Footwear in those with knee osteoarthritis

NewsBot · Oct 25, 2014

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A survey of footwear advice, beliefs and wear habits in people with knee osteoarthritis
Kade L Paterson, Tim V Wrigley, Kim L Bennell and Rana S Hinman
Journal of Foot and Ankle Research 2014, 7:43 doi:10.1186/s13047-014-0043-8

BackgroundExpert 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.

Methods204 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.

ResultsOnly 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%).

ConclusionsMost 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.
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Admin2 · Oct 25, 2014

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NewsBot · Nov 14, 2014

Relation of Shoe Stability to Risk of Knee Cartilage Damage: The Multicenter Osteoarthritis Study.
K. Douglas Gross, Howard J. Hillstrom, Jingbo Niu, Michael C. Nevitt, James C. Torner, Cora E. Lewis and DavidT.Felson.
American College of Rheumatology Conference; Boston 14-19 November 2014

Background/Purpose: Clinical guidelines recommend that “every pa- tient with knee osteoarthritis should receive advice concerning appropriate footwear”,yettherecommendedcontentofthisadviceisnotspeciﬁed.Some studies suggest that highly ﬂexible shoes can protect the tibiofemoral (TF) joints against excessive load during gait, while other studies underscore the importance of stable or supportive shoes as a means of protecting the patellofemoral(PF)jointagainstmaltrackingbroughtaboutbyfootpronation. The purpose of this observational study was to determine the relationship between the stability characteristics of a person’s usual walking shoe and the 2-yearriskofworseningcartilagedamageinthemedialTF,lateralTF,andPF knee compartments.

Methods: The Multicenter Osteoarthritis Study (MOST) includes middle agedandolderadultsthathaveorareatriskofkneeOA.Subjectswereasked to bring their usual walking shoes and, adapting the methods of Barton et al., examinersatthe60-monthvisitscoredthesagittal,torsional,andheelcounter stability of each subject’s shoe as 0 ﬂexible or 1 stable / supportive (kappa 0.69). A Summative Shoe Stability Score (0–3) was calculated as the sum of the three component test scores. 1.0T MRIs were obtained at the 60 and 84-month exams, and one knee per subject was scored using Whole Organ MRI Scores (WORMS) to indicate the extent of cartilage damage (0–6)ineachof5sub-regionsofthemedialandlateralTFcompartments,and each of 4 sub-regions of the PF compartment (kappa 0.63). Using separate logistic regression models for each compartment, we estimated the relative odds of worsening knee cartilage damage in categories of increasing shoe stability, while adjusting for covariates. Generalized estimating equations accounted for non-independence between sub-regions of a compartment.

Results: 1126 subjects (mean / sd age 66.8 / 7.5 yrs, BMI 29.6 / 4.8 kg/m2; 61.7% female, 89.8% white) contributed 1124, 1123, and 1116 knees to the analysis of cartilage damage in the medial TF, lateral TF, and PF compartments, respectively. A majority of shoes (64.3%, 68.3%, and 55.0%, respectively) were scored as stable / supportive during sagittal, torsional, and heel counter stability tests, with 47.8% of shoes obtaining the maximum Summative Shoe Stability Score of 3 and only 25.5% obtaining the minimum score of 0. Relative odds of worsening cartilage damage in the medial TF, lateral TF, and PF knee compartments did not change across categories of increasing shoe stability (p 0.05 for all comparisons).

Conclusion: These observational ﬁndings do not conﬁrm an association between usual walking shoe stability and 2-year risk of worsening cartilage damageinmedialTF,lateralTF,orPFkneecompartments.Futurestudiesare needed to clarify the shoe characteristics that are most relevant for persons with knee OA.
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NewsBot · Nov 14, 2014

Foot Center of Pressure in Knee Osteoarthritis (OA) and Its Association withKneeLoadReductionwithBarefootWalking.
ChristopherFerrigno, RoyH.Lidtke,MarkusWimmer,AnjaliNair,LauraE.Thorp,LouisF.Fogg, JoelA.BlockandNajiaShakoor.
American College of Rheumatology Conference; Boston 14-19 November 2014

