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Tse CTF, Ryan MB, Dien J, Scott A, Hunt MA. An exploration of changes in plantar pressure distributions during walking with standalone and supported lateral wedge insole designs. J Foot Ankle Res 2021; 14:55. [PMID: 34615545 PMCID: PMC8493692 DOI: 10.1186/s13047-021-00493-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Kintec Footlabs Inc, Surrey, BC, Canada
| | - Michael B Ryan
- Kintec Footlabs Inc, Surrey, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Jason Dien
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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Lam WK, Cheung CC, Huang Z, Leung AK. Effects of shoe collar height and arch-support orthosis on joint stability and loading during landing. Res Sports Med 2021; 30:115-127. [PMID: 33579163 DOI: 10.1080/15438627.2021.1888102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined the effects of shoe collar height and foot orthosis on ground reaction force (GRF), ankle and knee mechanics during landing. Sixteen male university basketball players performed drop landing when wearing different shoes with collar height (high vs. low) and foot orthoses (arch-support vs. flat). Biomechanical variables included vertical peak GRF and joint angles and moments in sagittal and coronal planes were analysed with two-way ANOVA with repeated measures (α = 0.05). Results indicated that high-collar shoes had significantly smaller peak ankle dorsiflexion (P < 0.001), smaller ankle sagittal total RoM (P < 0.001), higher forefoot peak GRF (P = 0.009) and peak knee valgus moment (P < 0.001) compared with low-collar shoes. Wearing arch-support orthoses induced higher forefoot peak GRF (P < 0.001) but smaller ankle inversion moment (P = 0.001) compared to flat-orthoses. Furthermore, significant interactions between collar-height and orthosis were found only for initial ankle plantarflexion (P = 0.023) and knee flexion (P = 0.035), but not in any kinetics variables. The findings suggest increased collar height and arch-support orthoses appear to reduce the risks of ankle sprains during landing, but might increase loading at adjacent joints.
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Affiliation(s)
- Wing-Kai Lam
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, China.,Department of Kinesiology, Shenyang Sport University, Shenyang, China.,Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Company, Beijing, China
| | - Chris C Cheung
- Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Company, Beijing, China.,Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhiguan Huang
- Guangdong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, China
| | - Aaron K Leung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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3
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Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA. Orthoses versus gait retraining: Immediate response in improving physical performance measures in healthy and medial knee osteoarthritic adults. Proc Inst Mech Eng H 2020; 234:749-757. [PMID: 32459132 DOI: 10.1177/0954411920924525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The conservative techniques of treating knee osteoarthritis (kOA) include wearing orthoses such as knee braces and laterally wedged insoles and applying gait modification techniques such as toe-in gait and toe-out gait. This study aimed at assessing the immediate effects of these techniques in improving physical function of healthy and kOA participants. Five Osteoarthritis Research Society International (OARSI) recommended performance-based tests were randomly applied to measure physical function: (1) 30-second chair stand test (30CST), (2) 40-m (4 × 10) fast-paced walk test (40FPW), (3) stair climb test (SCT), (4) timed up and go test (TUGT) and (5) 6-minute walk test (6MWT) during a single-visit on 20 healthy and 20 kOA patients (age: 59.5 ± 7.33 and 61.5 ± 8.63 years, BMI: 69.95 ± 9.86 and 70.45 ± 8.80 kg/m2). The interventions included natural gait, toe-out gait, toe-in gait, laterally wedged insoles and knee brace. Analysis was performed through repeated-measures ANOVA and independent sample t-test. 30CST and TUGT showed no significant differences for the five test conditions (p > 0.05). Toe-out showed profound effects via pairwise comparison in impairing the physical function while knee brace improved it during 40FPW, SCT and 6MWT. In general, all the tested conservative techniques except laterally wedged insoles had immediate effects on physical performance measures in both healthy and medial knee osteoarthritis participants. The valgus knee brace improved the parameters the most, while toe-out gait impaired them the most. Future studies can develop strategies for improving gait retraining methods on the basis of issues identified by this study.
