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Current research has strongly suggested, if not validated, that postural distortions are a common cause of chronic musculoskeletal pain (e.g., chronic knee pain). Over the past 45 years I have published on the link between gravity drive (abnormal) pronation and global postural distortions.

• Rothbart BA 2015. The Link Between the Foot And Cerebellum. Resolving Chronic Musculoskeletal Pain. Journal Comprehensive Integrative Medicine. Vol 1(2), 45-57.

Based on these factors, a strong argument can be made that using lateral heel posts to treat knee/patellar pain (see photo below) is iatrogenic. Yet this protocol is still advocated (see citations below).



I can only assume that the authors of these publications are either

(1) Not conversant on the link between abnormal pronation and postural distortions, and/or ​

(2) Not conversant on the link between postural distortions and the development of chronic inflammation in weight bearing joints.​

Constantino de Campos, G., Rezende, M., Pasqualin T. et al. Lateral wedge insole for knee osteoarthritis: Randomized clinical trial. Sao Paulo Medical Journal, October 2014.
Esfandiari E., Kamyab, M., et.al. The effect of lateral wedge insole with and without subtalar strap on vertical component of ground reaction force in knee osteoarthritis. Journal War and Public Health. September 2011.
Tipnis R., Anloague, P., et.al. The dose-response relationship between lateral foot wedging and the reduction adduction moment. Clinical Biomechanics. 2014, 29(9)

 

Brian, that is not a very good assumption.
The valgus foot wedge should be used to reduce the "postural distortion" affects of genu varum. There is literature that shows decreased external knee adduction moment and other literature showing decrease in knee pain with valgus wedges.

The question is whether the benefit of decreased knee pain is worth the risk of increased pronation moment on the foot.
I had a patient with genu varum who had a foot problem I tried to help with a varus foot wedge that made his knee pain worse.

 

I am a strong advocate of: Put nothing underneath the foot unless you know the etiology of the pathomechanics. Otherwise, harm can be inadvertently done to the patient.

To reiterate what I have stated above, placing a heel valgus wedge underneath the feet will, in time, result in chronic musculoskeletal pain. So why would an healthcare provider use a valgus heel wedge to attenuate knee pain when he/she understands it can result in debilitating chronic back, neck, jaw (etc) pain. To me, that is malfeasance, if not downright malpractice.

In the example you gave above, I would determine the underlying cause of the angular distortion in the knee and treat that cause directly. (Several possibilities are the PreClinical Clubfoot Deformity and the Primus Metatarsus Supinatus foot deformity). I would not use a valgus wedge to treat the visual distortion (which is a symptom, not a primary etiology).

In my opinion, valgus wedges should never used to treat symptoms resulting from primary biomechanical aberrations.

The only reason I can think of (offhand) to use a valgus wedge, is in cases resulting from severe trauma or possibly certain metabolic bone diseases.