Background/Purpose: Biomechanical factors including excessive knee loadinghavebeenshowntobeimportantinthepathophysiology,severityand progression of knee osteoarthritis (OA). Several biomechanical interventions reduce knee loads by altering foot mechanics, and there is a great deal of interestinbetterunderstandingmechanicalrelationshipsbetweenthefootand knee. We have previously shown that barefoot walking in OA is associated with a signiﬁcant reduction in knee loading compared to conventional footwear. Here we evaluate the role of foot center of pressure (COP) in predicting the unloading response of the knee when walking barefoot. Methods: Participants with radiographic (KL grades 2) and symptom- atic(atleast30mmpainof100mmscalewhilewalking)medialcompartment knee OA underwent gait analyses with their own shoes and while walking barefoot. For simultaneous COP and 3-D ground reaction force acquisition, a pressure platform (Emed, Novel, Munich, Germany) was mounted onto aforce plate (Bertec, Columbus, OH) and the stacked assembly was leveled with the walkway. All capture systems were run at 100 Hz to allow for accurate syncing of stance phase, knee moments, and plantar pressures. Foot COP was quantiﬁed by determining a custom Medial to Lateral Pressure Index (MLPI) while barefoot. The peak knee adduction moment (KAM) was evaluated as a surrogate of medial knee loading. Linear regression was used to evaluate the relationship between foot COP and percent reductions in the KAM with walking barefoot compared to own shoes. The relationships between foot COP and other gait parameters and OA severity were also evaluated. Results: 22 participants (15 women, mean age (SD) of 6211) were evaluated. 10 had a KL grade of 2 and 12 had a KL grade of 3 at the affected knee. Barefoot walking was associated with a 15% reduction in the KAM compared to walking with participants own shoes (2.551.00 vs 2.171.01%BW*ht, p0.001); notably, the magnitude of reduction of the KAM with barefoot walking was associated with a more medial foot COP after adjusting for speed and stride length (adjusted r20.509, p0.049). A medialized foot COP was associated with worse KL grade, slower walking speed and shorter strides during gait (r20.564, p0.002). Radiographic severity explained 9 to 26% of the variance in the foot COP while speed and stride length explained 17 to 47%. Conclusion:Footmechanicsareimportantcontributorstokneeloadingin OA. There is controversy in the literature regarding the foot COP and how it may relate to various foot-targeted interventions in OA. This study suggests thatamoremedialfootCOPisassociatedwithgreaterreductionsintheKAM during barefoot walking. Thus, foot COP may help predict knee loading responses to walking barefoot or an intervention that simulates barefoot walking
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Admin2 · Nov 14, 2014

Characteristics of Conventional Footwear and Their Association with Reductions in Knee Loading with a Flexible Footwear Intervention.
Najia Shakoor, Roy H. Lidtke, Chris Ferrigno, Anjali Nair, Markus A. Wimmer, Laura E. Thorp, K. Douglas Gross and Joel A. Block.
American College of Rheumatology Conference; Boston 14-19 November 2014

Background/Purpose: The peak external knee adduction moment (KAM) as measured through gait analyses has been associated with severity, progression and pain in medial knee osteoarthritis (OA); thus, biomechanical approachestokneeOAaimtoreducetheKAM.Wepreviouslyreportedthat ﬂat ﬂexible footwear may reduce the KAM compared to wearing conven- tional footwear. However, the characteristics of conventional footwear that inﬂuence the magnitude of this reduction remain unclear. Here we evaluate thefootwearofparticipantswithkneeOAtoidentifythepropertiesassociated with response to a ﬂexible footwear intervention.