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Affiliation(s)
- Saad Jawaid Khan
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Department of Biomedical Engineering, Faculty of Engineering Science and Technology, Ziauddin University, Karachi, Pakistan
| | - Soobia Saad Khan
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Juliana Usman
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdul Halim Mokhtar
- Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noor Azuan Abu Osman
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia.,University of Malaysia Terengganu, Terengganu, Malaysia
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4
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Khan SJ, Khan SS, Usman J, Mokhtar AH, Abu Osman NA. 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. Prosthet Orthot Int 2019; 43:148-157. [PMID: 30192706 DOI: 10.1177/0309364618796849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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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Affiliation(s)
- Saad Jawaid Khan
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,2 Department of Biomedical Engineering, Riphah International University, Islamabad, Pakistan
| | - Soobia Saad Khan
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Juliana Usman
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,3 Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdul Halim Mokhtar
- 4 Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noor Azuan Abu Osman
- 1 Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,3 Centre for Applied Biomechanics, University of Malaya, Kuala Lumpur, Malaysia.,5 The Chancellery, University of Malaysia Terengganu, Terengganu, Malaysia
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Lewinson RT, Madden R, Killick A, Wannop JW, Preston Wiley J, Lun VMY, Patel C, LaMothe JM, Stefanyshyn DJ. Foot structure and knee joint kinetics during walking with and without wedged footwear insoles. J Biomech 2018; 73:192-200. [PMID: 29673934 DOI: 10.1016/j.jbiomech.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/01/2017] [Accepted: 04/01/2018] [Indexed: 11/19/2022]
Abstract
The relationship between static foot structure characteristics and knee joint biomechanics during walking, or the biomechanical response to wedged insoles are currently unknown. In this study, 3D foot scanning, dual X-ray absorptiometry and gait analysis methods were used to determine structural parameters of the foot and assess their relation to knee joint loading and biomechanical response to wedged insoles in 30 patients with knee osteoarthritis. In multiple linear regression models, foot fat content, height of the medial longitudinal arch and static hind foot angle were not associated with the magnitude of the knee adduction moment (R2 = 0.24, p = 0.060), knee adduction angular impulse (R2 = 0.21, p = 0.099) or 3D resultant knee moment (R2 = 0.23, p = 0.073) during gait. Furthermore, these foot structure parameters were not associated with the patients' biomechanical response to medial or lateral wedge footwear insoles (all p < 0.01). These findings suggest that static foot structure is not associated with gait mechanics at the knee, and that static foot structure alone cannot be utilized to predict an individual's biomechanical response to wedged footwear insoles in patients with knee osteoarthritis.
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Affiliation(s)
- Ryan T Lewinson
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada; Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Canada.
| | - Ryan Madden
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - Anthony Killick
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - John W Wannop
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
| | - J Preston Wiley
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Canada
| | - Victor M Y Lun
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Canada
| | - Chirag Patel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada
| | - Jeremy M LaMothe
- Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Canada
| | - Darren J Stefanyshyn
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Canada; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Canada
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Combined effects of knee brace, laterally wedged insoles and toe-in gait on knee adduction moment and balance in moderate medial knee osteoarthritis patients. Gait Posture 2018; 61:243-249. [PMID: 29413792 DOI: 10.1016/j.gaitpost.2018.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test the hypothesis that toe-in gait (TI) will further reduce first peak (Knee Adduction Moment) KAM and decrease balance when combined with a knee brace (KB) and laterally wedged insoles (LWI) in medial knee osteoarthritis (kOA) patients. PARTICIPANTS Twenty patients with bilateral symptomatic medial kOA. INTERVENTIONS 4-point leverage-based KB, full-length LWI with 5° inclination and toe-in gait (TI). MAIN OUTCOME MEASURES First and second peak knee adduction moment (fKAM and sKAM respectively), balance and pain. METHODS The fKAM and sKAM were determined from 3-dimensional gait analysis with six randomized conditions: (1) N (without any intervention), (2) KB, (3) KB + TI, (4) LWI, (5) LWI + TI, (6) KB + LWI + TI. Balance was assessed by Biodex Balance System using three stability settings, (i) Static (ii) Moderate dynamic setting for fall risk (FR12) and (iii) High dynamic setting for fall risk (FR8). RESULTS The reduction in fKAM and sKAM was greatest (19.75% and 12%) when TI was combined with KB and LWI respectively. No change in balance was observed when TI combined with KB, and LWI and when used concurrently with both the orthosis at static and FR12 conditions. Significant balance reduction was found at FR8 for KB + TI (22.22%), and KB + LWI + TI (35.71%). Pain increased significantly for KB (258%), KB + TI (305%), LWI + TI (210%) and KB + LWI + TI (316%). LWI showed no effect on pain. CONCLUSIONS There is a synergistic effect of TI when combined with KB and LWI concurrently in sKAM reduction. However, the concurrent use of TI, KB and LWI decreases balance and pain as assessed on a highly dynamic platform.
