watertown, MA, USA) were used to collect ground reaction force data with a sampling rate of 1000 Hz. e AMTI custom stairs [22] were fixed to the two force plate measure forces on each stair using a standard approach [23]. After familiarization with the test process, each participant performed a stand static trial and then five valid trials of stairs ambulation at a self-selected pace in the step-by-step manner without using the handrails. ...
Background. Poor balance is one of the risk factors for falls in patients with knee osteoarthritis (KOA), which is related to the symptoms. Electroacupuncture (EA) is one of the traditional Chinese conservative methods commonly used to improve the symptoms in patients with KOA. Objective. To assess whether EA increases the dynamic balance during stair negotiation among patients with KOA. Methods. A total of 40 KOA patients were assigned to two groups randomly (true electroacupuncture vs. mock electroacupuncture). Acupoints around the knee were selected in the true electroacupuncture (TEA) group with electrical stimulation (2 Hz). In the mock electroacupuncture (MEA) group, about 2 cm next to the above acupoints, the needles were inserted superficially without electrical stimulation. All the participants received 11 sessions of stimulation treatment in three weeks. The primary outcome was margin of stability (MOS). Secondary outcomes included hip kinematics and kinetics as well as pain. Results. There was no significant difference between the two groups for self-reported pain (). During ascent, there was no difference between groups in MOS value in both directions, which was the anterior-posterior (A/P) direction and medial-lateral (M/L) direction at initial contact and toe-off as well as the midstance in the gait cycle, and no difference for the hip kinematics and kinetics between the groups was detected (). For descent, at the toe-off event, the TEA group was more unstable as compared to the MEA group in the A/P direction () but not in the M/L direction, and the hip showed a larger internal rotator moment (); at the midstance, the TEA group showed a lower abductor moment than the MEA group (). Conclusions. Based on the assessment results from the chosen patients with KOA, the TEA did not demonstrate a significant effect in improving the dynamic balance during stair negotiation in comparison with the MEA. This finding does not support EA as a conservative treatment to improve the dynamic balance in such patients.
1. Introduction
Among people age 45 years or older, the overall prevalence of symptomatic knee osteoarthritis (KOA) was 8.1% [1]. Elderly people suffered a high risk of falls [2], and the fall-related injuries contributed to a huge economic burden [3]. Elderly patients with KOA were 54% more likely to experience a fall than those without KOA in the past year [4]. So, the economic burden of elderly KOA patients may be higher than those of their peers.
A recent systematic review shows poor balance is one of the risk factors for falls in KOA patients [5], which is related to symptoms such as pain, muscle weakness, and limitation to range of joint motion [6]. Balance refers to the stability to maintain the centre of mass (COM) over the base of support (BOS) [6], and it can be divided into static and dynamic balance. The clinical standing balance tests, such as the Step Test, Single Leg Stance Test, or laboratory-based measurements of standing balance, such as the centre of pressure (COP) velocity and Biodex score, show that KOA patients performed worse with regard to standing balance than healthy controls [7, 8]. For dynamic balance, it refers to the ability to maintain the COM on the BOS by considering the body position and velocity while doing some dynamic tasks [9], and KOA patients also performed impairments, such as lower Community Balance and Mobility Scale scores as compared to the healthy controls [10]. Conservative treatment, such as transcutaneous electrical nerve stimulation (TENS) simultaneously combined with local heat [11] and electrical stimulation combined with continuous passive motion [12], can relieve pain and potentially improve the dynamic balance in KOA patients during gait. Acupuncture can improve the symptoms and functional activities of KOA patients [13] and alter the gait control strategy toward a normal pattern to meet the demand of supporting the body [14].
But most studies focused on the gait and paid less attention to the effect of the conservative treatment on the dynamic balance during stair negotiation. Stair climbing is a common activity of daily life. The fall risk of stair walking is higher than that of flat walking, especially in stair descent [15]. A previous study used the extrapolated centre of mass (XCOM) method to evaluate the dynamic balance when KOA patients descended stairs and disclosed that older individuals showed reduced dynamic balance control as compared with young individuals [16]. Therefore, the aim of this study was to determine the efficacy of acupuncture combined with electrical stimulation (true electroacupuncture, TEA) and mock electroacupuncture (MEA) for dynamic balance in patients with KOA. We hypothesized that TEA would be better than MEA to improve the dynamic balance in KOA patients during stair climbing, especially in descent.
2. Methods
The study is a randomized controlled clinical trial (ChiCTR-IIR-16010284) whereby the ethical approval was obtained from the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine Institutional Review Board (No. 2016KY-007-01), and each participant signed an informed consent form voluntarily.
2.1. Participants
Forty patients (7 males) aged from 48 to 79 with a diagnosis of bilateral symptomatic KOA, in accordance with the random number table, were assigned into an experimental group (TEA group) and a control group (MEA group).
