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Many conservative treatments exist for medial knee osteoarthritis (OA) which aims to reduce the external knee adduction moment (EKAM). The objective of this study was to determine the difference between different shoes and lateral wedge insoles on EKAM, knee adduction angular impulse (KAAI), external knee flexion moment, pain, and comfort when walk...
Contexts in source publication
Context 1
... (referred to hereafter as the "supported" wedge 18 whereas the other had no medial support (the "typical" wedge). 25 During the trial, these lateral wedges were inserted into the flat-soled control shoe with participants having a minimum of 5 min familiarisation period to the condition. The mobility shoe was a flexible grooved shoe 16 (see Fig. ...
Context 2
... we examined the effects of the conditions on measures of medial loading (Tables 1 and 2, Fig. 3), we found that barefoot walking had the greatest effect on early stance peak EKAM, lowering it by À7.6% (p < 0.001 vs. control shoe). Both lateral wedges reduced the early stance peak EKAM by À5.9 and À5.6% (p ¼ 0.001 vs. control shoe) for typical and supported respectively as we have previously reported. ...
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Background
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Background:
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Methods:
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Citations
... As opposed to flat walking shoes, flip-flops, and being barefoot, "stability" shoes and clogs increased the EKAM by roughly 10% to 15% (45,46). The overall pooled effect estimated suggest that the barefoot have resulted in a statistically significant reduction in the first peak KAM compared to mobility shoe (43)(44)(45). The overall MD is pooled to 0.10; 95% CI (0.05, 0.14) with a substantial heterogeneity, I 2 of 97%. ...
... The primary result mentioned in the research was the first peak EKAM. The first peak EKAM was reported in all 10 studies (33)(34)(35)(36)(38)(39)(40)(41)(42)(43). The meta-analysis for the first peak EKAM included a total of 12 comparisons because several research did multiple analyses with other insole variables (<5 0 and >5 0 to <9 0) , such as the arch support or the length of the wedge. ...
... In contrast, Jones et al, in his study found that the initial part of the stance phase was substantially decreased by both barefoot walking and lateral wedge insoles, whereas the latter stages of the stance phase were significantly reduced with lateral wedge insoles with equal distribution of population with medial OA knee. (43). The use of various wedging and control footwear also had an impact on clinical heterogeneity. ...
Objective • The purpose of this systematic study is to provide clear, patient-focused, recent, evidence-based, and consensus recommendations for footwear and footwear modifications with effects that are globally relevant in OA knee. • The identification and quantitative rating of studies estimating 1 st and 2 nd KAM by wearing different types of footwear and insoles in patients with OA knee. Method: Five databases were searched. A full search of 258 articles was found. To be included in this study, the population should be with OA of any grade without any ambulatory aids, male and female were included with age group above 54 years. For the intervention, all the types of shoes and any kind of modification in the shoes were included. The Primary outcome of interest relating to the biomechanical risk of disease progression was the 1st and 2nd Knee Adduction Moment. Eligible studies were pooled using meta-analysis. Result: Twenty-three studies were included with a total population of 841. Variable stiffness shoe (Mean Difference MD:-0.27; 95% CI:-0.34,-0.21) and Moleca (Mean Difference MD:-0.25; 95% CI:-0.56, 0.05) (Mean Difference MD:-0.25; 95% CI:-0.56, 0.05) have a comparably large statistically significant reduction in KAM with low heterogeneity (Ch 2 = 1.49, I 2 = 0%). The quality of all the studies is moderate (modified Downs and Black quality checklist) and low to moderate risk of bias (QUADAS 2). Conclusion: Biomechanical parameters related to the medial knee load, including first peak EKAM and second peak EKAM, were reduced with the use of footwears and footwear modification, apart from the mobility shoes in first peak KAM and MBT in second peak KAM in comparison with barefoot. VSS and Moleca show significant changes in KAM. Future studies need to consider in terms of height of arch in LWI, duration of footwear usage, material, and rigidity of insole, consider the grades of OA knee for baseline for disease specific recommendation. However, based on our study, the footwear and its modifications show an immediate reduction in EKAM. VSS and Moleca have greater effect in reducing EKAM.