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7
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Dessery Y, Belzile É, Turmel S, Corbeil P. Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis. Prosthet Orthot Int 2017; 41:356-363. [PMID: 27555447 DOI: 10.1177/0309364616661254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. OBJECTIVES To verify if such effects occur in participants with medial knee osteoarthritis. STUDY DESIGN Randomized single-blinded study. METHODS Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. RESULTS Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. CONCLUSION Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.
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Affiliation(s)
| | - Étienne Belzile
- 2 Centre de recherche FRQS du Centre hospitalier universitaire de Québec, Quebec, QC, Canada
| | - Sylvie Turmel
- 2 Centre de recherche FRQS du Centre hospitalier universitaire de Québec, Quebec, QC, Canada
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Shaw KE, Charlton JM, Perry CKL, de Vries CM, Redekopp MJ, White JA, Hunt MA. The effects of shoe-worn insoles on gait biomechanics in people with knee osteoarthritis: a systematic review and meta-analysis. Br J Sports Med 2017; 52:238-253. [PMID: 28684391 DOI: 10.1136/bjsports-2016-097108] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The effect of shoe-worn insoles on biomechanical variables in people with medial knee osteoarthritis has been studied extensively. The majority of research has focused specifically on the effect of lateral wedge insoles at the knee. The aim of this systematic review and meta-analysis was to summarise the known effects of different shoe-worn insoles on all biomechanical variables during level walking in this patient population to date. METHODS Four electronic databases were searched to identify studies containing biomechanical data using shoe-worn insole devices in the knee osteoarthritis population. Methodological quality was assessed and a random effects meta-analysis was performed on biomechanical variables reported in three or more studies for each insole. RESULTS Twenty-seven studies of moderate-to-high methodological quality were included in this review. The primary findings were consistent reductions in the knee adduction moment with lateral wedge insoles, although increases in ankle eversion with these insoles were also found. CONCLUSION Lateral wedge insoles produce small reductions in knee adduction angles and external moments, and moderate increases in ankle eversion. The addition of an arch support to a lateral wedge minimises ankle eversion change, and also minimises adduction moment reductions. The paucity of available data on other insole types and other biomechanical outcomes presents an opportunity for future research.