All participants met the following inclusion criteria: (1) had been diagnosed by a physician with bilateral symptomatic KOA according to the clinical and radiographic criteria proposed by the American College of Rheumatology [17], (2) had both knees with grade 2 or 3 according to the standards of the Kellgren/Lawrence grade [18] by radiographic examination and(3) maintained the ability to walk and climb stairs without assistance.
Participants were excluded if they met any of the following exclusion criteria: (1) had asymptomatic KOA patients or other neuromusculoskeletal diseases that may affect gait and/or cognitive function, such as lower extremity injury, rheumatoid arthritis, neuropathic arthropathy, stroke, or fracture; (2) accepted intra-articular injection, such as a corticosteroid, in the previous two months; (3) accepted a total knee replacement or planned to have the surgery in the following year; and (4) underwent any biomedical treatment, such as medication, exercise programme or physical therapy, traditional Chinese Medicine therapy, and other rehabilitative therapy in the last week.
2.2. Treatment
Every participant of the experimental group accepted a 30-minute TEA treatment, while the control group received MEA treatment. According to a previous study [19] and the clinical experience of the members of the research group, seven acupoints around the knees, namely Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34), Yinlingquan (SP 9), Xuehai (SP 10), Liangqiu (ST 34), and Zusanli (ST 36) (Figure 1) were selected and acupunctured with a 1.5-inch single needle (0.30 × 40 mm, Wuxi Jiajian Medical Instruments Co., LTD, China) through the skin to a depth of 1.5 inch by an experienced acupuncturist. Then, the needles were connected to electric needling equipment (G6805, Shanghai Medical Instruments Co., LTD, China), of which the 2 Hz continuous square pulse at a maximal current intensity of patient tolerance was chosen. Each channel of G6805 has two electrodes, and we used two channels. One of the electrodes of the first channel was connected to the needle that was inserted into the Neixiyan, while the other one was connected to Yinlingquan. For the second channel, the electrodes were connected with Yanglingquan and Liangqiu, respectively. During the 30-minute TEA stimulation, all the patients reported “de qi” sensations, which is a feeling of heaviness, numbness, or distention at the area of acupoints [20]. In the MEA stimulation, the same needle as the experimental group was pierced into the skin at nearly 0.5 cm in depth at points that were 2 cm next to the acupoints and away from the meridian by another experienced acupuncturist. And the electric needling equipment was also connected to the needles with no power. During the 30-minute MEA stimulation, none of the patients had “de qi” sensations.
... Fourteen papers were randomised control trials, 18 had a pre-post intervention study design, 1 was a cross-sectional observational study and there was also a single prospective case-control study. Regarding interventions used by the studies, 22 papers looked at LWIs; 12 looking specifically at the effectiveness of LWIs compared to a control (either no insole or a neutral one) [40,49,[54][55][56][57][58][59][60][61][62][63], 2 looked at the effect of insole rigidity [64,65], 2 at insole customisation [66,67], 1 at the effect of insole length [68], 2 at the effect of different elevations of LWIs [69,70], 1 at the correlation between disease severity and LWIs' effectiveness [71], and finally 2 papers investigated the effectiveness of arch support [72,73]. Eleven papers looked at footwear's effect on knee OA: 1 at the effect of different footwear of knee OA [74], 5 at barefoot mimicking shoes [75][76][77][78][79], 3 at variable sole height shoes [80][81][82], and 2 at variable stiffness shoes [83,84]. ...
... However, LWIs' biomechanical efficacy has been well documented. Several papers found that LWIs decreased unfavourable knee loading (either KAM or KAII) during normal walking [49,62], and stair ascent and descent [55]. Table 6 Studies that evaluated the effect of footwear on pain, functional and biomechanical outcomes on medial compartment knee osteoarthritis patients. ...
Background
Knee osteoarthritis is a disease of the joint causing decreased function and pain. Currently, treatments range from medication to surgery, with the use of different insoles and footwear recommended. These methods are effective by either correcting the position of the knee or providing shock absorption. However, there is little understanding of the effective characteristics of these devices.
Research question
This paper aims to investigate this question and provide future areas of research to help better define treatment guidelines. Foot orthoses are an example of non-pharmacological conservative treatments mentioned in National Institute for Health and Care Excellence (NICE) guidelines to treat knee osteoarthritis (OA). These include lateral wedge insoles (LWI), developed with the intention of load reduction of the knee. Different footwear has also been shown to affect pain, biomechanical and functional outcomes in knee OA patients.
Methods
To address what features of LWIs and footwear make them effective in the treatment of knee OA, scientific databases were used to search for papers on this topic and then selected to be included based on pre-defined criteria. Data were extracted and analysed from these studies to provide a basis for possible areas for future development of these foot orthoses, and research required to improve clinical treatment guidelines. Databases used were PubMed, Scopus and Web of Science.
