Original article
Effects of Disease Severity on Response to Lateral Wedged Shoe Insole for Medial Compartment Knee Osteoarthritis

https://doi.org/10.1016/j.apmr.2006.08.018Get rights and content

Abstract

Shimada S, Kobayashi S, Wada M, Uchida K, Sasaki S, Kawahara H, Yayama T, Kitade I, Kamei K, Kubota M, Baba H. Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis.

Objective

To determine the effects of lateral wedged insoles on knee kinetics and kinematics during walking, according to radiographic severity of medial compartment knee osteoarthritis (OA).

Design

A prospective case control study of patients with medial compartment OA of the knee.

Setting

Gait analysis laboratory in a university hospital.

Participants

Forty-six medial compartment knees with OA of 23 patients with bilateral disease and 38 knees of 19 age-matched healthy subjects as controls.

Interventions

Not applicable.

Main Outcome Measures

We measured the peak external adduction moment at the knee during the stance phase of gait and the first acceleration peak after heel strike at the lateral side of the femoral condyles. Kellgren and Lawrence grading system was used for radiographic assessment of OA severity.

Results

The mean value of peak external adduction moment of the knee was higher in OA knees than the control. Application of lateral wedged insoles significantly reduced the peak external adduction moment in Kellgren-Lawrence grades I and II knee OA patients. The first acceleration peak value after heel strike in these patients was relatively high compared with the control. Application of lateral wedged insoles significantly reduced the first acceleration peak in Kellgren-Lawrence grades I and II knee OA patients.

Conclusions

The kinetic and kinematic effects of wearing of lateral wedged insoles were significant in Kellgren-Lawrence grades I and II knee OA. The results support the recommendation of use of lateral wedged insoles for patients with early and mild knee OA.

Section snippets

Patients and Healthy Volunteers

The recruited subjects were 23 patients with bilateral medial compartment knee OA (ie, 46 knees), representing all consecutive patients examined at the Gait Analysis Laboratory, Division of Physical Therapy and Rehabilitation, Fukui University Hospital, between December 1998 and February 1999, who fulfilled the following exclusion criteria. The exclusion criteria were knee pain due to pathologic conditions other than OA, such as rheumatoid arthritis and pseudogout, and knee with flexion

Results

Table 2 lists the values of step length, stride width, and walking velocity. These parameters were significantly lower in OA patients than the control. The use of lateral wedged insoles in OA patients did not change the step length and walking velocity, but significantly increased the stride width. Peak adduction moment during the stance phase of the gait cycle was significantly higher in knee OA patients than the control (table 3,fig 2). The use of lateral wedged insoles significantly

Discussion

A positive correlation between the magnitude of the knee moment and walking velocity has been already reported.23 Walking velocity may also influence the magnitude of first acceleration peak. However, in the present study, application of lateral wedged insoles did not result in significant changes in these parameters in knee OA patients. Our results of the intrinsic effect of the lateral wedged insoles in knee OA patients excluded the effect of walking velocity. On the other hand, increase of

Conclusions

We confirmed in the present study the kinetic and kinematic benefits of wearing lateral wedged insoles in grades I and II medial compartment knee OA patients. However, there was no correlation between kinetic and kinematic effects, suggesting different pathogenic mechanisms. However, we support the clinical recommendation of the use of lateral wedged insoles for patients only with early and mild knee OA.

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