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Will the use of external supination moment Foot orthotics increase the rates of Medial knee OA

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Jan 19, 2012.

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Will the use of external supination moment Foot orthotics increase the rates of Medial knee OA

  1. it might in some

    80.0%
  2. no it will not

    0 vote(s)
    0.0%
  3. yes it will rates of medial knee OA will increase

    0 vote(s)
    0.0%
  4. it might but it is not going to change how you treat patients

    20.0%
Multiple votes are allowed.

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    We had a thread on this which went nowhere. - http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=10528

    Highlights.


    So though a poll might be the go as well. multiple picks available

    Over on this ( OESH Shoes' Company Says "Ditch Your Orthotics" )thread Kevin Highlighted a few promotional points for the new shoes which will save the world, by the by the cue of Cure all products is getting longer.


    This statement may not be wrong, but then the next question becomes would it change your treatment plan ?



    of Course the vice verse supinate the foot increase abduction moments acting on the knee.
     
    Last edited by a moderator: Jan 21, 2012
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    I think I alluded to this in another thread.

    If you look at some of Nigg's work and the flawed work from Kerrigan et al, then it looks as though a foot orthoses will increase the knee abduction moment in about 50% of people (bearing in mind that both the Nigg and Kerrigan studies did not use anything that resembles a 'foot orthotic' that people actually use in clinical practice) ... also bear in mind that this is also a zero sum game ... if the adduction moment increases, then the abduction moment must decrease (it don't figure that the above studies did not report on this!).

    Also based on flawed research (again from Kerrigan et al!), it is possible that barefoot/minimalist/forefoot strike running can decrease the adduction moment ... again no one mentions what moments went up (...its a zero sum game!)

    So if we accept the above data (I not quite prepared to do that yet), then when we put an orthotic under the foot, then there is a 50% chance that we increase the knee adduction moment and decrease the abduction moment --- that theoretically does increase the risk for medial knee OA (as a high abduction moment is a major risk factor) ... but in that same person we going to decrease the opposite moments ... that may help some with problems at the knee related to those moments.

    Also bear in mind that there is a 50% chance that we decrease the risk for medial Knee OA as it decreases the adduction moment ... (and increased the abduction moment and risk for problems associated with that!)

    How do we know if a foot orthotic is actually going to increase or decrease the risk for medial knee OA ..... I don't know. I suspect which moments get changed are all related to joint lever arms, tibial alignment and ranges of motion.

    Should we be concerned about this? What if an orthotic does increase the knee adduction moment? Even if it does, this has to be moderated with the effect that the orthotic actually has on the pain the patient has.

    I take this approach:
    The other two main risk factors for knee OA are obesity and hereditary issues ... if they are present and there is a 50% chance that the orthotic add to that millieu then we have to acknowledge that (bear in mind there is a 50% we decrease the risk!)

    If the patient is not overweight and has no family history OA, then its doubtful any increase in the knee adduction moment is going to cause any knee OA.

    The same principle applies to barefoot/minimalist/forefoot strike running - if the injury history is related to high adduction moments, then they should be doing this. if the injury history is related to high abduction moments, then they should be rearfoot striking .... theoretically.
     
  3. efuller

    efuller MVP

    If you believe that medial heel skive orthoses increase supination moment by shifting the center of pressure under the foot then that same shift of center of pressure is occurring at the knee as well. If you have genu valgum, a medial shift in the center of pressure will decrease external abduction moment, and if you have genu varum a medial shift in the center of pressure and this will increase external adduction moment.
     
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