... Additionally, a study on lateral wedges reported a correlation between changes in pKAM and iKAM, with larger reductions in iKAM observed in patients with larger pKAM reductions [17]. Beyond that, there is a paucity of data on the pKFM and pKEA, as well as on other types of insoles [18]. Furthermore, although there could be significant differences among patients in their responses to insole interventions [17,19], to the authors' knowledge, no study has individually analyzed the patients. ...
... Furthermore, it confirmed the observations of two prior studies regarding a positive association between pKAM and iKAM changes [17] as well as an absence of association between pKAM and pAEM changes [24]. The present study also substantiated the data in the literature, sometimes from a single study, regarding the average effects of lateral wedges on a group of patients with medial knee OA to decrease the pKAM, iKAM, and pAEM and to lead to inconsistent changes in pKFM, pKEA, and pHAM [9][10][11]18]. This variability in the biomechanical response among patients could explain the inconsistent clinical outcomes reported for this intervention [12,13]. ...
Using insoles to modify walking biomechanics is of keen interest for the treatment of medial-compartment knee osteoarthritis. So far, insole interventions have focused on reducing the peak of the knee adduction moment (pKAM) and have led to inconsistent clinical outcomes. This study aimed to evaluate the changes in other gait variables related to knee osteoarthritis when patients walk with different insoles to provide insights into the necessity to enlarge the biomechanical analyses to other variables. Walking trials were recorded for 10 patients in four insole conditions. Changes among conditions were computed for six gait variables, including the pKAM. The associations between the changes in pKAM and the changes in the other variables were also assessed individually. Walking with different insoles had noticeable effects on the six gait variables, with high heterogeneity among patients. For all variables, at least 36.67% of the changes were of medium-to-large effect size. The associations with the changes in pKAM varied among variables and patients. In conclusion, this study showed that varying the insole could globally influence ambulatory biomechanics and that limiting measurement to the pKAM could lead to an important loss of information. Beyond the consideration of additional gait variables, this study also encourages personalized interventions to address inter-patient variability.
... Different amounts of lateral wedging have been suggested, such as 4, 5, 6, 10, or 11 • [13]. Previous studies have failed to demonstrate effectiveness in patients with osteoarthritis of the knee, despite the acute effects on the biomechanics of these types of insoles [14]. To the best of our knowledge, only one study has tried to understand the biomechanical effects of several wedging angles [15]. ...
Lateral wedge insoles are recommended in order to minimize the impacts of osteoarthritis of the knee. The amount of wedging required to induce a biomechanical response with clinical significance is still controversial. This study aimed to investigate the immediate biomechanical effects of different amounts of wedging in symptomatic medial knee OA. A 3D motion capture system and five force platforms were used to acquire walking kinematic and kinetic data along a 10 m walkway. Each participant was tested for six different lateral wedge insoles (0, 2, 4, 6, 8, and 10°) in a randomized order. Thirty-eight patients with medial osteoarthritis of the knee were recruited. The application of insoles resulted in an incremental reduction of the first peak of the external knee adduction moment under all experimental conditions in comparison with the control condition (0° insole). A significant increase (p < 0.05) was observed in peak ankle eversion and in ankle eversion at the first peak of the external knee adduction moment with insoles higher than 8° and 6°, respectively. Slight variations to lateral wedge insoles, greater than 2°, appear to induce significant biomechanical changes in patients with knee osteoarthritis.
... On the other hand, the pressure on the medial compartments is about 2.5 times more than the lateral compartment of the knee [10]. This inequality in the distribution of forces may explain the greater involvement of osteoarthritis in the medial knee compartment than in the lateral knee compartment [11,12]. ...
Background:
Considering the increasing importance of the new method of arthroplasty in the treatment of knee osteoarthritis and the possibility of its two-stage and one-stage process, as well as considering that each method has its own merits, this study examines these disadvantages and comparisons.
Methods:
In this cross-sectional study, 119 patients undergoing bilateral knee arthroplasty surgery were enrolled in the study, in the first group with the simultaneous process (60) and the second group who were willing two stages (from a period of three months or more) 59 patients, Then the treatment outcomes were compared in both groups.
Results:
The mean duration of hospitalization in the simultaneous group was significantly lower than that in the staged group (P < 0.05). The average surgery cost in the staged method was significantly higher than that of the same group (P < 0.05). The mean knee motion range and patients' satisfaction in the two groups did not significantly differ. In the short term, patients' satisfaction was higher in the stage method.
