Full length articleLong-term effects of lateral wedge orthotics on hip and ankle joint space widths
Section snippets
Background
Osteoarthritis (OA) is a leading cause of knee pain, especially in older adults. The pathophysiology is complex and as of yet not entirely understood. However, clinical studies have suggested that mechanical factors play a significant role in the progression of knee OA. Coronal plane (Varus or valgus) alignment deformities are both associated with faster disease progression [1]. Lateral wedge insoles have been studied as one option to modify the mechanical environment of the medial knee.
Materials and methods
We prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee (Fig. 1). Patients were subjects of a longitudinal randomized double-blind placebo controlled three-year trial evaluating the effects of lateral wedge orthotics in patients with medial knee OA. Subjects were recruited to the study both from the Rush University clinic system and through public service announcements in the local media. Each subject met the following criteria to be eligible: presence of
Results
Baseline characteristics of the study patients are given in Table 1. There was no statistically significant difference between the two groups at baseline with respect to age, gender, BMI, years since diagnosis of OA or index side.
The magnitude of JSW changes between baseline and month 36 revealed no significant differences between the wedge and the neutral orthotics groups, at either the hip or the ankles (Table 2).
Forty five patients completed the 36-month study. Although the number of drop
Discussion
We previously presented the beneficial mechanical effects of lateral wedged insoles at the knees and demonstrated that they provide sustained mechanical unloading and may delay the progression of joint space narrowing in medial knee OA [25], [26]. In this study, we tested the hypothesis that lateral wedge orthotics used for medial knee OA might affect the integrity of the other large joints of the lower extremities, using radiographic joint space narrowing as a widely accepted surrogate for
Conclusion
Conventional lateral wedge insoles, being used for the treatment of medial knee osteoarthritis are not likely to adversely affect the joint space widths of hip and ankle joints over 36 months. Our results suggest that even with prolonged use for knee OA over three years, wedged inserts do not appear to promote adverse consequences in the other joints of the lower extremity. These findings should be reassuring for those interested in using lateral wedged insoles to provide mechanical unloading
Conflict of interest
Non.
Ethical board review statement
The study was approved by the Institutional Review Board of Rush Medical College.
Acknowledgements
This study has been supported, in part, by National Institute of Health (NIAMS 1P50 AR048941). Berna Goker has received travel funding for this study from ‘Turkish Society of Rheumatology (TRD, formerly named Turkish Society for Education and Research in Rheumatology, RAED-Romatoloji Arastırma ve Egitim Dernegi).
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