Methods: ParticipantswithmedialcompartmentkneeOAwereprovided with a ﬂexible study shoe (previously described “mobility shoe”) and were asked to bring their own conventional shoes that they used most often for walking activities. Their own shoes were evaluated for stability/ﬂexibility with the following 3 tests: 1) Sagittal stability: the shoe was held perpendic- ular to a ﬂat surface with the tip of the toe on the ground and approximately 5poundsofloadwasappliedverticallyontheheel;2)Torsionalstability:the shoe was held parallel to the ground with a hand at the heel and the toe and about 5 pounds of torque was applied; 3) Heel counter stability: about 5 pounds of force was applied to the medial and lateral heel counter using the thumbandindexﬁnger.Withallthreetests,theresistancetodeformationwas classiﬁed on a 3-point grading scale (0: rigid, 1:supportive, 2: ﬂexible). The heel height of the shoes was also measured. Gait analyses were performed while walking in subjects’ own shoes and the ﬂexible study shoes. Paired t-tests were used to evaluate overall percent reduction in the KAM with the ﬂexible footwear compared to participants’ own shoes, and the association between reduction in the KAM and measures of their own shoe ﬂexibility/ stability was evaluated using Spearman’s coefﬁcient.

Results: 22 participants (15 women, mean age (SD) of 6211 yrs) were evaluated. Overall, the use of the ﬂexible study shoes was associated with a signiﬁcant 6% reduction in the KAM (2.551.00 vs 2.401.00 %BW*ht, p0.007).ThepercentreductiondemonstratedintheKAMwassigniﬁcantly associatedwiththesagittal(rho0.470,p0.027),torsional(rho0.470, p0.027), and heel counter stability (rho0.551, p0.008) of the partic- ipant’s own shoe, with more rigid footwear being associated with greater KAM reduction. The assessments for sagittal and torsional stability did not appear to provide unique information since they were strongly correlated (rho 1.0)withoneanother.Interestingly,heelheightwasnotassociatedthe extent of KAM reduction (rho0.181, p0.488).

Conclusion: Footwear has been associated with knee joint loading and choiceoffootwearmaybeanimportantconsiderationinkneeOA.Thisstudy suggests that those wearing more rigid footwear may expect the greatest beneﬁt in medial knee load reduction with transition to ﬂexible footwear and supports the concept that ﬂexibility is an important load-reducing feature of footwear. Simple protocols to evaluate footwear such as those used in this studymaybebeneﬁcialinhelpingpatientsmakechoicesregardingfootwear.
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NewsBot · Oct 13, 2016

Effects of footwear on the knee adduction moment in medial knee osteoarthritis: classification criteria for flat flexible versus stable supportive shoes
Kade L. Paterson et al
Osteo & Cart; in press

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. 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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NewsBot · Nov 10, 2016

Effect of Footwear on Joint Pain and Function in Older Adults With Lower Extremity Osteoarthritis.
Wagner A, Luna S.
J Geriatr Phys Ther. 2016 Nov 7

BACKGROUND AND PURPOSE:
Lower extremity osteoarthritis (OA) is a common condition among older adults; given the risks of surgical and pharmaceutical interventions, conservative, lower-cost management options such as footwear warrant further investigation. This systematic review investigated the effects of footwear, including shoe inserts, in reducing lower extremity joint pain and improving gait, mobility, and quality of life in older adults with OA.
METHODS:
The CINAHL, SPORTDiscus, PubMed, RECAL, and Web of Knowledge databases were searched for publications from January 1990 to September 2014, using the terms "footwear," "shoes," "gait," "pain," and "older adult." Participants who were 50 years or older and those who had OA in at least one lower extremity joint narrowed the results. Outcomes of interest included measures of pain, comfort, function, gait, or quality of life. Exclusion criteria applied to participants with rheumatoid arthritis, amputation, diabetes, multiple sclerosis, use of modified footwear or custom orthotics, purely biomechanical studies, and outcomes of balance or falls only. Single-case studies, qualitative narrative descriptions, and expert opinions were also excluded.
RESULTS:
The initial search resulted in a total of 417 citations. Eleven articles met inclusion criteria. Two randomized controlled trials and 3 quasiexperimental studies reported lateral wedge insoles may have at least some pain-relieving effects and improved functional mobility in older adults at 4 weeks to 2 years' follow-up, particularly when used with subtalar and ankle strapping. Three randomized controlled trials with large sample sizes reported that lateral wedges provided no knee pain relief compared with flat insoles. Hardness of shoe soles did not significantly affect joint comfort in the foot in a quasiexperimental study. A quasiexperimental designed study investigating shock-absorbing insoles showed reduction in knee joint pain with 1 month of wear. Finally, a cross-sectional prognostic study indicated poor footwear at early ages exhibits an association with hindfoot pain later in life.
DISCUSSION AND CONCLUSION:
Because of the limited number of randomized control trials, it is not possible to make a definitive conclusion about the long-term effects of footwear on lower extremity joint pain caused by OA. There is mounting evidence that shock-absorbing insoles, subtalar strapping, and avoidance of high heels and sandals early in life may prevent lower extremity joint pain in older adults, but no conclusive evidence exists to show that lateral wedge insoles will provide long-term relief from knee joint pain and improved mobility in older adults with OA. More high-quality randomized control trials are needed to study the effectiveness of footwear and shoe inserts on joint pain and function in older adults with OA.
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NewsBot · Feb 9, 2018