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Affiliation(s)
- Kathryn E Shaw
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Christina K L Perry
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Courtney M de Vries
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Matthew J Redekopp
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jordan A White
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Xing F, Lu B, Kuang MJ, Wang Y, Zhao YL, Zhao J, Sun L, Wang Y, Ma JX, Ma XL. A systematic review and meta-analysis into the effect of lateral wedge arch support insoles for reducing knee joint load in patients with medial knee osteoarthritis. Medicine (Baltimore) 2017; 96:e7168. [PMID: 28614253 PMCID: PMC5478338 DOI: 10.1097/md.0000000000007168] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the immediate effects of lateral wedge arch support insoles (LWAS) on reducing the knee joint load in patients with medial knee osteoarthritis (OA) compared with an appropriate control. METHODS Databases including Medline, EMBASE, Web of Science, Wiley Online Library, Cochrane library, and Google Scholar were searched with no limits on study date or language, from the earliest available date to October 31, 2016. The included studies had to have the aim of reducing knee load and have an appropriate control. The main measured values were the first and second peak external knee adduction moments (EKAM) and the knee adduction angular impulse (KAAI). The random-effects model was used for analyzing the eligible studies. RESULTS Nine studies met the inclusion criteria with a total of 356 participants of whom 337 received LWAS treatment. The risk of methodological bias scores (quality index) ranged from 21 to 27 of 32. Treatment with LWAS resulted in statistically significant reductions in the first peak EKAM (P = .005), the second peak EKAM (P = .01), and the KAAI (P = .03). However, among trials in which the control treatment was control shoes, the LWAS showed no associations on the first peak EKAM (P = .10) or the KAAI (P = .06); among trials in which the control treatment was neutral insoles, the LWAS showed no associations on the second peak EKAM (P = .21) or the KAAI (P = .23). At the same time, the LWAS showed no statistically significant reduction on the first peak EKAM (P = .39) when compared with flat insoles. CONCLUSION Although meta-analysis outcomes of all studies indicated statistically significant associations between LWAS and reductions of the first peak EKAM, second peak EKAM and KAAI in people with medial knee OA while walking, different results existed in subgroups using various control conditions for comparison. These findings do not support the use of LWAS insoles for reducing knee load. An optimal LWAS treatment should provide the appropriate height of arch support and amount of lateral wedging. Further research should investigate the best combination of these 2 parameters to achieve efficacy without altered comfort.
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Affiliation(s)
- Fei Xing
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Bin Lu
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Ming-jie Kuang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Ying Wang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Yun-long Zhao
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Jie Zhao
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Tianjin Medical University
| | - Lei Sun
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Yan Wang
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Jian-xiong Ma
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
| | - Xin-long Ma
- Biomechanics Labs of Orthopedics Institute, Tianjin Hospital
- Department of Orthopedics, Tianjin Hospital, Tianjin, People's Republic of China
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Paterson KL, Bennell KL, Wrigley TV, Metcalf BR, Kasza J, Hinman RS. Effects of footwear on the knee adduction moment in medial knee osteoarthritis: classification criteria for flat flexible vs stable supportive shoes. Osteoarthritis Cartilage 2017; 25:234-241. [PMID: 27729290 DOI: 10.1016/j.joca.2016.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/30/2016] [Accepted: 10/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To validate simple criteria that distinguish flat flexible from stable supportive walking shoes by comparing their effects on the knee adduction moment (KAM) in people with medial knee osteoarthritis (OA). DESIGN This was a cross-sectional biomechanical study. We proposed five criteria to differentiate flat flexible from stable supportive shoes, and selected three pairs of shoes representing each class for biomechanical testing. 28 participants aged ≥50 years with symptomatic medial knee OA underwent gait analysis barefoot and wearing each of the six selected shoes, in random order. Differences in the peak KAM, KAM impulse and peak knee flexion moment (KFM) across test conditions were evaluated with a two-way repeated measures analysis of variance (ANOVA). Immediate changes in walking pain between conditions were also compared. RESULTS Increases in KAM from barefoot were lower with each of the three flat flexible shoe styles (peak KAM: 6.1-8.9%; KAM impulse: 2.4-5.1%) compared to their stable supportive counterparts (peak KAM: 11.6-15.1%; KAM impulse 10.5-13.2%). There was a significant main effect for footwear class on peak KAM and KAM impulse, whereby stable supportive shoes increased the KAM significantly more than flat flexible shoes (P < 0.001). There were no differences in the KFM or immediate walking pain between footwear classes. CONCLUSIONS Our proposed criteria can be used by researchers and clinicians to select flat flexible shoes for people with medial knee OA to minimise knee loading. Future research should evaluate whether wearing shoes based on these criteria translates to improvements in knee OA symptoms and/or slows structural disease progression.
