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Do foot orthoses increase the risk for medial knee OA?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Apr 15, 2008.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    The Influence of Arch Supports on Knee Torques Relevant to Knee Osteoarthritis.
    Franz JR, Dicharry J, Riley PO, Jackson K, Wilder RP, Kerrigan DC.
    Med Sci Sports Exerc. 2008 Apr 9 [Epub ahead of print]
  2. Admin2

    Admin2 Administrator Staff Member

  3. Interesting one! I remember asking this question on the "lateral wedging of knee for knee OA". If lateral weding increases Lateral compression...

    Having said that i tried lateral wedging for a patient with radiographically diagnosed severe medial OA the other week. Result was an INCREASE in medial pain. :wacko:

    I theorised that this was because the presence of medial knee OA did not preclude the inflammation / pain in the medial ligaments and it was these which were being aggravated (pain was reproducable on superficial palpation). Short of sending her back to the orthopeadic chop shop what is a pod to do? Reluctant to use medial posting because i don't want to increase medial compression in the knee. Can't do lateral wedging.

    In the end i used a casted orthotic with a high heel cup cast in semi WB about 5 degrees off maximal pronation (which is where she walks) on the basis that it will stabilise things somewhat without increasing medial compression too much. To cowardly to shoot for STN.

  4. Craig Payne

    Craig Payne Moderator

    I am preparing a powerpoint on this for a presentation at conference this weekend. The solution is going to have to be one of tradeoffs. To fix one problem, we may have to acknowledge an increased risk for another. ie rob peter to pay paul

    Robbing Peter to pay Paul

  5. You might also say that "there is no such thing as a free lunch".
    Sorry, don't know how to embed it like what Craig did.:eek:

    The question is though, were these subjects "normal" or did they actually "require" varus wedging? Also, what are the effects of "abnormal" pronation on the knee joint?
    Last edited: Apr 16, 2008
  6. Peter

    Peter Well-Known Member

    Andy Horwood alluded to this very concept many years ago at Biomechanics Summer School (UK). It certainly explained why some of my then FFOs were not tolerated by some pts with medial Tibio-femoral jt OA.
  7. bob

    bob Active Member

    Peter - you must be pretty sick of people robbing you to pay this 'Paul' character by now!

    How about corticosteroid injections for the knee OA in conjunction with the orthotics?
  8. CraigT

    CraigT Well-Known Member

    I think this is similar to my approach.
    Rather than laterally wedging, I aim for lateral support through the cuboid via a skive at this level (similar to a Feehery mod) with possibly a Denton modification to stiffen the shell along the lateral column. I generally get very good results with this, and find there are less negatives that you would, at least in theory, get from too much pronatory moment.
    If you do not have the effect that you want with this, you can always try the wedge.
    I think this is a reasonable first step, rather than a more extreme wedge from the beginning...
  9. Atlas

    Atlas Well-Known Member

    Spot on.
  10. markjohconley

    markjohconley Well-Known Member

    Opinions appreciated.

    - I am a 54 y/o male with significant genu varum.
    - I have CRF (post throat infection post inhaling too much nail dust (hypothesis)) so I can't take the prophylactic gout medication.
    - Not much trauma needed to set off an episode.
    - I therefore don't walk much (or bicycle at all).
    - I recently increased the rearfoot varus wedging (whilst maintaining forefoot lateral wedging) to facilitate the windlass mechanism.
    - I survived a 2 week bushwalking trip (Uluru, Kata Tjuka? etc) without an episode.
    - One week after my holiday B/ knees started to "kill me", with aching immediately proximal and distal to the joint, especially sore on end ROM knee flexion
    - I have removed the wedging alltogether
    - I've booked into an assessment with a "good" sports physio.

    Again any prescriptive opinions greatly appreciated.
    Mark C
  11. markjohconley

    markjohconley Well-Known Member

    OK, OK, euthanasia?
  12. Hmmm. Sounds pretty bad. You could join the Australian Cricket team.:D

    Ahem. Sorry.

    Difficult to come up with much on the basis of that cos their is not a whole buncha biometric data their. If your pain is distil and proximal rather than IN the joint specific medial OA seems less likely as a DX so lateral wedging may not be the way forward. Are we talking compresive joint, tensile ligament or muscular pain here?

    Is it possible that the mechanism for the medial rearfoot / lateral forefoot is countertorsional "locking" in the Mid tarsal joint? Could it be that the increasing amount of orthotic modification has reduced the shock absorbtion capability of the STJ?

    Might not be a frontal -> rotational issue. Are there any sagital issues / mods on the insoles?

    Have you been using elastic / neophrene supports?

    Just a few thoughts

  13. markjohconley

    markjohconley Well-Known Member

    Thanks Robert,
    Yes and good

    That I don't know, but it's really aggravated by flexing the knee, especially if I remain kneeling (which I do do a lot to prevent any aggravating the ol' "nurses back")

    Definitely methinks

    Only what is provided by the "cobra pad" like medial extension of the wedge, and no, only felt wedges on the sock lining.
    Thanks again Robert

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