Long-term effects of lateral wedge orthotics on hip and ankle joint space widths

doi:10.1016/j.gaitpost.2016.09.017

Gait & Posture

Volume 51, January 2017, Pages 36-40

https://doi.org/10.1016/j.gaitpost.2016.09.017 Get rights and content

Highlights

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Lateral wedges do not lead to adverse effects on the joint space widths of ankles.
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Lateral wedges do not lead to adverse effects on the joint space widths of hips.
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Results suggest that lateral wedge insoles are safe for ankles and hips.

Abstract

Background

Lateral wedge insoles have been used for the treatment of medial knee osteoarthritis (OA) and have been shown to reduce loading of the medial compartment of the knee. However, as the entire lower extremity acts as a single kinetic chain, altering the biomechanics of the knee may also have significant effects at the ankles or hips. We aimed to evaluate the effects of lateral wedge orthotics on ankle and hip joints, compared to neutral orthotics, by assessing the changes in joint space width (JSW) during 36 months of continuous use.

Methods

We prospectively enrolled 109 subjects with symptomatic osteoarthritis of the medial knee according to the American College of Rheumatology criteria. The trial was double blind and patients were randomized to either wedged or neutral orthotic shoe inserts. Hip and ankle JSWs were quantified using plain radiographies at baseline and at 36-months follow-up.

Findings

45 patients completed the 36 month study. 31 of those who completed the study were using the lateral wedge versus 14 were using neutral orthotics. 2 patients in the wedge group had missing radiographs and were not included in the JSW analyses. There were no significant differences between the wedge and the neutral orthotics groups in the magnitude of JSW change at either the hip or the ankles at 36 month.

Interpretation

We found no significant adverse effects of the lateral wedges on ankles or hips. (ClinicalTrials.gov NCT00076453).

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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Full length articleLong-term effects of lateral wedge orthotics on hip and ankle joint space widths

Highlights

Abstract

Background

Methods

Findings

Interpretation

Section snippets

Background

Materials and methods

Results

Discussion

Conclusion

Conflict of interest

Ethical board review statement

Acknowledgements

Osteoarthritis Res. Soc.

Osteoarthritis Res. Soc.

Clin. Biomech. (Bristol, Avon)

Osteoarthritis Cartilage

Clin. Biomech. (Bristol, Avon)

Osteoarthritis Res. Soc.

Varus and valgus alignment and incident and progressive knee osteoarthritis

Ann. Rheum. Dis.

Effect of a novel insole on the subtalar joint of patients with medial compartment osteoarthritis of the knee

J. Rheumatol.

American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee

Arthritis Care Res. (Hoboken).

A new approach to prevention of knee osteoarthritis: reducing medial load in the contralateral knee

J. Rheumatol.

Bracing and orthoses: a review of efficacy and mechanical effects for tibiofemoral osteoarthritis

PM & R

Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis

JAMA

The effect of laterally wedged shoes on the loading of the medial knee compartment-in vivo measurements with instrumented knee implants

J. Orthop. Res.

Kinetic and kinematic changes with the use of valgus knee brace and lateral wedge insoles in patients with medial knee osteoarthritis

J. Orthop. Res.

The effect of a subject-specific amount of lateral wedge on knee mechanics in patients with medial knee osteoarthritis

J. Orthop. Res.

Full length article
Long-term effects of lateral wedge orthotics on hip and ankle joint space widths