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Affiliation(s)
- K L Paterson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - T V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - B R Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Collins NJ, Hinman RS, Menz HB, Crossley KM. Immediate effects of foot orthoses on pain during functional tasks in people with patellofemoral osteoarthritis: A cross-over, proof-of-concept study. Knee 2017; 24:76-81. [PMID: 27825592 DOI: 10.1016/j.knee.2016.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/13/2016] [Accepted: 09/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of the study was to determine whether prefabricated foot orthoses immediately reduce pain during functional tasks in people with patellofemoral osteoarthritis, compared to flat insoles and shoes alone. METHODS Eighteen people with predominant lateral patellofemoral osteoarthritis (nine women; mean [SD] age 59 [10]years; body mass index 27.9 [3.2]kg/m2) performed functional tasks wearing running sandals, and then wearing foot orthoses and flat insoles (random order). Participants rated knee pain during each task (11-point numerical rating scales), ease of performance and knee stability (five-point Likert scales), and comfort (100mm visual analogue scales). RESULTS Compared to shoes alone, foot orthoses (p=0.002; median difference 1.5 [IQR 3]) and flat insoles (p<0.001; 2 [3]) significantly reduced pain during step-downs; foot orthoses reduced pain during walking (p=0.008; 1 [1.25]); and flat insoles reduced pain during stair ambulation (p=0.001; 1 [1.75]). No significant differences between foot orthoses and flat insoles were observed for pain severity, ease of performance or knee stability. Foot orthoses were less comfortable than flat insoles and shoes alone (p<0.05). CONCLUSIONS In people with patellofemoral osteoarthritis, immediate pain-relieving effects of prefabricated, contoured foot orthoses are equivalent to flat insoles. Further studies should investigate whether similar outcomes occur with longer-term wear or different orthosis designs.
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Affiliation(s)
- Natalie J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia.
| | - Rana S Hinman
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Hylton B Menz
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Kay M Crossley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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12
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Hatfield GL, Cochrane CK, Takacs J, Krowchuk NM, Chang R, Hinman RS, Hunt MA. Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet. J Orthop Res 2016; 34:1597-605. [PMID: 26800087 DOI: 10.1002/jor.23174] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/13/2016] [Indexed: 02/04/2023]
Abstract
UNLABELLED This study compared immediate changes in knee and ankle/subtalar biomechanics with lateral wedge orthotics with and without custom arch support in people with knee osteoarthritis and flat feet. Twenty-six participants with radiographic evidence of medial knee osteoarthritis (22 females; age 64.0 years [SD 8.0 years], BMI 27.2 kg/m(2) [4.2]) and flat feet (median foot posture index = + 5) underwent three-dimensional gait analysis for three conditions: Control (no orthotic), lateral wedge, and lateral wedge plus arch support. Condition order was randomized. Outcomes included frontal plane knee and ankle/subtalar biomechanics, and comfort. Compared to the control, lateral wedge and lateral wedge with arch support reduced the knee adduction moment impulse by 8% and 6%, respectively (p < 0.05). However, the lateral wedge resulted in a more everted foot position (4.3 degrees) than lateral wedge plus arch support (3.2 degrees) (p < 0.05). In contrast, lateral wedge plus arch support reduced foot frontal plane excursion compared to other conditions (p < 0.05). Participants self-reported significantly more immediate comfort with lateral wedge plus arch support compared to the control, whereas there was no difference in self-reported comfort between lateral wedge and control. No immediate changes in knee pain were observed in any condition. CLINICAL SIGNIFICANCE Rather than prescribing lateral wedges to all patients with knee osteoarthritis, those who have medial knee osteoarthritis and flat feet may prefer to use the combined orthotic to reduce loads across the knee, and to minimize the risk of foot and ankle symptoms as a consequence of orthotic treatment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1597-1605, 2016.