Knee Pain and the Use of Various Types of Footwear-A Review.
Chugthai M et al
https://www.ncbi.nlm.nih.gov/pubmed/29421838?dopt=Abstract

Knee pain is a highly prevalent condition in the United States with multiple etiologies, with two of the most common sources being osteoarthritis (OA) and patellofemoral pain (PFP). These conditions can lead to reduced physical function and a poor quality of life. Various modalities have been used to decrease the amount of knee pain that individuals' experience; however, they are not always successful and can be expensive. Several studies have reported on specialized footwear for symptomatic alleviation of conditions that affect the knee, this is because it has been theorized that certain footwear can alter the forces placed by muscles on lower-extremity joints, and can potentially alleviate pain by reducing the load placed on the joint. Therefore, the purpose of this study was to review the current literature on the use of various types of footwear used in patients who suffer from knee pain. Specifically, we evaluated: (1) knee OA and (2) PFP and the effect that different footwear has on patients' symptoms. Multiple different types of footwear and orthosis were utilized to treat patients with chronic knee pain. However, the results from reported outcomes by different studies are conflicting, which warrant further studies. Nevertheless, there are enough positive results to view this as a potential major modality to utilize for the treatment of knee OA.
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NewsBot · Jan 17, 2021

The Effect of Flat Flexible Versus Stable Supportive Shoes on Knee Osteoarthritis Symptoms
A Randomized Trial
Kade L. Paterson, BAppSci(Hons), BPod, PhD, Kim L. Bennell, BAppSci(Physio), PhD
Source

Background:
Experts recommend that persons with knee osteoarthritis wear stable supportive shoes; however, evidence suggests that flat flexible shoes may be more beneficial.

Objective:
To compare flat flexible with stable supportive shoes for knee osteoarthritis symptoms.

Design:
Participant- and assessor-blinded randomized trial. (Prospectively registered with the Australian New Zealand Clinical Trials Registry [ACTRN12617001098325])

Setting:
Community.

Participants:
164 patients with moderate to severe symptomatic radiographic medial knee osteoarthritis.

Intervention:
Flat flexible (n = 82) or stable supportive shoes (n = 82), worn for at least 6 hours a day for 6 months.

Measurements:
Primary outcomes were changes in walking pain (measured by an 11-point numerical rating scale) and physical function (as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index subscale of 0 to 68 points) at 6 months. Secondary outcomes included additional pain and function measures, physical activity, and quality of life. Other measures included adverse events.

Results:
Of 164 participants recruited, 161 (98%) completed 6-month primary outcomes. No evidence was found that flat flexible shoes were superior to stable supportive shoes in primary outcomes. Evidence did show a between-group difference in change in pain favoring stable supportive shoes (mean difference, 1.1 units [95% CI, 0.5 to 1.8 units]; P = 0.001) but not function (mean difference, 2.3 units [CI, −0.9 to 5.5 units]; P = 0.167). Improvements in knee-related quality of life and ipsilateral hip pain favored stable supportive shoes (mean difference, −5.3 units [CI, −10.0 to −0.5 units] and 0.7 units [CI, 0.0 to 1.4 units], respectively). Flat flexible shoes were not superior to stable supportive shoes for any secondary outcome. Fewer participants reported adverse events with stable supportive shoes (n = 12 [15%]) compared with flat flexible shoes (n = 26 [32%]) (risk difference, −0.17 [CI, −0.30 to −0.05]).

