Lateral foot wedging for medial knee OA

Press Release:
Simultaneous knee, foot support may improve knee OA management

 

The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint.
Vincent KR, Conrad BP, Fregly BJ, Vincent HK.
PM R. 2012 May;4(5 Suppl):S3-9.

 

Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after 1 year of wear.
Barrios JA, Butler RJ, Crenshaw JR, Royer TD, Davis IS.
J Orthop Res. 2012 Oct 23.
Abstract

 

Redistribution of knee stress using laterally wedged insole intervention: Finite element analysis of knee-ankle-foot complex.
Liu X, Zhang M.
Clin Biomech (Bristol, Avon). 2012 Oct 30.

 

Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis.
Shull PB, Shultz R, Silder A, Dragoo JL, Besier TF, Cutkosky MR, Delp SL.
J Biomech. 2012 Nov 9.

 

This clinical trial was just registerd, even though it says 'completed':
Lateral Wedge Insole With Subtalar Strapping for Knee Osteoarthritis

 

Effects of a modified shoe on knee load in people with and without knee osteoarthritis
Kim L. Bennell, Crystal O. Kean, Tim V. Wrigley, Rana S. Hinman
Arthritis & Rheumatism; Accepted Article

 

How Effective are Lateral Wedge Orthotics in Treating Medial Compartment Osteoarthritis of the Knee? A Systematic Review of the Recent Literature.
Malvankar S, Khan WS, Mahapatra A, Dowd GS.
Open Orthop J. 2012;6:544-7.

 

I have been consistent in my positioon with regards to applying lateral heel wedges to patients with medial kee complaints should not be primary care is not dampened and possibly supported by this Meta-analysis.

It clearly states that:
there is not enough evidence in the literature to prove that lateral wedge orthotics are an effective treatment for varus osteoarthritis of the knee[/B

In addition, there is no mention is made about the compensatory fact that when a force is applied to the STJ to increase pronatory stiffness to the rearfoot and suprastructure, this is counter-productive (produces negative secondary compensatory forces in the foot and elsewhere for many feet as a side effect).

Summarily, there is no high level evidence to show that lateral heel wedges are a valid treatment for medial knee compartment OA as has been offered by those debating me.
Dennis.

 

This clinical trial was just registered:
Therapeutic Effects of Insoles on Patients With Knee Osteoarthritis

 

Customized Foot Insoles Have a Positive Effect on Pain, Function, and Quality of Life in Patients with Medial Knee Osteoarthritis
Søren Thorgaard Skou, Lea Hojgaard, Ole H. Simonsen,
JAPMA January/February 2013 vol. 103 no. 1 50-55

 

This is a great example of EBM in action.

Pilot studies leading to further investigation which leads to more longitudinal studies which results in upgrades/advances in treatment paradigms based on EBM.

I will now incorporate lateral heel wedges for those patients with KOA into my secondary protocols of The Foot Centering Theory of Biomechanics.

The point that I am making here is that it has been the practice of some biomechanists who are EBM oriented to chastise and reduce the importance of theories and pilot studies that may conflict with their existing biomechanical protocols (as this one did to mine until I change my protocol to conform to the evidence) stifling those with potential merit from ever becoming accepted EBM.
Simultaneously, these self proclaimed and verified "open minded practitioners" praise pilot studies that fit their way of practice more than they deserve.

This stifles the expansion of our common biomechanical knowledge and reduces the possibility that some advances to our science never harvest because they have their toes cut off before they can walk on their own.

A specific example of this was when I correctly labeled a pilot study involving the subtalar joint axis with the same, valid criticisms that is utilized to reduce the import of pilot studies that declare the STJ Axis potentially less important than SALRE proponents purport.

Until The Arena uses universal protocols to judge the literature and lets all EBM breathe, I will review all pilot programs that do not seem to go along with Foot Centering accurately, reducing their effectivelness until they harvest into higher level EBM as in this case.

To quote Ian Fleming: Instead of Live and Let Die, Let's Live and Let Live.

Many in the biomechanical world are confident in their own skins enough to acknowledge that there are some valid points and potential upgrades to biomechanics that I have fathered and foster. I am a recognized authority when it comes to biomechanics and orthotics internationally. Yet if you read these pages, from day one, one would get a different opinion.

You have allowed me to take Foot Typing and Vaulting, potentially valid upgrades to biomechanics practice and turn them into the "F" and "V" Words here on The Arena.

This remains your right but life would be easier and biomechanics more acceptable enmasse if we worked from the unbiased, free thinking nil that some of us falsely proclaim doing.

Congratulations to all those involved with putting the lateral wedge/.KOA paradigm on the biomechanical map and a toast to 2013 being the dawn of a new biomechanical era, The Era of Biomechanical Open Mindedness.
:drinks

Dennis

 

Superiority of laterally elevated wedged insoles to neutrally wedged insoles in medial knee osteoarthritis symptom relief
Mohammad Reza Hatef, Zahra Mirfeizi, Maryam Sahebari, Mohammad Hassan Jokar, Mahyar Mirheydari
International Journal of Rheumatic Diseases (Early View)

 

Six-Week Gait Retraining Program Reduces Knee Adduction Moment, Reduces Pain, and Improves Function for Individuals with Medial Compartment Knee Osteoarthritis
Pete B. Shull et al
Journal of Orthopaedic Research; Early View

 

In my language, this is a MERF approach to medial knee adduction moment.

Lateral heel wedges fall into the ORF category.

The last one we need a gander at would be architectural as in ..
Is there a position that the foot can be maintained in using an orthotic shell that would reduce the knee adduction moment.

