The Effects of an Unloading Knee Brace and Insole with Subtalar Strapping for Medial Osteoarthritis of the Knee (original) (raw)
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Abstract Knee osteoarthritis is the most common disease encountered in the Physical Therapy Clinic. The main outcomes of Physiotherapy treatment is based on symptomatic pain relief along with prevention of deterioration of the functional capacity and improvement in ADL. Among the various conservative treatments for knee OA, lateral wedged insole is the latest treatment concept based on correction of knee varus deformity with the change in foot position. Addition of exercise helps in the maintenance of the correction as muscle strength is required to align the bony levers. This study compares the effect of lateral wedged insole with subtalar strapping along with exercises as treatment option for knee OA with that of exercises alone. Objectives To find out the efficacy of lateral wedged insole with subtalar strapping along with exercises on medial compartment 3rd gradeknee OA. Methods 30 subjects were included in the study based on the inclusion and exclusion criteria and clinical cri...
Indian Journal of Orthopaedics, 2021
Using foot orthoses for managing medial knee osteoarthritis (MKOA) is common, although its effectiveness is in debate. Most orthoses are placed inside the shoe as a lateral wedged insole. Thus, most studies in this area have focused on the effect of insoles used with shoes. This study compared the effects of a lateral wedge with subtalar strap (combined insole) used while barefoot and lateral wedged insole fitted within sandal on pain, function and external knee adduction moment (EKAM) in patients with MKOA to consider which orthotic treatment is better. In this quasi-experimental pretest–posttest study, 29 participants with medial knee osteoarthritis were divided into two groups: (1) combined insole (n = 15) and (2) sandal (n = 14) groups. We recorded their gait while walking with and without orthoses using a motion analysis system. We evaluated their pain and performance with visual analog scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, 30 s...
Osteoarthritis and Cartilage, 2005
To assess the optimal duration of daily wear for a laterally wedged insole with subtalar strapping in subjects with medial compartment osteoarthritis of the knee (knee OA). The setting was an outpatient clinic. Eighty-one patients with knee OA were prospectively randomized according to birth date and to either 2 weeks of treatment with a lateral wedge with subtalar strapping for less than 5 h (the short group), 5-10 h (the medium group) or greater than 10 h (the long group) each day, or to treatment with a subtalar strapping band without lateral wedge (the placebo group). Standing radiographs were used to analyze the femorotibial angle for each subject, both with and without their respective orthotic device. The remission scores of Lequesne index were compared among the four groups at the conclusion. The short (n=21), medium (n=20) and long (n=18) groups demonstrated a significant greater valgus correction of the femorotibial angle than the placebo group (n=22) (P<0.0001). The remission score was significantly improved in the medium group compared to the placebo (P=0.001) and long (P=0.001) groups. An optimal duration of insole with subtalar strapping wear for patients with varus deformity knee OA may be between 5 and 10 h each day.
Iranian Rehabilitation Journal, 2012
Objective: Patients suffering from mild to moderate knee osteoarthritis may be treated with unloader knee orthoses or laterally wedged insoles. This study aimed to identify and compare the effects of two orthoses in these patients. Methods: 56 patients with medial compartment knee OA were evaluated when wearing an unloader knee orthosis and insoles with a 6° lateral wedge which were randomly assigned. Testing was performed at baseline and after 6 months of use with the two types of orthoses. The KOOS score was used to assess outcomes in this study. A paired T test was used for comparing base line and the 6th month post interventions KOOS sub scale score. An independent T test was used for analyzing the efficacy between the two orthoses. Results: Each of the interventions improved all the parameters comparing to the baseline condition (P=0.000). However, in comparing the effect between these orthoses, we did not find significant differences in activities of daily living (P=0.871), or...
Journal of Bone and Joint Surgery - British Volume, 2005
In this cross-over study, we evaluated two types of knee brace commonly used in the conservative treatment of osteoarthritis of the medial compartment. Twelve patients confirmed radiologically as having unilateral osteoarthritis of the medial compartment (Larsen grade 2 to grade 4) were studied. Treatment with a simple hinged brace was compared with that using a valgus corrective brace. Knee kinematics, ground reaction forces, pain and function were assessed during walking and the Hospital for Special Surgery scores were also determined. Significant improvements in pain, function, and loading and propulsive forces were seen with the valgus brace. Treatment with a simple brace showed only significant improvements in loading forces. Our findings suggest that although both braces improved confidence and function during gait, the valgus brace showed greater benefit.
Arthritis & Rheumatism, 2002
Objective. To assess the effect of an insole with subtalar strapping on patients with medial compartment osteoarthritis (OA) of the knee. Methods. Novel lateral wedged insoles with elastic subtalar strapping (the subtalar strapping support group) and ankle supporters with a lateral wedged heel insert (the sock-type ankle support group) were prepared. Eighty-eight female outpatients with knee OA were treated with 1 of the 2 insoles for 8 weeks. Femorotibial angle was assessed by standing radiographs with and without unilateral insole use for each subject. Symptoms of knee OA were evaluated according to the severity index of Lequesne et al at baseline and at the final assessment. Results. Participants wearing the insole with subtalar strapping (n ؍ 42) demonstrated significantly decreased femorotibial angle (an average of change: ؊3.1°؎ 2.5°, P < 0.0001), but a significant difference was not found in the sock-type ankle support group (n ؍ 46; ؊0.4°؎ 1.1°, P > 0.05). In the subtalar strapping support group, pain during bed rest with full extension of the knee (P < 0.0001), pain after getting up (P ؍ 0.04), pain on getting up from a seated position (P ؍ 0.021), maximum distance walked (P ؍ 0.009), and aggregate severity score (P < 0.0001) were significantly improved compared with baseline. In contrast, significant symptomatic improvement was detected only in the aggregate score (P ؍ 0.016) in the sock-type ankle support group, but not in any of the 10 specific categories. Conclusion. The lateral wedged insole with subtalar strapping induces correction of the femorotibial angle and symptomatic relief in patients with varus-deformity knee OA.
Efficacy of Knee Braces and Foot Orthoses in Conservative Management of Knee Osteoarthritis
American Journal of Physical Medicine & Rehabilitation, 2011
Raja K, Dewan N: Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review. Am J Phys Med Rehabil 2011;90:247Y262. A systematic analysis was conducted on the effectiveness of knee braces and foot orthoses in conservative management of knee osteoarthritis. The methodologic quality of the randomized clinical trials, controlled clinical trials, and observational studies were systematically reviewed using the Structured Effectiveness Quality Evaluation Scale. Twenty-five studies met the inclusion criteria. The orthoses used in the studies included Generation II osteoarthritis knee brace, valgus knee braces, functional off-loading knee braces, knee sleeves, lateral-wedged insoles with subtalar strapping, medial-wedged insoles, and specialized footwear. Results suggest that knee braces and foot orthoses are effective in decreasing pain, joint stiffness, and drug dosage. They also improve proprioception, balance, Kellgren/ Lawrence grading, and physical function scores in subjects with varus and valgus knee osteoarthritis. Knee braces and foot orthoses could be cautiously considered as conservative management for relief of pain and stiffness and improving physical function for persons with knee osteoarthritis. The conclusions of this review are limited by methodologic considerations like poor quality of trials and heterogeneity of interventions.