Limitation:
No “usual shoes” control group and a select patient subgroup, which may limit generalizability.

Conclusion:
Flat flexible shoes were not superior to stable supportive shoes. Contrary to our hypothesis, stable supportive shoes improved knee pain on walking more than flat flexible shoes.
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NewsBot · Feb 22, 2021

Compromised balance control in older people with bilateral medial knee osteoarthritis during level walking
Pei-An Lee et al
Sci Rep. 2021 Feb 12;11(1):3742

About half of the elderly population has knee osteoarthritis (OA), showing altered gait patterns with increased fall risk. The current study aimed to identify the effects of severe bilateral medial knee osteoarthritis on gait balance control, in terms of the inclination angle (IA) of the center of pressure to center of mass vector, and the rate of change of IA (RCIA). Fifteen older adults with severe bilateral medial knee OA and 15 healthy controls walked at their preferred walking speed while the kinematic and forceplate data were measured to calculate IA, RCIA and temporal-spatial parameters. The OA group showed compromised gait balance control, due to a decreased average and range of sagittal RCIA over double-limb support (DLS, p < 0.002) and single-limb support (SLS, p < 0.002), as well as an increased sagittal IA (DLS, p < 0.005). Significantly decreased frontal RCIA averages during DLS, heel-strike and toe-off, and decreased RCIA ranges during SLS and swing (p < 0.027) were also observed. Reducing RCIA during DLS appeared to help reduce the loading rate and pain at the knees, and reduced RCIA at the subsequent SLS. The results indicated an increased risk of loss of balance in the OA group, and may warrant regular monitoring for reduced RCIA during gait to determine fall risk.
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NewsBot · Apr 8, 2021

Survey of footwears in Japanese elderly with knee osteoarthritis
Shinya Ogaya &Kita Shunsuke
7 Apr 2021

Improper footwear can lead to painful knee and functional limitations for knee osteoarthritis (OA) patients. This study aimed to examine the use of different footwear types in Japanese knee OA and no knee symptomatic control elderly. The participants answered questionnaires comprised of demographic data, knee function and footwear survey. In the footwear survey, they chose the type of footwear and answered wearing time with it. The knee OA was classified according to American College of Rheumatology criteria. A total of 219 elderly participants were selected of which 69 who did not satisfy the criteria were excluded and the remainder were grouped as knee OA (97) and control group (53). The OA had a significant relationship to categorize the number of footwears adjusted by gender. Most subjects in both group used more than 3 footwears regularly. Knee OA had a smaller number of footwears. Total time of wearing shoes in a day was significantly shorter in the knee OA group (4.95 hours) compared to 6.67 hours in the control group. Few knee OA participants used sandal/Flip flop than the control individuals (23.2% in knee OA and 45.3% in control) and the knee OA group had a shorter time wearing time. Therapists should ask the wearing shoe and provide the shoe intervention to multiple footwear depending on individual patients’ lifestyle.
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NewsBot · Jul 20, 2021

Effect of heeled shoes on joint symptoms and knee osteoarthritis (OA) in older adults: a 5-year follow-up study.
Perry, Thomas A, Dando, Charlotte, Spector, T. D., Hart, Deborah J, Arden, Nigel and Bowen, Catherine
Arthritis Care & Research. (In Press)