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Affiliation(s)
- Gillian L Hatfield
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher K Cochrane
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judit Takacs
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Natasha M Krowchuk
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Chang
- Human Performance Engineering Laboratory, Reebok International, Canton, Massachusetts
| | - Rana S Hinman
- Department of Physiotherapy, Center for Health Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Hsieh RL, Lee WC. Clinical effects of lateral wedge arch support insoles in knee osteoarthritis: A prospective double-blind randomized study. Medicine (Baltimore) 2016; 95:e3952. [PMID: 27399068 PMCID: PMC5058797 DOI: 10.1097/md.0000000000003952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We compared the short-term efficacy of rigid versus soft lateral wedge arch support (LWAS) insoles for patients with knee osteoarthritis (OA), as assessed using the International Classification of Functioning, Disability and Health (ICF) system, through a prospective, double-blind, randomized controlled trial.Participants who fulfilled the combined radiographic and clinical criteria for knee OA, as defined by the American College of Rheumatology, were randomly prescribed 1 pair of rigid or soft LWAS insoles. Body functions and structures were evaluated according to Kellgren-Lawrence scores, the Foot Posture Index, Hospital Anxiety and Depression Scale scores, the pain-pressure threshold, postural stability, dynamic balance, and fall risk; activities and participation were assessed according to 10-m fast speed walking, stair climbing and chair rising times, and Chronic Pain Grade questionnaire responses; and knee OA-related health status was evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Hospital Anxiety and Depression Scale scores, the pain-pressure threshold, physical activity, balance, Chronic Pain Grade questionnaire responses, and the KOOS were recorded before treatment and at 1-, 2-, and 3-month follow-ups.We enrolled 90 participants, 70 women and 20 men, with mean ages of 60.6 ± 10.8 and 63.1 ± 10.8 years in the rigid and soft LWAS insole groups, respectively. Repeated-measures analysis of covariance revealed significant time × group effect improvements in pain (P = 0.008 for the KOOS), stair ascent time (P = 0.003), daily living function (P = 0.003 for the KOOS), sports and recreation function (P = 0.012 for the KOOS), and quality of life (P = 0.021 for the KOOS) in the soft LWAS insole group.Patients with knee OA who used soft LWAS insoles for a short term showed more significant improvement than did those who used rigid LWAS insoles in pain, physical activity, daily living function, sports and recreation function, and quality of life, which belong to the body functions and structures and the activities and participation components in the ICF scheme.
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Affiliation(s)
- Ru-Lan Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University
- Correspondence: Ru-Lan Hsieh, Department of Physical Medicine and Rehabilitation, Shin-Kong Wu Ho-Su Memorial Hospital, No.95, Wen Chang Rd, Shih Lin District, Taipei 11101, Taiwan (e-mail: )
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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14
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Sawada T, Kito N, Yukimune M, Tokuda K, Tanimoto K, Anan M, Takahashi M, Shinkoda K. Biomechanical effects of lateral and medial wedge insoles on unilateral weight bearing. J Phys Ther Sci 2016; 28:280-5. [PMID: 26957775 PMCID: PMC4756021 DOI: 10.1589/jpts.28.280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022] Open
Abstract
[Purpose] Lateral wedge insoles reduce the peak external knee adduction moment and are
advocated for patients with knee osteoarthritis. However, some patients demonstrate
adverse biomechanical effects with treatment. In this study, we examined the immediate
effects of lateral and medial wedge insoles under unilateral weight bearing. [Subjects and
Methods] Thirty healthy young adults participated in this study. The subjects were
assessed by using the foot posture index, and were divided into three groups: normal foot,
pronated foot, and supinated foot groups. The knee adduction moment and knee-ground
reaction force lever arm under the studied conditions were measured by using a
three-dimensional motion capture system and force plates. [Results] In the normal and
pronated groups, the change in knee adduction moment significantly decreased under the
lateral wedge insole condition compared with the medial wedge insole condition. In the
normal group, the change in the knee-ground reaction force lever arm also significantly
decreased under the lateral wedge insole condition than under the medial wedge insole
condition. [Conclusion] Lateral wedge insoles significantly reduced the knee adduction
moment and knee-ground reaction force lever arm during unilateral weight bearing in
subjects with normal feet, and the biomechanical effects varied according to individual
foot alignment.