Conclusion:
The simultaneous approach to hospitalization time and costs was better than the staged method, but in the long-term, there was a significant difference in other aspects.
... Die Entscheidung gegen solch eine Empfehlung leitet sich hier aber teilweise von der unklaren Evidenz ab und nicht zwingend von einer klaren Evidenz gegen eine Therapieform. Speziell bei der unikompartimentellen Gonarthrose kann die Verwendung einer lateralen oder medialen Schuhranderhöhung und gegebenenfalls die Anpassung einer speziellen entlastenden Orthese, zum Beispiel Unloader-Braces, eine Besserung von Lebensqualität, Schmerz und Funktion erreichen und auch zur weiteren Therapieentscheidung beitragen [39,40]. Allerdings besteht bei allen Orthesen -speziell bei den Unloader-Braces -häufig aufgrund des eingeschränkten Tragekomforts eine deutlich eingeschränkte Compliance der Patienten. ...
... They shift the center of pressure (COP) laterally to decrease the adduction moment arm at the knee [10]. Previous studies have shown that lateral wedges with an inclination of 5° or 6° significantly reduced the peak KAM by 4-6% during level walking compared to walking without a wedge [10][11][12]. However, the lateral shift in the COP also increases the ankle eversion moment (AEM) [13]. ...
... Under the Shoe + FO condition, a similar pattern of COP trajectory was observed; therefore, the first and second peak KAMs decreased. This result is in agreement with those of previous studies [12,25]; there were significant changes in the reduction of the peak KAM in response to lateral wedges with arch support. However, the 3D-printed FOs in this study were used without any additional lateral posting wedges. ...
Lateral wedges are a common conservative treatment for medial knee osteoarthritis (OA). However, use of lateral wedges might increase the ankle eversion moment. To minimize the risk of ankle symptoms, lateral wedges with custom arch support are suggested. However, the manufacturing process of a custom foot orthosis (FO) is complicated, labor-intensive, and time-consuming. The technology of 3D printing is an ideal method for mass customization. Therefore, the purpose of this study was to develop custom FOs using 3D-printing techniques and to evaluate the effects of 3D-printed FOs in patients with knee OA. Fifteen patients with medial knee OA were enrolled into this study. Kinematic and kinetic data were collected during walking by using an optical motion capture system. A paired-sample t-test was conducted to compare biomechanical variables under two conditions: walking in standard shoes (Shoe) and walking in shoes embedded with 3D-printed FOs (Shoe + FO). The results show that the first and second peak knee adduction moments were significantly reduced by 4.08% and 9.09% under the Shoe + FO condition. The FOs alter the biome-chanical environment in a way that reduces the variables used to infer abnormal loads at the knee and ankle that could result in painful symptoms.
... At the biomechanical level, the external knee adduction moment, which correlates with the severity of the varus deformity, represents a dynamic parameter for the load distribution of the knee joint in the frontal plane and is used as a surrogate parameter for the disease progression. 25 Especially in the early stance phase, there is a close correlation between external knee adduction moment and the contact forces in the medial compartment of the knee. 5 The reduction of external moments in the frontal plane is therefore the most important target in the treatment of medial knee osteoarthritis. ...
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.
... In addition, a commercially-available combined orthotic device incorporating 5°lateral wedging and medial arch support was included. This orthotic insole has been demonstrated to limit rearfoot eversion and knee external adductor moment during walking, 20 whilst the influence on running gait has not been explored. It was hypothesised that during running (i) the medial wedge insole (Medial Wedge) would decrease rearfoot eversion and increase knee external adductor moment; (ii) the lateral wedge insole (Lateral Wedge) would decrease the peak knee adductor moment, with an accompanied increase in rearfoot eversion and knee internal rotation angles; (iii) the combined orthotic device (Combined Insole) would reduce rearfoot eversion and knee external adductor moment. ...
... The observed reduction in knee external adductor moment for the Combined Insole compared to the Control is consistent with that reported in previous studies 20 and other lateral wedge insole devices, 14,16 and can be attributed to the specific design feature of a 5°lateral wedge along the length of the lateral foot. Whilst lateral wedge insole devices have been demonstrated to be beneficial for reducing knee external adductor moment in walking, 28 the potential application of this type of intervention in running has not been extensively investigated, especially for older female runners. ...