Objective: our aims were to examine the effects of heeled shoes on incident knee OA and joint pain. Methods: we used longitudinal data from the Chingford 1000 Women Study (Chingford Study); a prospective cohort of women aged ≥50 years. Participants with musculoskeletal disorders and/or a history of knee-related injury/surgery were excluded. Participants were followed for up to 5-years for incident outcomes including; i) radiographic knee OA (RKOA) and ii) joint pain (feet, knees, hips and back). Footwear data including ever worn heels ≥2 inches and, daytime/evening hours (per week) spent wearing heeled shoes over five-decades (ages <20, 20-30, 30-40, >50 years) were available at Year 10 whilst knee radiographs and joint symptom data were also collected at Year 15. Cumulative time spent wearing heeled shoes was calculated for women reporting ever use of heeled shoes (≥2 inches). Multiple logistic regression was used to examine the relationship between exposures and outcomes (from years 10 to 15). Results: 356 women were eligible at Year 10 with the median (IQR) age 60 (56 to 65) years. Compared to non-use, ever use of heeled shoes (≥2 inches) was not associated with incident RKOA (1.35, 95% CI 0.56 to 3.27). No association was observed between increasing cumulative time spent wearing heels and incident outcomes. Conclusion: compared to the non-use of heeled shoes, ever use of heels (≥2 inches) was not associated with incident RKOA and incident joint symptoms, respectively. Further, increasing cumulative time spent wearing heels was not associated with any of our outcomes.
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NewsBot · May 2, 2022

Knee Pain Reduction Using a Shock-Absorbing Sole
Arnold S. Ross DPM, MS and Lester J. Jones DPM, MSEd
JAPMA

Background: The biomechanics of the foot and leg are responsible for shock absorption during human gait. Lack of shock absorption is known to be a key component of knee pain. This study compares a new model of shoe sole with a built-in modification intended to absorb shock with a traditional sole shoe to examine whether shoe design modifications can help alleviate knee pain.

Methods: A double-blind randomized controlled study was performed. Fifty-two adults with overuse symptoms of knee pain, either unilateral or bilateral, were enrolled and randomly assigned to use the intervention sole or the traditional sole shoes. For 5 weeks, participants wore either the shoe with the intervention sole or the shoe with the traditional sole, rating their knee pain on a 10-point visual analog scale at study onset, midway, and study completion.

Results: After 5 weeks, participants using the intervention sole shoe reported an average reduction in knee pain of 85%, significantly better than participants using the traditional sole shoe (P < .001), whose average pain scores increased. Positive effects on back and foot pain were also observed in those with the intervention sole shoe compared with the traditional sole shoe.

Conclusions: The intervention shock-absorbing sole represents an approach to midsole and outsole construction that can potentially increase shock absorption and decrease knee pain during prolonged standing and walking.
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NewsBot · Jun 3, 2022

Modulation of internal tissue stresses of the knee via control of variable-stiffness properties in a 3D-printed footwear: A combined experimental and finite element analysis
Wen-Ming Chen et al
Med Eng Phys 2022 Jun;104:103800

Aims: Therapeutic footwear with variable-stiffness properties has been shown to be effective in reducing the external knee adduction moment. However, the exact changes of internal tissue stresses following intervention with variable-stiffness footwear remains unknown. The objective of this study is to construct a finite element model of the foot-ankle-knee complex to investigate the therapeutic efficacy of the variable-stiffness footwear in modulating internal knee joint stress distributions.

Methods: Footwear with lateral-to-medial stiffness ratio of 1.00, 1.33, 1.49 and 1.77 were designed and 3D-printed as lattice structures at different porosity levels. A three-dimensional finite element model of the foot-ankle-knee complex was constructed with cartilage-meniscus structures characterized by magnetic resonance imaging. Ground reaction forces and muscular loads estimated from gait experiments with 3D-printed variable-stiffness footwear were used to drive the model, and effects of footwear intervention with four stiffness ratios on tibiofemoral joint loads were evaluated during the simulated instant in gait.

Results: Compared with the constant-stiffness design, the variable-stiffness footwear reached a maximum reduction of the first peak knee adduction moment up to 17.1%. As the lateral-to-medial stiffness ratio increases, the peak stresses at the meniscus in the medial compartment of the knee were reduced by 5.0%, 7.9%, and 16.4%, respectively. The stress-modifying effects were less pronounced for the lateral compartment of the knee.