Now we are talking Foot Centering Theory.

Can we get a gander at the "Retraining Program"? or the entire article so I can apply it in my Evidence Based Biomechanical Practice?.

Dennis

 

It worked so well for Dana, maybe it will work just as well for Dennis?

 

Hi all,

can someone enlighten me....when looking at the mean tibia angle from the first to the last session, it looks like there is a one degree difference in angle. Is there a chance that that small an amount of change could improve function and pain?

regards,

sceptical

 

Little to no change in kinematics is not always a good representation of a change in kinetics.

A one degree difference in tibial angle, if this is an actual change in tibial angle and not a measurement error, could produce a very significant change in pressures within the medial and lateral compartments of the knee.

For the same reason, one cannot assume that just because a foot orthosis does not invert the calcaneus that the orthosis is not significantly reducing the compression forces within the sinus tarsi between the lateral process of the talus and the floor of the sinus tarsi and/or reducing the tension force required by the posterior tibial tendon to supinate the subtalar joint out of the maximally pronated position (Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989). Clinicians and researchers that deal with treating and researching musculoskeletal injuries need to understand this fundamental principle of biomechanics before they can appreciate that the analysis of kinematics, without a corresponding analysis of kinetics, is fraught with error and often leads to faulty misrepresentations of reality.

 

Dear Kevin,

thank you for your reply. I was referring to the below study, and to the angle of the tibia after gait re-education from week one to week six:

Six-Week Gait Retraining Program Reduces Knee Adduction Moment, Reduces Pain, and Improves Function for Individuals with Medial Compartment Knee Osteoarthritis

sincerely,

Peter

 

Peter:

Where does it say in the abstract of the paper you mentioned that "the mean tibia angle from the first to the last session, it looks like there is a one degree difference in angle"?

 

Figure 1, page 1.

from week one to week six...

 

I suppose if I had, or anyone else had access to the paper here on Podiatry Arena, then we would all know what you are talking about.

 

I attached it here, I hope its the complete article. The methods to the gait re-education isnt explained very well.

 

From latest LER:
The role of varus thrust in knee osteoarthritis

 

A systematic review investigating the efficacy of laterally wedged insoles for medial knee osteoarthritis
P. Penny, J. Geere, Toby O. Smith
Rheumatology International; April 2013

 

The effectiveness of voluntary modifications of gait pattern to reduce the knee adduction moment.
van den Noort JC, Schaffers I, Snijders J, Harlaar J.
Hum Mov Sci. 2013 May 3

 

Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after 1 year of wear.
Barrios JA, Butler RJ, Crenshaw JR, Royer TD, Davis IS.
J Orthop Res. 2013 May;31(5):659-64.

 

Lateral wedges alter mediolateral load distributions at the knee joint in obese individuals.
Russell EM, Miller RH, Umberger BR, Hamill J.
J Orthop Res. 2013 May;31(5):665-71.

 

Knee abduction angular impulses during prolonged running with wedged insoles.
Lewinson RT, Worobets JT, Stefanyshyn DJ
Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine [2013]

 

Conservative management of symptomatic knee osteoarthritis: a flawed strategy?
Crawford DC, Miller LE, Block JE.
Orthop Rev (Pavia). 2013 Feb 22;5(1):e2.

 

EFFECT OF UNILATERAL AND BILATERAL USE OF LATERALLY WEDGED INSOLES WITH ARCH SUPPORTS ON IMPACT LOADING IN MEDIAL KNEE OSTEOARTHRITIS
Amira Abdallah
Br J Sports Med 2013;47:e3

 

Much has been written on foot pathomechanics resulting in knee symptomatology. What has not been discussed in this thread is: What is the primary cause of the foot pathomechanics.

I have found that two abnormal inherited foot structures (Primus Metatarsus Supinatus and the PreClinical Clubfoot Deformity) frequently result in chronic knee pain. The most common radiographic changes I see in the knee joint resulting from these two foot structures is a medial collapse (compression) of the joint space.

I have found that if one uses lateal wedging in either of these foot structures, the knee pain is exacerbated.

Professor Brian

 

Foot pressure pattern and its correlation with knee range of motion limitations for individuals with medial knee osteoarthritis
Isao Saito, et al
Archives of Physical Medicine and Rehabilitation; Article in Press

 

Hi Kathleen,

I could not agree with you more. My research over the past 40 years has demonstrated that changes in foot function can dramatically change posture. I have linked some of these postural changes (e.g., postural distortions) to the development of chronic musculoskeletal pain.

The quickest way to change foot function is to place something underneath the feet (e.g., insoles, orthotics etc). With this in mind, using an insole (e.g., lateral wedge) to 'see what happens', in my opinion, should be avoided.

Professor Rothbart

 

The biomechanical effects of a new design of lateral wedge insole on the knee and ankle during walking
Richard K. Jones, Min Zhang, Philip Laxton, Andrew H. Findlow, Anmin Liu
Human Movement Science; Volume 32, Issue 4, August 2013, Pages 596–604

 

Relationship between foot function and medial knee joint loading in people with medial compartment knee osteoarthritis
Pazit Levinger, Hylton B Menz, Adam D Morrow, John R Bartlett, Julian A Feller and Neil R Bergman
Journal of Foot and Ankle Research 2013, 6:33 doi:10.1186/1757-1146-6-33

 

Alignment, Mass and Orthoses in Medial Compartment Knee Osteoarthritis
Rebecca Moyer,
The University of Western Ontario PhD Thesis; 2013