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Affiliation(s)
- Tomonori Sawada
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Hiroshima International University, Japan
| | | | - Kazuki Tokuda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kenji Tanimoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Masaya Anan
- Institute of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Makoto Takahashi
- Institute of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Koichi Shinkoda
- Institute of Biomedical and Health Sciences, Hiroshima University, Japan
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15
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The Effect of Lateral Wedge and Medial Arch Support on Displacement of Ground Reaction Force in Patients with Knee Osteoarthritis. JOURNAL OF REHABILITATION 2016. [DOI: 10.20286/jrehab-170172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Moyer RF, Ratneswaran A, Beier F, Birmingham TB. Osteoarthritis year in review 2014: mechanics--basic and clinical studies in osteoarthritis. Osteoarthritis Cartilage 2014; 22:1989-2002. [PMID: 25456294 DOI: 10.1016/j.joca.2014.06.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/18/2014] [Accepted: 06/25/2014] [Indexed: 02/02/2023]
Abstract
The purpose of this review was to highlight recent research in mechanics and osteoarthritis (OA) by summarizing results from selected studies spanning basic and clinical research methods. Databases were searched from January 2013 through to March 2014. Working in pairs, reviewers selected 67 studies categorized into four themes--mechanobiology, ambulatory mechanics, biomechanical interventions and mechanical risk factors. Novel developments in mechanobiology included the identification of cell signaling pathways that mediated cellular responses to loading of articular cartilage. Studies in ambulatory mechanics included an increased focus on instrumented knee implants and progress in computational models, both emphasizing the importance of muscular contributions to load. Several proposed biomechanical interventions (e.g., shoe insoles and knee braces) produced variable changes in external knee joint moments during walking, while meta-analysis of randomized clinical trials did not support the use of lateral wedge insoles for decreasing pain. Results from high quality randomized trials suggested diet with or without exercise decreased indicators of knee joint load during walking, whereas similar effects from exercise alone were not detected with the measures used. Data from longitudinal cohorts suggested mechanical alignment was a risk factor for incidence and progression of OA, with the mechanism involving damage to the meniscus. In combination, the basic and clinical studies highlight the importance of considering multiple contributors to joint loading that can evoke both protective and damaging responses. Although challenges clearly exist, future studies should strive to integrate basic and clinical research methods to gain a greater understanding of the interactions among mechanical factors in OA and to develop improved preventive and therapeutic strategies.
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Affiliation(s)
- R F Moyer
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - A Ratneswaran
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - F Beier
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - T B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada.
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17
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Paterson KL, Wrigley TV, Bennell KL, Hinman RS. A survey of footwear advice, beliefs and wear habits in people with knee osteoarthritis. J Foot Ankle Res 2014; 7:43. [PMID: 25352917 PMCID: PMC4210582 DOI: 10.1186/s13047-014-0043-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/07/2014] [Indexed: 11/10/2022] Open
Abstract
Background Expert opinion recommends cushioned and supportive footwear for people with knee osteoarthritis (OA). However, little is known about the footwear advice people receive from healthcare professionals, or the beliefs and footwear habits of people with knee OA. This study aimed to determine i) what types of shoes people are advised to wear for their knee OA and by whom; ii) establish which types of shoes people with knee OA believe are best for managing their knee OA symptoms and (iii) which shoes they wear most often. Methods 204 people with symptomatic knee OA completed an online survey. The survey comprised 14 questions asking what footwear advice people had received for their knee OA and who they received it from, individual beliefs about optimal footwear styles for their knee OA symptoms and the types of footwear usually worn. Results Only one third (n = 69, 34%) of participants reported receiving footwear advice for their knee OA, and this was most frequently received from a podiatrist (n = 47, 68%). The most common advice was to wear sturdy/supportive shoes (n = 96, 47%) or shoes with arch supports (n = 84, 41%). These were also amongst the shoe styles that participants believed were best for their knee OA (n = 157 (77%) and n = 138 (68%) respectively). The type of shoes most frequently worn were athletic (n = 131, 64%) and sturdy/supportive shoes (n = 116, 57%). Conclusions Most people with knee OA who completed our survey had not received advice about footwear for their knee OA symptoms. Our participants typically believed that sturdy/supportive shoes were best for their knee OA and this shoe style was most frequently worn, which is reflective of expert opinion. Future research is needed to confirm whether sturdy/supportive shoes are indeed optimal for managing symptoms of knee OA. Electronic supplementary material The online version of this article (doi:10.1186/s13047-014-0043-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kade L Paterson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Tim V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC Australia
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