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is lateral foot posting always safe in medial knee OA treatment?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by David Smith, Jun 11, 2015.

  1. David Smith

    David Smith Well-Known Member


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    Does lateral f/foot posting for medial Knee O Arthritis tend to cause pathology associated with increased pronation moments about the foot and ankle complex

    Is it always safe even if the OA knee pain is accompanied by a max pronated foot with restricted rearfoot eversion?

    Lateral foot wedging for medial knee osteoarthritis
    Tagged with: knee osteoarthritis
    Lateral wedging for medial knee osteoarthritis is recommended by several national rheumatology associations. Lateral wedging works by decreasing the external knee adduction moment at the knee. It does not change knee alignment. Two of the key risk factors for medial knee osteoarthritis are a high adduction moment and obesity. Both of these are predictors of the rate of progression of medial knee osteoarthritis. The results of research on lateral wedging for medial knee osteoarthritis is mixed, but this could be due to the inclusion criteria in studies (as high BMI is a predictor, they should be excluded from lateral wedging studies) and there is an inconsistency in the type of lateral wedge used. The evidence is that the wedge should be full length and not just under the heel. There is not one piece of evidence that lateral foot wedging actually puts the foot at increased risk for any problems. For more information on this, see this thread on Podiatry Arena: Lateral foot wedging for medial knee OA & How do you do lateral wedging for medial knee osteoarthritis [http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=867] (article from - http://www.podiatry-portal.com/lateral-foot-wedging-for-medial-knee-osteoarthritis/31/)
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    If you look at all the published studies on lateral wedging for knee OA, this never gets mentioned. It never comes up as an issue. This means either:
    1) Its not a problem
    2) No one is looking.

    In our RCT of lateral wedging for medial knee, we followed 200 people over the age of 50 for a yr. In that cohort only one developed foot pain (around the insertion of post tib). In a cohort of people over 50, how many people in a yr would you expect to develop foot pain anyway? More than a few? In the lateral wedge group we only had one .... not bad?
     
  3. toomoon

    toomoon Well-Known Member

    I think the whole point of lateral posting in a medial OA group is that it is designed (and all the studies include) a clearly symptomatic population. Lateral wedging not only reduces the EKAM, but it reduces symptoms AND disease progression. Given the morbidity associated with major knee OA, this really is an informed choice on the lesser of 2 evils!
     
  4. Simon:

    In my research for my upcoming article on treating medial knee OA with valgus-wedged insoles/orthoses, I came across a very interesting article which described a patient that developed bone edema in the lateral compartment of the knee after use of valgus-wedged insoles that resolved after removing the valgus wedged insoles. Therefore, one must be careful and schedule more frequent followup appointment when using these insoles since they may cause injury (Chaler J, Torra M, Dolz JL, Muller B, Garreta R: Painful lateral knee condyle bone marrow edema after treatment with lateral wedged insole. Am J Phys Med Rehab, 89(5):429-433, 2010).

    BTW, Simon. What's on the song list this year for "The Tarsal Coalition"? Is my jacket back from the cleaners yet? Looking forward to it!:drinks
     
  5. In everything you do with an insole

    you will be robbing Peter to Pay Paul, so there will be a change is stress due to the increased Pronation moment

    If this will (and if so where) become pathology will be Individual
     
  6. David Smith

    David Smith Well-Known Member

    Ok thanks for your replies, I read thru the previous Pod arena thread on lateral posting and medial knee OA and that came to the same conclusion.
    I have a customer who has left medial knee OA but who was more concerned with lateral column pain of the left foot, The 5th ray was more weight bearing because of restricted stj eversion and max pronation in stance causing a compression syndrome, so I was going to design the orthoses with that problem in mind. However on return for assessment and casting he reported that the osteopath had fixed his foot and now he was more concerned about his knee pain. So I was in a quandary about which would be the best design. I'm going for laterally posted f/foot with lateral heel skive and see what happens. I tried OTC Vasyli Hoke laterally posted orthoses as a test an they gave instant pain reduction

    regards Dave Smith
     
  7. Trevor Prior

    Trevor Prior Active Member

    As we discussed in the thread on TST and Root, a recent meta-analysis has questioned the efficacy of lateral wedged orthoses and there is evidence that the EKAM increases in approximately 30% of subjects with laterally wedged orthoses. That would suggest that patients need careful counselling and follow up.

    Chapman GJ, Parkes MJ, Forsythe L, Felson DT, Jones RK, OA & Cart, 2015 – in press

    Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT, Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis, JAMA, 2013, 310(7):722-730
     
  8. Dennis Kiper

    Dennis Kiper Active Member

    Trevor


    a patient that developed bone edema in the lateral compartment of the knee after use of valgus-wedged insoles that resolved after removing the valgus wedged insoles. Therefore, one must be careful and schedule more frequent followup appointment when using these insoles since they may cause injury


    I'm in agreement with Kirby here. It's a shooting match--try a wedge, if that doesn't work try a #4 iron.

    A perfect example of poor technology for a dynamic problem.
     
  9. TL74

    TL74 Active Member

    I agree Dennis. I will always try a RF wedge first to determine initial results. Further treatment must always be followed closely.
     
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