Reports of greater incidence of knee pain and injury in older female runners compared with their younger counterparts may be associated with differences in lower limb biomechanics that influence knee joint loading. The aim of this study was to investigate footwear interventions aimed at influencing lower limb biomechanics in older female runners (>45 years). Strategies for reducing peak rearfoot eversion and the external knee adductor moment were investigated, since both measures have been associated with knee joint injury. Twenty female runners (mean age 50.7 ± 5.6 years) performed 10 running trials in four footwear conditions: neutral running shoe (Control); neutral shoe with 4° medial heel wedge insole (Medial Wedge); neutral shoe with 4° lateral heel wedge insole (Lateral Wedge); and neutral shoe with combined insole with 5° lateral wedge and medial arch support (Combined Insole). Peak rearfoot eversion and knee external adductor moment were compared for the four conditions using RMANOVA and post-hoc Tukey tests ( p < 0.05). Compared with the Control, peak rearfoot eversion was lower for the Combined Insole condition, with this value being lower than for all other insole conditions ( p < 0.05). Compared with the Control, the peak knee external adductor moment was lower for the Lateral Wedge and the Combined Insole conditions ( p < 0.05). These results support the use of a combined insole with lateral wedge and medial arch support for the reduction of peak rearfoot eversion and peak knee external adductor moment, variables that have been associated with increased risk of knee injury. If aiming to reduce knee external adductor moment alone, then the lateral wedge technology employed in this study provides an effective method for older female runners.
... They shift the center of pressure (COP) laterally to decrease the adduction moment arm at the knee [10]. Previous studies have shown that lateral wedges with an inclination of 5° or 6° signi cantly reduced the peak KAM by 4-6% during level walking compared with during walking without lateral wedges [10][11][12]. However, the lateral shift in the COP also increases the ankle eversion moment (AEM) [13]. ...
... Under the Shoe + FO condition, a similar pattern of COP trajectory was observed; therefore, the rst and second peak KAMs decreased. This result is in agreement with those of previous studies [12,21]; there were signi cant changes in the reduction of the peak KAM in response to lateral wedges with arch support. However, the 3D-printed FOs in this study were used without any additional lateral posting wedges. ...
Background: Lateral wedges comprise a common conservative treatment for medial knee osteoarthritis (OA). However, use of lateral wedges might increases the ankle eversion moment. To minimize the risk of ankle joint, lateral wedges with custom arch support are suggested. However, the manufacturing process of a custom foot orthosis (FO) is complicated, labor intensive, and time consuming. The technology of 3D printing is an ideal method for mass customization. Therefore. the purpose of this study was to develop custom FOs using 3D printing techniques and to evaluate the biomechanical effects of 3D-printed FOs in patients with medial knee OA.
Methods: Fifteen patients with medial knee OA were enrolled into this study. Kinematic and kinetic data were collected during walking by using an optical motion capture system. A paired-sample t-test was conducted to compare biomechanical variables under two conditions: walking in standard shoes (Shoe) and walking in shoes embedded with 3D-printed FOs (Shoe + FO).
Results: Under the Shoe + FO condition, the center of pressure at the peak knee adduction moment significantly shifted laterally by 2.71 mm compared with the Shoe condition. No significant difference in the peak knee flexion moment was observed between the two conditions. In addition, both the first and second peak knee adduction moments were significantly reduced by 4.08% and 9.09% under the Shoe + FO condition. The 3D-printed FOs did not affect the ankle eversion moment but caused a decrease in the peak ankle inversion moment.
Conclusions: The 3D-printed FOs caused a decrease in the ankle inversion moment, the first and second peak knee adduction moments by changing the center of pressure path laterally. Although the decrease in the knee flexion moment from the use of 3D-printed FOs was nonsignificant, such FOs engender biomechanical changes and positively influence the biomechanics of patients with knee OA.
... 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]. The remaining 1 paper compared the effectiveness of shoes and insoles on knee OA [85]. Regarding outcome measures, all papers looked at least one of the primary outcome measures we wanted to assess. ...
... Jones et al. looked at several testing conditions, including different types of shoes and wedges [85] (See Table 7). ...
... The mobility shoe did show a significant reduction in immediate knee pain and improved scores (< 0.001), but did not change medial loading. Lateral wedge insoles showed comparable reductions in medial knee loading [85]. Functional outcomes were not tested. ...
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.