Conclusion: The variable-stiffness footwear design produced stress relieving to the cartilage and meniscus structures, and the fact that lower stiffness ratio had reached significantly less effects, suggesting a favourable stress-relief effect should consider footwear with a higher lateral-to-medial stiffness ratio.
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NewsBot · Jul 25, 2023

Effect of Footwear Type on Biomechanical Risk Factors for Knee Osteoarthritis
Jan Malus et al
Source

Background:
Regular walking in different types of footwear may increase the mediolateral shear force, knee adduction moment, or vertical ground-reaction forces that could increase the risk of early development of knee osteoarthritis (OA).
Purpose:
To compare kinematic and kinetic parameters that could affect the development of knee OA in 3 footwear conditions.
Study Design:
Controlled laboratory study.
Methods:
A total of 40 asymptomatic participants performed walking trials in the laboratory at self-selected walking speeds under barefoot (BF), minimalistic (MF), and neutral (NF) footwear conditions. Knee joint parameters were described using discrete point values, and continuous curves were evaluated using statistical parametric mapping. A 3 × 1 repeated-measures analysis of variance was used to determine the main effect of footwear for both discrete and continuous data. To compare differences between footwear conditions, a post hoc paired t test was used.
Results:
Discrete point analyses showed a significantly greater knee power in NF compared with MF and BF in the weight absorption phase (P < .001 for both). Statistical parametric mapping analysis indicated a significantly greater knee angle in the sagittal plane at the end of the propulsive phase in BF compared with NF and MF (P = .043). Knee joint moment was significantly greater in the propulsive phase for the sagittal (P = .038) and frontal planes (P = .035) in BF compared with NF and MF and in the absorption phase in the sagittal plane (P = .034) in BF compared with MF and NF. A significant main effect of footwear was found for anteroposterior (propulsion, ↑MF, NF, ↓BF [P = .008]; absorption, ↑BF, MF, ↓NF [P = .001]), mediolateral (propulsion, ↑MF, NF, ↓BF [P = .005]; absorption, ↑NF, MF, ↓BF [P = .044]), and vertical (propulsion, ↑NF, BF, ↓MF [P = .001]; absorption, ↑MF, BF, ↓NF [P < .001]) ground-reaction forces. Knee power showed a significant main effect of footwear (absorption, ↑NF, MF, ↓BF [P = .015]; propulsion, ↑MF, NF, ↓BF [P = .039]).
Conclusion:
Walking in MF without sufficient accommodation affected kinetic and kinematic parameters and could increase the risk of early development of knee OA.
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NewsBot · Aug 3, 2023

Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis
Samual A Kayll, et al
Source

Objective To evaluate the effects of biomechanical foot-based interventions (eg, footwear, insoles, taping and bracing on the foot) on patellofemoral loads during walking, running or walking and running combined in adults with and without patellofemoral pain or osteoarthritis.

Design Systematic review with meta-analysis.

Data sources MEDLINE, CINAHL, SPORTdiscus, Embase and CENTRAL.

Eligibility criteria for selecting studies English-language studies that assessed effects of biomechanical foot-based interventions on peak patellofemoral joint loads, quantified by patellofemoral joint pressure, reaction force or knee flexion moment during gait, in people with or without patellofemoral pain or osteoarthritis.

Results We identified 22 footwear and 11 insole studies (participant n=578). Pooled analyses indicated low-certainty evidence that minimalist footwear leads to a small reduction in peak patellofemoral joint loads compared with conventional footwear during running only (standardised mean difference (SMD) (95% CI) = −0.40 (–0.68 to –0.11)). Low-certainty evidence indicated that medial support insoles do not alter patellofemoral joint loads during walking (SMD (95% CI) = −0.08 (–0.42 to 0.27)) or running (SMD (95% CI) = 0.11 (–0.17 to 0.39)). Very low-certainty evidence indicated rocker-soled shoes have no effect on patellofemoral joint loads during walking and running combined (SMD (95% CI) = 0.37) (−0.06 to 0.79)).