Results and Significance
Thirty-four out of 226 papers were included after application of inclusion and exclusion criteria. Regarding LWIs, the characteristics showing the most beneficial effect on either biomechanical, functional or pain outcomes were customisation, full-length, 5° elevation, shock absorption and arch support. For footwear, barefoot mimicking soles produced the most favourable biomechanics. Results also showed that insoles work in correcting the position of the knee, but it may or may not affect patients’ pain and function.
... Hence, various studies have examined the effects of using different orthotics intervention to increase stability, range of motion, knee flexion, and speeds; and to reduce loads and moments over the lower limb joints (the hip, knee, ankle joints) during stair climbing [4][5][6][7]. Nevertheless, few studies have provided a precise baseline about the hip, knee, ankle joints' biomechanics during stair climbing for orthotists and therapists to compare their results with that baseline when working with pathological groups. ...
... Hence, various studies have examined the effects of using different orthotics intervention to increase stability, range of motion, knee flexion, and speeds; and to reduce loads and moments over the lower limb joints (the hip, knee, ankle joints) during stair climbing [4][5][6][7]. Nevertheless, few studies have provided a precise baseline about the hip, knee, ankle joints' biomechanics during stair climbing for orthotists and therapists to compare their results with that baseline when working with pathological groups. ...
Citation: Al-Fatafta HH, Liu AM, Hutchins SW and Jones RK. The lower limb joints test-retest repeatability in the sagittal, frontal and transverse planes of movement during stair ascent and descent among young, healthy individuals (2019) Pros Orth Open J 3:1:1. Abstract Introduction: The repeatability of both kinetics and kinematics of the knee joint among healthy individuals has been evaluated previously with measurement error, hence, it was important to use the same previous method to evaluate the repeatability of the hip and ankle joints as well in the sagittal, frontal, and transverse planes among healthy individuals during stair climbing the force plates attached interlaced stairway.
... It has been shown that gait modification by varying the external forces on the knee through valgus bracing and lateral wedges can decrease the knee adduction moment (KAM) and/or shift the centre of pressure of the ground reaction force (GRF) laterally [4][5][6][7]. These measures are surrogates of the medial knee contact forces (KMF) and the efficacy of these approaches is highly dependent on the individual subject [8,9]. ...
Medial knee joint osteoarthritis (OA) is a debilitating and prevalent condition. Surgical treatment consists of redistributing the forces from the medial to the lateral compartment through osteotomy, or replacing the joint surfaces. As the mediolateral load distribution is related to the action of the musculature around the knee, the aim of this study was to devise a technique to redistribute these forces non-surgically through changes in muscle excitation. Eight healthy subjects participated in the experiment, and neuromuscular electrical stimulation was used to change the muscle forces around the knee. A musculoskeletal model was used to quantify the loading on the medial compartment of the knee, and a novel algorithm devised and implemented to simulate neuromuscular electrical stimulation. The forces and moments at the knee, ground reaction forces, walking velocity and step length were quantified before and after stimulation. Stimulation of the biceps femoris resulted in a significant decrease in the second peak of the medial knee joint loading by up to 0.17 body weight (p = 0.016). Kinematic parameters were not significantly affected. Neuromuscular electrical stimulation can decrease the peak loads on the medial compartment of the knee, and thus offers a promising therapy for medial knee joint OA.
... Lateral wedge insoles might also protect the contralateral knee from progressive degeneration, in patients with unilateral medial osteoarthritis by reducing bilateral medial knee loading. [6].Furthermore, lateral wedge insoles consistently reduced the overall magnitude of medial compartment loading during stair ascent and descent [7].Results of studies investigating the clinical efficacy of lateral wedge insoles without subtalar strapping for the palliation of symptomatic medial knee OA have been mixed [8,9]. ...
Background
Lateral wedge insoles have been used for the treatment of medial knee osteoarthritis (OA) and have been shown to reduce loading of the medial compartment of the knee. However, as the entire lower extremity acts as a single kinetic chain, altering the biomechanics of the knee may also have significant effects at the ankles or hips. We aimed to evaluate the effects of lateral wedge orthotics on ankle and hip joints, compared to neutral orthotics, by assessing the changes in joint space width (JSW) during 36 months of continuous use.
Methods
We prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee according to the American College of Rheumatology criteria. The trial was double blind and patients were randomized to either wedged or neutral orthotic shoe inserts. Hip and ankle JSWs were quantified using plain radiographies at baseline and at 36-months follow-up.
Findings
45 patients completed the 36 month study. 31 of those who completed the study were using the lateral wedge versus 14 were using neutral orthotics. 2 patients in the wedge group had missing radiographs and were not included in the JSW analyses. There were no significant differences between the wedge and the neutral orthotics groups in the magnitude of JSW change at either the hip or the ankles at 36 month.
Interpretation
We found no significant adverse effects of the lateral wedges on ankles or hips. (ClinicalTrials.gov NCT00076453).