Conclusion Minimalist footwear may reduce peak patellofemoral joint loads slightly compared with conventional footwear during running only. Medial support insoles may not alter patellofemoral joint loads during walking or running and the evidence is very uncertain about the effect of rocker-soled shoes during walking and running combined. Clinicians aiming to reduce patellofemoral joint loads during running in people with patellofemoral pain or osteoarthritis may consider minimalist footwear.
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NewsBot · Feb 22, 2024

The Footwear and Footwear Modifications for Reducing Biomechanical Risk Factor, External Knee Adduction Moment for Medial Knee Osteoarthritis Progression: A Systematic Review and MetaAnalysis
Reshma Jaya Prakash, Richard K Jones
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Objective • The purpose of this systematic study is to provide clear, patient-focused, recent, evidence-based, and consensus recommendations for footwear and footwear modifications with effects that are globally relevant in OA knee. • The identification and quantitative rating of studies estimating 1st and 2nd KAM by wearing different types of footwear and insoles in patients with OA knee. Method: Five databases were searched. A full search of 258 articles was found. To be included in this study, the population should be with OA of any grade without any ambulatory aids, male and female were included with age group above 54 years. For the intervention, all the types of shoes and any kind of modification in the shoes were included. The Primary outcome of interest relating to the biomechanical risk of disease progression was the 1st and 2nd Knee Adduction Moment. Eligible studies were pooled using meta-analysis. Result: Twenty-three studies were included with a total population of 841. Variable stiffness shoe (Mean Difference MD: -0.27; 95% CI: -0.34, -0.21) and Moleca (Mean Difference MD: -0.25; 95% CI: -0.56, 0.05) (Mean Difference MD: -0.25; 95% CI: -0.56, 0.05) have a comparably large statistically significant reduction in KAM with low heterogeneity (Ch2 = 1.49, I2 = 0%). The quality of all the studies is moderate (modified Downs and Black quality checklist) and low to moderate risk of bias (QUADAS 2). Conclusion: Biomechanical parameters related to the medial knee load, including first peak EKAM and second peak EKAM, were reduced with the use of footwears and footwear modification, apart from the mobility shoes in first peak KAM and MBT in second peak KAM in comparison with barefoot. VSS and Moleca show significant changes in KAM. Future studies need to consider in terms of height of arch in LWI, duration of footwear usage, material, and rigidity of insole, consider the grades of OA knee for baseline for disease specific recommendation. However, based on our study, the footwear and its modifications show an immediate reduction in EKAM. VSS and Moleca have greater effect in reducing EKAM.
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NewsBot · Apr 11, 2024

An exploration of footwear preferences, attitudes and beliefs in people with knee osteoarthritis: A qualitative study
Michelle D Smith et al
Musculoskelet Sci Pract. 2024 Mar 27

Background: Although footwear can improve pain and function in individuals with knee osteoarthritis (OA), perspectives about footwear in this population have not been explored.

Objectives: This qualitative study explored preferences, attitudes and beliefs about footwear in adults with knee OA.

Methods: Twenty individuals with a clinical diagnosis of knee OA (aged 45-79 years, 65% women) participated in semi-structured interviews about factors which influence footwear selection, the effect of footwear on knee symptoms, and footwear modifications. Data were analysed thematically.

Results: Four themes, with sub-themes, were identified: i) there are specific footwear characteristics people look for, with comfort as their top priority; ii) shoe appearance is important; iii) footwear can aggravate or ease symptoms; and iv) people with knee OA find footwear in a variety of ways. Participants related built-in arch support, a cushioned insole and low/no heel, without addition of foot orthoses, to comfort, and were willing to pay more for comfort and quality. Appearance was also a consideration, and participants indicated they would tolerate short periods of symptom aggravation for aesthetic shoes. Participants felt that footwear choice affected their knee symptoms and risk of slipping/twisting. Participants reported that their footwear choices were determined through trial-and-error, and sometimes on advice from health professionals or shoe store salespersons.

Conclusions: There are specific footwear features important to individuals with knee OA. Knowledge of these features can be used by health professionals to inform footwear discussions with knee OA patients and serve as considerations when developing footwear targeted for this population.
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